Reduction In Numeric Rating Scale Score Research Articles

Effectiveness of Cannabis Oil as an Adjuvant Therapy in Patients with Severe Knee Osteoarthritis: A Randomized, Double-Blind Study

Purpose: The removal of cannabis from Thailand's narcotic drug list presents both opportunities and challenges for medical use. The effectiveness of cannabis oil in treating severe knee osteoarthritis in patients awaiting total knee arthroplasty was evaluated in this study. Methods: Thirty-two patients with severe knee osteoarthritis, unresponsive to conservative treatment, were enrolled and divided into two equal groups. The control and experimental groups received syrup and cannabis oil, respectively, at night for 30 days. Pain and quality of life (QOL) were assessed using the Numeric Rating Scale (NRS), and the Knee Injury and Osteoarthritis Outcome Score (KOOS), respectively. Liver and kidney functions were also assessed. Results: The experimental group showed a significant reduction in NRS scores compared to the control group (p = 0.00015). Significant improvements were observed in KOOS subscales for pain, activities of daily living (ADL), and QOL (p = 0.01). However, the symptoms subscale improvement was not significant (p = 0.14). When comparing the KOOS subscales, no significant differences were observed between the groups (p > 0.05). Liver and kidney function remained stable in both groups. Despite these improvements, the changes did not reach a minimal clinically important difference (MCID), indicating limited clinical perceptibility to the patients. Conclusions: Cannabis oil was associated with significant improvements in pain, ADL, and QOL in severe knee osteoarthritis. Although improvements did not meet MCID thresholds, observed benefits suggest potential for pain management. Larger controlled studies are recommended to confirm its clinical efficacy in pain management.

Long-term efficacy and reduced side-effects of buprenorphine in patients with moderate and severe chronic pain.

Chronic pain significantly impacts quality of life and poses substantial public health challenges. Buprenorphine, a synthetic analog of thebaine, is recognized for its potential in managing moderate to severe chronic pain with fewer side effects and a lower incidence of tolerance compared to traditional opioids. This retrospective study aimed to assess the long-term efficacy and safety of buprenorphine transdermal patches in patients with moderate and severe chronic pain, with a focus on pain relief sustainability and tolerance development. This retrospective observational study involved 246 patients prescribed buprenorphine transdermal patches. We evaluated changes in pain intensity using the Numeric Rating Scale (NRS), assessed opioid tolerance based on FDA guidelines for morphine-equivalent doses, and measured patient-reported outcomes through the Patients' Global Impression of Change (PGIC). Any adverse events were also recorded. Over the 36-month period, there was a significant reduction in NRS scores for both moderate and severe pain patients, demonstrating buprenorphine's sustained analgesic effect. Tolerance measurement indicated that no patients required increases in morphine-equivalent doses that would meet or exceed the FDA's threshold for opioid tolerance (60mg/day of morphine or equivalent). Additionally, patient satisfaction was high, with the PGIC reflecting significant improvements in pain management and overall wellbeing. The side effects were minimal, with skin reactions and nausea being the most commonly reported but manageable adverse events. The study findings validate the long-term use of buprenorphine transdermal patches as an effective and safe option for chronic pain management, maintaining efficacy without significant tolerance development. These results support the continued and expanded use of buprenorphine in clinical settings, emphasizing its role in reducing the burdens of chronic pain and opioid-related side effects. Further research is encouraged to refine pain management protocols and explore buprenorphine's full potential in diverse patient populations.

Wrist and ankle acupuncture relief moderate to severe postoperative pain after functional endoscopic sinus surgery: A randomized controlled study

Introduction The study aimed to validate the effectiveness of Wrist and Ankle Acupuncture (WAA) in attenuating moderate to severe postoperative pain following Functional Endoscopic Sinus Surgery (FESS). Methods Participants were randomly allocated into a treatment group ( n = 57) and a control group ( n = 58). The treatment group underwent WAA treatment, while the control group received sham acupuncture treatment. The Numeric Rating Scale (NRS) was employed to assess postoperative pain. The sleep efficiency, the amount of rescue medication, and the adverse events were also evaluated for both groups. Results A significant immediate reduction in NRS scores was observed in the treatment group ( p < .01). At 2, 4, 8, 22, and 24 h after first treatment, pain intensity decreased in the WAA group compared with the control group ( p < .01). Moreover, the WAA group demonstrated superior sleep efficiency relative to the control group on the night after surgery ( p < .01). And the mean number of rescue tablets used on the WAA group was obviously lower than the control group ( p < .01). There were no serious adverse events in both groups, and all adverse events completely disappeared within 3 days. Conclusion WAA effectively alleviated postoperative discomfort associated with nasal packing subsequent to FESS and enhanced sleep quality during the postoperative night. The anatomical superficiality of the acupuncture points employed reduces the risk of adverse events while yielding effective analgesic results, thus validating its suitability for clinical application.

A retrospective study on the clinical characteristics and treatment outcomes of patients with burning mouth syndrome.

Burning mouth syndrome (BMS) refers to a condition characterized by pain sensations such as burning or tingling, or sensory disturbances in the tongue or oral mucosa without any specific local or systemic cause for more than 3 months. This study retrospectively investigated the clinical characteristics of 248 BMS patients (217 women, 31 men, mean age 64.7±11.2 years). Treatment outcomes were assessed using the Numeric Rating Scale (NRS). Parafunctional habit control education, saliva substitute, and counselling for psychological stability were implemented at the first visit, resulting in a significant reduction in NRS scores at the second visit. Medication such as clonazepam or zinc supplements were administered from the second to fourth visit, leading to a significant reduction in NRS scores compared to the initial visit. The various treatment options can be applied to alleviate the symptoms of BMS. Forty-eight patients (19.35%) exhibited serum zinc concentration of 70μg/dL or lower. A well-designed clinical study with a large number of patients is needed to compare the therapeutic effects between underlying conditions, medications, and nutritional supplementation including zinc.

The improvement of pain symptoms in patients with burning mouth syndrome through combined laser and medication therapy.

The etiology of Burning Mouth Syndrome (BMS) remains unclear. To explore the differences in the therapeutic efficacy of pain improvement between medication therapy and laser therapy in patients with BMS. 45 BMS patients were randomly divided into three groups: The Combination therapy group (Group A, n= 15), The Medication therapy group (Group B, n= 15), and the Laser therapy group (Group C, n= 15). The pain condition of the patients was evaluated using the Numeric Rating Scale (NRS), and the improvement in pain before and after treatment was compared among the three groups. All three groups (A, B, and C) showed a significant reduction in NRS scores after treatment, with statistically significant differences observed among the different groups. Group A exhibited the most significant improvement, with a statistically significant difference before and after treatment. Laser and medication therapy are effective methods for reducing oral burning pain * symptoms, and their combined use yields more significant therapeutic effects.

The Short-Term Outcome of Transforaminal Epidural Steroid Injection in Patients with Radicular Pain Due to Foraminal Stenosis from Lumbar Isthmic Spondylolisthesis.

In this study, we evaluated the therapeutic outcomes of transforaminal epidural steroid injection (TFESI) in managing chronic radicular pain due to foraminal stenosis. Furthermore, we evaluated its effectiveness according to isthmic spondylolisthesis (IS) severity. We included 40 patients with radicular pain due to IS-derived foraminal stenosis in our study and treated them with TFESI. Two patients were lost during follow-up. Based on the lateral lumbar radiograph findings, we allocated the recruited patients with < 25% slippage by IS to Group 1 (n = 23) and those having 25-50% slippage to Group 2 (n = 15). The degree of pain was measured using a numeric rating scale (NRS) at pre-treatment and 1 and 2 months after TFESI. In 38 patients who completed the study, the NRS at pre-treatment was significantly reduced at the 1- and 2-month follow-ups. In the Group analysis, the NRS scores were significantly reduced after TFESI in both Groups 1 and 2, regardless of IS severity. However, the reduction in NRS scores 1 month after TFESI was significantly greater in Group 1 than in Group 2. Moreover, the rate of successful treatment outcomes was significantly higher (65.2%) in Group 1 than in Group 2 (26.7%). After TFESI, chronic radicular pain was significantly reduced regardless of IS severity, and its effect persisted for at least 2 months. However, its effect was superior when the vertebra slippage by IS was less than 25% compared to patients with 25%-50%.

Efficacy of Pericapsular Nerve Group Block for Pain Reduction and Opioid Consumption after Total Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.

The aim of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) for comparison of the effectiveness of pericapsular nerve group (PENG) block with that of other analgesic techniques for reduction of postoperative pain and consumption of opioids after total hip arthroplasty (THA). A search of records in the PubMed, Embase, and Cochrane Library, and ClinicalTrials.gov databases was conducted in order to identify studies comparing the effect of the PENG block with that of other analgesics on reduction of postoperative pain and consumption of opioids after THA. Determination of eligibility was based on the PICOS (participants, intervention, comparator, outcomes, and study design) criteria as follows: (1) Participants: patients who underwent THA. (2) Intervention: patients who received a PENG block for management of postoperative pain. (3) Comparator: patients who received other analgesics. (4) Outcomes: numerical rating scale (NRS) score and opioid consumption during different periods. (5) Study design: clinical RCTs. Five RCTs were finally included in the current meta-analysis. Significantly lower postoperative opioid consumption at 24 hours after THA was observed in the group of patients who received the PENG block compared with the control group (standard mean difference=-0.36, 95% confidence interval -0.64 to -0.08). However, no significant reduction in NRS score at 12, 24, and 48 hours after surgery and opioid consumption at 48 hours after THA was observed. The PENG block showed better results for opioid consumption at 24 hours after THA compared with other analgesics.

Prediction of the Efficacy of Lumbar Sympathetic Block in Patients with Lower Extremity Complex Regional Pain Syndrome Type 1 Based on the Sympathetic Skin Response.

Complex regional pain syndrome type 1 (CRPS-1) is prevalent after trauma, with intractable pain being the most prominent clinical symptom. The impact of sympathetic block on CRPS is unclear. The goal of this study was to explore the characteristics that predict successful symptom relief with lumbar sympathetic block (LSB) in patients with lower extremity CRPS-1. The study was designed as a prospective cohort study. Ninety-eight patients diagnosed with lower extremity CRPS-1 between March 2021 and March 2022 were enrolled as participants. All of the patients received two LSB treatments within a month. Sympthetic skin response (SSR) and numeric rating scale (NRS) were recorded before and after LSB treatment. The procedure was judged as a clinically positive response if the patients a 50% or greater reduction in NRS scores. Patients were divided into positive response and negative response groups after LSB treatment: LSB (+) and LSB (-), and the different characteristics and examination findings of the two groups of patients were compared. Furthermore, a multivariable logistic regression model was utilized to evaluate the predictors of successful symptom relief following LSB treatment. A total of 43.9% (43/98) of patients experienced successful symptom relief, while 56.1% (55/98) had unsuccessful symptom relief. After LSB treatment of all subjects, the overall NRS score decreased, the SSR amplitude increased, and the SSR latency shortened in the affected extremity (P < 0.05). There was a significant difference in the change in SSR amplitude between the LSB (-) and LSB (+) groups (P = 0.000). A 12-month disease duration had an OR (odds ratio) of 4.477 (P = 0.009), and a 510-µV baseline SSR amplitude of the affected extremity had an OR of 7.508 (P = 0.000) in the multivariable analysis that included these explanatory variables. Patients with lower extremity CRPS-1 can experience significant pain relief after LSB treatment. The predictors of successful symptom relief after LSB treatment were a baseline SSR amplitude of the affected extremity < 510µV and a disease duration < 12months. The study was registered in the Chinese Clinical Trial Registry (ID: ChiCTR2000037755, date of registration: September 4, 2020).

An Open-label, Prospective, Multicentric, Cohort Study of Nimesulide/Paracetamol Fixed Drug Combination for Acute Pain Management: Sub-group Analysis.

Nimesulide has been evaluated in numerous clinical studies in the management of a variety of acute painful conditions. However, there is limited Indian data available on the nimesulide/paracetamol fixed drug combination (FDC). Hence, an open-label prospective multicentric study was conducted to evaluate the safety and efficacy of this FDC in the management of acute painful conditions in real-world settings. A prospective, open-label, and multicenter study conducted at 24 centers across Indian patients with acute painful conditions due to trauma, tendinitis, myalgia, low backache, sprains, pulled muscle, soft tissue injury, dental pain, and dental procedure/surgery. Nimesulide/paracetamol FDC was prescribed by clinicians as a part of routine practice. The effectiveness was evaluated on the numerical rating scale (NRS), that is, pain intensity at rest and movement, and the physician/patient global assessment scale (GAS) among the subgroups of acute painful conditions like myalgia, dental pain, low backache, etc. Hepatic safety was also evaluated among the subgroups at the end of treatment. A total of 464 patients were included in the study. The reduction in NRS score at rest and movement during treatment duration across different types of pain was statistically significant (p &lt; 0.001). Pain reduction was evident as per patient and physician GAS at the end of treatment in all indications. No clinically significant difference was found in liver parameters at the end of the study. Nimesulide/paracetamol (FDC) was well tolerated across all the subgroups. Nimesulide/paracetamol FDC was found to be well-tolerated and effective in pain management across all acute painful conditions in a real-world setting without any hepatic safety concerns.

Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia.

There is still no consensus on perioperative pain control techniques in patients undergoing laparoscopic surgery; protocols of conventional therapy can be improved by the use of perioperative anaesthesiologic techniques, such as epidural or loco-regional analgesic administration as transversus abdominis plane (TAP) block. The aim of this evaluation was to investigate the role of laparoscopic-assisted TAP block during repair of diastasis recti associated with primary midline hernias in term of post-operative pain relief. This was a retrospective evaluation of a prospectively maintained database including patients undergoing laparoscopic repair of diastasis recti associated with primary ventral hernia. Patients were divided into two groups: Group A patients (n = 34) received laparoscopic-assisted bilateral TAP-block of 7.5 mg/ml ropivacaine for each side and Group B patients (n = 29) received conventional post-operative therapy. All patients received 24 h infusion of 20 mg morphine; pain was checked at 6, 24 and 48 h after surgery by numeric rating scale (NRS) score. A rescue analgesia by was given if NRS score was >4 or on patient request. No differences in operative time, complications and post-operative stay, no complications related to TAP-block technique were found. Post-operative pain scores (determined by NRS) were found to be significantly different between groups. Group A patients showed a significant reduction in NRS score at 6, 24 and 48 h (P < 0.005) and in the number of patients requiring further analgesic drugs administration (P < 0.005) compared to Group B patients. Laparoscopic-guided TAP-block can be considered safe and effective in the management of post-operative pain and in the reduction of analgesic need in patients undergoing laparoscopic repair of diastasis recti and ventral hernias. The non-randomised nature of the study and the lack of a consistent series of patients require further evaluations.

MP18-06 EFFICACY OF PULSED ELECTROMAGNETIC FIELD (PEMF) THERAPY FOR PELVIC PAIN REDUCTION AND SYMPTOM IMPROVEMENT IN INTERSTITIAL CYSTITIS: A PILOT STUDY

You have accessJournal of UrologyCME1 May 2022MP18-06 EFFICACY OF PULSED ELECTROMAGNETIC FIELD (PEMF) THERAPY FOR PELVIC PAIN REDUCTION AND SYMPTOM IMPROVEMENT IN INTERSTITIAL CYSTITIS: A PILOT STUDY Dylan T. Wolff, Peyton Lee, Christina Ross, Robert J. Evans, Gopal Badlani, Tyler Overholt, Raymond Xu, Catherine A. Matthews, and Stephen J. Walker Dylan T. WolffDylan T. Wolff More articles by this author , Peyton LeePeyton Lee More articles by this author , Christina RossChristina Ross More articles by this author , Robert J. EvansRobert J. Evans More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , Tyler OverholtTyler Overholt More articles by this author , Raymond XuRaymond Xu More articles by this author , Catherine A. MatthewsCatherine A. Matthews More articles by this author , and Stephen J. WalkerStephen J. Walker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PEMF therapy is effective for pain reduction in select chronic pain disorders. The present study evaluated the efficacy of PEMF therapy for pain/symptom management in women with non-bladder centric interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Women (ages 18-80 yo) with a confirmed diagnosis of IC/BPS, a numeric rating scale (NRS) score for pelvic pain ≥6, and an anesthetic bladder capacity (BC) >400ml underwent 8-minute full body PEMF sessions, twice daily, for 4 weeks. The primary outcome measure was a reduction in NRS score ≥ 2-points. The O’Leary Sant Interstitial Cystitis Symptom and Problem Indices (ICSI/ICPI), Pain and Urgency/Frequency (PUF) patient symptom scale, Female Genitourinary Pain Index (F-GUPI), and the Short Form-36 (SF-36) Quality of Life questionnaires, completed at weeks 1 (baseline), 4 (conclusion), and 12 (8-week follow-up), were used to assess secondary outcomes. A 7-day voiding diary was collected at baseline and 4 weeks. Treatment effects were assessed via Wilcoxon-signed rank test; p <0.05 = significant. RESULTS: Of 10 participants, 8 completed the 4-week treatment, and 7/8 (87.5%) had a significant reduction in pelvic pain (6.88 to 4.19, p=0.011) after 4 weeks. There was also a significant decrease in ICSI, ICPI, PUF, and GUPI symptom scores, daily number of voids, and mean nocturia score (Table 1, p<0.05). Patients also experienced significant increases in the SF-36 quality of life energy/fatigue, social function, and pain scores (P<0.05). At 8-week post-therapy, the positive effects were somewhat attenuated, yet 3/7 patients (42.9%) continued to have significant pain reduction (p=0.047). Mean NRS, ICSI, and PUF scores remained significantly lower (p<0.05), and the SF-36 energy/fatigue remained significantly elevated while emotional well-being and general health scores (unchanged at 4 weeks) had increased significantly from baseline (p<0.05). No adverse events were reported. CONCLUSIONS: This proof-of-concept interventional trial found significant pain reduction, decreases in subjective symptom scores, and increases in quality-of-life scores for nearly all patients. Many benefits persisted for 8 weeks post-therapy. Randomized, sham-controlled trials are necessary to validate these findings. Source of Funding: N/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e297 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan T. Wolff More articles by this author Peyton Lee More articles by this author Christina Ross More articles by this author Robert J. Evans More articles by this author Gopal Badlani More articles by this author Tyler Overholt More articles by this author Raymond Xu More articles by this author Catherine A. Matthews More articles by this author Stephen J. Walker More articles by this author Expand All Advertisement PDF DownloadLoading ...

Abstract No. : ABS1499: Role of platelet-rich-plasma versus dextrose-prolotherapy in the management of partial rotator cuff tear- A randomised controlled trial.

Background and Aims:Regenerative medicines like Platelet-Rich plasma (PRP) and Dextrose-Prolotherapy (DP) are gaining popularity for treating partial Rotator Cuff tear (PTRCT). Thisstudy aimed to compare the efficacy of ultrasound-guided PRP versus DP for reducing pain and improving functional ability in patients with chronic PTRCT.Methods:One hundred and twenty patients of both sexes, aged 18-65 years, with PTRCT and having persisting pain >6 in Numeric Rating Scale (NRS), even after conservative treatment for at-least two months, were included in study. After assessment, 104 patients were randomly allocated into two groups. Group P (n=54) received PRP 2-3ml at 0 and 4weeks. Group D (n=50) received 2-3ml of 12.5% dextrose at 0, 3 and 6 weeks. Injections were given using ultrasound. Patients (n=92) were assessed with NRS score and University of California at Los Angeles (UCLA) shoulder score before 1st injection,and at 8 weeks and 12 weeks after 1st injection. Friedman ANOVA test followed by Wilcoxon test was done for within group comparison whereas between group comparison were done by Mann Whitney U test. A P value <0.05 was considered significant.Results:Significant reduction in NRS score and UCLA score were found in both the groups at 8 weeks and 12weeks after injection, compared to pre- injection scores (0week)(figure 1). No significant difference were found in between two groups at any point of time.Figure 1Mean numerical rating scale score for pain at different time points.Conclusion:Both PRP and DP are equally effective in reduction of pain and improvement in shoulder functional ability in patients with PTRCT for at least 12 weeks.

Low-dose ketamine as an analgesic agent in the emergency department: Efficacy and safety.

Interest in using low-dose ketamine (LDK) as an alternative analgesic to manage acute pain in the emergency department (ED) has increased. The aim of this systematic review was to compare and evaluate the analgesic effect and safety of LDK for the management of acute pain in the ED. Databases were searched and all published articles that met the inclusion criteria were used. Electronic research was conducted on a total of 85 articles, and 13 articles that were relevant in terms of content, topic, and aim were selected for further review. The studies were analyzed and categorized after review. The results demonstrated that in 53.84% (7 of 13) of articles, a significant reduction or more than 50% reduction in pain in the group of patients treated with ketamine (alone or combined with other analgesics) was reported. However, in 46.15% (6 out of 13) of the reviewed articles, no significant difference was observed between the pain reduction in the groups treated with ketamine alone and ketamine with other analgesics. The highest decrease in numerical rating scale (NRS) score was 6 and the lowest was 1. There was also a 100% reduction in NRS score in 14 of 30 patients treated with 0.15 mg/kg ketamine and 0.5 mg/kg hydromorphone. According to the results of the present study, the use of LDK as an analgesic with low side effects can be suggested. However, further research is needed to determine the appropriate concentration with fewer side effects.

Factors associated with treatment success after combined transforaminal epidural steroid injection and dorsal root ganglion pulsed radiofrequency treatment in patients with chronic lumbar radicular pain.

The aim of the study is to identify predictors of treatment success with combined transforaminal epidural steroid injection (TFESI) and dorsal root ganglion pulsed radiofrequency (DRG-PRF) in patients with lumbar radicular pain (LRP) associated with lumbar disc herniation. The study included 48 patients with herniation-related LRP who underwent TFESI and DRG-PRF treatment between November 1, 2020 and April 30, 2021. Patient age, sex, symptom duration, history of lumbar surgery, and numeric rating scale (NRS) pain scores before and at 10 days, 1 month, and 3 months after treatment were evaluated retrospectively. Treatment success was defined as ≥50% improvement or a 4-point decrease in NRS score at 3 months. Twenty-nine female and 19 male patients with a mean age of 51.54 ± 13.31 years were analyzed. The median symptom duration was 6 (interquartile range: 8.50) months. Symptom duration did not affect treatment success (p = 0.105). History of spinal surgery was more common among patients with failed treatment but was not statistically associated with treatment success. A 1-unit increase in pre-treatment NRS score was associated with 72% lower odds of treatment success (p = 0.022), while a 1-unit increase in NRS score on post-treatment day 10 compared to the pre-treatment value was associated with 95% lower odds of treatment success (p = 0.008). Symptom duration and history of spinal surgery were not predictive of treatment success with combined TFESI and DRGPRF for herniation-related LRP. However, the 3-month prognosis was significantly better for patients with a marked reduction in NRS score at 10 days.

Spinal cord stimulation in severe cases of complex regional pain syndrome: A retrospective cohort study with long-term follow-up.

Complex regional pain syndrome (CRPS) is a debilitating pain condition often resistant to standard treatment modalities. In these cases, spinal cord stimulation (SCS) can be an option, but the effect on CRPS remains disputed. We aimed to assess the long-term effect of SCS on CRPS. We retrospectively analysed 51 CRPS patients implanted with an SCS system at the University Hospitals in Aarhus or Odense, Denmark, with a median follow-up time of 4.4years. Primary outcomes were pain intensity on a numeric rating scale (NRS) and the Patients' Global Impression of Change (PGIC). Secondary outcomes were patient satisfaction, work status, consumption of pain medication, the Major Depression Inventory (MDI), Pain Catastrophizing Scale (PCS) and quality of life (QoL) measured using the Short-Form Health Survey (SF-36). For each outcome measure, baseline data were compared to the latest collected data point. A significant pain relief was found with a mean reduction in NRS score of 2.4 (95% CI: 1.7-3.0, p<0.0001). 68.8% reported 'much improved' or 'very much improved' on the PGIC scale. 87.5% would choose SCS again for the same outcome. A significant beneficial impact was found on MDI score, PCS, SF-36 summary scores and consumption of tricyclic antidepressants, antiepileptic drugs and opioids. No statistical effect was found on work status. Pain intensity, depression, pain catastrophizing, pain medication use and QoL were significantly improved after SCS implantation, with high patient satisfaction rates in CRPS patients. This study supports the continued use of SCS in the treatment of severe CRPS. This study presents detailed data from a large, well-characterized cohort of Danish CRPS patients treated with SCS, analyzing several outcome measures. The results serve to document SCS as an effective treatment for severe CRPS and expands the cumulative level of evidence in favor of its use. Additionally, analysis of preoperative patient characteristics suggests that SCS treatment should not be withheld in patients with a high degree of psychological distress or high consumption of analgesics.

Genicular Nerve Pulsed Dose Radiofrequency (PDRF) Compared to Intra-Articular and Genicular Nerve PDRF in Knee Osteoarthritis Pain: A Propensity Score-Matched Analysis.

BackgroundChronic knee osteoarthritic (OA) pain is a common and debilitating complaint in elderly patients. Despite numerous pharmaceutical options, the majority of patients still experience long-term pain. Genicular nerve (GN) radiofrequency has become increasingly popular as a treatment for knee pain. This retrospective study aimed to evaluate the effects of pulse dose radiofrequency (PDRF) in patients with chronic knee OA pain.Patients and MethodsPropensity score matching analysis was performed in a retrospective cohort of 78 patients with moderate-severe knee OA pain unresponsive to conservative treatment who underwent PDRF GN or intra-articular (IA) and PDRF GN. Pain relief was measured using the numeric rating scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient Global Impression of Change (PGIC) at 3 and 6 months post-intervention.ResultsA significant reduction in NRS scores was reported at 3 (p<0.001) and 6 months (p<0.001) after PDRF in both groups. NRS was lower in PDRF IA + GN than PDRF GN (p<0.0001). WOMAC pain was significantly reduced at 3 months in PDRF IA + GN group (baseline: 10.12±3.14, 3 months: 6.25±2.44, p=0.0001). WOMAC stiffness and function were improved only at 3 months in PDRF IA + GN compared to baseline (p=0.007 and p=0.006, respectively). A longer period of pain relief was reported after PDRF IA + GN (6.75±2.42 months) compared to PDRF GN (4.31±2.85 months, p<0.001) in association with higher PGIC scores.ConclusionThis is the first study that compared two different PDRF techniques. PDRF GN and PDRF IA + GN were both effective in reducing pain at 3 and 6 months follow-up. However, only PDRF IA + GN was able to improve WOMAC scores at 3 months after the treatment with a longer period of efficacy compared to PDRF GN alone.

Facial expression differences indicate pain improvement at the emergency department

Purpose: Pain is a major symptom for patients to seek medical services, but limited evidence supports the applicability and usage of facial expressions as a pain measurement strategy in the emergency department (ED). In this study, we explored possible differences in facial expressions before and after pain management and compared these differences with those in a self-reported pain scale. Methods: In this observational study, convenience sampling of patients admitted to the ED was conducted. Two video sessions of facial expressions were recorded for each participant, and participants rated their painon a self-reported numeric rating scale (NRS). A total of 25 facial parameters were extracted per frame. The main outcome measurements were the differences in facial parameters, and their correlation with changes in NRS scores was examined. Results: This study included 163 participants. A stronger reduction in NRS scores was associated with differences in systolic blood pressure (sBPr = 0.247, P = 0.011) and the following changes in facial features: eye opening (left: r = -0.210, P = 0.007; right: r = -0.206, P = 0.008), eye aspect ratio (left: r = -0.382, P &lt; 0.001; right: r = -0.305, P &lt; 0.001), and head rotation angle (r = 0.218, P = 0.005). Pain improvement (a difference of ≥ 4 in NRS scores) was associated with differences in BP (sBP, odds ratio [OR] = 0.973, 95%confidence interval [CI]: 0.949-0.998, P = 0.034; dBP, OR = 1.078, 95% CI: 1.026-1.113, P = 0.003), eye aspect ratio (Left: β = 5.613, 95% CI: 2.234-14.104, P &lt; 0.001; Right: β = 2.743, 95% CI: 1.395-5.391, P = 0.003), and nasolabial fold variation (β = 0.548, 95% CI: 0.306-0.982, P = 0.043), after adjustment for variables Conclusions: Intraindividual changes in facial expressions can be used to track clinically relevant differences in pain. Facial expressions alone cannot be used as a pain measurement strategy in the ED.

The Effect of Botulinum Toxin Injection into the Common Extensor Tendon in Patients with Chronic Lateral Epicondylitis: A Randomized Trial.

Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU injection.

Outcome of intra-articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis.

Lumbar facet joint osteoarthritis (FJOA) caused by degenerative change(s) is considered to be the main cause of facet joint-origin low back pain (LBP). Intra-articular lumbar facet joint (IA LFJ) corticosteroid injection is widely used for controlling pain induced by FJOA. In the current study, the outcomes of IA LFJ corticosteroid injection were evaluated according to the severity of FJOA. A total of 50 patients who received IA LFJ corticosteroid injections for the treatment of LFJ pain were recruited. Patients were classified into three groups according to the severity of FJOA, which was indicated during a lumbar axial MRI. A total of 10 patients were assigned to group A (patients with mild FJOA), 27 to group B (patients with moderate FJOA) and 13 to group C (patients with severe FJOA). Pain intensity was evaluated using a numerical rating scale (NRS) prior to treatment and at 1, 2 and 3 months after treatment. A total of 26 (52%) patients experienced successful treatment outcomes (defined as >50% reduction in NRS score at 3 months). Patients in all groups demonstrated a significant decrease in NRS scores at 1, 2 and 3 months after IA LFJ corticosteroid injection compared with the pre-treatment score (P<0.001). However, the effect of IA LFJ corticosteroid injection was not significantly different among the three groups (P=0.889). The results demonstrated that facet joint-origin LBP was significantly reduced after IA LFJ corticosteroid injection, regardless of the severity of FJOA. The results of the current study indicated that IA LFJ corticosteroid injection is a beneficial clinical option for managing LBP caused by FJOA.

Botulinum Toxin Type A for Pain in Advanced Parkinson's Disease.

Background and Objective Pain is a frequent symptom in Parkinson's disease (PD), and the therapeutic alternatives are scarce. The goal of this trial was to measure the effects of botulinum toxin type A (BTXA) in the treatment of limb pain in advanced PD. Methods A randomized double-blind crossover versus placebo study of BTXA for limb pain in advanced Parkinson's disease was conducted. Subjects received individualized BTXA/placebo dosing per pain distribution in limbs. The primary outcome was a measure of change in global pain on a numeric rating scale (NRS) at 4 and 12 weeks postinjection and on a visual analogue scale 12 weeks after treatment. Secondary outcomes included the percentage of responders, physician-rated clinical global impressions, MDS-UPDRS and PDQ-39 scores, and adverse events. Results A total of 12 subjects completed the trial. Treatment with BTXA (average dose=241.66 U) produced a significant reduction in NRS score 4 weeks after the injections (-1.75 points, range from -3 to 7, p=0.033). However, there was no significant difference compared to placebo (p=0.70). Participants with dystonic pain showed a greater reduction in NRS score after 4 weeks when treated with BTXA (2.66 points vs. 0.75 for placebo). There were no significant differences for any of the secondary outcomes or significant adverse events. Conclusions Targeted BTXA injections were safe in patients with limb pain and advanced PD; however, the present study failed to show a significant effect when compared to placebo. Further studies may be focused on evaluating the effect of BTXA particularly in dystonic pain.