Reduction In Visual Analog Scale Research Articles

Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis.

To compare clinical outcomes following steroid injections using the anterior and posterior approaches. Systematic review with meta-analysis. Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. Patients with adhesive capsulitis. Glenohumeral steroid injections using either anterior or posterior approach. Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc

ObjectiveTo compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc.MethodsThis retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes.ResultsDuring the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B’s mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A’s mouth opening did not significantly improve. Regarding pain, Group A’s VAS score decreased by 0.463 ± 0.778 after one month, and Group B’s score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups.ConclusionCompared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

Robotic endoscopic transforaminal lumbar interbody fusion: A single institution case series

BackgroundRobotic-assisted, endoscopic transforaminal lumbar interbody fusion (RE-TLIF) is a promising, minimally invasive surgical option for degenerative lumbar spondylosis/spondylolisthesis; however, outcomes data and efficacy are limited, especially in multilevel disease. Here, we present the first reported series of patients that underwent either single or multilevel RE-TLIF. MethodsA retrospective review was performed on 23 consecutive patients who underwent a single level or multilevel RE-TLIF by a single surgeon. Variables included demographics, perioperative results, pain scores, and functional outcome scores. ResultsEighteen patients (78.3 %) underwent single level RE-TLIF and 5 patients (21.7 %) underwent multilevel RE-TLIF. The median reduction of visual analog scale (VAS) for low back pain (LBP) of all subjects was 6 (IQR = 4.5, 6.5) with no significant difference between single level and multilevel RE-TLIF (p = 0.565). The median reduction of VAS for leg pain of all subjects 7 (IQR = 6, 8) with no significant difference between single level and multilevel RE-TLIF (p = 0.702). Median blood loss was 25 cc (IQR = 25, 25) and 50 cc (IQR = 25, 100) for single and multilevel RE-TLIF, respectively (p = 0.025), whereas median length of stay was 1 (IQR = 1, 1; mean = 1.0 ± 00.18) days and 1 (IQR = 1, 2; mean = 1.4 ± 00.54) days, respectively (p = 0.042). One major complication was observed requiring reoperation for demineralized bone matrix migration resulting in an L5 radiculopathy. ConclusionsSingle and multi-level RE-TLIF appears to be a safe and efficacious approach with comparable outcomes to open and other minimally invasive approaches. Additionally, we observed favorable accuracy in robot-assisted pedicle screw, endoscope, and interbody device placement.

The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study

Aim: Patients with De Quervain's stenosing tenosynovitis (DQT) experience problems in daily living activities due to the chronic inflammatory process and tenderness around the wrist. This study aimed to compare the effects of prolotherapy and steroid injection on short-term functional outcomes in DQT patients. Methods: In this retrospective study between January 2022 and 2023, a cohort of 34 patients with complete demographic data and elbow pain and functional scores, which were recorded at pre-treatment, two weeks, and six weeks post-treatment, was divided into the steroid injection (n=17) and prolotherapy (n=17) groups. Demographic and clinical data of all patients were recorded. The outcomes of the Visual Analogue Scale (VAS) score for wrist pain, Quick Disability Assessment of Arm, Shoulder, and Hand Problems (QuickDASH), and the Health Assessment Questionnaire (HAQ) for wrist functions were examined. Results: Initial assessments did not reveal any differences between groups in terms of VAS (p=0.756), QuickDASH (p=0.168), and HAQ (p=0.615). In the second week post-treatment, there was a significant reduction in VAS, QuickDASH, and HAQ in steroid injection compared to the prolotherapy (p=0.001). This difference continued at sixth-week post-treatment; VAS (p=0.007), QuickDASH (p=0.003), and HAQ (p=0.011) were found to be significantly lower in steroid injection than in the prolotherapy. Conclusion:Our findings underscore the superior effectiveness of steroid injection compared to prolotherapy in reducing wrist pain and improving functional outcomes in patients with DQT. These findings benefit orthopedic settings in choosing treatment options logically, though further research is needed to understand long-term effects and mechanisms.

The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis.

Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients, lacking effective treatment options. A review was conducted utilizing EMBASE, MEDLINE, and all evidence-based medicine reviews to evaluate the effect of fat grafting as a treatment option for PMPS from database inception to 29 April 2023 (PROSPERO ID: CRD42023422627). Nine studies and 812 patients in total were included in the review. The overall mean change in visual analog scale (VAS) was -3.6 in 285 patients following fat grafting and 0.5 in 147 control group patients. There was a significant reduction in VAS from baseline in the fat grafting group compared to the control group, n = 395, mean difference = -2.17 (95% CI, -2.95 to -1.39). This significant improvement was also noted in patients who underwent mastectomy without reconstruction. Common complications related to fat grafting include capsular contracture, seroma, hematoma, and infection. Surgeons should consider fat grafting as a treatment option for PMPS. However, future research is needed to substantiate this evidence and to identify timing, volume of fat grafting, and which patient cohort will benefit the most.

Outcomes of combined treatment of patients with acute lumbodynia

Introduction. Acute dorsalgia is a common reason to seek outpatient medical care in Russia. The clinical picture usually includes muscular-tonic and pain syndromes. The most common form of dorsalgia by localization is acute lumbar pain (lumbodynia).Aim. To evaluate the effectiveness of Spascuprel®, Traumeel S in the complex treatment of patients with acute lumbar pain in real-world clinical practice.Materials and methods. We conducted a non-interventional, prospective, observational study of 110 outpatients aged 26 to 65 years. Patients received a standard on-demand therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, Group 1 received Spascuprel® and Traumeel® C, and Group 2 received centrally acting muscle relaxants. The effectiveness of treatment was assessed using the visual analogue scale (VAS) of pain intensity and the limitations of various activities in daily living were measured using the Roland – Morris questionnaire. Consideration was given to the exacerbation duration, the need for additional intake of NSAIDs, and the number of cases of pain exacerbation within 60 days from the start of participation in the observational study.Results. Under treatment, pain intensity showed statistically significant decreases in VAS scores (from 61.0 to 35.5 scores out of 100 according to VAS by Day 7 and to 19.5 scores by Day 14 of treatment in Group 1, from 61.2 to 41.1 and to 25.8 scores in Group 2, respectively (p &lt; 0.05)). A more rapid decrease was observed in VAS pain intensity score from baseline in Group 1. Over 2-month observation period, group 1 had less exacerbations (p &lt; 0.05) and fewer cases of need for additional intake of NSAIDs (p &lt; 0.05). The frequency and severity of adverse events did not differ between two groups.Conclusion. A more rapid decrease in VAS pain intensity scores and reduction in the need for NSAIDs were noted in the group of patients with acute dorsalgia who used Traumeel® C and Spascuprel® in addition to standard NSAID therapy.

Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients.

Laminectomy has long been a "gold standard" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT). A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman's correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted. The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient. FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.

A pilot study on Langerhans cells in keratoconus patients by in vivo confocal microscopy before and after corneal cross-linking and correlation with eye rubbing

PurposeThe aim of this study was to investigate the corneal microstructure and Langerhans cells using in vivo confocal microscopy in keratoconus patients before and after cross-linking, and to correlate the morphologic findings with clinical and patient-reported outcomes, including eye rubbing (ER) behavior. MethodsPatients with progressive keratoconus undergoing iontophoresis-assisted epithelium-on cross-linking (I-CXL) were consecutively enrolled. In vivo confocal microscopy was performed before and 6 months after treatment. Patients were asked to quantify their ER behavior on a Visual Analogue Scale (VAS) and completed the Keratoconus Outcomes Research Questionnaire and the Ocular Surface Disease Index questionnaires at the same time points. Visual acuity, tear osmolarity, topography, aberrometry, and pachymetry of both eyes were assessed. ResultsThirteen patients were included in this pilot study. Preoperatively, the mean Langerhans cells density was 35,615 cells per mm2, and the median morphology was 3. The mean ER VAS before treatment was 7,077 out of 10. The ER VAS showed significant positive correlations with both Langerhans cells density and morphology of the study eye. After treatment, a statistically significant reduction in ER VAS and in Langerhans cells variables was observed. The mean sub-basal plexus nerve density was comparable to pre-operative values 6 months after I-CXL. ConclusionsBased on this preliminary evidence, the presence of high density of mature Langerhans cells in the central cornea of keratoconus patients and its correlation with eye rubbing support the role of inflammation in keratoconus. The reduction in these markers after treatment may suggest a potential of CXL in moderating immune-related inflammation and eye rubbing in the medium term.

A Retrospective Study of 91 Patients Treated with Percutaneous Kyphoplasty for Mild Osteoporotic Vertebral Compression Fractures and a New Evaluation Scale of Shape and Filling Effect of Cement

BackgroundPercutaneous kyphoplasty (PKP) is commonly used to treat severe osteoporotic vertebral compression fractures (OVCFs) by restoring vertebral height. However, its application in mild cases is not frequently discussed. MethodsThe study retrospectively included 100 treated vertebral bodies of the 91 patients mentioned before, and efficacy was evaluated using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores preoperatively, 2 days postoperatively, and at 1 and 6 months after treatment, as well as mean variation in vertebral body height. The study also examined complications such as pain recurrence, delayed vertebral fracture, and loss of vertebral height, and developed a scale to assess the shape and filling effect of cement (SFEC) and its impact on complications. ResultsThe results showed significant reductions in mean VAS and ODI scores from pre- to post-surgery and an increase in vertebral body height. However, complications occurred in 10 patients who received treatment for 11 vertebral bodies, including pain recurrence, fractures, and loss of vertebral height. Among the 10 patients with complications, 7(63.6%) vertebral bodies had dissatisfied SFEC scores, compared to 22(24.7%) vertebral bodies with dissatisfied SFEC scores in 81 patients without complications (89 vertebral bodies). ConclusionsPKP is a safe and effective method for treating mild OVCFs, but attention should be paid to the shape and filling effects of cement during surgery to prevent later complications. The developed SFEC scale provides a specific and quantitative standards for evaluating the recovery status after PKP, which need further validations.

MRI-based cartilage changes and clinical effectiveness of autologous intra-articular platelet-rich plasma injections in symptomatic patients with moderate osteoarthritis of the knee

BackgroundAn autologous blood product containing a high percentage of various growth factors, cytokines, and modulating factors such as platelet-rich plasma (PRP) is thought to play a role in chondral remodeling by promoting the production of cartilage matrix molecules and repairing and regenerating articular cartilage. In symptomatic patients with moderate osteoarthritis (OA) of the knee, we aimed to investigate MRI-based cartilage changes and the clinical efficacy of autologous intra-articular PRP injections.ResultsThirty-three patients with grades 2 and 3 OA of knees as per Kellgren and Lawrence OA classification underwent three consecutive PRP injections at monthly intervals. These patients were followed up monthly for the first 3 months, and then after every 3 months at 6 months, 9 months, and 12 months. There was statistically significant improvement in joint pain and functionality with the visual analogue scale (VAS) scores showing a reduction from 7 ± 2 at baseline to 2.76 ± 1.34 at 12 months and Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) scores declining from 77.91 ± 1 1.6 at baseline to 23.61 ± 19.1 at 12 months (p < 0.05). The reduction in VAS and WOMAC scores was maximum during the first 3 months after PRP therapy. MRI showed a statistically insignificant improvement in cartilage thickness [Whole Organ Magnetic Resonance Imaging Score (WORMS) 3.15 ± 1.41 to 3.3 ± 0.84) (p > 0.05)].ConclusionsPRP had a positive effect on pain alleviation and patient functioning, but there was no significant change in articular cartilage as measured by MRI.

The Safety and Efficacy of Posterior Lumbar Interbody Fusions in the Outpatient Setting.

Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. Results The current study included 36 outpatient PLIF cases with 94.4% of the study cohort undergoing a single-level PLIF. The average Oswestry Disability Index (ODI) score improved by 20.4 points from preoperative measurements (p = 0.0002), and the visual analog scale (VAS) score improved by 27.2 points (p = 0.0001). The postoperative fusion rate was 94.4%. One intraoperative complication occurred (2.78%), and four postoperative complications occurred (11.11%). There were no subsequent admissions throughout the postoperative follow-up period; however, two of the 36 patients (5.56%) did require reoperation, both in an outpatient setting. Conclusions This study demonstrates that open posterior lumbar interbody fusions performed in an outpatient setting can be performed safely and effectively, with a significant reduction in VAS and ODI pain scores.

EFFECTIVENESS OF ULTRASOUND GUIDED PLATELET RICH PLASMA INJECTION IN COMPARISON WITH EXTRACORPOREAL SHOCK WAVE THERAPY ON IMPROVING PAIN AND FUNCTION IN PATELLAR TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Patellar Tendinopathy is an insertional tendinopathy of the extensor apparatus of the knee that affect athletes practicing several sports at every level of participation but is found mainly in elite athletes involved in jumping activities. The characteristic complaint is an anterior knee pain with insidious onset, localized in the involved area. Diagnosis is clinical and is typically based on medical history and clinical findings. Many methods to treat Patellar Tendinopathy have been evaluated, and there is no true consensus on the most efficacious treatment strategy. Objectives: To determine the effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function among athletes with Patellar Tendinopathy. Study Design: Randomized controlled trial Methods: Forty-four athletes with patellar tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: autologous PRP injections under ultrasound guidance (PRP group n = 22), and 3 sessions of focused extracorporeal shock wave therapy (ESWT group n = 22). The outcome measures were Victorian Institute of Sports Assessment–Patella (VISA-P) questionnaire and pain visual analog scale (VAS). For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by students t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the groups comparison was analysed using students t-test. A p-value &lt;0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection. Within group comparison showed statistically significant improvement in VISA-P score and reduction in VAS from baseline at all follow ups (p=0.00) in the PRP group. While in the ESWT group, maximum improvement was seen from baseline to 1st follow up at 4 weeks (p = 0.01). However subsequent follow up showed reduction in VISA-P Scores and increased VAS but remained above the baseline values and it was statistically significant (p &lt; 0.05) (Table III). Conclusion: Ultrasound guided injection of platelet rich plasma lead to significant improvement in pain and function over the long term in comparison with focused ESWT in the treatment of patellar tendinopathy in athletes and thereby enabling faster return to sports.

Efficacy of quadratus lumborum block in the treatment of acute and chronic pain after cesarean section: A systematic review and meta-analysis based on randomized controlled trials.

This analysis aimed to explore the analgesic effects of quadratus lumborum block on acute and chronic postoperative pain among patients undergoing cesarean section. PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases for Randomized Controlled Trials (RCTs) that focused on the use of quadratus lumborum block in cesarean section procedures were searched from the inception of the databases until December 2022. Studies were screened based on inclusion and exclusion criteria, and were then conducted for quality assessment and data extraction. Meta-analysis was performed using Stata 15.0 software. Two researchers independently screened the studies, extracted data, and evaluated the risk of bias for the included studies. In case of any disagreements, it was resolved by consultation with a third party opinion. A total of 21 studies involving 1976 patients were finally included, with an overall acceptable study quality level. Compared to the control group, the administration of Quadratus Lumborum Block (QLB) resulted in significant reduction in the postoperative 24-hour visual analog scale (VAS) score (WMD = -0.69, 95% CI: -1.03 ~ -0.35, P < .001) and the consumption of opioid analgesics within 24 hours after surgery (WMD = -2.04, 95% CI: -2.15 ~ -1.92, P = .002). The incidence of chronic pain 3 months QLB (OR = 0.41, 95% CI: 0.09 ~ 1.88, P = .253) and 6 months (OR = 0.83, 95% CI: 0.33 ~ 2.07, P = .686) after surgery were observed to increase as compared with the control group. The use of QLB for postoperative analgesia after cesarean section, particularly in the relief of acute postoperative pain, had been proven to significantly decrease the VAS score and morphine consumption within the first 24 hours after surgery. However, further studies are needed to determine its impact on managing chronic postoperative pain.

Effect of Transdermal Microneedle Patch Plus Nonsteroidal Anti-Inflammatory Drug in Knee Osteoarthritis: A Randomized, Double-Blind Study

Purpose: No recent clinical study has shown the efficacy of transdermal microneedle patch (TDM) plus nonsteroidal antiinflammatory drug (NSAID) in early knee osteoarthritis (OA). This study aimed to determine the effect of TDM plus NSAID on synovial hypertrophy, knee pain, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score in osteoarthritic knees. Methods: A randomized, controlled, double-blind trial was conducted. One hundred participants, aged 40–70 years, with painful knee OA and radiographic nonstructural changes were randomly assigned into two groups to undergo TDM plus NSAID (ketorolac 30 mg) or TDM (placebo) at the medial joint line of the knee twice (once weekly). The synovial thickness was measured using ultrasonography at pretreatment, weeks 1, 2, and 4. The visual analog scale (VAS) for pain, WOMAC score, and adverse events (AEs) were also recorded. Results: The TDM plus NSAID group demonstrated a significant reduction in synovial thickness and VAS at weeks 2 and 4 compared with the placebo group (P&lt;0.05). At week 4, the mean synovial thickness reduction was 1.1 and 0.3 mm, and the mean VAS reduction was 3.2 and 1.7 for the TDM plus NSAID and placebo groups, respectively. The mean WOMAC scores at week 4 were significantly reduced (5.7 and 0.9 for the TDM plus NSAID and placebo groups, respectively). No complication and treatment-related AEs occurred. Conclusions: TDM plus NSAID significantly reduced synovitis and improved the pain score in knee OA after 2 weeks. The WOMAC score improved at week 4 without any AEs. Thai Clinical Trials Registry (TCTR), TCTR identification number is TCTR20200613001.

Clinical analysis of transverse process fractures: A comprehensive study on patient characteristics, management, and outcomes in trauma care.

Transverse process fractures (TPFs) are commonly encountered in trauma patients and are often associated with polytrauma. While traditionally considered stable injuries, recent research suggests their significance in spinal trauma may be under-estimated. This study aims to provide insights into the management and outcomes of TPFs, evaluating their predictive potential for identifying clinically significant spinal fractures and associated injuries. A retrospective review of trauma registry data from a Level I trauma center was conducted, encompassing patients with TPFs from September 2022 to September 2023. Inclusion criteria involved patients aged 18 or older with confirmed TPFs via com-puted tomography (CT) and magnetic resonance imaging (MRI), managed nonoperatively. Data on demographics, injury mechanisms, associated injuries, pain management, and treatment outcomes were analyzed. Pain severity and functionality were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). A total of 190 patients, predominantly male (129 patients, 67.9%), with a mean age of 45.7 years, were included in the study. Motor vehicle accidents (MVA) were the leading cause of admission (44.7%). Thoracic injuries were the most common associ-ated pathology. Of the study cohort, 88 patients (46.3%) presented with single-level TPFs, while 102 patients (53.7%) had multilevel fractures. Analysis revealed distinct differences between these groups, with multilevel TPF patients exhibiting a higher frequency of associated injuries and a notable proportion requiring hospitalization or surgical intervention. Multilevel TPF patients exhibited higher initial pain and disability scores compared to single-level TPF patients. Both groups showed significant reductions in VAS and ODI scores at the 3-month follow-up. TPFs, previously considered minor injuries, demonstrate significant pain and functional limitations. They often accompany systemic pathologies, particularly in multilevel fractures, necessitating a multidisciplinary approach to management. The "Protection, Rest, Ice, Compression, Elevation" (PRICE) approach, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and muscle relaxants, along with collar or brace support when necessary, proves effective in pain management and functional improvement. These findings emphasize the importance of recognizing TPFs as complex injuries requiring tailored management strategies. Further research and collaboration among healthcare providers are warranted to refine treatment approaches and optimize outcomes for patients with TPFs.

The effectiveness of using pulsed electromagnetic fields for osteoarthritis of the knee joint

BACKGROUND: Osteoarthritis is one of the most common forms of pathology of the musculoskeletal system with significant impairment of motor function, which is one of the main causes of disability in the population.&#x0D; AIM: This study was aimed at testing the effectiveness of the portable device "ALMAG+" with pulsed electromagnetic fields in the treatment of pain in patients with osteoarthritis of the knee joint.&#x0D; MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial included patients with radiographic evidence of knee osteoarthritis and persistent pain greater than 40 mm on a visual analogue scale (VAS). The study included daily treatment with pulsed electromagnetic fields from the ALMAG+ device for 1 month in 60 patients with knee osteoarthritis. The primary outcome measure was reduction in pain intensity assessed by VAS and WOMAC scales. Secondary outcomes included the 36-item Short Form Medical Outcomes Study version 2 (SF-36 v2) quality of life, pressure pain threshold, and changes in non-steroidal anti-inflammatory drug/analgesic use.&#x0D; RESULTS: Sixty-six patients were enrolled in the study, and 60 completed the study. After 1 month of treatment, pulsed electromagnetic fields caused a significant reduction in pain VAS and WOMAC scores compared to placebo. In addition, patients receiving pulsed electromagnetic fields improved pain tolerance, which was reflected in changes in pain threshold, and physical condition. We obtained a significant and statistically significant effect of the organized pulsed electromagnetic fields factor on VAS pain scores (F=47.6; p=0.00006); assessments of the severity of pain, joint function and stiffness on the scales of the WOMAC questionnaire also significantly changed under the influence of the pulsed electromagnetic fields factor (F=14.7; p=0.001). 26% of patients in the pulsed electromagnetic fields group discontinued non-steroidal anti-inflammatory drug/analgesic therapy. No adverse events were identified during treatment.&#x0D; CONCLUSION: These results suggest that pulsed electromagnetic fields therapy is effective in relieving pain in patients with knee osteoarthritis and also affects pain threshold, stiffness, and physical functioning. In the future, it is desirable to conduct larger studies, including those comparing the effectiveness of pulsed electromagnetic fields therapy with standard pharmacological approaches for osteoarthritis.

Predictors of Clinical Failure after Endoscopic Lumbar Spine Surgery During the Initial Learning Curve

This study aims to identify clinical factors that may predict failed endoscopic lumbar spine surgery to guide surgeons with patient selection during the initial learning curve. This is an Australasian prospective analysis of the first 105 patients to undergo lumbar endoscopic spine decompression by 3 surgeons. Modified MacNab outcomes, visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were utilized to evaluate clinical outcomes at 6 months postoperatively. Descriptive statistics and ANOVA t tests were performed to measure statistically significant (P < 0.05) associations between variables using GraphPad Prism v10. Patients undergoing endoscopic lumbar surgery via an interlaminar or transforaminal approach have overall good/excellent modified MacNab outcomes and a significant reduction in postoperative VAS and ODI scores. Regardless of the anatomic location of disc herniations, good/excellent modified MacNab outcomes and significant reductions in VAS and ODI were reported post-operatively, however, not in patients with calcified disc herniations. Patients with central and foraminal stenosis overall reported poor/fair modified MacNab outcomes, however, there were significant reductions in VAS and ODI scores postoperatively. Patients with subarticular stenosis or an associated spondylolisthesis reported good/excellent modified MacNab outcomes and significant reductions in VAS and ODI scores postoperatively. Patients with disc herniation and concurrent degenerative stenosis had generally poor/fair modified MacNab outcomes. The outcomes of endoscopic spine surgery are encouraging with low complication and reoperation rates. However, patients with calcified disc herniations, central canal stenosis, or disc herniation with concurrent degenerative stenosis present challenges during the initial learning curve and may benefit from traditional open or other minimally invasive techniques.

Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review

Background Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO. Methods Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy. Results PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 ± 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 ± 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point. Conclusion It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population.

Endoscopic Ultrasound-Guided Celiac Plexus Block Can Be a Useful Procedure for Pain Relief in Chronic Pancreatitis When Used Selectively

Abstract Background and Objectives: Endoscopic ultrasound (EUS)-guided celiac plexus block (CPB) for pain relief in chronic pancreatitis (CP) has wide variation in results as reported in the literature. The objective was to find out the efficacy of EUS-CPB in painful CP from our region where phenotype of CP is different from West and to find out factors favoring response to EUS-CPB. Methods and Results: Patients with known CP who underwent EUS-CPB were assessed for response to CPB. Response to EUS-CPB was recorded as more than 50% reduction in visual analogue scale (VAS) score for pain severity at 1 week, 4 weeks, 12 weeks and 24 weeks after procedure. Factors between responders and nonresponders were analyzed. Among 29 patients who underwent EUS-CPB during the study period, response was seen in 72.4% patients after the procedure. The mean time to response to EUS-CPB was 1.22 (± 0.43) days. Mean duration of response was 8 months (± 4.73). Short duration of painful CP (≤2 years) was seen in 15 patients (51.72%) and long duration (&gt;2 years) was seen in 14 (48.27%). Among responders (21/29), those patients who had short duration of disease had significantly lower median VAS score at 12 weeks, (1 versus 3, p-value= 0.026) and at 24 weeks, (1.5 versus 2.5, p-value= 0.049), as compared to those with longer duration of disease. Overall, 83.3% males responded as compared to 54.54% females (p = 0.04). Significant proportion of subjects who responded either stopped or used analgesics occasionally (p &lt; 0.0001). There was no statistically significant difference in response to EUS-CPB with respect to age, prior history of endoscopic retrograde cholangiopancreatography (ERCP), etiology of CP, prior history of surgery, or whether only EUS-CBP was done (p &gt; 0.05 for all). Conclusion: EUS-CPB can be effective when used in select group of painful CP patient who are not immediate candidates for surgery especially in early course of disease. It can be offered to patients with persistent pain despite optimum medical therapy. When effective, it can reduce need for analgesic medication at least in short to medium term.

Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients: A Randomized Clinical Trial.

To determine whether scheduled low-dose, short-term ketorolac is associated with reduced length of stay, opioid use, and pain in orthopaedic polytrauma patients. Double-blinded, randomized controlled trial. One Level 1 trauma center. From August 2018 to October 2022, 70 orthopaedic polytrauma patients between 18-75 years-old with a New Injury Severity Score (NISS) > 9 were randomized. 70 participants were enrolled, with 35 randomized to the ketorolac group and 35 to the placebo group. 15 mg of intravenous (IV) ketorolac every 6 hours for up to 5 inpatient days or 2 mL of IV saline in a similar fashion. Length of Stay (LOS), Morphine Milligram Equivalents (MME), Visual Analogue Scale (VAS), and Complications. Study groups were not significantly different with respect to age, BMI, and NISS (p>0.05). Median LOS was 8 days (interquartile range [IQR], 4.5 to 11.5) in the ketorolac group compared to 7 days (IQR, 3 to 10) in the placebo group (p = 0.275). Over the 5-day treatment period, the ketorolac group experienced a 32% reduction in average MME (p = 0.013) and a 12-point reduction in baseline-adjusted mean VAS (p = 0.037) compared to the placebo group. There were no apparent short-term adverse effects in either group. Scheduled low-dose, short-term IV ketorolac was associated with significantly reduced inpatient opioid use and pain in orthopaedic polytrauma patients with no significant difference in LOS and no apparent short-term adverse effects. The results support the use of scheduled low-dose, short-term IV ketorolac for acute pain control among orthopaedic polytrauma patients. Further studies are needed to delineate lasting clinical effects and potential long-term effects, such as fracture healing. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.