Postintervention Pain Scores Research Articles

Effects of White Noise on Pain Scores and Salivary Cortisol Levels in Surgical Neonates: A Randomized Controlled Trial.

Neonates experience varying intensities of pain after surgery. While white noise has been used for postoperative pain relief in infants, its effects on neonates after surgery need further exploration. This study aimed to evaluate the effects of white noise on pain scores and salivary cortisol levels in surgical neonates. In this randomized controlled trial, 64 neonates scheduled for surgery were recruited and assigned by block randomization into 2 groups. The intervention group listened to white noise at 50dB, while the control group listened to white noise at 0dB, for 30minutes 6 times for 48hours postoperatively. Pain scores, measured by the COMFORTneo Scale, and salivary cortisol levels were compared. Although pain scores decreased after surgery in all subjects, no statistically significant difference was observed between the 2 groups (P=.937). There was a significant difference between pre- and postintervention pain scores in the intervention group only (P=.006). Salivary cortisol levels decreased after intervention in the intervention group, but there was no significant difference between pre- and postintervention levels in the 2 groups (P=.716). Given the reduction in pain scores and salivary cortisol concentrations after white noise intervention, white noise shows potential as an adjunctive soothing measure for neonates after surgery. Future studies are needed to confirm the efficacy and utility of white noise intervention in clinical settings.

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.

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.

An Interprofessional Approach to Chronic Pain Management and Education.

The opioid epidemic highlights the importance of evidence-based practices in the management of chronic pain and the need for improved resident education focused on chronic pain treatment and controlled substance use. We present the development, implementation, and outcomes of a novel, long-standing interprofessional safe prescribing committee (SPC) and resulting policy, protocol, and longitudinal curriculum to address patient care and educational gaps in chronic pain management for residents in training. The SPC developed and implemented an opioid prescribing policy, protocol, and longitudinal curriculum in a single, community-based residency program. We conducted a postcurriculum survey for resident graduates to assess impact of knowledge gained. We conducted a retrospective chart review for patients on chronic opioid therapy to assess change in morphine equivalent dosing (MED) and pain scores pre- and postintervention. A postcurriculum survey was completed by 20/26 (77%) graduates; 18/20 (90%) felt well-equipped to manage chronic pain based on their residency training experience. We completed a retrospective chart review on 57 patients. We found a significant decrease in MED (-20.34 [SE 5.12], P&lt;.0001) at intervention visit with MED reductions maintained through the postintervention period (-9.43 per year additional decrease [SE 5.25], P=.073). We observed improvement in postintervention pain scores (P=.017). Our study illustrates the effectiveness of an interprofessional committee in lowering prescribed opioid doses and enhancing chronic pain education in a community-based residency setting.

Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Slow deep breathing (SDB) may help patients with acute pain. The primary aim of this systematic review and meta-analysis is to investigate the effects of SDB on acute pain. Secondary aims include investigating the effects of SDB on acute pain-related physical and emotional functioning. An a priori protocol was registered and a database search was conducted by a reference librarian. Randomized controlled trials (RCT) were eligible for inclusion and exclusion criteria included studies of SDB for non-pain indications and studies that applied SDB as a component of an encompassing intervention. The risk or bias was assessed using the Cochrane Collaboration's revised tool for assessing risk of bias in randomized trials. Meta-analysis was conducted using the random effects model. A total of 11 968 studies were screened and seven RCTs met inclusion criteria; five were judged to have low risk of bias. Meta-analysis of post-intervention pain scores demonstrated that SDB was associated with significantly lower pain scores compared with a control group, but with high levels of heterogeneity. Subgroup analyzes demonstrated that trials of burn pain were associated with a larger reduction in pain which partially explains the heterogeneity. Very low certainty evidence suggests that SDB may reduce acute pain intensity. Further research is needed to identify patients who are candidates for SDB and determine the best approach to deliver this therapy.

The Effect of Rhythmic Breathing on the Severity of Sternotomy Pain after Coronary Artery Bypass Graft Surgery: A Randomized Controlled Clinical Trial.

Background Moderate-to-severe pain is reported in up to 75% of the patients in the first 48 hours after cardiac surgery. Evidence suggests that distraction is an effective nursing intervention for controlling short-term and transient pain. Distraction can be achieved by various techniques, including progressive muscle relaxation, meditation, and rhythmic breathing (RB). The present research aimed at evaluating the impacts of RB on the severity of sternotomy pain after Coronary Artery Bypass Graft (CABG). Methods This randomized, controlled clinical trial was conducted on 60 patients after CABG surgery at the open-heart surgery Intensive Care Unit (ICU) of Kowsar Hospital, affiliated to Semnan University of Medical Sciences in Semnan, Iran. The patients were selected through convenience sampling and randomly assigned to two groups, including (1) intervention or RB and (2) control groups. RB was performed in the intervention group every 12 hours (9 a.m. and 9 p.m.) for three consecutive days after the surgery. The control group received only routine care for pain control (opioid analgesics) with no additional interventions. The severity of pain was measured every day in both groups of patients before and after the interventions using the Visual Analog Scale (VAS). Results The mean postintervention pain scores were significantly different from the mean preintervention scores in the intervention group (p < 0.05). The changes in the mean pain score in the intervention group were also significantly different from the corresponding changes in the controls (p < 0.05). Conclusion Based on the results, the severity of pain after the intervention was significantly lower in the RB group compared to the control. RB was found to be an effective technique for reducing the patients' pain and is therefore recommended as a post-CABG pain control technique. Iranian Registry of Clinical Trials: this trial is clinically registered with IRCT20120109008665N7, registered 3 September 2018.

S0081 Virtual Reality Can Reduce Pain and Opioid Use in Sphincter of Oddi Dysfunction (SOD) Type III: A Prospective Pilot Study

INTRODUCTION: Patients with classic SOD III have chronic debilitating pain not amenable to pharmacologic or endoscopic therapy. Our previous studies have shown benefits of virtual reality (VR) for pain management through immersive three-dimensional (3D) multisensory experiences, but only in short-term inpatient settings. To evaluate the impact of VR for chronic pain in patients with SOD III in an outpatient setting. METHODS: In this prospective pilot cohort study, adults who met the criteria for conventional SOD III (biliary-type pain for ≥3 months without abnormal liver enzymes or imaging) with an average pain score of ≥3 out of 10 for at least 3 episodes per week were enrolled. The study was divided into four 2-week periods: pre-intervention, early VR intervention, late VR intervention, and post-intervention. Subjects were given Samsung Gear Oculus headsets during the intervention period (early and late) with preloaded 21 VR experiences and were instructed to view one 3D VR experience at least 3 times a day for 10–15 minutes each. Throughout the study, subjects filled out daily questionnaires including pain scores on a numeric rating scale (0–10), pain medication use (opioids, NSAIDs, etc.), their VR experience, and hospitalizations. RESULTS: 9 patients were included with a median age of 47 (IQR, 41–51) years, 100% female, and a median disease duration of 8 (IQR, 5–9) years. Overall pain medication use decreased from 67% to 40% in the pre-intervention vs. post-intervention period. Opiate use also decreased from 40% to 20% in the same period. On univariate analysis, post-intervention pain scores decreased by 2.02 points out of 10 (95% CI: −2.55 to −1.49; P-value < 0.001; Table 1 and Figure 1) compared to pre-intervention pain scores. After adjusting for anti-depressant use in multivariable analyses, post-intervention pain scores remained significantly decreased by 1.99 points (95% CI: −2.60 to −1.39; P < 0.001). There were no adverse events or hospitalizations. Furthermore, 6/6 (100%) of patients had a positive VR experience. CONCLUSION: This is the first study evaluating VR for management of patients with SOD III. We showed that pain scores not only declined throughout the VR intervention period, but also in the post-intervention period, suggesting a possible sustained therapeutic benefit. Pain medication use, including opioids, was also reduced at the end of the study. Future large controlled trials should evaluate the role of VR in treating patients with SOD III.Table 1.: Univariate analysis of pain scores revealed multiple factors for significant pain score reduction including VR, older age, higher BMI, anxiety/depression, and use of anti-depressantsFigure 1.: Pain scores significantly improved during the VR intervention period and was sustained into the post-intervention period when compared to pre-intervention pain scores.

Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial

Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes. From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of -0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ. In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention. · Virtual reality (VR) represents a nonpharmacologic option for pain relief.. · VR has been little studied in pregnant or laboring women.. · VR was associated with a reduction in pain in nulliparous women in labor..

Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis

Objective: To describe reported outcomes of nonsurgical radiologic interventions for abdominal wall endometriosis in comparison with surgery where available. Data sources: A systematic search of Ovid Medline, Embase, PubMed, and Cochrane Controlled Register of Trials was performed from inception to January 2019 with no language restrictions. Study eligibility criteria: Studies were included if they evaluated a nonsurgical intervention in women with symptomatic abdominal wall endometriosis with both comparative and noncomparative study designs. Study appraisal and synthesis methods: Titles and abstracts were reviewed for relevance, and full-text articles were obtained and evaluated for inclusion, all in duplicate. Meta-analysis was performed when possible using a fixed effects model. Results: Of the 114 records reviewed, 16 full-text articles were assessed and 7 were included in analysis. The standard mean difference between pre- and post-intervention pain scores was similar between ultrasound-guided high-intensity focused ultrasound (USgHIFU) (−3.00; 95% confidence interval −3.34, −2.66) and cryoablation (−3.93; 95% confidence interval −5.73, −2.12). The mean percent decrease in lesion size following intervention was similar between USgHIFU (−61.38%; 95% confidence interval −78.64%, −44.11%), and cryoablation (−88.16%; 95% confidence interval −83.90%, −55.06%). When compared with surgical excision, mean length of stay was 2.78 days less in the nonsurgical intervention group (95% confidence interval −3.78, −1.79). Conclusions: Both USgHIFU and cryoablation are effective at reducing pain scores and lesion size in abdominal wall endometriosis. Mean length of stay was significantly less following a nonsurgical radiologic intervention for abdominal wall endometriosis compared with surgery. More studies are needed comparing complication and recurrence rates between nonsurgical radiologic interventions for abdominal wall endometriosis and surgery.

Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial.

ObjectivesTherapeutic virtual reality (VR) has emerged as an effective, drug-free tool for pain management, but there is a lack of randomized, controlled data evaluating its effectiveness in hospitalized patients. We sought to measure the impact of on-demand VR versus “health and wellness” television programming for pain in hospitalized patients.MethodsWe performed a prospective, randomized, comparative effectiveness trial in hospitalized patients with an average pain score of ≥3 out of 10 points. Patients in the experimental group received a library of 21 VR experiences administered using the Samsung Gear Oculus headset; control patients viewed specialized television programming to promote health and wellness. Clinical staff followed usual care; study interventions were not protocolized. The primary outcome was patient-reported pain using a numeric rating scale, as recorded by nursing staff during usual care. Pre- and post-intervention pain scores were compared immediately after initial treatment and after 48- and 72-hours.ResultsThere were 120 subjects (61 VR; 59 control). The mean within-subject difference in immediate pre- and post-intervention pain scores was larger in the VR group (-1.72 points; SD 3.56) than in the control group (-0.46 points; SD 3.01); this difference was significant in favor of VR (P < .04). When limited to the subgroup of patients with severe baseline pain (≥7 points), the effect of VR was more pronounced vs. control (-3.04, SD 3.75 vs. -0.93, SD 2.16 points; P = .02). In regression analyses adjusting for pre-intervention pain, time, age, gender, and type of pain, VR yielded a .59 (P = .03) and .56 (P = .04) point incremental reduction in pain versus control during the 48- and 72-hour post-intervention periods, respectively.ConclusionsVR significantly reduces pain versus an active control condition in hospitalized patients. VR is most effective for severe pain. Future trials should evaluate standardized order sets that interpose VR as an early non-drug option for analgesia.

Auricular Acupuncture for the Treatment of Pediatric Migraines in the Emergency Department.

Headache remains a frequent complaint for children presenting to a pediatric emergency department (ED). Typical treatments include oral or intravenous medications, but do not always relieve pain. An alternative intervention is auricular acupuncture. It has been shown to be effective in the treatment of migraines in adults. The objective of this study was to evaluate the utility and adverse effects of auricular acupuncture in the treatment of pediatric migraines in the ED. This was a prospective, interventional, cohort study of patients 8 to 18 years of age. Efficacious ear points were located by needle contact or electrical point finder with attention to 2 migraine lines on the ear. ASP gold semipermanent ear needles were placed in the efficacious points and patients were monitored for 15 minutes. The primary outcome was the change in preintervention and postintervention pain scores using a numerical self-reported pain visual analog scale (VAS). Nineteen patients elected to enroll in the study. The mean change in the VAS scores was both clinically and statistically significant at 7.03 (interquartile range, 6-8.5) with a P value of less than 0.001. Two patients elected to withdraw from the study secondary to incomplete resolution of migraine pain despite improvement in VAS scores. There were no known adverse events. With all subjects showing improvement or resolution of migraine headache, this pilot study introduces an alternative intervention to pediatric migraine management. Further studies are needed to evaluate the duration of symptom resolution and comparative effectiveness; auricular acupuncture seems to be a valid alternative.

The Hopeless Case? Palliative Cryoablation and Cementoplasty Procedures for Palliation of Large Pelvic Bone Metastases

Background: Metastases to the bone are common in cancer patients, and it has been estimated that up to 50% of patients with pelvic bone metastases will not achieve adequate pain control with medications alone. This has led to a paradigm shift over recent years towards the use and development of minimally invasive image-guided treatment options for palliation of bony metastases. Despite these developments, large metastatic lesions are still often considered to be “hopeless cases” that would garner little to no benefit from image-guided intervention. This study is the first large series to describe the novel use of combination percutaneous cryoablation and cementoplasty for palliation of such large metastases to the pelvis. Objectives: We aim to evaluate the efficacy and safety of image-guided percutaneous cryoablation and cementoplasty for palliation of large pelvic bone metastases. Study Design: This retrospective analysis was approved by our institutional review board. This study was conducted from January 2013 to December 2016, where consecutive patients referred for pain management of large pelvic bone metastases underwent combination percutaneous cryoablation and cementoplasty. Setting: This study took place at a tertiary care center after patients were referred following formal review from a multidisciplinary conference, which was comprised of interventional radiologists, pain management and palliative care physicians, radiation and medical oncologists, and when available, anesthesiologists. Methods: Forty-eight patients (36 men and 12 women) with a mean cohort age of 77.5 years (range: 52 – 89 years) were referred from the multidisciplinary conference for palliation of pelvic bone metastases. The inclusion criteria included patients with metastases greater or equal to 5.0 cm and significant pain refractory to conventional pain management regimens. All of the patients were deemed not to be surgical candidates. Mean pain scores were collected at numerous time-points along with procedural technical success rates and complication rates. Results: Combination cryoablation and cementoplasty was performed on 48 consecutively referred patients with a 100% technical success rate and no immediate complications. The pain levels demonstrated a significant decrease (P &lt; 0.001) following intervention, with mean pain scores of 7.9 (range: 5 – 10) and 1.2 (range: 0 – 7) throughout the week prior to intervention and at 24 hours postintervention, respectively. The post-intervention pain scores remained stable at 1 to 9 weeks followup (mean: 4.1 weeks). Three patents (6.3%) reported no change in pain following the intervention; however, no patients reported worsened pain. Limitations: The limitations of this study include its retrospective nature and the length of follow-up, which was often restricted given the life expectancy of our patient cohort. Conclusion: Combination cryoablation and cementoplasty is a novel and efficacious treatment option for palliation of large pelvic bone metastases. Marked improvements in pain, as well as mobility and quality of life, are often attainable. Key words: Pain, palliative care, palliation, percutaneous, cryoablation, cementoplasty, metastases, pelvis, interventional radiology, thermal ablation

Virtual Reality for Management of Pain in Hospitalized Patients: Results of a Controlled Trial

BackgroundImprovements in software and design and reduction in cost have made virtual reality (VR) a practical tool for immersive, three-dimensional (3D), multisensory experiences that distract patients from painful stimuli.ObjectiveThe objective of the study was to measure the impact of a onetime 3D VR intervention versus a two-dimensional (2D) distraction video for pain in hospitalized patients.MethodsWe conducted a comparative cohort study in a large, urban teaching hospital in medical inpatients with an average pain score of ≥3/10 from any cause. Patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, and epilepsy and those placed in isolation were excluded. Patients in the intervention cohort viewed a 3D VR experience designed to reduce pain using the Samsung Gear Oculus VR headset; control patients viewed a high-definition, 2D nature video on a 14-inch bedside screen. Pre- and postintervention pain scores were recorded. Difference-in-difference scores and the proportion achieving a half standard deviation pain response were compared between groups.ResultsThere were 50 subjects per cohort (N=100). The mean pain reduction in the VR cohort was greater than in controls (−1.3 vs −0.6 points, respectively; P=.008). A total of 35 (65%) patients in the VR cohort achieved a pain response versus 40% of controls (P=.01; number needed to treat=4). No adverse events were reported from VR.ConclusionsUse of VR in hospitalized patients significantly reduces pain versus a control distraction condition. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting; future randomized trials should confirm benefit with different visualizations and exposure periods.Trial RegistrationClinicaltrials.gov NCT02456987; https://clinicaltrials.gov/ct2/show/NCT02456987 (Archived by WebCite at http://www.webcitation.org/6pJ1P644S)

A systematic review of psychosocial therapies for children with rheumatic diseases

BackgroundTo assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases.MethodsWe conducted a literature search of MEDLINE and PsycINFO for randomized clinical trials of psychosocial interventions for pain and disability in children with rheumatic diseases from January 1969 to September 2015. Studies with a sample size less than 10 subjects were excluded. Study quality was assessed using the Jadad score.ResultsFive articles met inclusion criteria, for a total of 229 patients, aged 5 to 18 years. Two studies included children with fibromyalgia. Three studies included children with juvenile arthritis. Neither study in fibromyalgia reported the statistical significance of immediate between-group pre-post changes in functioning or pain. One study examining the effects of an internet-based psychosocial intervention in children with juvenile arthritis reported significant differences in post-intervention pain scores (p = 0.03). However, 2 studies did not show improvements in pain scores among children with juvenile arthritis treated with psychosocial interventions vs. a wait-list control or vs. an active control (massage). No studies reported significant between-group differences for functional outcomes in children with juvenile arthritis.ConclusionsThe available data were limited by the scarcity of randomized trials. Definite conclusions about the immediate effect of psychosocial interventions on pain and function in children with fibromyalgia could not be made because between-group comparisons of post-treatment change scores were not reported. For children with juvenile inflammatory arthritis, results of between-group comparisons for pain differed across studies, and analyses examining disability revealed no significant differences between groups.

Cryotherapy intervention in relieving arteriovenous fistula cannulation-related pain among hemodialysis patients at the King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia.

Pain during arteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients that leads to noncompliance to lifetime maintenance HD. This study was performed to determine the effect of cryotherapy on reducing pain during AVF cannulation among HD patients in the King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia. This is an experimental study which included 62 patients undergoing HD through an AVF. Randomization was used to assign the patients into the experimental (received cryotherapy) and control (no cryotherapy) groups. The Arabic version of Wong-Baker pain rating scale was used to determine the pain score. There was a significant difference in the pre-and post-intervention pain scores among the experimental group, while there was no such difference in the control group. The null hypothesis was rejected based on a P <0.05. Our study suggests that cryotherapy intervention to relieve AVF cannulation-related pain among adult patients undergoing HD is effective. Therefore, it is recommended that cryotherapy should be considered as a complementary intervention to reduce pain related to AVF cannulation.

The Clinical Utility of Virtual Reality in Inpatient Pain Management Among Patients with Gastrointestinal Disorders

Introduction: Improvements in soft ware, design, and cost reduction have made virtual reality (VR) a practical tool for an immersive, multi-sensory experience to distract patients from painful stimuli. While the utility of VR for pain management has been evaluated among few specific conditions, to our knowledge it has not been tested among hospitalized patients with gastrointestinal (GI) disorders. Herein, we evaluated the clinical utility of VR for inpatient pain management and its effect on blood pressure and heart rate in a cohort of hospitalized patients with a variety of GI disorders. Methods: We screened patients admitted to the inpatient medicine service for GI-related illnesses during a 4-month period. We excluded patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, epilepsy, and those in infectious isolation. Patients with at least one self-reported pain score of three or greater during the 24 hours preceding patient screening were selected to participate in the study. Eligible patients viewed a specific VR experience designed to reduce pain using the Samsung Gear Oculus VR goggles (Figure 1). We then compared pre and post intervention pain scores, blood pressure, and heart rate within subjects.Figure 1Results: A total of 13 patients participated in the study (Table 1). There was a statistically significant reduction in self-reported pain scores post VR intervention compared to before the intervention (pre-VR Mean = 3.8462 vs. post-VR Mean = 3.0000; P = 0.0025) corresponding to a 22% pain reduction and an observed effect size of 1.06 (Table 2). When adjusting for patients who reported no pain prior to VR intervention, similar findings were observed with a larger effect size of 1.83 (pre-VR Mean = 5.5556 vs. post-VR Mean = 4.3333; P = 0.0006). We did not observe a statistically significant change in systolic blood pressure, diastolic blood pressure, or mean heart rate (Table 2). Additionally, patients tolerated the intervention well and did not report any adverse effects.Table 1: Patient CharacteristicsTable 2: Physiological OutcomesConclusion: The use of VR for inpatients with GI disorders resulted in significant improvements in patient-reported pain scores, without influencing blood pressure and heart rate. VR is a potentially safe and practical tool to augment pain management in the acute inpatient setting. Further studies are indicated to further validate these findings, determine which subtypes of GI patients would benefit most from VR, and discover if long-term improvements in patient-reported pain scores are possible.

Effect of Music Therapy on Pain and Anxiety Levels of Cancer Patients: A Pilot Study.

Background:The pain associated with cancer is highly detrimental to the quality of life of the affected individuals. It also contributes to the anxiety of the patient. There is a need for a nonpharmacological approach in addition to the pharmacological therapy for the management of the pain for a more holistic improvement in the individual. With this study, we wish to achieve this through music.Objective:To assess the effect of music therapy on pain scores and anxiety levels of cancer patients with pain.Study Design:In this quantitative study, a comparative study was done on fourteen cancer patients admitted for pain relief under the Department of Pain and Palliative Medicine, of a tertiary care hospital, having moderate to severe pain (numerical pain rating scale [NRS] – of 4 to 10).Subjects and Methods:Convenience sampling was used. Patients were allocated to test group or control group nonrandomly. The test group patients were subjected to music therapy for 20 min while the control group patients were kept occupied by talking to them for 20 min. The NRS scale was used to assess the pre- and post-interventional pain scores and the Hamilton anxiety rating scale was used to assess the pre- and post-interventional anxiety scores in the two groups.Statistics:Student's t-test was used for comparing the pre- and post-interventional data. Two sample t-test was used to compare the data obtained from the control and study groups.Results:Statistically significant reduction seen in the pain scores in the test group after music therapy (P = 0.003). No statistically significant reduction seen in the pain score in the control group (P = 0.356). There was a statistically significant reduction in the postintervention pain scores in the test group compared to the control group (P = 0.034). The reduction in anxiety levels in both groups after intervention was not statistically significant.Conclusion:Music therapy was found to lower the pain score of a patient who had received standard palliative care for pain reduction. It was also more effective than the act of talking in reducing the pain score. A study with a larger sample size should be undertaken to conclude that, music therapy can be used in addition to morphine and other painkillers to reduce pain as a part of a more holistic approach to palliative care strategies.

Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins

This randomized trial compared four treatments for varicose great saphenous veins (GSVs). Five hundred consecutive patients (580 legs) with GSV reflux were randomized to endovenous laser ablation (980 and 1470 nm, bare fibre), radiofrequency ablation, ultrasound-guided foam sclerotherapy or surgical stripping using tumescent local anaesthesia with light sedation. Miniphlebectomies were also performed. The patients were examined with duplex imaging before surgery, and after 3 days, 1 month and 1 year. At 1 year, seven (5.8 per cent), six (4.8 per cent), 20 (16.3 per cent) and four (4.8 per cent) of the GSVs were patent and refluxing in the laser, radiofrequency, foam and stripping groups respectively (P < 0.001). One patient developed a pulmonary embolus after foam sclerotherapy and one a deep vein thrombosis after surgical stripping. No other major complications were recorded. The mean(s.d.) postintervention pain scores (scale 0-10) were 2.58(2.41), 1.21(1.72), 1.60(2.04) and 2.25(2.23) respectively (P < 0.001). The median (range) time to return to normal function was 2 (0-25), 1 (0-30), 1 (0-30) and 4 (0-30) days respectively (P < 0.001). The time off work, corrected for weekends, was 3.6 (0-46), 2.9 (0-14), 2.9 (0-33) and 4.3 (0-42) days respectively (P < 0.001). Disease-specific quality-of-life and Short Form 36 (SF-36(®)) scores had improved in all groups by 1-year follow-up. In the SF-36(®) domains bodily pain and physical functioning, the radiofrequency and foam groups performed better in the short term than the others. All treatments were efficacious. The technical failure rate was highest after foam sclerotherapy, but both radiofrequency ablation and foam were associated with a faster recovery and less postoperative pain than endovenous laser ablation and stripping.

Randomized Clinical Trial of VNUS® ClosureFAST™ Radiofrequency Ablation versus Laser for Varicose Veins

Conclusion: Radiofrequency ablation (RFA) using VNUS ClosureFAST (VNUS Medical Technologies, San Jose, Calif) is associated with less postprocedural pain than endovenous laser ablation (EVLA). Clinical and quality of life improvements for the two procedures are similar at 6 weeks. Summary: Endovenous ablative procedures have largely replaced standard saphenous stripping for treatment of saphenous reflux in patients with primary varicose veins. At the time of publication of this article, only one small randomized trial has compared VNUS ClosureFAST and EVLA (Almeida JI et al, J Vasc Interv Radiol 2009;20:752-9). This current study compares the most utilized technique for EVLA in Great Britain (980-nm wavelength and bare fiber) vs the most popular RFA system in Great Britain (VNUS ClosureFAST). Consecutive patients with primary great saphenous vein reflux were randomized to EVLA or RFA at a single center. The primary outcome measure was postprocedural pain at 3 days. Secondary outcome measures were quality of life at 6 weeks, as determined by the Aberdeen Varicose Vein Questionnaire (AVVQ) and Short Form 12 (SF-12), and clinical improvement using the Venous Clinical Severity Score (VCSS). Analysis was on an intention-to-treat basis. There were 64 patients randomized to EVLA and 67 to RFA. At 3 days, mean (SD) pain scores were 26.4 (22.1) mm for RFA and 36.8 (22.5) mm for EVLA (P = .010). Over 10 days, mean (SD) pain scores were 22.0 (19.8) mm for RFA vs 34.3 (21.1) mm for EVLA respectively (P = .001). Mean number of analgesic tablets used over 3 days and over 10 days was lower for RFA (P = .003) than EVLA (P = .001). There were no differences in AVVQ, SF-12, and VCSS scores at 6 weeks between the two groups (P = .887, P = .076, P = .449, respectively). Comment: The study demonstrated that VNUS ClosureFAST results in significantly less pain than 980-nm EVLA for ablation of the great saphenous veins in treatment of patients with varicose veins. The study supports previous publications that demonstrate less postprocedural pain after RFA but failed to show differences in outcomes after 1 month (Morrisson N, Semin Vasc Surg 2005;18:15-8 and Almeida J, et al, J Vasc Interv Radiol 2009;20:752-9). However, EVLA is continuing to be refined. There are newer fibers with longer wave lengths and jacketed laser fibers that appear to be associated with lower postintervention pain scores (Almeida J, et al. Vasc Endovasc Surg 2009;43:467-72). Data comparing these new devices with VNUS closure system will also eventually be required.