Reduction In Visual Analog Scale Score Research Articles

Assessment of the analgesic effectiveness of rectus sheath block in patients who had emergency midline laparotomy: Prospective observational cohort study

BackgroundPostoperative pain is a major concern after midline abdominal surgeries. Rectus sheath block (RSB) has been indicated after midline laparatomy; however, the analgesic effect of landmark technique on postoperative pain was not well investigated. Objectiveswe tested the hypothesis that RSB reduces pain scores, decreased total analgesic consumption and prolong first analgesic request time after emergency midline laparatomy. MethodsProspective observational cohort study was done from February 1 to May 10, 2018. Eighty eight patients were observed in this study, 44 in the RSB group and 44 in the non-exposed group. Pain severity was assessed in first 24 h postoperative period in terms of total analgesic consumption, first analgesic request time and visual analogue scale (VAS) score at 1 h,2 h,4 h,6 h,8 h, 10 h, 12 h and 24 h. ResultsThe RSB group had significantly reduced VAS score at rest and on movement at (1, 2, 4, 6 and 8 h), but not at (10, 12 and 24 h) point assessed. Patients in RSB group had reduced tramadol requirement compared to non-exposed group in 24 h (255.68 ± 80.13) VS (314.77 ± 97.40), P = 0.003). The 24 h diclofenac consumption was significantly lowered in RSB group (75(75–150) than non-exposed group (150(75–150), P = 0.031. Mean time to first analgesic request was significantly longer in RSB group (372.95 ± 131.41) than non-exposed group (50.34 ± 14.12), p ≤ 0.001). ConclusionsThe RSB group resulted in less pain scores, reduced total analgesic utilization and stayed for longer time for first analgesic request. Therefore we recommended RSB as part of multimodal analgesia after emergency midline laparatomy.

Pharmacotherapy in relieving the symptoms of burning mouth syndrome: A 1-year follow-up study.

Burning mouth syndrome (BMS) is a chronic intraoral burning sensation with no identifiable causes. In this study, we aim to demonstrate the effectiveness of treatment strategy using ethyl loflazepate monotherapy or in combination with milnacipran or amitriptyline. A hospital-based, retrospective study was conducted in 86 patients. The patients were divided into remission group and non-remission group. The remission group comprised patients who were satisfied with their pain relief within a year of treatment initiation and did not require any follow-up treatment. The treatment was considered effective if the patient got remission within 1year or was able to reduce the visual analogue scale (VAS) score to <20, in the absence of remission. The treatment strategy was effective in 76.7% of the patients. Significant reductions (p<.05) in VAS scores from 73.5±14.2 at first visit to 14.7±8.7 at last visit in the remission group, and from 79.7±14.3 at first visit to 33.4±23.7 after 1year of treatment in the non-remission group were noted. The treatment strategy using ethyl loflazepate monotherapy or in combination with milnacipran or amitriptyline can be very effective in reducing pain in BMS patients.

Effects of dexmedetomidine as an adjuvant to ropivacaine in scalp block for postcraniotomy analgesia

Objective To evaluate the safety and efficacy of dexmedetomidine (Dex) as an adjuvant to ropivacaine in scalp block. Methods Fifty patients, including 24 men and 26 women, American Society of Anesthesiologists(ASA) grade Ⅰ to Ⅲ, who were scheduled for elective craniotomy in Union Hospital from March to December 2018 were enrolled in the current study. They were randomly divided into two groups (n=25): group C and group Dex. They underwent bilateral scalp nerve block before general anesthesia induction, where 1 ml normal saline in 0.4% ropivacaine was used for group C, and 1 μg/kg Dex diluted into 1 ml normal saline in 0.4% ropivacaine was used for group Dex. Then, both groups were compared for Visual Analogue Scale (VAS) scores and Ramsay sedation scores 1, 2, 6, 12, 18 h and 24 h after craniotomy. Meanwhile, the duration of sensory block, the need for rescue analgesia, analgesic satisfaction scores and postoperative complications were recorded with 24 h after craniotomy. Results Compared with group C, remarkable decreased VAS scores were found in group Dex 6, 12, 18 h and 24 h after surgery (P 0.05). Group Dex presented markedly extended duration of sensory block and reduced need for rescue analgesia within 24 h after surgery (P 0.05). No significant difference was found in the incidence of peri-operative adverse reactions between the two groups (P>0.05). Conclusions The use of 1 μg/kg Dex as an adjuvant to ropivacaine for scalp block can effectively reduce VAS scores in patients after craniotomy, which provides better management of postoperative analgesia. Key words: Dexmedetomidine; Adjuvant; Scalp block; Postoperative analgesia

Virtual Reality-Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study.

ObjectiveAs technology continues to improve, it plays an increasingly vital role in the practice of medicine. This study aimed to assess the feasibility of the implementation of virtual reality (VR) in a rheumatology clinic as a platform to administer guided meditation and biofeedback as a means of reducing chronic pain.MethodsTwenty participants were recruited from a rheumatology clinic. These participants included adults with physician‐diagnosed autoimmune disorders who were on a stable regimen of medication and had a score of at least 5 on the pain Visual Analog Scale (VAS) for a minimum of 4 days during the prior 30 days. VAS, part of most composite outcome measurements in rheumatology, is an instrument used to assess pain that consists of a straight line with the endpoints ranging from “no pain at all” and “pain as bad as it could be.” Patients were randomized into two groups that differed in the order in which they experienced the two VR modules. One module consisted of a guided meditation (GM) environment, whereas the other module consisted of a respiratory biofeedback (BFD) environment. Data on pain and anxiety levels were gathered before, during, and after the two modules.ResultsThe three most common diagnoses among participants were rheumatoid arthiritis (RA), lupus, and fibromyalgia. There was a significant reduction in VAS scores after BFD and GM (P values = 0.01 and 0.04, respectively). There was a significant reduction in Facial Anxiety Scale after the GM compared with the BFD (P values = 0.02 and 0.08, respectively).ConclusionThis novel study demonstrated that VR could be a feasible solution for the management of pain and anxiety in rheumatology patients. Further trials with varying treatment exposures and durations are required to solidify the viability of VR as a treatment option in rheumatology clinics.

Expandable spacers provide better functional outcomes than static spacers in minimally invasive transforaminal lumbar interbody fusion.

Transforaminal lumbar interbody fusion is an effective and frequently performed surgical treatment of chronic lower back pain. Expandable interbody spacers are designed to create greater disc height through in situ expansion. It remains unclear whether the benefits of expandable technology will translate into clinical benefits. The current study compares expandable to static interbody spacers. This is a retrospective study of 99 patients (48 static and 51 expandable) at a single site. Radiographs were collected preoperatively and at 3 months postoperatively. Standard of care at this site requires radiographs to be taken past 3 months only if patients are suffering from a severe recurrence of symptoms. Patient reported outcomes, Oswestry disability index (ODI) and visual analog scale (VAS), were collected preoperatively, at 1 and 3 months postoperatively. Patients were contacted by the surgeon and patient reported outcomes were collected at a final time point. Average final follow-up for was 67.1±16.3 months and for expandable patients it was 43.0±4.2 months. At 3 months postoperatively and at final follow-up, patients treated with expandable interbody spacers had significantly lower average ODI scores than patients with static interbody spacers. Both groups reported significant reductions in VAS scores through all follow-up. At 4 years postoperative 8 static group patients and 3 expandable group patients returned for recurrence of symptoms. Expandable interbody spacers in this study were found to be comparable to static interbody spacers, with improvements in VAS and ODI scores.

Inhaled methoxyflurane (Penthrox\xae) versus placebo for injury-associated analgesia in children\u2014the MAGPIE trial (MEOF-002): study protocol for a randomised controlled trial

BackgroundPain from injuries is one of the commonest symptoms in children attending emergency departments (EDs), and this is often inadequately treated in both the pre-hospital and ED settings, in part due to challenges of continual assessment and availability of easily administered analgesic options. Pain practices are therefore a key research priority, including within the field of paediatric emergency medicine. Methoxyflurane, delivered via a self-administered Penthrox® inhaler, belongs to the fluorinated hydrocarbon group of volatile anaesthetics and is unique among the group in having analgesic properties at low doses. Despite over 30 years of clinical acute analgesia use, and a large volume of evidence supporting its safety and efficacy, there is a paucity of randomised controlled trial data for Penthrox®.MethodsThis is an international multi-centre randomised, double-blind, placebo-controlled phase III trial assessing the efficacy and safety of methoxyflurane delivered via the Penthrox® inhaler for the management of moderate to severe acute traumatic pain in children and young people aged 6–17 years. Following written informed consent, eligible participants are randomised to self-administer either inhaled methoxyflurane (maximum dose of 2 × 3 ml) or normal saline placebo (maximum dose 2 × 5 ml). Patients, treating clinicians and research nurses are blinded to the treatment. The primary outcome is the change in pain intensity at 15 min after the commencement of treatment, as measured by the Visual Analogue Scale (VAS) or the Wong-Baker FACES® Pain Rating scale, with the latter converted to VAS values. Secondary outcome measures include the number and proportion of responders who achieve a 30% reduction in VAS score compared to baseline, rescue medication requested, time and number of inhalations to first pain relief, global medication performance assessment by the patient, clinician and research nurse, and evaluation of adverse events experienced during treatment and during the subsequent 14 ± 2 days. The primary analysis will be by intention to treat. The total sample size is 110 randomised and treated patients per treatment arm.DiscussionThe Methoxyflurane AnalGesia for Paediatric InjuriEs (MAGPIE) trial will provide efficacy and safety data for methoxyflurane administered via the Penthrox® inhaler, in children and adolescents who present to EDs with moderate to severe injury-related pain.Trial registrationEudraCT, 2016–004290-41. Registered on 11 April 2017.ClinicalTrials.gov, NCT03215056. Registered on 12 July 2017.

ASSESSMENT OF THE THERAPEUTIC EFFECTS OF AUTOLOGOUS BLOOD VERSUS DEXTROSE PROLOTHERAPY FOR THE TREATMENT OF TEMPORO- MANDIBULAR JOINT HYPERMOBILITY. A RANDOMIZED PROSPECTIVE CLINICAL STUDY

Objectives: The aim of the current study was to assess the injection of autologous blood versus the dextrose prolotherapy for the treatment of TMJ hypermobility.Material & methods: This study was conducted on 30 patients who had TMJ subluxation. Patients were divided into 2 equal groups. Group A: 15 patients received autologous blood injection, and Group B: 15 patients received dextrose prolotherapy. Clinical evaluation was performed through Visual Analogue Scale (VAS) to assess patients’ pain preoperatively, at 2 weeks, 1, 3, and 6 months postoperatively. Painless maximum interincisal opening (MIO) was measured preoperatively, 2 weeks, and 3, 6 months postoperatively. Statistical analysis of data was performed.Results: Group B showed a significant (p≤0.001) higher MIO values compared to Group A for all follow-up intervals. There was Significant (p≤0.001) reduction in VAS scores at 2 weeks postoperatively in group A. While, the reduction in VAS at 2 weeks was non-significant (p≥0.001) in group B, but at 1 months postoperatively VAS started to show significant (p≤0.001) reduction. Conclusion: autologous blood injection was superior to dextrose prolotherapy regarding the number of injections needed, pain improvement, and maximal interincisal opening reduction.

Twelve-month outcomes of a bioabsorbable implant for in-office treatment of dynamic nasal valve collapse.

ObjectivesTo examine 12‐month outcomes for in‐office treatment of dynamic nasal valve collapse (NVC) with a bioabsorbable implant.Study DesignProspective, multicenter, nonrandomized study.MethodsOne hundred sixty‐six patients with severe‐to‐extreme class of Nasal Obstruction Symptom Evaluation (NOSE) scores were enrolled at 16 U.S. clinics (November 2016–July 2017). Patients were treated with a bioabsorbable implant (Latera, Spirox Inc., Redwood City, CA) to support the lateral wall, with or without concurrent inferior turbinate reduction (ITR), in an office setting. NOSE scores and Visual Analog Scale (VAS) were measured at baseline and 1, 3, 6, and 12 months postoperatively. The Lateral Wall Insufficiency (LWI) score was determined by independent physicians observing the lateral wall motion video.ResultsOne hundred five patients were treated with implant alone, whereas 61 had implant + ITR. Thirty‐one patients reported 41 adverse events, all of which resolved with no clinical sequelae. Patients showed significant reduction in NOSE scores throughout 12 months postoperatively (77.4 ± 13.4 baseline vs. 36.2 ± 22.7 at 1 month postoperatively, 33.0 ± 23.4 at 3 months, 32.1 ± 24.6 at 6 months, and 30.3 ± 24.3 at 12 months; P < 0.001). They also showed significant reduction in VAS scores postoperatively (69.7 ± 18.1 baseline vs. 31.3 ± 27.1 at 12 months postoperatively, P < 0.001). These results were similar in patients treated with implant alone and those treated with the implant + ITR. Consistent with patient‐reported outcomes, postoperative LWI scores were demonstrably lower (1.42 ± 0.09 and 0.93 ± 0.08 pre‐ and postoperatively, P < 0.001).ConclusionIn‐office treatment of dynamic NVC with a bioabsorbable implant improves clinical evidence of LWI at 6 months and improves nasal obstructive symptoms in a majority of patients up to 12 months.Level of Evidence2b Laryngoscope, 130:1132–1137, 2020

Comparison of the use of evaporative coolants and ice packs for the management of preoperative edema and pain in ankle fractures: a prospective randomized controlled trial.

The use of evaporative coolants in the management of acute musculoskeletal injury has received increasing attention recently. However, its efficacy compared with conventional cryotherapy in treating injured human subjects remains unclear. The purpose of this study is to compare the efficacy of evaporative coolants with that of ice packs in preoperative management of edema and pain in patients with an ankle fracture. Sixty-three patients in need of surgical treatment for ankle fracture were randomly assigned to either an evaporative coolant group or an ice pack group. Both treatments were applied for 5 days after injury and outcomes were measured daily. The primary outcome was a reduction in edema as measured by the figure-of-eight-20 method and the secondary outcome was measured by visual analog scale (VAS) for pain. Two-way analysis of variance with repeated measures showed no significant group effect and no significant group-by-time interaction in terms of reduction of edema and VAS score for pain between two groups. No adverse effects were reported in either group. Evaporative coolants exhibited comparable efficacy to ice packs in preoperative cryotherapy of ankle fractures without adverse effects. While evaporative coolants are more expensive than ice packs, they can present a viable option for cryotherapy. Level I, prospective randomized study.

Effects of capacitive and resistive electric transfer therapy in patients with knee osteoarthritis: a randomized controlled trial.

Capacitive and resistive electric transfer (CRET), an endogenous diathermy treatment, has been demonstrated to reduce pain and improve quality of life in numerous orthopedic degenerative and inflammatory problems but not in knee osteoarthritis (KOA). The aim of this prospective randomized controlled trial was to evaluate whether a 2-week program of CRET can reduce pain, stiffness and functional limitations in KOA compared with a sham treatment. Patients with KOA were randomly assigned to a study group (n = 31) or a control one (n = 22). The study group underwent six intermittent CRET applications, whereas the controls underwent a sham protocol without application of energy. The outcome measures were the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) (primary outcome) and the visual analogue scale (VAS) for pain and Medical Research Council Scale (secondary outcomes). All patients were evaluated before treatment (T0), at the end of treatment (T1), and at 1 (T2) and 3 months after treatment (T3). Results showed that CRET significantly improved strength, physical function and pain in patients with KOA. In the study group a reduction in WOMAC and VAS scores was observed at T1, T2, and T3 compared with T0. No significant changes of WOMAC and VAS scores were observed in the control group across all time points. Considering the small number of sessions, low cost and long-term benefits, CRET might be a useful therapeutic option for the conservative management of KOA to reduce pain, stiffness and functional limitation.

Botulinum toxin for the treatment of dystonia and pain in corticobasal syndrome

BackgroundDystonia is a key symptom in corticobasal syndrome (CBS), and upper limb dystonia is the most common phenotype. Dystonia‐associated pain is frequently reported and can be disabling, with poor benefit from oral treatments.Aims of the StudyTo investigate the role of botulinum toxin A (BoTNA) in the treatment of dystonia and associated pain in CBS.MethodsTen consecutive patients with a clinical diagnosis of probable CBS and dystonia with/without associated pain were treated with BoTNA every 3 months. Treatment efficacy was assessed during the first follow‐up visit, three months after the first injection, by means of caregiver impression (CI), evaluation of muscle tone with the Ashworth scale (AS), severity of pain measured with the visual analog scale (VAS).ResultsNine subjects underwent at least three treatments, four patients discontinued for progressive reduction in efficacy or disease progression, five patients are ongoing with good response, and one completed the 10th treatment. No local or systemic side effects were reported, and levodopa equivalent daily dose remained unchanged in most cases during the observational period. Significant improvement of AS was recorded (from 2.9 ± 0.7 to 2.0 ± 0.5, p = 0.003). CI ranged from mild to moderate benefit. All patients reported efficacy on pain, with a significant reduction of VAS score (from 7.7 ± 1.7 to 1.7 ± 0.7 in the Pain group, p = 0.016).ConclusionsOur study confirms safety, efficacy, and tolerability of BoTNA in the treatment of dystonia associated with CBS. Local treatment should be considered as a valid alternative to oral treatment modulation mainly in the presence of associated pain.

The Beneficial Effects of Traditional Chinese Exercises for Adults with Low Back Pain: A Meta-Analysis of Randomized Controlled Trials.

Objective: The aim of this meta-analytic review was to quantitatively examine the effects of traditional Chinese exercises (TCE) on pain intensity and back disability in individuals with low back pain (LBP). Methods: Potential articles were retrieved using seven electronic databases (Medline, Embase, Cinahl, Web of Science, Cochrane library, China National Knowledge Infrastructure, and Wanfang). The searched period was from inception to 1 March 2019. Randomized controlled trials (RCTs) assessing the effect of TCE on pain intensity and back disability in LBP patients were included. Pooled effect sizes were calculated using the random-effects models and 95% confidence interval (95% CI). Results: Data from eleven RCTs (886 individuals with LBP) meeting the inclusion criteria were extracted for meta-analysis. Compared with the control intervention, TCE induced significant improvements in the visual analogue scale (VAS) (Hedge’s g = −0.64, 95% CI −0.90 to −0.37, p < 0.001), Roland–Morris Disability Questionnaire (RMDQ) (Hedge’s g = −0.41, 95% CI −0.79 to −0.03, p = 0.03), Oswestry Disability Index (ODI) (Hedge’s g = −0.96, 95% CI −1.42 to −0.50, p < 0.001), and cognitive function (Hedge’s g = −0.62, 95% CI −0.85 to −0.39, p < 0.001). In a meta-regression analysis, age (β = 0.01, p = 0.02) and total exercise time (β = −0.0002, p = 0.01) were associated with changes in the VAS scores, respectively. Moderator analyses demonstrated that Tai Chi practice (Hedge’s g = −0.87, 95% CI −1.38 to −0.36, p < 0.001) and Qigong (Hedge’s g = −0.54, 95% CI −0.86 to −0.23, p < 0.001) reduced VAS scores. Interventions with a frequency of 1–2 times/week (Hedge’s g = −0.53, 95% CI −0.98 to −0.07, p = 0.02) and 3–4 times/week (Hedge’s g = −0.78, 95% CI −1.15 to −0.42, p < 0.001) were associated with reduced VAS scores, but this significant reduction on this outcome was not observed in the weekly training frequency of ≥5 times (Hedge’s g = −0.54, 95% CI −1.16 to 0.08, p = 0.09). Conclusions: TCE may have beneficial effects for reducing pain intensity for individuals with LBP, regardless of their pain status.

Cystoscopy Real-Time Self-Visualization and Its Impact in Patient's Pain Perception.

To determine if self-visualization of ambulatory cystoscopy provides a decrease in pain perception in male and female patients. A quasi-randomized controlled trial involving patients scheduled for ambulatory cystoscopy from August to November 2017. The indications were: hematuria, bladder cancer surveillance, lower urinary tract symptoms, and incontinence. The patients were quasi-randomized into two groups by scheduled date. Both groups received the same explanation before and during cystoscopy. The variables analyzed were gender, age, Visual Analog Scale (VAS) score, number of previous cystoscopies, and indication and positivity of the test for bladder neoplasia. All patients were analyzed by group and gender separately. The statistical tests used were: Wilcoxon rank-sum, Kruskal-Wallis, Mann-Whitney U test, Pearson correlation, and linear regression. Four hundred four patients were included (318 males and 86 females) and divided into two groups, group A (no self-visualization, n = 239) and group B (self-visualization, n = 165). In males, mean VAS score was 2.6 for group A and 2.5 for group B (p = 0.276); in females, VAS score was 2.78 for group A and 1.64 for group B (p = 0.008). Regarding the remaining variables analyzed, neither positivity of the test for neoplasia (p = 0.14) nor cystoscopy indication (p = 0.597) had any influence. In patients with two or more previous cystoscopies, a reduction in mean VAS score was seen in both genders. In males having their first cystoscopy the mean VAS score was 3.1 and decreased to 2.1 for the third or more (p = 0.001); in females the mean VAS score was 2.89 for the first and 1.56 for the third or more (p = 0.02), although this benefit tended to disappear when the number of previous cystoscopies was taken into account. In male patients, self-visualization of cystoscopy did not impact pain perception, while in female patients, it seemed to provide a benefit. The number of previous cystoscopies had an influence, diminishing the perception of pain, regardless of whether the patient visualized the procedure or not.

A non-interventional, prospective, multicentric real life Indian study to assess safety and effectiveness of un-denatured type 2 collagen in management of osteoarthritis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis (OA) is the most common musculoskeletal conditions affecting the quality of life. Undenatured collagen type II has emerged as one of the promising treatment options in treatment of OA. Despite being available in India, clinical safety and efficacy have not been evaluated. We performed a non-interventional, real-life study to determine its safety and efficacy in Indian population.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A non-interventional,&lt;strong&gt; &lt;/strong&gt;real-life study was performed in patients with OA of knee by 18 orthopaedicians in India. Patients enrolled were followed-up at day 30 (visit 2), day 60 (visit 3) and day 90 (visit 4). Efficacy was assessed by Western Ontario McMaster Osteoarthritis Index (WOMAC) and Visual Analogue scale (VAS) on each visit. Safety was assessed by incidence of suspected adverse events (AEs), and abnormal laboratory parameters.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among 291 enrolled patients 226 patients completed the study. Mean age of the population was 56.2±8.7 years and 53.3% of them were females. In 291 patients included in safety analysis, at least one treatment emergent adverse event (TEAE) was seen in 4.47% patients. None of the AEs were serious or resulted in termination of patient from the study. Nausea (1.37%) and headache (1.03%) were the common AEs. Treatment with undenatured collagen type II was associated with significant reduction in WOMC score (p&amp;lt;0.0001) and VAS scores (p&amp;lt;0.0001) from baseline to day 90.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Undenatured collagen type II is safe and efficacious in Indian patients with OA. This can be considered early in the initial management of OA.&lt;/p&gt;

Clinical efficacy and safety of a combined therapy of pulsed radiofrequency and pudendal nerve block in pudendal neuralgia patients

Objective To investigate the clinical efficacy and safety of the combined therapy of pulsed radiofrequency (PRF) and pudendal nerve block (PNB) in pudendal neuralgia patients. Methods Eighty patients diagnosed with pudendal neuralgia were randomly divided into a PRF+PNB group and a PNB group. The PRF+PNB group underwent both PRF and PNB, while the PNB group received PNB alone. All the patients were followed up to evaluate the Visual Analog Scale (VAS) scores and the Patient Health Quwstionnaire-9 (HPQ-9) scores on the postoperative 1, 14, 30 d and 90 d after surgery. All the surgical complications were recorded. Results A total of 77 patients were followed up, including 39 patients in the PNB group and 38 patients in the PRF+PNB group. On the 1 d after surgery, both groups presented remarkably reduced VAS scores compared with pre-operative levels (P 0.05). However, compared with the PNB group, the PRF+PNB group showed marked decreases in the VAS scores on 14, 30 d and 90 d after surgery(P<0.05). Furthermore, the PRF+PNB group showed marked lower HPQ-9 scores than the PNB group (P<0.05) in 90 d after operation. The 90 d effective rate was 92.1% for the PRF+PNB group and 35.9% for the PNB group. No severe adverse events were observed in either group. Conclusions Compared with PNB treatment alone, the combined therapy of pudendal nerve PRF and PNB is effective to relieve pain in patients with pudendal neuralgia in a longer period of time and improve patients′ depression symptoms, without postoperative adverse events. Key words: Pudendal neuralgia; Pulse radiofrequency treatment; Radiofrequency ablation; Pudendal nerve block; Ultrasound guidance

Lumbar epidural blood patch: effectiveness on orthostatic headache and MRI predictive factors in 101 consecutive patients affected by spontaneous intracranial hypotension.

Although epidural blood patch (EBP) is considered the gold-standard treatment for drug-resistant orthostatic headache in spontaneous intracranial hypotension (SIH), no clear evidence exists regarding the best administration method of this technique (blind vs target procedures). The aim of this study was to assess the long-term efficacy of blind lumbar EBP and predictors on preoperative MRI of good outcome. Lumbar EBP was performed by injecting 10 ml of autologous venous blood, fibrin glue, and contrast medium in 101 consecutive patients affected by SIH and orthostatic headache. Visual analog scale (VAS) scores for headache were recorded preoperatively, at 48 hours and 6 months after the procedure, and by telephone interview in July 2017. Patients were defined as good responders if a VAS score reduction of at least 50% was achieved within 48 hours of the procedure and lasted for at least 6 months. Finally, common radiological SIH findings were correlated with clinical outcomes. The median follow-up was 60 months (range 8-135 months); 140 lumbar EBPs were performed without complications. The baseline VAS score was 8.7 ± 1.3, while the mean VAS score after the first EBP procedure was 3.5 ± 2.2 (p < 0.001). The overall response rate at the 6-month follow-up was 68.3% (mean VAS score 2.5 ± 2.4, p < 0.001). Symptoms recurred in 32 patients (31.7%). These patients underwent a second procedure, with a response rate at the 6-month follow-up of 78.1%. Seven patients (6.9%) did not improve after a third procedure and remained symptomatic. The overall response rate at the last follow-up was 89.1% with a mean VAS score of 2.7 ± 2.3 (p < 0.001). The only MRI predictors of good outcome were location of the iter > 2 mm below the incisural line (p < 0.05) and a pontomesencephalic angle (PMA) < 40° (p < 0.05). Lumbar EBP may be considered safe and effective in cases of drug-refractory SIH. The presence of a preprocedural PMA < 40° and location of the iter > 2 mm below the incisural line were the most significant predictors of good outcome. Randomized prospective clinical trials comparing lumbar with targeted EBP are warranted to validate these results.

Comparative evaluation of fluoro calcium phosphosilicate, calcium sodium phosphosilicate, and strontium chloride hexahydrate containing dentifrice for the treatment of dentin hypersensitivity: A randomized single-blind study

Aims and Objectives: This study aimed to evaluate and compare the clinical effectiveness of dentifrices containing fluoro calcium phosphosilicate, calcium sodium phosphosilicate, and strontium chloride hexahydrate for the treatment of dentin hypersensitivity (DH) when applied twice daily. Materials and Methods: Participants with a history of DH and with visual analog scale (VAS) score of ≥5 to a painful test stimuli response (dental explorer) in at least one tooth at the qualifying baseline visit were enrolled in this four-week randomized study. Participants (n = 93) were randomly allocated to one of the following groups: Group 1––fluoro calcium phosphosilicate (BioMin™), Group 2––calcium sodium phosphosilicate (NovaMin®), and Group 3––strontium chloride hexahydrate. Clinical effectiveness (VAS), perceived sensation score (verbal rating scale [VRS]), participants’ subjective assessment (four-item questionnaire) and oral health-related quality of life (Oral Health Impact Profile-14 [OHIP-14]) questionnaire) were assessed. Results: A significant (P < 0.0001) reduction in symptoms over a period of four weeks (from baseline) was noted in all groups; however, the intergroup difference was not statistically significant. At week 2, the percentage reductions in VAS (Group 1: 58.19%; Group 2: 49.18%; Group 3: 52.69%) and VRS (Group 1: 58.19%; Group 2: 47.16%; Group 3: 49.05%) scores were higher in Group 1 as compared with other groups. Subjective assessment results and oral health-related quality of life were comparable in all the three groups at the end of four weeks. Conclusion: Fluoro calcium phosphosilicate bioactive glass containing desensitizing dentifrice treatment may provide better treatment response for the treatment of DH because of its early onset of action in relieving hypersensitivity symptoms as compared with other dentifrices (CTRI/2018/04/013481).

Effectiveness of continuous versus pulsed short-wave diathermy in the management of knee osteoarthritis: A randomized pilot study.

Background:Short-wave diathermy (SWD) is an electrotherapeutic modality used in the conservative treatment of knee osteoarthritis (KOA). Electromagnetic radiation delivered in continuous (cSWD) or pulse (pSWD) mode provides a deep heating effect on tissues. There is no consensus on outcomes of treatment with cSWD versus pSWD in KOA. The aim of this study was to compare the effects of cSWD versus pSWD on pain, functionality and walking distance in KOA.Methods:34 female patients aged 49-65 with KOA were randomized into two groups. A total of 27 patients completed the study. One group (n=11) was treated with cSWD, the other (n=16) with pSWD for three weeks. Patients were assessed before, after and at one month post therapy. Outcome measures included visual analogue scale (VAS) for knee pain, Western Ontario and Mcmaster University Osteoarthritis Index (WOMAC) and a six-minute walking test (6MWT).Results:Based on the minimal clinically important improvement (MCII), there was a reduction in VAS and WOMAC scores in both cSWD and pSWD groups post treatment (-37.3mm, 31.2mm respectively for VAS and 26%, 23% respectively for WOMAC) and at one month post treatment. There was no difference in pre and post treatment VAS for pain, WOMAC or 6MWT scores between the two groups. There was a small post treatment effect size on between- group 6MWT scores (Cohen’s d: 0.238).Conclusion:Both treatment options appear to be efficacious in reducing pain and improving functionality in KOA. There was no between-group difference. A larger study must be conducted to consolidate these findings.

Thermal Microcautery, a Form of Peripheral Nerve Field Stimulation for Treatment of Painful Knee Osteoarthritis: Non-Randomized Controlled Trial

Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful knee osteoarthritis (PKO). Methods: A non-randomized controlled trial was employed. All PKO patients on a waiting list for knee replacement were offered PNFS-TMC. Patients in the intervention group received 4 sessions (2 weeks apart) of PNFS-TMC by a pin-point tip of a metal rod. The rod was heated over a flame for 5 minutes before being used to induce a single 1 mm second-degree burn over points of tenderness. The control group was selected from the same waiting list. The primary outcome was assessed by Visual Analogue Scale (VAS) scores. The secondary outcomes were changes in levels of physical day to day activity, sleep and analgesics. Results: 16 PNFS-TMC intervention group patients and 15 control group patients were subject to analysis. Baseline VAS score was higher in PNFS-TMC group [9 ± 1.23 (95% CI 8.38 - 9.61) versus 5.93 ± 2.11 (95% CI 4.81 - 7.06) in the control, P < 0.0001]. VAS scores after 8 weeks (i.e. 4 sessions) were lower in the PNFS-TMC group [4.64 ± 2.08 (95% CI 3.57 - 5.72) versus 6.73 ± 2.01 (95% CI 5.61 - 7.85) respectively with P = 0.0058]. In the PNFS-TMC group, VAS score decreased from 9 ± 1.23 (95% CI 8.38 - 9.61) at baseline to 4.64 ± 2.08 (95% CI 3.57 - 5.72) after 4 sessions (P < 0.0001). In control group, VAS score showed a non-significant increase in VAS score from 5.93 ± 2.11 (95% CI 4.81 - 7.06) to 6.73 ± 2.01 (95% CI 5.61 - 7.85) (P = 0.2844). Results indicate reduction of pain VAS scores in the PNFS-TMC group (P < 0.0001). Eleven patients (68.7%) experienced increased capacity to perform daily physical activities P < 0.0001 and 5 (31.2%) showed no change in activity P < 0.0418. 5 (33.3%) of the patients in the control group became worse and 10 (66.7%) experienced no change. Conclusions: PNFS-TMC could offer a simple, safe, cheap and effective method of pain management in chronic PKO patients.

Postoperative analgesia with ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block after arthroscopic knee surgery.

Objective:The objective of this study is to evaluate the postoperative analgesic effect of a combination of ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block (FICB) after knee arthroscopy.Materials and Methods:Forty patients scheduled for knee arthroscopy were randomized to receive either 30 ml of 0.25% ropivacaine alone (Group A, n = 20) or combined with dexmedetomidine 1 μg/kg (Group B, n = 20). Pain intensity was evaluated using the visual analogue scale (VAS), at rest and during activity at 4, 6, 8, 12, and 24 h after surgery. Level of consciousness was evaluated using the Ramsay sedation score. Time to first analgesic request after surgery, the dose of analgesic used in the first 24 h after surgery, variation of heart rate, and adverse reactions were also recorded.Results:VAS scores at 6 and 12 h after surgery were significantly lower in Group B compared to Group A (P < 0.05). No significant difference was observed in the Ramsay sedation score or time to first analgesic request after surgery (P > 0.05). The total dose of analgesic used in the first 24 h after surgery was higher in Group A than in Group B. The incidence of bradycardia was higher in Group B compared to Group A. No adverse reactions were observed in either group.Conclusion:FICB with a combination of ropivacaine and dexmedetomidine resulted in significant reduction of VAS scores with lower postoperative analgesic requirement after arthroscopic knee surgery. No adverse reactions or complications were noted except for lower heart rate in Group B patients.