Post Pain Research Articles

Efficacy of massage versus massage with post isometric relaxation in temporomandibular disorders: a randomized controlled trial

BackgroundTemporomandibular joint disorder (TMD) is a common condition affecting the masticatory muscles and joint mobility.ObjectivesThe primary objective was to compare the effects of massage therapy alone and massage therapy combined with post-isometric relaxation exercises in patients with TMD for pain and maximal mouth opening.DesignAssessor-blinded randomized controlled trial.SettingSir Ganga Ram Hospital, Chaudhry Muhammad Akram Dental Hospital, Lahore Medical and Dental Hospital.SubjectsTemporomandibular joint disorder patients.InterventionGroup A (n = 23) received conventional treatment including massage and therapeutic exercises consecutively for 2 weeks. Group B (n = 23) received post-isometric relaxation technique along with conventional treatment for consecutive 2 weeks.Main measuresThe main outcome measures were pain and maximal mouth opening. Pain was measured using the Visual Analogue Scale (VAS) and maximal mouth opening (MMO) was measured using the TheraBite Scale.ResultsBoth groups demonstrated significant improvements in pain and MMO scores post-treatment. However, Group B (massage with post-isometric relaxation exercises) showed significantly better outcomes compared to Group A (massage alone). There was a statistically significant difference in post-treatment pain scores (P = 0.000) and MMO scores (P = 0.000) between the two groups.ConclusionThe results suggest that massage therapy combined with post-isometric relaxation is more effective than massage therapy alone in managing pain and improving mouth opening in TMD patients. The study provides evidence supporting the use of these therapies in TMD management.Trial registry numberNCT05810831. Date of registration/First submission: 15 March 2023.

Inadequate anticoagulation and hyperuricemia cause knee pain after platelet-rich plasma injection: A retrospective study.

Platelet-rich plasma treatment delays the need for total knee replacement in patients with knee osteoarthritis. However, its use and preparation remain controversial. The aim of this study was to investigate the relationship between anticoagulant use in the preparation of platelet-rich plasma and post-treatment pain in patients with knee osteoarthritis. Additionally, we explored the efficacy of platelet-rich plasma over medium- and long-term follow-up periods and identified other factors that may affect treatment outcomes. In this retrospective study, 225 patients with knee osteoarthritis, who underwent knee platelet-rich plasma treatment from June 2021 to January 2022, were examined at three study centres. Patients were categorised, based on the type and amount of anticoagulant used during platelet-rich plasma preparation, into 4% sodium citrate (SC) 0.6mL, 4% SC 1mL, 4% SC 2mL, heparin 0.1mL, and heparin 0.2mL groups. We analysed the patients' basic information, pain after treatment, and inflammatory markers (i.e., interleukin 6, tumour necrosis factor-α, and hypersensitive C-reactive protein) in the joint fluid via enzyme-linked immunosorbent assay and joint fluid crystallisation. Additionally, we assessed the patients' Western Ontario and McMaster University scores and minimal clinically significant differences after treatment. Patients in the 4% SC 0.6mL and heparin 0.1mL groups experienced less pain after platelet-rich plasma treatment than did patients in the high-dose anticoagulant group. The joint fluid of patients with pain in these groups had lower levels of inflammatory markers. Patients treated with SC had slightly better medium- and long-term therapeutic outcomes than did patients treated with heparin. Patients with poorly controlled hyperuricemia also experienced pain after platelet-rich plasma treatment. The results suggest that platelet-rich plasma prepared using high-dose anticoagulants or administered to patients with poorly controlled hyperuricaemia may lead to moderate-to-severe knee pain and joint effusion after joint puncture therapy. Platelet-rich plasma had a therapeutic effect on knee osteoarthritis; however, its efficacy gradually decreased over time. SC anticoagulant is more suitable for platelet-rich plasma preparation than is heparin. Further studies are needed to understand the safety and the various factors influencing platelet-rich plasma therapy.

Short all-out isokinetic cycling exercises of 90 and 15 s unlock exercise-induced hypoalgesia.

Acute physical activity leads to exercise-induced hypoalgesia (EIH). However, to what degree it can be induced by very short but highly intensive exercise is largely unknown. This study aims to investigate the effects of two different short all-out isokinetic exercise sessions on EIH. Twenty young male participants underwent three different interventions (90, 15 s all-out isokinetic cycling, respectively, and control) after an individualized low-intensity warm-up in a randomized-controlled-crossover design. Before (pre), after warm-up (post 1) as well as immediately post-intervention (post 2) pain sensitivity was measured employing pressure pain thresholds (PPT; in N) at the elbow, knee and ankle joints as well as the sternum and forehead. Performance parameters (e.g. lactate, perceived exertion, heart rate) were documented. A 'time' × 'intervention' × 'body site' interaction effect (p < 0.001, η2 partial = 0.110) was observed for PPT. Both isokinetic interventions resulted in EIH at all body sites, even after ruling out any warm-up effects, while effects were larger for 90 s (maximum increase of 25.7 ± 11.7 N) compared to 15 s (maximum increase of 19.3 ± 18.9 N), and control (maximum increase of 8.0 ± 6.1 N). Compared to control, 15 s also resulted in hypoalgesic effects and differences were not observed at all sites. In this study, 90 s resulted in higher lactate, subjective exhaustion and heart rate levels compared to 15 s and control (p < 0.001), while higher values were also observed for 15 s compared to control. Global EIH assessed immediately after exercise can be induced by short highly intensive exercises. The effects are greater when the subjective and the objective exertion are higher as induced by the 90 s intervention. This study investigates the potential for brief, highly intensive exercise sessions to induce exercise-induced hypoalgesia (EIH). The research demonstrates that EIH can indeed be triggered by such short workouts, with greater effects observed during a 90 s session compared to a 15 s one, most likely due to higher subjective and objective exertion. These findings offer insights into the potential for extremely brief but intense exercises to alleviate pain, impacting exercise recommendations and pain management strategies.

The influence of fascial manipulation on shoulder range of motion, pain, and function in individuals with chronic shoulder pain

BackgroundA prevalent musculoskeletal condition that has a substantial socioeconomic impact and causes considerable morbidity is chronic shoulder pain (CSP). CSP may result from a dysfunction of the upper quarter region's (UQR) myofascial continuum (MC), which is connected by deep fascia. Fascial Manipulation® (FM), proposed by Luigi Stecco, involves deep kneading performed at specific points on the deep fascia. FM is considered to reinstate the gliding of the fascial layers, thus may aid in the reduction of pain and improvement of shoulder function. ObjectiveThis study aims to determine the influence of FM on shoulder pain, passive range of motion (PROM), and function in participants with CSP. DesignSingle group, pretest-posttest design. MethodEighteen individuals with CSP aged 18–45 years were recruited. FM was applied to the painful and densified centre of coordination (CC) points on the MC of the UQR based on Stecco's FM method. The therapist performed the baseline, post-treatment, and numerical pain rating scale (NPRS) at rest and during activity, PROM, and pressure pain threshold (PPT). The follow-up measurements were done after seven days following the FM intervention. Also, the baseline and follow-up measurements of disability of arm, shoulder, and hand (DASH) score were performed. ResultsA considerable improvement in all shoulder PROM (p < 0.01), DASH score (p = 0.01), and pain reduction (p = 0.01) following FM were observed. However, the PPT showed no differences following FM (p > 0.05). ConclusionFM may be an effective treatment strategy in reducing pain and improving shoulder range of motion and function in patients with CSP.

Exploring Patient Pain Experiences during and after Conventional Red Light and Simulated Daylight Photodynamic Therapy for Actinic Keratosis: A Qualitative Interview Study.

Simulated daylight photodynamic therapy is a relatively new and potentially less painful alternative to conventional red light photodynamic therapy for actinic keratosis. Qualitative research exploring patient experiences of pain and skin reactions during these treatments is scarce. To address this, semi-structured interviews were conducted of 10 patients aged 60-81 years with symmetrically distributed actinic keratoses 4 weeks after split-face treatment with conventional red light photodynamic therapy and simulated daylight photodynamic therapy. The participants were recruited from an ongoing clinical randomized trial. Interviews (median length 35 min) were conducted between June 2022 and January 2023, audio-recorded, transcribed verbatim, and analysed qualitatively using content analysis, as described by Graneheim and Lundman. Participants reported that conventional red light photodynamic therapy was very painful during illumination and transiently painful in the post-treatment period, while simulated daylight photodynamic therapy was almost painless during illumination and led to minor post-treatment pain. Also, skin reactions were more intense and longer-lasting with conventional red light photodynamic therapy than with simulated daylight photodynamic therapy. Most participants expressed a treatment preference for simulated daylight photodynamic therapy but had reservations about its unestablished long-term effectiveness. This study underscores the considerable pain associated with conventional red light photodynamic therapy, and the pivotal importance of shared decision-making when selecting the most appropriate treatment.

Moving pain management programmes into the digital age: development and evaluation of an online PMP for people with chronic pain.

In response to Coronovirus Disease (COVID-19) health care restrictions, the pain management programme delivered group treatment digitally (OPMP). We aimed to: 1) evaluate pain related outcomes of the OPMP, 2) evaluate patient satisfaction and qualitive feedback of the OPMP and 3) compare OPMP outcomes with the pre-pandemic face to face (F2F) PMP outcomes. Age, gender, pain duration, occupational status, referral information and patient satisfaction data were collected. Pre- and post-treatment pain related outcomes were compared by calculating mean difference, benchmarking with effect size (Cohen's d) and determining clinically significant change (CSC) for OPMP and F2F PMP. Two-hundred and thirty-seven patients provided outcome data, with 60 completing the OPMP and 177 completing the F2F PMP. OPMP patients were 10 years younger than the F2F PMP (44.8 vs 53.3), more were female (6.5:1 vs 2.8:1), more were working (45% vs 27%) and fewer were retired (3% vs 17%). The OPMP showed improvements comparable to the F2F PMP. Large effect size was reported across all outcome domains including objective physical outcomes. Eighty-one percent of OPMP patients were 'extremely likely' to recommend the programme but just over 50% of patients felt F2F would provide greater clinical benefits. The results support that OPMP is effective for carefully selected patients following a multidisciplinary team assessment however more complex cases still require F2F PMP.

Comparing the Effects of Intramuscular Injections of Dexamethasone and Ketorolac Tromethamine on Post-treatment Endodontic Pain: An In Vivo Study.

Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory drugs such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) would be reasonable therapy options. The purpose of this study was to compare and assess the efficacy of intramuscular injections of dexamethasone and ketorolac tromethamine versus placebo in reducing post-treatment endodontic pain in individuals undergoing root canal treatment. Patients diagnosed with symptomatic irreversible pulpitis were selected. Nonsurgical endodontic therapy was carried out in a single visit. After completion of the root canal therapy, the patients were randomly assigned to one of the three groups for intramuscular drug administration. In group 1, 2 ml of sterile saline was administered, in group 2, 1 ml of 4 mg dexamethasone was administered; and in group 3, 1 ml of 30 mg ketorolac tromethamine was administered.Preoperative and postoperative pain intensity was measured by a verbal rating scale. Postoperatively, the incidence and severity ofpain were recorded after four, 24, and 48 hours. All three groups showed a highly statistically significant reduction in pain scores when compared to preoperative levels. At the end of four hours, dexamethasone and ketorolac tromethamine showed highly significant results. Dexamethasone significantly reduced pain after 24 hours when compared to ketorolac and placebo groups. At the conclusion of 48 hours, all three groups experienced a gradual decrease in pain levels. Effective and complete debridement of infected root canal system provides predictable gradual reduction of post-endodontic pain.

Favorable Clinical Outcomes After Humeral Head Depressor Muscle Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR. We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR. Randomized controlled single-blind study. Level 1B. A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized "DM-Co-A Training" was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality. There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group (P < 0.05). A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.

Pilot study of musculoskeletal pain in ophthalmologists following participation in a fifteen-minute online Iyengar yoga program.

To evaluate the prevalence of musculoskeletal (MSK) complaints in ophthalmologists and to assess whether participation in an online Iyengar yoga video program improves the baseline pain scores and awareness of proper posture in the clinic and operating room. Ophthalmologists were recruited from online professional forums for this nonrandomized, prospective study. A pre-intervention survey, including demographics, office and procedure volumes, wellness activities, and baseline MSK pain scores, was completed. A fifteen-minute instructional video focusing on simple yoga poses for the neck, shoulder, and lower back created by one of the authors, who is both an ophthalmologist and a certified Iyengar yoga teacher, was provided to participants to complete three times weekly for a total of 4 weeks. A post-intervention survey collecting MSK pain scores and information about ergonomics and compliance was completed. Fifty ophthalmologists completed the pre-intervention survey, of whom 49 (98%) reported at least 1 episode of MSK discomfort in the preceding year. Of those, discomfort was cervical in 36 (72%), in the shoulder(s) in 15 (29%), thoracic spinal in 23 (46%), lumbar spinal in 23 (46%), and centered in the wrist, hand, or finger in 22 (44%). Of the 50 ophthalmologists, 22 submitted the post-intervention surveys. The post-intervention pain scores were decreased compared to baseline for cervical spine (P < 0.01), shoulder (P < 0.01), thoracic spine (P < 0.01), lumbar spine (P < 0.01) and wrist, hand, or finger (P < 0.01). 20 respondents (91%) reported improved awareness of their posture in the clinic and operating room, and 19 (86%) felt that this awareness would decrease their MSK symptoms. Among our small group of survey respondents, a fifteen-minute Iyengar yoga video program specifically designed for ophthalmologists reduced MSK pain and improving awareness of proper ergonomics for practicing ophthalmologists.

Effect of cognitive-behavior therapy for children with functional abdominal pain: a meta-analysis

BackgroundCognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children’s functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP).MethodsPubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL).ResultsA total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment.ConclusionsWe observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research.

Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis.

Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefitsand perceived harms of cannabis and opioids. Results & conclusion: Survivors (N=25) experienced addiction fears, stigmaand access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.

The Effect of a Six-Week Home Exercise Program on Pain and Disability in UltrasoundDiagnosed Patients with Subacromial Subdeltoid Impingement Syndrome: A Randomized Controlled Trial

Background &amp; Objectives: There is conflicting evidence regarding the effects of exercise on shoulder impingement syndrome. Exercise therapy is one of the methods used to reduce pain and increase muscle strength in patients with shoulder impingement syndrome. There are several exercise therapy programs available in this area. The purpose of this study is to evaluate the effect of exercise therapy on pain and disability in patients with shoulder impingement syndrome. Materials &amp; Methods: This randomized clinical trial was conducted in 25 patients with impingement syndrome from the Dastgheib Yasaei Pain Clinic in Fasa. Patients were randomized to receive medication (n=13) or medication plus exercise therapy (n=12). The Oswestry Disability Index (ODI) and the Verbal Numeric Rating Scale were used to measure disability and pain intensity before and after the intervention. Patient satisfaction was measured using the Likert scale. Independent and paired t-test, Mann-Whitney U test, and chi-squared were performed at a significant level of P≤0.05. Analyses were performed with SPSS software (version 25.0). Results: There were no differences between groups in pre-intervention demographics (P&gt;0.05), pain intensity (P=0.16), and ODI scores (0.93). Post-intervention pain and ODI scores were significantly higher in the medication group than in the medication-exercise group (P=0.06, P=0.03, respectively). There was a significant difference in pain and ODI scores at post-intervention compared to pre-intervention in both groups (P&lt;0.001). The difference in pain intensity between pre- and post-intervention in both groups was also statistically significant (P=0.006). There was a significant difference in patient satisfaction between groups (P=0.03). Conclusion: These results suggest that a regular exercise program, along with medication, may be effective in reducing pain and disability in patients with shoulder impingement syndrome.

A systematic review and network meta-analysis of pharmaceutical interventions used to manage chronic pain.

It is estimated 1.5 billion of the global population suffer from chronic pain with prevalence increasing with demographics including age. It is suggested long-term exposure to chronic could cause further health challenges reducing people's quality of life. Therefore, it is imperative to use effective treatment options. We explored the current pharmaceutical treatments available for chronic pain management to better understand drug efficacy and pain reduction. A systematic methodology was developed and published in PROSPERO (CRD42021235384). Keywords of opioids, acute pain, pain management, chronic pain, opiods, NSAIDs, and analgesics were used across PubMed, Science direct, ProQuest, Web of science, Ovid Psych INFO, PROSPERO, EBSCOhost, MEDLINE, ClinicalTrials.gov and EMBASE. All randomised controlled clinical trials (RCTs), epidemiology and mixed-methods studies published in English between the 1st of January 1990 and 30th of April 2022 were included. A total of 119 studies were included. The data was synthesised using a tri-partied statistical methodology of a meta-analysis (24), pairwise meta-analysis (24) and network meta-analysis (34). Mean, median, standard deviation and confidence intervals for various pain assessments were used as the main outcomes for pre-treatment pain scores at baseline, post-treatment pain scores and pain score changes of each group. Our meta-analysis revealed the significant reduction in chronic pain scores of patients taking NSAID versus non-steroidal opioid drugs was comparative to patients given placebo under a random effects model. Pooled evidence also indicated significant drug efficiency with Botulinum Toxin Type-A (BTX-A) and Ketamine. Chronic pain is a public health problem that requires far more effective pharmaceutical interventions with minimal better side-effect profiles which will aid to develop better clinical guidelines. The importance of understanding ubiquity of pain by clinicians, policy makers, researchers and academic scholars is vital to prevent social determinant which aggravates issue.

Risk factors for the outcome and prognosis of multiple myeloma patients with pathological fractures undergoing percutaneous vertebroplasty.

This study focuses on the clinical features affecting the outcome and prognosis of multiple myeloma (MM) associated with spinal fractures. We retrospectively analyzed the clinical data of 194 MM patients with pathologic thoracic or lumbar spine fractures admitted to Dongying People's Hospital from April 2005 to February 2021. Patients were categorized into effective and ineffective groups based on post-treatment pain scores and mobility to analyze the influencing factors on the efficacy. Univariate analysis showed that age ≥60 years, number of vertebral fractures ≥2, and conservative treatment were associated with the outcomes. The number of vertebral fractures ≥2 (OR=2.198, P=0.034) and conservative treatment (OR=1.685, P=0.012) were identified as independent risk factors. In addition, survival curves were depicted using the Kaplan-Meier method, and independent risk factors affecting 2-year survival included efficacy (HR=17.924, P<0.001), age (HR=3.544, P=0.003) and International Staging System staging (HR=10.770, P=0.001). Finally, we constructed a high-accuracy prognostic model for predicting 2-year survival of MM patients with pathologic fractures (AUC=0.756). In conclusion, this study identified independent risk factors affecting the outcome and survival of MM patients with morbid fractures by systematically analyzing clinical characteristics and constructing a survival prediction model, thus providing effective guideline for clinical treatment.

Comparison of the Effect of Continuous Radiofrequency and Pulsed Radiofrequency Treatment on Third Occipital Neuralgia

Background: Third occipital neuralgia (TON) is an uncommon headache caused by C2-3 zygapophyseal joint osteoarthritis. Both continuous and pulsed radiofrequency have been used to treat TON. However, no studies have compared the effects of continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) on TON. This study aimed to determine the most effective treatment for TON. Methods: A total of 61 patients were enrolled. CRF was performed at 80°C for 90 sec at three target lesions. During PRF, 42°C for 120 sec was applied to the target lesions. Numeric rating scale score (NRS) was assessed in all patients before treatment and at 2 weeks, 3, and 6 months after treatment. Successful treatment was defined as an NRS pain reduction of at least 50% at 6 months, as compared with the pretreatment score. Results: The mean post treatment pain scores at 2 weeks, 3, and 6 months were significantly lower in both groups. At 2 weeks and 6 months post-procedure, the CRF group showed significantly more pain reduction than the PRF group. The prevalence of pain reduction by at least 50% was lower in the PRF group than in the CRF group. The proportion of patients with &gt; 50% reduction in the NRS was 71% in the CRF versus 50% in the PRF group at the final follow-up. Conclusion: CRF was associated with earlier and longer pain reduction than PRF in patients with TON. Therefore, CRF should be recommended for patients with TON as much as possible.

The Effect of Smartphone-Based Nursing Therapy to Reducing Post Cardiac Surgery

The disease that is the number one cause of death in the world today is heart disease. Actions to overcome the problem of coronary heart disease, one of them with surgery. Pain is a significant issue at all stages of surgery. Post-cardiac surgery discomfort should be manageable with smartphone-based nursing care. The goal of this study was to determine if smartphone-based nursing care may help heart surgery patients feel less pain. The research design used a quasi-experimental pre- and post-control group design. The sample size in this study was 46 respondents, which were divided into 23 respondents in the intervention group and 23 respondents in the control group. The inclusion criteria of this study were cardiac surgery patients on the first day, adult patients receiving paracetamol drip therapy and 1000 mg tablets, and hemodynamic stability. Nursing interventions to deal with pain in this study were carried out using hypnosis and music videos in smartphone-based applications. Research results showed a post-treatment pain score of 2.04 in the intervention group and 4.60 in the control group. Nursing interventions carried out using videos in smartphone-based applications are able to overcome post-cardiac surgery pain, so pain management using smartphones can be an intervention choice to deal with post-cardiac surgery pain. Hypnosis and music nursing interventions using videos on smartphone-based applications can be used as nursing therapy to treat pain after cardiac surgery.

Changes in pain following bilateral intermittent theta-burst, transcranial magnetic stimulation for depression: A retrospective chart review

ABSTRACT Introduction Pain management in patients with chronic pain and comorbid depression is challenging and understudied. There is interest in intermittent theta-burst stimulation (iTBS), a new modality of repetitive transcranial magnetic stimulation (rTMS). This retrospective review describes changes in pain, anxiety and depression throughout iTBS treatment at the dorsolateral prefrontal cortex (DLPFC). Methods A retrospective chart review was conducted of patients who underwent their first acute series of iTBS treatments at the DLPFC for depression at a single institution between 2020 and 2023. Data on depression, anxiety, and pain were collected throughout iTBS treatment using the Beck Depression Inventory–II (BDI-II; higher scores indicate worse depression) and visual analogue scale (VAS; 0–100, higher scores indicate worse pain, anxiety, and depression). Nonparametric tests were used for all analyses. Results Of 104 patients, 52 reported moderate pain at baseline (50.0%). Median BDI-II scores decreased from 38.0 (interquartile range [IQR] = 29.0–44.0) to 24.0 (IQR = 9.0–36.0) from pre- to posttreatment (P < 0.001). Of the 32 patients with both pre- and posttreatment pain scores, there was a significant decrease from 40.0 (IQR = 5.5–71.8) to 15.0 (IQR = 3.5–53.8; P = 0.037). In patients with at least moderate pain at baseline, pain scores decreased from 71.0 (IQR = 55.0–80.0) to 20.0 (IQR = 11.0–71.0; P = 0.004). Ten of 32 patients with available pre- and posttreatment scores reported ≥30% reduction in pain scores (31.2%). Conclusion These preliminary results, suggesting decreases in pain following iTBS treatment, provide a rationale for future rigorous investigations to evaluate this intervention for depression and comorbid chronic pain.

A Randomized Controlled Trial Comparing Ultrasonography-Guided Needle Aspiration and Surgical Drainage for the Management of Breast Abscess.

Background A breast abscess is a localized collection of inflammatory exudate in breast tissue. It is more common in lactating women. Treatment of the breast abscess is usually by incision and drainage, which is accompanied by extensive trauma, lengthy surgical incisions, psychological distress, surgical scar, and discomfort during dressing changes. Recent research has shown that ultrasonography-guided needle aspiration is an alternative to incision and drainage for breast abscess treatment, has superior cosmetic outcomes, and has fewer costs. However, there are no clear guidelines for the same. The primary objective of this study was to assess and contrast the outcomes and efficacy of two approaches in the treatment of breast abscesses: ultrasonography-guided needle aspiration and conventional incision and drainage. Methods This was a single-center, prospective, randomized, controlled, non-inferiority trial. Patients with breast abscesses were randomized either to receive needle aspiration or incision drainage. Patients with lactational breast abscesses were encouraged to breastfeed from either breast. The antibiotic was given for 10 days to all the patients. The study's main focus was on the primary outcome, which was the failure rate. Additionally, several secondary outcomes were examined, including postoperative pain, time required for healing, presence of residual abscess or recurrence, formation of fistulas, and the assessment of scar appearance. Results A total of 44 patients were randomized to 23 and 21 in each arm. There was no statistical difference in treatment failure (p-value=0.862), fistula formation (p-value=1.00), and recurrence (p-value=1.00). There was a significant statistical difference in healing period (p-value <0.001), scar formation (p-value <0.0001), continuation of breastfeeding (p-value=0.005), and clinical resolution (p-value=0.002). There was a significant reduction in post-intervention pain in the needle aspiration group than in the other group (p-value <0.001). Conclusion This study showed a significant difference in postoperative pain, healing time, the continuation of breastfeeding, and scar formation in the needle aspiration group, favouring minimally invasive treatment for breast abscess. However, due to the small sample size, we could not conclude that ultrasonography-guided needle aspiration of the breast abscess is non-inferior to the conventional incision and drainage.

Music as an Adjuvant Therapy in Postoperative Pain and Physiologic Parameters: Pre-Test, Post-Test Intervention Study

BackgroundPoorly controlled postoperative pain remains a significant challenge. Music is a safe, inexpensive, non-invasive intervention that can be used in managing pain in surgical patients.ObjectivesTo evaluate effectiveness of music intervention as an adjuvant therapy in attenuating postoperative pain among patients with tibia/fibula fractures.MethodologyA cross-sectional pre-test, post-test intervention study design was utilized to conduct a study involving 20 tibia-fibula patients, divided equally into intervention and control groups. Self-selected music was administered for 20 minutes to the intervention group once on day-3 after surgery. Data was collected using a demographic questionnaire and Visual Analogue Scale (VAS).Data was analyzed using SPSS software version 29.0. Descriptive statistics analyzed continuous and categorical data. T-test compared means of physiologic parameters and pain levels in pre-and post-intervention. ANCOVA established the relationship between music and post-intervention pain levels.FindingsUse of music alongside conventional therapy significantly reduced pain in the intervention group than in the control group (P = 0.014). Music had no statistically significant impact on the physiological parameters.ConclusionMusic therapy is effective as an adjuvant therapy for pain management and can therefore reduce the use of analgesics among surgical patients.Rwanda J Med Health Sci 2023;6(3):290-302

Efficacy of Extracorporeal Shock Wave and Pulse Electromagnetic Field Therapies in Calcaneal Spurs.

Various treatment methods are available for calcaneal spur, which can cause disability. Objective: To evaluate the efficacy of pulsed electromagnetic field therapy (PEMFT) added to extracorporeal shock wave therapy (ESWT) on pain and functional capacity in treating calcaneal spurs. Patients with calcaneal spurs who were recommended ESWT or ESWT+PEMFT and whose Foot Function Index (FFI) and visual analogue scale (VAS) values were available in their records were retrospectively analyzed. The two groups were ESWT (n=35) and ESWT+PEMFT (n=40). FFI and VAS scores were obtained from their records before treatment, after treatment, and in the third month after treatment. The two groups were similar regarding their pre-treatment FFI and VAS scores. In intra-group evaluation, statistically significant decreases were found in terms of the FFI pain, disability, and activity limitation and VAS scores in both groups after treatment and in the third month after treatment compared to the pre-treatment period. In the comparison between the groups, the post-treatment and post-treatment third-month FFI pain, disability, and activity limitation and VAS scores were significantly lower in the PEMFT+ESWT group than the ESWT group (P<0.001). A calcaneal spur is a condition that can cause pain and functional limitation in patients. Various studies have demonstrated the efficacy of ESWT in the treatment of calcaneal spurs. In our study, we observed that PEMFT added to ESWT significantly improved the pain and functionality of the patients. Further studies are needed to evaluate the efficacy of PEMFT in calcaneal spurs.