Reduction In Pain Severity Research Articles

Soluble CCR2 gene therapy controls joint inflammation, cartilage damage, and the progression of osteoarthritis by targeting MCP-1 in a monosodium iodoacetate (MIA)-induced OA rat model

BackgroundOsteoarthritis (OA) is the most common type of degenerative arthritis and affects the entire joint, causing pain, joint inflammation, and cartilage damage. Various risk factors are implicated in causing OA, and in recent years, a lot of research and interest have been directed toward chronic low-grade inflammation in OA. Monocyte chemoattractant protein-1 (MCP-1; also called CCL2) acts through C–C chemokine receptor type 2 (CCR2) in monocytes and is a chemotactic factor of monocytes that plays an important role in the initiation of inflammation. The targeting of CCL2–CCR2 is being studied as part of various topics including the treatment of OA.MethodsIn this study, we evaluated the potential therapeutic effects the sCCR2 E3 gene may exert on OA. The effects of sCCR2 E3 were investigated in animal experiments consisting of intra-articular injection of sCCR2 E3 in a monosodium iodoacetate (MIA)-induced OA rat model. The effects after intra-articular injection of sCCR2 E3 (fusion protein encoding 20 amino acids of the E3 domain of the CCL2 receptor) in a monosodium iodoacetate-induced OA rat model were compared to those in rats treated with empty vector (mock treatment) and full-length sCCR2.ResultsPain improved with expression of the sCCR2 gene. Improved bone resorption upon sCCR2 E3 gene activation was confirmed via bone analyses using micro-computed tomography. Histologic analyses showed that the sCCR2 E3 gene exerted protective effects against cartilage damage and anti-inflammatory effects on joints and the intestine.ConclusionsThese results show that sCCR2 E3 therapy is effective in reducing pain severity, inhibiting cartilage destruction, and suppressing intestinal damage and inflammation. Thus, sCCR2 E3 may be a potential therapy for OA.

Analgesic Medication in Fibromyalgia Patients: A Cross-Sectional Study.

There is no approved drug for fibromyalgia syndrome (FMS) in Europe. In the German S3 guideline, amitriptyline, duloxetine, and pregabalin are recommended for temporary use. The aim of this study was to cross-sectionally investigate the current practice of medication in FMS patients in Germany. We systematically interviewed 156 patients with FMS, while they were participating in a larger study. The patients had been stratified into subgroups with and without a decrease in intraepidermal nerve fiber density. The drugs most commonly used to treat FMS pain were nonsteroidal anti-inflammatory drugs (NSAIDs) (41.0% of all patients), metamizole (22.4%), and amitriptyline (12.8%). The most frequent analgesic treatment regimen was “on demand” (53.9%), during pain attacks, while 35.1% of the drugs were administered daily and the remaining in other regimens. Median pain relief as self-rated by the patients on a numerical rating scale (0–10) was 2 points for NSAIDS, 2 for metamizole, and 1 for amitriptyline. Drugs that were discontinued due to lack of efficacy rather than side effects were acetaminophen, flupirtine, and selective serotonin reuptake inhibitors. Reduction in pain severity was best achieved by NSAIDs and metamizole. Our hypothesis that a decrease in intraepidermal nerve fiber density might represent a neuropathic subtype of FMS, which would be associated with better effectiveness of drugs targeting neuropathic pain, could not be confirmed in this cohort. Many FMS patients take “on-demand” medication that is not in line with current guidelines. More randomized clinical trials are needed to assess drug effects in FMS subgroups.

The effect of herbal medicine in reducing the severity of oral lichen planus: A systematic review and meta-analysis

Background: Oral lichen planus (OLP) is a chronic autoimmune mucocutaneous disease of unknown aetiology. The reported use of herbal medicines may promote the healing of OLP lesions. Purpose: We aim to determine the effectiveness of herbal medicine to reduce the clinical and pain severity of OLP. Methods: PubMed, Cochrane Library and Wiley Online Library were reviewed according to the inclusion criteria. Risk of bias was performed for the randomised control trial (RCT) and cohort studies to assess the effectiveness of herbal medicines for OLP treatment. Outcomes were recorded based on pain severity and the quality of life of patients with OLP. The mean difference and effect size of studies were pooled. Reviews: Out of 1,034 papers, six publications were selected and reviewed. The most common types of OLP lesions were erosive and atrophic and were mainly found at the buccal site. OLP was common in the range of 27–74 years, especially in females. The herbal medicines used in the publication were curcumin, lycopene, purslane, aloe vera and quercetin. Improvement in quality of life or OLP severity was recorded in the intervention group treated with purslane, curcumin and lycopene (P<0.05) but not in the control group. The total effect of herbal medicine in reducing pain severity (measured with the Visual Analogue Scale [VAS]) in OLP patients was not significant (mean difference 0.13; 95% CI -0.202 to 0.463; p=0.442). Conclusions: Herbal medicine cannot be used as a single regime to reduce pain severity. Further research is recommended to evaluate cohort design studies to observe the prolonged effect of herbal medicine in OLP lesions. PROSPERO registration number: CRD42021262282 (2021)

Practice Patterns and Perspectives on Stereotactic Body Radiation Therapy for the Metastatic Spine From Lower- and Middle-Income Countries.

We wanted to understand the current practice patterns and stereotactic body radiation therapy (SBRT) utilization for spine metastases in lower- and middle-income countries (LMICs). A questionnaire was designed to identify the current practice patterns of treating spine metastases, uptake of spine SBRT in routine care, dose fractionations commonly used, and the perceived benefits and toxicities of using ablative doses. Individuals registering for a spine SBRT workshop were requested to answer the questionnaire. We received 395 responses from radiation oncologists (ROs) working in 12 different LMICs. The majority of respondents were from an academic institute (57.5%). Two hundred seventy-four respondents further identified themselves from the government/public sector (44.89%), corporate/private sector (47.89%), not-for-profit organization (5.4%), or public-private partnership (5.4%). The respondents indicated that 8.43%, 27.46%, 41.73%, and 10.04% of the spine metastases patients are treated using clinical marking, X-ray-based, 3D conformal radiation therapy, and SBRT, respectively. A third of the respondents did not have any experience of spine SBRT; those with high-volume practice were predominantly from an academic institute. The majority of respondents would use spine SBRT to reduce pain severity (71.9%) and achieve durable pain control (61.01%) in the setting of oligometastases (92.73%) and reirradiation (56.69%). Respondents preferred 3- to 5-fraction regimens (64.9%) over 1-2 fractions (33.68%). The top three reasons for not using spine SBRT were resource constraints (50%), lack of machine (37.11%), and lack of training (27.34%). There is heterogeneity in spine SBRT practice and utilization between academic and nonacademic institutes. Resource and infrastructure constraints along with lack of training are limiting the use of SBRT among ROs from LMICs. Collaborative studies from LMICs will help in resolving unique challenges posed by resource constraints.

Interpretable Machine Learning May Help Personalize Topical Analgesics for Pain Patients

Purpose: Topical analgesics have gained acceptance in guidelines for the treatment of pain. The Kailo Pain Patch® is a topically applied analgesic adhesive patch, with a recent study showing reduced pain severity and interference scales in comparison to a control group. However, as with any analgesic modality, treatment response is variable. Advances in technology, such as pharmacogenomic evaluation and machine learning (artificial intelligence) have emerged as tools to assist clinicians with selecting the most suitable treatments for a variety of disease states. There is limited data on the use of these technologies for pain management; only limited studies have applied machine learning to personalize the treatment of chronic pain patients. This report analyzed the PREVENT Study using an existing modified interpretable machine learning method to personalize the selection of the most suitable protocol for use of the Kailo Pain Patch® and other topical analgesics. Patients and methods: Data from the IRB-approved observational PREVENT study were used in the present analysis of 128 (89 females,39 males) chronic pain patients and 20 controls answering the Brief Pain (BPI) questionnaire along with additional questions in the baseline and after 30 days of treatment with the Kailo Pain Patch®. An interpretable machine-learning model was used to build pain outcome prediction models. This method is a multi-objective ensemble classification/regression technique, which combines multi-objective evolutionary algorithms with Support Vector Machines, Random Forests, and feature filtering techniques to optimize the classification model and minimize the utilized feature subset. Three basic endpoints were examined as outputs to the prediction models including Total BPI Severity, Total BPI Interference, and Total medication changes in the follow- up period. Both classification and regression models were constructed for these endpoints and a “leave-one-out” cross-validation strategy was used to evaluate the generalization ability, classification, and regression performance of the deployed models. Results: Experimental results showed that the trained models with the proposed machine learning method were able to predict endpoints with extremely high accuracy, with the AUC exceeding 90% and Spearman correlation metric exceeding 0.4 for all endpoints, overcoming the classification and regression performances of other benchmark models, including the recently introduced XGBoost. The interpretable machine learning method was able to reduce the number of significant features to 15 and was able to identify some of the most important characteristics of responders and non-responders allowing for a personalized approach to creating an individualized pain treatment approach. Applying the trained model in a previous IRB-approved Observational Study (OPERA) dataset (631 chronic pain patients) demonstrated that most of the participants (>70%) who did not benefit from other topical analgesics therapies, as well as more than 50% of responders to OPERA study medications, would have noted improvement from the pain patch studied in PREVENT. Conclusions: Artificial intelligence and machine learning technologies are advancing multiple areas in fields of medicine, including pain management. A model has been developed which continues to be refined; here we show use of that model for predicting response to topical analgesic therapies. We will continue to refine these tools and make them available to front-line clinicians through a user-friendly web interface (https://kailo.insybio.com/) that can be used to support analgesic clinical decision making [15 questions].

SP8.2.4 Mindfulness-based Cognitive Therapy (MBCT) reduces symptoms in patients with chronic visceral pain, and is associated with the alteration of pain-evoked neural activity and resting functional connectivity in the descending pain modulatory system

Abstract Aims Chronic visceral pain can cause repeated presentations to surgical services. Cognitive therapies show promise but are not often considered in the surgical setting. This study aims to assess the efficacy and mechanisms of MBCT-IBS, a mindfulness-based cognitive intervention for irritable bowel syndrome (IBS). Methods Fifteen women with IBS underwent a 6-week MBCT-IBS training course. Before and after this they completed validated questionnaires on symptoms, and functional MRI brain scans during thermal pain and at rest. Results MBCT-IBS led to improved symptoms (p<0.05). Increased temperatures were required to achieve 5/10 pain ratings (mean 1.21°C, p<0.001), indicating reduced pain sensitivity. Neuroimaging showed that MBCT-IBS led to altered pain responses in the anterior cingulate, the prefrontal cortex, the amygdala and the precuneus (Z>2.3, p<0.05). In the left dorsolateral prefrontal cortex (dlPFC) this correlated with reduced pain severity scores (rs(11)=-0.614, p=0.025). Altered functional connectivity was seen between the right dlPFC and multiple regions involved in emotional and sensory aspects of pain processing, including the amygdala. There was also altered connectivity between the amygdala and sensorimotor cortices (Z>2.3, p<0.05). Conclusions MBCT-IBS was an effective treatment for IBS. The fact that there was altered activity in and connectivity between key parts of the descending endogenous pain modulatory system suggests that MBCT-IBS may be an effective intervention for patients with dysfunctional pain pathways in whom the pathological cause for their pain is unclear. It is non-invasive and inexpensive, and has the potential to reduce the incidence of unnecessary surgical intervention in patients with chronic visceral pain.

Neuromodulation Therapy for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review.

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and painful condition in patients who have received chemotherapy. The role of neuromodulation therapy in treating pain and improving neurological function in CIPN remains unclear and warrants evidence appraisal. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review to assess change in pain intensity and neurological function after implementation of any neuromodulation intervention for CIPN. Neuromodulation interventions consisted of dorsal column spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), or peripheral nerve stimulation (PNS). In total, 15 studies utilized SCS (16 participants), 7 studies utilized DRG-S (7 participants), and 1 study utilized PNS (50 participants). Per the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria, there was very low-quality GRADE evidence supporting that dorsal column SCS, DRG-S, and PNS are associated with a reduction in pain severity from CIPN. Results on changes in neurological function remained equivocal due to mixed study findings on thermal sensory thresholds and touch sensation or discrimination. Future prospective, well-powered, and comparative studies assessing neuromodulation for CIPN are warranted.

Treating Persistent Pain: A Nurse Co-Led, Interdisciplinary Model for Primary Care

The public health crisis of chronic pain has only increased in recognition since the Institute of Medicine's (IOM) Relieving Pain in America (2011) called for a cultural transformation in the way pain is viewed, treated, and put forward specific recommendations for action. The National Pain Strategy (NPS) provides a roadmap for putting these recommendations into practice. We implemented a program that placed nurses and behavioral specialists at the head of an interdisciplinary team utilizing best practices. In this program, nurses enacted the NPS recommendations to advance care for patients with persistent pain on long-term opioid treatment. This program promoted professional growth in nurses along with fostering success for patients. Compared with patients receiving usual care, patients in the program achieved greater reductions in pain severity, pain-related disability, and pain-related functional interference and reported greater satisfaction with pain-related care and primary care services. This article will detail the NPS-aligned practice approaches these nurses and their teams used, describe the training for the nurses, and speak to opportunities to enhance the nurse's capacity for this role in hopes of providing a model for the future implementation of an NPS-based approach by nurses.

Mini-open Rotator Cuff Repair Can Still Be a Good Surgical Technique to Repair a Rotator Cuff

Background: The clinical outcomes of rotator cuff repair (RCR) surgeries vary because each method has its own advantages and limitations. Objectives: This study aimed to compare the short-term outcomes of arthroscopic RCR (ARCR) and mini-open RCR (MRCR). Methods: In this study, we included 49 patients with a diagnosis of full rotator cuff tear who had undergone ARCR and MRCR at Poursina Hospital of Rasht and Akhtar Hospital of Tehran from 20 March 2017 to 20 March 2020. The patients were divided into ARCR (n = 24) and MRCR (n = 25) groups. The two surgical procedures were compared with each other before surgery and three and six months after surgery in terms of shoulder function based on UCLA, disability based on QUICKDASH, range of motion (ROM), and pain based on Visual Analogue Scale (VAS). Data were analyzed by chi-square, independent t-test, and repeated measures analysis of variance (ANOVA). Results: There were no differences between the groups in terms of demographic details. The mean duration of surgery was significantly higher in the ARCR group compared to MRCR group (125.5 vs. 70.42 minutes). The short-term outcomes in the two groups on three measurement occasions showed a significant improvement in shoulder function, disability, and ROM in both groups along with a reduction in pain severity (P < 0.05); however, there was no significant difference between the two groups on any of the three occasions (P > 0.05). Conclusions: Shoulder function, disability, ROM, and pain were not different between the two groups, but duration of surgery was less in MRCR group. Therefore, under the same conditions, MRCR is a better choice than ARCR due to its short duration of surgery.

A feasibility study on yoga’s mechanism of action for chronic low back pain: psychological and neurophysiological changes, including global gene expression and DNA methylation, following a yoga intervention for chronic low back pain

IntroductionYoga has been shown to reduce pain and improve function in populations with chronic low back pain (cLBP), yet the underlying molecular mechanisms remain elusive. This study examined the feasibility and acceptability of a yoga research protocol, including recruitment, retention, and data collection, and investigated the preliminary effects of yoga on psychological and neurophysiological functions, including gene expression and DNA methylation profiles, in participants with cLBP.MethodsA one-arm trial was conducted with 11 participants with cLBP who enrolled in a 12-week yoga intervention. Data on subjective pain characteristics, quantitative sensory testing, and blood for analysis of differentially expressed genes and CpG methylation was collected prior to the start of the intervention and at study completion.ResultsBased on pre-determined feasibility and acceptability criteria, the yoga intervention was found to be feasible and highly acceptable to participants. There was a reduction in pain severity, interference, and mechanical pain sensitivity post-yoga and an increase in emotion regulation and self-efficacy. No adverse reactions were reported. Differential expression analysis demonstrated that the yoga intervention induced increased expression of antisense genes, some of which serve as antisense to known pain genes. In addition, there were 33 differentially hypomethylated positions after yoga (log2 fold change ≥ 1), with enrichment of genes involved in NIK/NF-kB signaling, a major pathway that modulates immune function and inflammation.Discussion/conclusionsThe study supports the feasibility and acceptability of the proposed protocol to test a specific mechanism of action for yoga in individuals with cLBP. These results also support the notion that yoga may operate through our identified psychological and neurophysiologic pathways to influence reduced pain severity and interference.

Innovation in the Treatment of Persistent Pain in Adults With NF1: Implementation of the iCanCope Mobile App

Background Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic condition affecting 1 in 2500 individuals. Over 50% of individuals with NF1 report significant pain and discomfort, which may be associated with benign and malignant tumors, but is often not localized to a structural lesion, thus presenting treatment challenges for patients and their medical caregivers. To date, there are very few treatments aside from surgical intervention to mitigate pain. Objective We developed the iCanCope-NF mobile app for pain self-management. iCanCope-NF is a customized self-monitoring and pain management mobile app designed to provide resources and support for those having chronic pain due to NF1. The app enables users to access daily pain monitoring and quality of life check-ins, allows them to plot interrelated variables on various timelines to observe trends in pain and interference across different areas of life (such as sleep, physical activity, and mood), and provides them with the option to set physiological and psychological goals as well as a robust library of written and video resources to help manage pain symptoms and to better cope with NF1. Methods This paper evaluated the iCanCope-NF to reduce pain severity and interference in adults with NF1. A total of 80 participants across 3 different groups (control, iCanCope-NF access condition, and iCanCope-NF contingency management condition where subjects were provided monetary incentives for engaging with the various features within the app [CM]) completed a randomized clinical trial in which evaluations were completed at intake (initial day of participation), discharge (2 months after intake), and 6 weeks after discharge. Results Preliminary data analysis demonstrated individuals randomized to the iCanCope-NF + CM had greater engagement with the mobile app than individuals who were randomized to iCanCope-NF. Additionally, individuals in the iCanCope-NF + CM consistently checked in more (SD 59.5/60 days) than individuals in the iCanCope-NF group (SD 51/60 days). Pain interference, as measured by the Pain Interference Index (PII), was significantly different across all 3 groups at discharge: control (M=6.3), iCanCope (M=5.7), iCanCope + CM (M=5.1), P<.05. Conclusions Qualitative interviews completed at discharge for individuals with access to the app indicated that the app was a “wonderful measuring tool” and “provided credibility of my pain symptoms,” and that it was a dramatic and distinctive aide in the monitoring and tracking of their pain symptoms. We demonstrated preliminary acceptability and efficacy for iCanCope-NF as the first pain self-management tool for individuals with NF1. iCanCope-NF + CM was successful in increasing engagement and decreasing pain interference. Trial Registration ClinicalTrials.gov NCT04561765; https://clinicaltrials.gov/ct2/show/NCT04561765 Conflicts of Interest None declared.

Effectiveness of Mindfulness-based Stress Reduction (MBSR) on Patients With Chronic Pain: A Randomized Clinical Trial

Objectives: This research aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on pain intensity, anxiety, depression, and quality of life (QoL) of patients with chronic pain via randomized clinical trials. Methods: The study population consisted of all patients with chronic pain referred to Imam Reza Hospital. Of these patients, 50 cases who met the inclusion criteria and were willing to participate in the study were selected through convenience sampling and randomly assigned to the experimental (n=25) or control groups (n=25). After selecting the patients and randomly assigning them to the two groups, the research questionnaires were completed by the patients before and after the treatment. After obtaining a written consent letter from the research participants, the experimental group received MBSR therapy (8 weekly sessions) while the control group did not receive any intervention. The questionnaires included the numeric pain rating scale (NPRS), the World Health Organization quality of life (WHOQOL) (WHOQOL-BREF), the Beck anxiety inventory (BAI), and the Beck depression inventory-2nd edition (BDI-II). To comply with the ethical principles, after the end of the study, MBSR therapy was administered to the control group as well. The data were analyzed via analysis of variance and multivariate analysis of covariance in the SPSS software, v. 19. Results: The results of the analysis showed that MBSR therapy reduces pain severity, anxiety, and depression in patients with chronic pain (P<0.05). The findings also showed that MBSR therapy improves the QoL of patients with chronic pain (P<0.05). Conclusion: Along with the common medications for chronic pain, MBSR therapy can be used to improve the QoL and reduce the severity of pain, anxiety, and depression in patients with chronic pain.

Use Of Cinnamon, Vitamin D And Starch Capsules to Attenuate Different Types of Dysmenorrhea

Dysmenorrhea disorder is a significant concern of this era in young girls at the stage of the menarche or near menstrual period. Primary dysmenorrhea is prevailing all around the world. Objectives: To evaluate reducing effects of Cinnamon, vitamin D and starch capsules in patients suffering from dysmenorrhea. Methods: The 30 candidates for each group were selected following the minimum sample size rule. The questionnaire and numeric pain rating scale were the main tools for assessing dysmenorrhea severity, reduction in dysmenorrhea, quality of life and other variables in patients. Results: The demographic data showed that the maximum participants belonged to middle-class families, well-educated and living in their own homes. The results depicted that Cinnamon reduced pain severity, bleeding and physical pain and improved physical activity, leisure activities, life satisfaction, health services, meaningful life and body appearance among most participants. Likewise, vitamin D also exhibited a significant reduction in dysmenorrhea symptoms and increased the quality of life among most patients. However, the effects of starch capsules were observed to be less effective than the cinnamon tea and vitamin D. Conclusions: The study concluded that cinnamon tea and vitamin D were the best therapy for reducing dysmenorrhea symptoms.

Efficacy of Low-Level Laser Therapy in Reducing Pain in the Initial Stages of Orthodontic Treatment.

Purpose There is no consensus about the mechanism and efficacy in alleviating pain of the lower-level laser therapy (LLLT) during orthodontic treatment. This study aimed to evaluate the LLLT effectiveness clinically in reducing pain caused by orthodontic movement that occurs in the early stages of treatment. Methods The sample consisted of 54 patients in need of orthodontic treatment divided into two groups. A 28 experimental patients group (initial mean age: 26.84 years old) was undergone gallium-aluminum-arsenide infrared laser application on 12 points for each tooth immediately after the installation of the first alignment archwire, and a 26 patients control group (initial mean age: 29.13 years old) was undergone to no pain control intervention at all. Pain intensity was measured by using a visual analog scale, which was marked pain level (mm) reported in 06, 24, 48, and 72 hours. The perception of pain (beginning, peak, decline, and absence) was evaluated by filling up a questionnaire. To compare the intensity and perception of pain between groups, a nonparametric Mann–Whitney has been performed. Results The experimental group showed levels (mm) at 6 (p < 0.001), 24 (p=0.004), and 48 hours (p=0.007) and perception of pain (hours) in the peak (p=0.026), decline (p=0.025), and absence (p=0.008) significantly lower compared to the group control. Conclusion Low-level laser therapy is effective in reducing pain severity caused by orthodontic forces activation, and it promotes the analgesic action lasting effect during the most painful feeling time.

Diamagnetic Therapy in a Patient with Complex Regional Pain Syndrome Type I and Multiple Drug Intolerance: A Case Report

Complex regional pain syndrome (CRPS) is a neurologic chronic pain condition hard to diagnose and treat, and able to significantly impact the quality of life. Currently, the available multimodal, individualized treatments (i.e., pharmacological and non-pharmacological therapies including invasive procedures) are aimed only at symptom control. Herein, we report a 69-year-old Caucasian female who came to our attention due to a 3-year history of severe (10/10) burning pain in her right ankle, along with oedema and local changes in skin color and temperature, which occurred after the ankle sprain. Previous pharmacological attempts failed due to multiple drug intolerance. Clinical examination confirmed the CRPS type I diagnosis, and a weekly diamagnetic therapy protocol was started since the patient refused further medications and interventional procedures. After 10 weeks of treatment, a significant (p &lt; 0.01) reduction in pain severity and absence of oedema (difference in ankles’ circumference: from 3 cm to 0) were observed, with consequent improvements in quality of life and no adverse events. Although high-quality clinical evidence is still lacking, our case report suggests further investigating the potential use of diamagnetic therapy as a non-invasive and safe adjunctive treatment for CRPS, and as an alternative when patients did not benefit from drugs and/or refuse invasive procedures.

Comparing Auditory and Visual Distractions for Reducing Pain Severity and Pain Anxiety in Older Outpatients with Burn: A Randomized Controlled Trial.

Pain and anxiety are major issues among older patients with burn injuries. Complementary medicine and non-pharmacological methods can relieve pain and anxiety in older people, but comparison of the effects of these methods needs further research. This study aimed to compare the effects of auditory and visual distractions on pain severity and pain anxiety in older outpatients referred to a burn clinic for dressing change. In this randomized controlled clinical trial, older men were randomly assigned to three groups as auditory distraction, visual distraction, and control (n = 45 in each group). The Visual Analogue Scale (VAS) and the Burn Specific Pain Anxiety Scale (BSPAS) were used to asses pain severity and pain anxiety before and immediately after the interventions, and after wound dressing. Reduction in pain severity and pain anxiety after visual distraction was reported. Auditory distraction only reduced pain anxiety. Therefore, visual distraction had a better effect on alleviating pain anxiety compared with auditory distraction. Visual distraction is suggested to be used during dressing changes for older outpatients with burn injuries in outpatient clinics in order to reduce their burn-related suffering and improve their collaboration with the therapeutic regimen.

Using A Novel, Non-Drug, Topical Pain-Relief Patch to Improve Pain and Function: Final Analysis of the PREVENT Study

Background and Aims: The Global Burden of Disease Study 2016 confirmed that the high prevalence of pain and pain-related diseases is the leading cause of disability and disease burden globally. Pain is the most common reason patients consult primary care providers in the United States. According to recent literature, over 40% of adult Americans, an estimated 100 million people, live with chronic or recurrent pain. Of these, approximately 11 million adults in the US have high-impact chronic pain, or pain that lasts 3 months or longer and is accompanied by at least one major activity restriction. Ongoing research is needed to identify alternative strategies to existing treatment approaches as a means to reduce pain severity, pain interference with function, and to improve patients’ overall quality of life. Optimal treatment strategies employ multimodal approaches that provide optimal benefit and minimal harm. Chronic pain is often categorized as either nociceptive (caused by damage to tissue or inflammatory stimuli) or neuropathic (damage to somatosensory nervous system). Mainstay therapies for pain include anti-inflammatory agents, opioids, and other oral and topical analgesics. Despite this approach, a large percentage of pain patients do not achieve adequate pain relief, and these traditional medication approaches are often associated with undesirable and potentially dangerous adverse effects. Alternative evidence-based multimodal approaches of pain management are therefore needed. Potential therapies include use of combination pharmacotherapies, which target both central and peripheral nociceptive mechanisms, and nonpharmacological interventions. Incorporation of micro and nanotechnologies into the development of novel treatment formulations has shown to have positive effects on patients. Topical analgesics, including pain relief patches, are a potentially valuable strategy in the management of a variety of conditions associated with musculoskeletal and various neuropathic pain disorders. The purpose of this minimal risk, observational study was to evaluate patients with mild or moderate pain and evaluate perceptions of pain treatment and associated symptoms with the use of a novel, non-drug and micro/nanotechnology-based topical pain-relieving patch via validated scales over the course of 30 days. Methods: This analysis of the PREVENT IRB-approved study evaluated the efficacy of a topical pain-relieving patch (Kailo Pain Relieving Patch (Pain Relief Technologies, USA) in reducing Brief Pain Inventory (BPI) scores in patients experiencing mild, moderate, or severe pain. The Treatment Group (TG) of 128 adult patients (89 females,39 males) with arthritic, neuropathic, or musculoskeletal pain received patches for 30 days. A Control Group (CG) of 20 adult patients (15 females, 5 males) did not initially receive the patch, and then crossed over to the Crossover Treatment Group (CROSSG), Surveys were administered to all patients at baseline, 14 days, and 30 days to assess changes in pain severity and interference by BPI Short Form. Changes in oral pain medication use, side effects and satisfaction with patch use were also assessed. Results: Over 30 days, treatment group mean BPI Severity score decreased 61% (4.9 to 1.9/10?P&lt; .001) and mean BPI Interference score decreased 61% (3.8 to 1.5/10?P&lt; .001) The control group showed an increase in both BPI Severity of 23% (3.0 to 3.7/10) and BPI Interference Score of 58% (1.2 to 1.9/10). After crossing over to treatment, patients in the crossover group reported a decrease in BPI Severity score of 76% (3.7 to .9/10) and a decrease in BPI Interference score of 79% (1.9 to .4/10). No side effects of treatment were reported. After 30 days, 91% of patients reported “less” or “a lot less” usage of oral medications. 86% of patients were very/extremely satisfied with the patch and preferred the pain-relieving patch to oral medications. Results also showed improvements in Quality of Life (QoL), mood, and relations with other people, sleep, walking ability, and enjoyment of life. Conclusions: Study results indicate that this novel, micro/nanotechnology-based topical pain-relieving patch can reduce BPI pain severity and interference scores and related pain for adult patients with arthritic, neuropathic, and musculoskeletal pain. Options such as this should be considered by healthcare clinicians and patients as part of a multimodal treatment approach. Patient outcomes further encourage more research to be conducted to confirm these results.

Treatment Preferences of Physical Therapists in Management of Carpal Tunnel Syndrome: A Cross Sectional Survey

Background: Carpal tunnel syndrome affects one out of ten people throughout their lives, and repetitive work related conditions affecting wrist and hand are the most common cause of prolonged absenteeism from work and limited functional ability. Multiple physical therapy interventions have been used by physical therapists for reducing pain severity, increasing range of motion and decreasing functional limitations in carpal tunnel syndrome.Methods: A cross-sectional survey was conducted among 196 physical therapists in Karachi, Pakistan. Demographic data of physical therapists was obtained, as well as information regarding carpal tunnel syndrome and its intervention techniques used.Conclusion: There existed variability among the treatment preferences of physical therapists regarding the management of carpal tunnel syndrome. A majority of respondents (72.4%) used nerve mobilization techniques, and therapeutic ultrasound was given by 66.3%. The least common intervention used was myofascial release (28.1%). Different approaches had been given in combination as well, which showed that physical therapists are also aware about the recent approaches and their effects for the management of CTS.

The Effectiveness of Facet Joint Local Corticosteroid Injection in Diagnosis and Treatment of Facet Joint Syndrome

Objectives: To evaluate outcomes of lumbar facet joint injection with local corticosteroid in treatmentof chronic low back pain according to Oswestry disability Index(ODI).Patients and Methods: Interventional prospective study on 23 patients attended the outpatient clinic ofOrthopedic Surgery in Cairo University Hospitalscomplaining of chronic low back pain not responsiveto medical treatment and physiotherapy from September 2018 to august 2019.Results: The mean age of the patients was 41.17 ± 9.74 years and 47.8% were males. Facet jointcorticosteroid injection resulted in significant reduction of pain severity of patients as it ranged 5:10(mean 7.3 ±1.5) pre-injection and improved to 0 :6 (mean 3.6 ± 1.7) 3-month post injection(Pvalue:0.001)while the ODI score ranged 26:80 (mean 47.4 ±15.7) pre-injection and improved to 4:46 (mean 28.8 ±10.4) three months post injection(Pvalue 0.001).Conclusion: intra-articular facet joint injection is crucial in the diagnosis and treatment of facet jointsyndrome.

Chronic pain experience through COVID-19: a comparison of reports prior and during the early stages of the pandemic.

The impacts of COVID-19 and imposed restrictions on individuals with chronic noncancer pain continue to emerge, varying across countries. More recent research (including with longitudinal designs) suggests that the pandemic may not have such a disproportionate effect on chronic noncancer pain and its management as first thought. This longitudinal study, with assessments before the pandemic (2019) and early during the pandemic (May-July 2020), examined changes in validated measures of pain severity, pain interference, prescription opioid misuse, and mental health symptoms. Patients (N = 236) self-reported significant improvements in pain severity, pain interference, pain self-efficacy, pain catastrophizing, prescription opioid misuse, depression, and anxiety symptoms over time. Approximately 30% and 33% of patients achieved minimally important reductions (10% change) in pain severity and pain interference, respectively. In follow-up exploratory analyses, prepandemic sociodemographic and psychological factors predictive of 10% improved (vs 10% worse) pain severity and interference were investigated in logistic regressions. Reduction in pain interference was predicted by current employment, older age, and higher pain self-efficacy. There were no significant predictors of reduction in pain severity. The impact of COVID-19 on patients' pain experience and mental health was negligible in the early stages of the pandemic, and findings suggest improvements through the period. Targeted interventions that promote the protective factor of pain self-efficacy and build resilience may buffer patients' future response to the pandemic because it evolves as a part of our new normal. Targeted social determinants of health interventions that direct resources toward maintaining employment could also be important.