Pretreatment Visual Analog Scale Scores Research Articles

The positive effect of pulse electromagnetic field therapy on pain and disability in chronic low back pain: a comparative study

BackgroundLow back pain that lasts longer than three months is called chronic low back pain. Chronic low back pain is among the most common problems in the world, causing severe disability and loss of employment in patients.ObjectiveTo investigate the effect of pulse electromagnetic field therapy (PEMFT) added to routine physical therapy on pain and functional status in patients with chronic low back pain.MethodsThis retrospective comparative study included 69 patients with chronic low back pain. The patients were divided into two groups: those who received lumbar transcutaneous electrical nerve stimulation, infrared, and ultrasound treatments, and those who additionally received PEMFT. The files of patients with chronic low back pain were reviewed, and those who had been evaluated using the Quebec Back Pain Disability Scale (QBPDS) in terms of functional capacity and effects of low back pain and the Visual Analogue Scale (VAS) for pain both before and after treatment were included in the study.ResultsNo significant difference was detected between the two groups’ pretreatment VAS and QBPDS scores (p > 0.05). The second-and-third measurement scores of both groups were significantly lower than their first-measurement VAS and QBPDS scores (p ˂ 0.001), but there was no significant difference between their second- and third-measurement scores (p > 0.05). According to the inter-group comparison of the VAS and QBPDS scores, the second and third-measurement scores of the PEMFT group were significantly lower than those of the control group (p ˂ 0.001).ConclusionsPEMFT seems to be able to alleviate pain intensity and ameliorate disability in patients with chronic low back pain. PEMFT can be considered an effective and safe option that can be added to routine physical therapy modalities for relieving chronic low back pain frequently encountered in clinical practice. Further studies validating the effectiveness of PEMFT could strengthen its position in the management of chronic low back pain.

Comparison between Effectiveness of Mets and Static Stretching on Trapezius in Upper Cross Syndrome

Background: Upper cross syndrome involves an imbalance between the muscles of the anterior and upper trunk and the posterior skeletal muscles, leading to postural and functional issues. Muscle Energy Techniques (METs) and stretching exercises are common interventions, but their comparative effectiveness remains unclear.Objective: The study aimed to compare the effectiveness of METs and stretching in treating pain and improving functional status in patients with upper cross syndrome.Methods: This randomized clinical trial was conducted at the Physical Therapy Department of Mayo Hospital, Lahore, over six months. Sixty-two patients with upper cross syndrome were randomly assigned to two groups, each consisting of 31 participants. Group 1 received METs and conventional therapy, while Group 2 received static stretching and conventional therapy. The primary outcome measures were pain intensity, measured by the Visual Analogue Scale (VAS), and functional status, assessed using the Neck Disability Index (NDI). The intervention period lasted four weeks, and statistical analyses were performed using SPSS version 25.Results: In Group 1, the pre-treatment VAS score was 7.41 (± 1.08), decreasing to 3.41 (± 1.11) post-treatment, while in Group 2, the VAS score dropped from 7.16 (± 1.50) to 4.87 (± 1.56). The pre-treatment NDI score in Group 1 was 40.19 (± 6.15), which improved to 32.51 (± 6.16) post-treatment. In Group 2, the NDI score improved from 40.06 (± 5.88) to 35.74 (± 5.82). Both groups demonstrated significant improvement in pain and functional status, with METs showing greater effectiveness (p < 0.05).Conclusion: Muscle Energy Techniques were more effective in reducing pain and improving functional status in patients with upper cross syndrome compared to stretching exercises.

Effectiveness of Pain Neuroscience Education on Chronic Pain in Diabetic Neuropathy

Background: Diabetic neuropathy, a common complication of diabetes mellitus, often leads to chronic pain, significantly impacting the quality of life. Pain Neuroscience Education (PNE) has emerged as a potential intervention to address the bio-psychosocial aspects of chronic pain. This study aimed to evaluate the effectiveness of PNE in combination with conventional therapy in reducing pain and improving the quality of life in individuals with diabetic neuropathy. Objective: The primary objective was to assess the impact of Pain Neuroscience Education combined with conventional therapy on pain levels and quality of life in patients with diabetic neuropathy. Methods: A randomized clinical trial was conducted with 30 participants, divided into two groups: 15 in the treatment group and 15 in the control group. Participants were recruited from neurology and physical therapy outpatient departments and selected based on specific inclusion and exclusion criteria. The treatment group received PNE and conventional therapy (TENS, stretching, and strengthening exercises), while the control group received only conventional therapy. Pain levels were assessed using the Visual Analogue Scale (VAS) at baseline and after 6 weeks of intervention. Results: The pre-treatment VAS scores showed no significant difference between the groups (Treatment: Mean = 57.00, SD = 16.77583; Control: Mean = 56.2667, SD = 15.91705, P = 0.903). Post-treatment, the treatment group exhibited a significant reduction in pain (Mean = 19.6667, SD = 6.39940) compared to the control group (Mean = 45.3333, SD = 14.81634), with a mean difference of 25.66 and a P-value of 0.000. Conclusion: The study demonstrated that Pain Neuroscience Education, when combined with conventional therapy, significantly reduces pain and improves the quality of life in patients with diabetic neuropathy. This suggests that PNE could be an effective component of a multi-modal approach to managing diabetic neuropathy pain.

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.

Evaluation of the Effectiveness of Wet Cupping Therapy in Fibromyalgia Patients: A Randomized Controlled Trial

Introduction: The aim of this study was to investigate the efficacy of wet cupping therapy (WCT) in patients diagnosed with fibromyalgia syndrome (FMS) as a complementary method in fibromyalgia treatment. Materials and Methods: A total of 120 participants between 18 and 65 years who were diagnosed with FMS were included in the study. They were randomized into two groups: 60 patients as the intervention and 60 patients as the control group. Each participant in the intervention group received 3 sessions of WCT once a month in addition to their ongoing treatment whereas the control group received only routine medical treatment. The evaluation was conducted in both groups based on the fibromyalgia impact questionnaire (FIQ), visual analog scale (VAS), and quality of life scale (QoL) parameters initially (at 0th week) and 1 week after the WCT sessions (at the 10th week). For the comparison of quantitative variables showing a normal distribution between the two groups, the Student’s t test was used, while the Mann-Whitney U test was employed for variables not showing a normal distribution. The χ2 test and Continuity (Yates) Correction were used for the comparison of qualitative data. The significance level was set at p < 0.05. Results: The study included 107 female and 13 male participants, with a mean age of 45.79 ± 8.49 years. When comparing the pretreatment FIQ, VAS, and QoL scores with the scores obtained after three sessions of WCT, it was observed that in the WCT group, the FIQ and VAS values significantly decreased compared to the control group while the QoL significantly increased compared to the control group (p < 0.001 in all). Conclusion: The findings obtained from this study indicate that WCT can be an effective treatment option for patients with FMS.

THE EFFICACY OF CT-GUIDED PERCUTANEOUS CORDOTOMY ON INTRACTABLE PAIN IN PATIENTS WITH LUNG CANCER

ABSTRACT&#x0D; &#x0D; Aim&#x0D; This study was carried out to evaluate the efficacy of CT-guided percutaneous cordotomy and postoperative complications in the treatment of intractable pain associated with lung cancer. &#x0D; &#x0D; Material &amp;Method&#x0D; Computed tomography (CT) guided-cordotomy was performed on 10 lung cancer patients unresponsive to medical and interventional pain management methods.&#x0D; &#x0D; Results&#x0D; The mean pretreatment and post treatment visual analogue scale (VAS) scores of the patients were determined as 10 ± 0.0001 and 1.00 ± 0.67, respectively. Additionally, the mean pretreatment and posttreatment Karnofsky Performance Scale (KPS) scores of the patients were calculated as 40± 9.42 and 73±10.59, respectively. Accordingly, there was a statistically significant difference between the pretreatment and posttreatment VAS and KPS scores. Furthermore, the mean pretreatment and posttreatment morphine equivalent dose of the patients were found as 860.2±199.8 mg and 220.7±69.08 mg, respectively.&#x0D; &#x0D; Conclusion&#x0D; The findings of this study suggest that cordotomy is a valuable treatment option for intractable pain problems in patients suffering from lung cancer.

Effectiveness of extracorporeal shock wave therapy according to plantar calcaneal spur types

Objective: The aim of this study is to group patients with plantar heel pain and calcaneal spurs detected via lateral foot x-rays based on the angle between the spur and the calcaneus and compare the efficacy of an Extracorporeal shock wave therapy (ESWT) treatment between these groups. Materials and Methods: The patients were divided into three groups based on the measurement the angle between the plantar calcaneal spur and the calcaneus. Those with a measured angle of &lt;30° were classified as Group 1, ranging between 30–60° as Group 2, and &gt;60° as Group 3. Demographic characteristics, spur length, visual analog scale (VAS) and foot function index score (FFI), and pain and function evaluation were used as the pre-and posttreatment data in each group. Results: Out of the 170 patients, 96 (56.5%) were included in Group 1, 65 (38.2%) were in Group 2, and 9 (5.3%) in Group 3. The posttreatment VAS and FFI scores of the patients were significantly lower than the pretreatment scores (p &lt; 0,001). It was determined that the highest and lowest VAS and FFI score changes in the posttreatment period was in Group 3 and Group 1, respectively. In the correlation analysis, a positive correlation was found between the measured angle value and pretreatment VAS and FFI scores, age, and spur length. Conclusion: ESWT is an effective treatment method for calcaneal spurs, but further studies are needed on PCS classifications and the efficacy of the treatment selected based on these classifications.

Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia.

Pelvic floor physical therapy (PFPT) is first-line therapy for treatment of pelvic floor tension myalgia (PFTM). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone. This was a retrospective cohort analysis of 87 female patients with PFTM who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release. Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4, respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008). PFTPI immediately followed by PFPT offered more improvement in pain for patients with PFTM. This may be due to greater tolerance of myofascial release immediately following injections.

Importance of quadratus lumborum muscle trigger point injection and prolotherapy technique for lower back and buttock pain.

Low back pain is a heterogeneous disease. Myofascial pain and enthesopathy of the quadratus lumborum muscle are important causes of lower back and/or buttock pain. However, a concrete, safe, and effective injection technique for the treatment of trigger points and enthesopathy in the quadratus lumborum muscle has not yet been developed. We aimed to evaluate the importance of the quadratus lumborum muscle and introduce an effective landmark-based blind injection technique for treating quadratus lumborum trigger points and enthesopathy. Adult patients (n = 17) with lower back and/or buttock pain were placed in the lateral decubitus position. Next, we delicately palpated the quadratus lumborum muscle to accurately locate its lesions, including trigger points, taut bands, and tendon lesions, after five key landmarks had been identified. A newly designed 60-90-mm, 28G thin hypodermic needle was inserted at the tender points. The needle was typically advanced until its tip touched the transverse process to treat myofascial trigger points and tendon lesions in the iliolumbar and lumbocostal fibers, excluding superficial trigger points of the iliocostal fibers. Subsequently, lidocaine (0.5%) or a mixture of lidocaine (0.5%) and dextrose (12.5-15%) was injected. The pretreatment visual analog scale score for all 17 patients decreased from ≥4-8/10 (mean 5.588) to 0-1/10 (mean 0.294) after completion of all treatments. The total number of treatments was one to four in acute and subacute cases and two to eight in chronic cases. The mean follow-up period was 73.5 days (treatment period: range, 4 to 43 days + at least 60 days of follow-up). Herein, we describe for the first time a landmark-based integrated injection technique for the treatment of trigger points and myofascial pain in the quadratus lumborum; this technique is safe, effective, and can be used with or without steroids, fluoroscopy, or ultrasound guidance.

Correlation of Complex Impacted Mandibular Teeth with Pericoronitis and Effect of Minimally Invasive Tooth Extraction on Patients' Long-term Outcome of Masticatory Ability.

Objective To explore the correlation of complex impacted mandibular teeth and pericoronitis, as well as the effect of minimally invasive tooth extraction on patients' long-term outcomes of masticatory ability. Methods A total of 101 patients with complex impacted teeth who were treated in our hospital from March 2019 to June 2021 were selected and divided into the control group (n = 55) and the observation group (n = 46) according to the different treatment methods. The patients in the control group were given conventional extraction treatment, and the patients in the observation group were given minimally invasive extraction treatment. The clinicopathological features of patients complicated by pericoronitis were observed and the relationship between complex impacted mandibular teeth and pericoronitis was discussed. Additionally, we made statistics on operative time (OT), intraoperative blood loss (IBL), dental socket integrity score, and adverse reactions (ARs) and compared the clinical efficacy between the observation group and control group. The Visual Analogue Scale (VAS) and Oral Health Impact Profile scale (OHIP-14) were utilized for pain assessment and oral health status evaluation, respectively. Bite force (BF) and masticatory efficiency were also measured. Results OG showed less OT and IBL than CG, with a higher dental socket integrity score (P < 0.05). In addition, OG outperformed CG with a higher overall response rate and a lower incidence of ARs (P < 0.05). The pretreatment VAS score, mouth-opening degree, and OHIP-14 score differed insignificantly between groups (P > 0.05). After treatment, the VAS score of OG decreased, while the mouth-opening degree and OHIP-14 score increased (P < 0.05). Finally, the mastication ability was higher in OG at 7 days postoperatively, but there was no difference between groups at 6 months postoperatively (P > 0.05). Conclusion Complex mandibular impacted teeth can easily induce pericoronitis, so clinicians should pay attention to the influencing factors of pericoronitis. Minimally invasive surgery for complex impacted mandibular teeth can effectively improve treatment outcomes, accelerate patient rehabilitation, and provide more effective protection for patients' oral health and masticatory ability, which is worth promoting in clinical use.

Prolotherapy Method in Treatment of Chronic Low Back Pain

Objective: The aim of this study is to evaluate the effectiveness of 5% dectrose prolotherapy on low back pain in patients with chronic low back pain without neurological deficits. Material-Method: Prolotherapy with 5% dextrose was applied to patients with localized low back pain, hip pain, spreading pain in the legs for more than six months. Stretching exercises were recommended after prolotherapy and an analgesic containing paracetamol (500 mg) + codeine phosphate (10 mg) + caffeine (30) mg was used for analgesia for the first 3 days. Prolotherapy was planned 3 times with an interval of twenty days. Results: Thirty patients between the ages of 24-73 were included in the study. Eighteen patients received 3 sessions whereas twelve patients received 2 sessions of prolotherapy. Visual analogue scale (VAS) pain scores of all patients decreased. The mean pre-treatment VAS score was 8.43 and it decreased to 2.41 after the treatment. None of the patients had side effects that would terminate the treatment.Conclusion: The data obtained in the study show that prolotherapy is effective in treating chronic low back pain. We did not conduct long-term follow-up in our study. After three sessions and between sessions, we assessed the current state of well-being. More extensive studies will guide clarification of its place in the treatment of long-term low back pain.

Comparison of Acupuncture and NSAID Efficacy in Patients with Chronic Pelvic Pain Using Pain Disability Index and Visual Analogue Scale

Chronic pelvic pain (CPP) is continuous, noncyclical, and present for more than six months. Nonsteroidal anti-inflammatory drugs (NSAID) are widely used. Complementary medicine is considered when pain treatment is insufficient. There are studies available investigating the effect of acupuncture. In this study, we aimed to compare the effectiveness of acupuncture with NSAIDs. Patients admitted to Ankara Atatürk Research Hospital in a one-year period and diagnosed with CPP were included. Patients with organic pathology were excluded. Acupuncture was applied to 38 patients and 30 patients received NSAIDs according to their choice. Visual Analog Scale (VAS) and Pain Disability Index (PDI) were applied. Pre-treatment PDI in the acupuncture group was 47.15±11.84 and it was 24.95±14.16 after treatment. Pre-treatment VAS score in the acupuncture group was 6.89±1.57 and it was 3.78±1.91 after treatment. Pre-treatment PDI in the NSAID group was 25.7 and it was 15.5 after treatment. VAS in the NSAID group pre-treatment was 4.40±2.44 and it was 2.63±2.20 after treatment. Both of the groups had significant decreases in their scores. The pre-treatment scores in the acupuncture group were higher than the NSAID group. This finding may indicate that patients in the acupuncture group were NSAID resistant. Hence, acupuncture could be a choice for NSAID resistant patients.

Role of Triple Injection Platelet-Rich Plasma for Osteoarthritis Knees: A 2Years Follow-Up Study.

To assess the clinical outcomes of intra-articular Platelet-rich plasma (PRP) injection in knee osteoarthritis (OA) at 2year follow-up. This was a prospective interventional study. 68 cases (105 knees) with Kellgren-Lawrence (KL) grades I, II and III knee OA received 3 intra-articular injections of PRP 1month apart. The cases were followed up for 2-years. Outcomes were measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Visual analog scale (VAS) scores. The mean age was 51.7years. 18 knees had KL grade I, 55 had grade II and 32 had grade III OA. The mean pre-treatment VAS score decreased significantly at 1year (mean difference -5.3, p = 0.003) and 2year follow-up (mean difference -6, p = 0.007). The mean pre-treatment WOMAC score decreased significantly at 1year (mean difference -45.9, p = 0.011) and at 2year (mean difference -52.4, p = 0.009). The WOMAC and VAS scores improved significantly from baseline to final follow-up across all KL grades (p = 0.001 and 0.001, 0.009 and 0.007, 0.021 and 0.017 for WOMAC and VAS across KL grade I, II and III, respectively). There was no significant differences in WOMAC and VAS scores between three KL grades at final follow-up (p = 0.17 and 0.09, respectively), although the baseline scores had significant difference (p = 0.001 for both VAS and WOMAC) with worse scores in higher KL grades. The variables like age, sex, BMI, KL grade, baseline VAS and baseline WOMAC did not predict the final VAS and WOMAC scores. Triple injection of intra-articular PRP given one month apart significantly relieves the symptoms ofknee OA till 2years in KL grade I, II and III. The improvement in symptoms at 2-year follow-up did not differ across different KL grades.

Efficacy of Routinely used Analgesics in Management of Pulpal Pain Postoperatively a Clinical Study.

Aim:The aim of this study was to evaluate the efficacy of various routinely used analgesics in the management of pulpal pain preoperatively.Materials and Methods:A total of 150 patients were randomly selected and divided into five groups each. At initial visit, a self-administered questionnaire was given, and patients were asked to mark on the Visual Analog Scale (VAS) indicating severity of pain at that moment which is taken as a pretreatment VAS score. Group I patients received aceclofenac + paracetamol, Group II: ketorolac tromethamine, Group III: lornoxicam + paracetamol, Group IV: tramadol + paracetamol, and Group V: paracetamol. All the patients are requested to record their pain levels at 4 h, 6 h, 8 h, 24 h, and 48 h by means of VAS scores before and after treatment.Results:There was no significant decrease in frequency of pain when compared in the first three groups, whereas in Group III and Group IV, the patients experienced an effective reduction in pain because of sustained releasing ability of these drugs. Overall, there was no statistically significant differences among all the groups.Conclusion:This study suggests that there was no significant difference in reduction of pain preoperatively. However, lornoxicam + paracetamol and tramadol + paracetamol were effective because of their sustained releasing ability. Ketorolac was effective to reduce the pain for shorter duration. Paracetamol can be advised in compromised patients where safety is concerned.

The efficacy and successful factors of pulsed radiofrequency treatment of lumbosacral radicular pain patients

ObjectiveStudies have reported several treatment modalities for patients with lumbosacral radicular pain. However, the available evidence is not robust to establish definitive conclusions. The goal of this study was to evaluate the clinical efficacy of pulsed radiofrequency (PRF) treatment in patients with lumbosacral radicular pain. MethodsWe have retrospectively reviewed and analyzed lumbosacral radicular pain in 34 patients who underwent PRF treatment at our institute. Diagnostic selective nerve root block was performed and patients who experienced more than 50% pain reduction were exposed to PRF. Pain relief was evaluated based on visual analog scale (VAS) scores at pre-treatment, 2 weeks, 3 and 6 months post-treatment. A success group and outcome were defined by more than 50% reduction in VAS scores at 6 months. ResultsSuccessful outcome was achieved in 47% of patients. None of the patients had any side effects or procedure-related complications during the follow-up. Sex, number of lesions of treatment and pre-treatment VAS score showed no statistically significant differences between success and failure groups. The age of success group (52.9 ± 17.30 years) was significantly (P < 0.002) lower than in failure group (70.5 ± 14.4 years). The success versus failure ratio was 67% in patients with herniated lumbar disc (HLD) (n = 21) and 22% in those with spinal stenosis (n = 9). Interestingly, all patients with l failed back surgery syndrome (n = 4) belonged to the failure group. ConclusionsPRF treatment of lumbosacral radicular pain patients is a safe and efficacious treatment option, especially in younger and HLD patients.

Short Term Effectiveness of Intraatricular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in a tertiary care hospital.

Objective: To determine mean decrease in VAS pain score of intraarticular injection of methyl prednisolone acetate in patients of subacromial impingement syndrome. Methods: Its Descriptive Case Series/ Quasi experimental study. Study was conducted in department of Orthopedics Unit- I, Jinnah hospital Lahore. Study completed in Six months i.e. from June 2014 to December 2014.After taking an informed consent, 70 newly diagnosed cases of Subacromial impingement syndrome by history and examination (described by the patient as pain in subacromial space when the humerus was elevated or internally rotated and tested by having the patient place his hand on the unaffected shoulder and gradually forward flexing the shoulder (positive impingement sign)which have not received any kind of treatment were included. Results: Effectiveness of intraarticular injection of methyl prednisolone acetate was measured on visual analogue scale (VAS) from 0 to 10 by VAS score after 6 weeks. 70 patients with mean age of 36.2 ± 10.6 years were included. 61 patients (75.7%) were male, 10 patients (14.3%) had gout and 20% were diabetic. Mean pretreatment VAS score was 5.03 ± 1.58 while mean post-treatment VAS score was 3.86 ± 0.839. Mean reduction was 1.17 ± 1.57 ranged from 2 to 6. There was non-significant association of age and diabetes with mean reduction in VAS score while female gender and gout were significantly and negatively associated with treatment outcome. It is concluded that mean reduction in VAS score after 6 weeks of treatment of subacromial impingement syndrome after intra articular methylprednisolone injection is 1.17 ± 1.57 and acceptable. Conclusion: It is concluded that intraatricular injection of methyl prednisolone injection is efficacious and effective for treatment of Subacromial impingement syndrome in Pakistani population. Keyword: subacromial impingement syndrome, intra articular methylprednisolone injection, visual analogue scale, effectiveness.

Tennis elbow brace and wrist cock-up splint in the management of tennis elbow: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The purpose of our study was to compare the efficacy of a wrist splint with a forearm counterforce strap brace in the management of tennis elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted between January and December 2018 comprising of 75 patients suffering from lateral epicondylitis managed conservatively with splints. Patients were randomized into three treatment groups, group 1 received tennis elbow forearm brace, group 2 received wrist extension splint, group 3 received both tennis elbow forearm brace and wrist extension splint. The patient-rated tennis elbow evaluation (PRTEE) score and visual analogue scale (VAS) scores were calculated at 0, 3 and 6 weeks of the treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean difference of pre-treatment and post-treatment PRTEE score was significant in all three groups and was maximum for group 3 patients (32.42) followed by group 2 patients (27.04) followed by group 1 patients (20.06). Pre-treatment and post-treatment VAS score difference was maximum for group 3 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Significant symptomatic relief can be achieved in patients with tennis elbow by using either tennis elbow forearm brace or wrist extension splint or both. Provided proper patient selection and compliance, wrist extension splint achieves better symptomatic relief and functional outcome as compared to tennis elbow brace.&lt;/p&gt;

Ultrasound-guided dextrose injection treatment for chronic myofascial pain syndrome: A retrospective case series.

Background:Due to the lack of an evidence-based consensus, managing refractory myofascial pain syndrome is challenging for clinicians. Dextrose injection (dextrose prolotherapy) emerged as a promising, cost-effective treatment. This study evaluated the efficacy of targeted ultrasound-guided dextrose injection for localized myofascial pain syndrome.Methods:We retrospectively reviewed the clinical outcomes of 45 patients with myofascial pain syndrome refractory to alternative treatments with targeted ultrasound-guided dextrose injection. Pretreatment symptom severity and symptomatic response 1 month after treatment were statistically analyzed using a visual analog scale (VAS)-based scoring system.Results:Of 45 patients, 8 (24.4%) reported complete resolution of symptoms at the treated site. In total, 36 (80.0%) patients reported greater than 50% improvement in their symptoms. The mean pretreatment and posttreatment VAS scores were 7.0 and 2.44 (p < 0.001), indicating an overall 65.0% reduction in symptom severity.Conclusion:Targeted ultrasound-guided dextrose injection was remarkably effective for refractory localized myofascial pain syndrome, significantly reducing symptom intensities in the majority of treated patients within 1 month after a single injection.

Can a Pretreatment Visual Analog Scale Predict Treatment Outcome in Allergic Rhinitis?

Background: The visual analogue scale (VAS) is a simple and useful tool to assess the severity of allergic rhinitis. Whether a pretreatment VAS score can guide appropriate medication is unclear. Objective: The aim of this study was to evaluate whether a pretreatment VAS score could be used to predict therapeutic response. Methods: A prospective 4-week cohort study involving 101 allergic rhinitis patients was carried out. All patients were treated with triamcinolone acetonide aqueous nasal spray 220 μg once daily for 28 days. The treatment outcomes were evaluated using VAS scores (0–10 cm), total nasal symptoms scores (TNSSs), nasal mucociliary clearance times (NMCCTs), and global symptom controls (GSCs). The minimal clinically important differences (MCIDs) method was used to separate the patients into with and without improvement groups. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of pretreatment VAS scores in relation to MCIDs after treatment. Results: Pretreatment VAS scores showed a positive correlation with pretreatment TNSSs and NMCCTs (ρ = 0.66, p < 0.001 and r = 0.44, p < 0.001, respectively), and a negative correlation with GSCs after treatment (r = –0.53, p < 0.001). The MCID values of TNSSs and NMCCTs were 3.19 and 2.78, respectively. The cutoff value of pretreatment VAS ranged between 6.5 and 7.7 points, with an average value of 7.1. Conclusion: A pretreatment VAS score of 7 or higher was associated with an unfavorable treatment outcome, which suggests the potential therapeutic predictive value of VAS scoring.

Predictive Effect of Cervical Sagittal Parameters on Conservative Treatment of Single-Segment Cervical Spondylotic Radiculopathy

To explore whether the cervical sagittal parameters affect the conservative treatment of single-segment cervical spondylotic radiculopathy and whether the conservative treatment of single-segment cervical spondylotic radiculopathy can be predicted by cervical sagittal parameters. Cervical spondylotic radiculopathy is currently treated with a stepwise approach, and conservative treatment is recommended. However, there is insufficient evidence to support the efficacy of conservative treatment. Between January 2013 and January 2018, 121 patients with single-segment cervical spondylotic radiculopathy were enrolled in this study. The inclusion criteria included complete cervical lateral radiographs. The following radiographic parameters were measured: C0-2 Cobb angle; C2-7 Cobb angle (CL), C7 slope (C7S), neck tilt (NT), thoracic inlet angle (TIA), T1 slope (T1S), C2-7 sagittal vertical axis (SVA), cervical tilt, cranial tilt, and cervical curvature index (CCI). Cervical spine function and quality of life were assessed using a visual analog scale (VAS) and the Neck Disability Index (NDI). According to the therapeutic effect, the patients were divided into group A (effective conservative treatment group) and group B (ineffective conservative treatment group). Effective conservative treatment was defined as conservative treatment for 3 months (1 nonsteroidal analgesic and 1 neurotrophic drug, supplemented by cervical traction and a neck support brace) resulting in a 60% reduction in NDI score. The Pearson correlation coefficient was used to calculate the correlation between each sagittal parameter and functional score. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to determine independent risk factors and critical values. In the effective conservative treatment group (group A), the pretreatment NDI score was significantly positively correlated with the pretreatment VAS score and negatively correlated with CL, C7S, TIA, T1S, cervical tilt, and CCI. In the ineffective conservative treatment group (group B), the pretreatment NDI score was significantly positively correlated with the pretreatment VAS score and NT, and negatively correlated with age, CL, C7S, T1S, cervical tilt, and CCI. Based on logistic regression analysis and ROC curve analysis, we found that a larger C2-7 Cobb angle before treatment was the sole independent risk factor for conservative treatment (P < 0.001). Patients with a C2-7 Cobb angle >7.7° had a greater likelihood of receiving effective conservative treatment. In patients with single-segment cervical spondylotic radiculopathy, a larger C2-7 Cobb angle before treatment was the sole independent risk factor for effective conservative treatment (P < 0.001). Conservative treatment was more likely to be effective when the C2-7 Cobb angle is >7.7°.