Pain Scale Research Articles

Optimalisatie en validatie van de Vlaamse Observationele Pijnschaal bij Meervoudige Beperkingen (VOPS-MB) voor personen met een Meervoudige Beperking: een multidisciplinaire benadering

Optimization and validation of the Flemish Observational Pain Scale for Multiple Disabilities (VOPS-MB) for individuals with multiple disabilities: a multidisciplinary approach Introduction: People with severe cognitive impairments and multiple disabilities often experience pain, but this pain frequently goes unrecognized or untreated, negatively impacting their quality of life. Pain management in this group is challenging due to limited communication abilities and the lack of validated pain assessment tools. Aim: This study aims to optimize and validate the VOPS-MB pain scale of the Leieborg Care Center in Deinze for use with individuals with multiple disabilities. Methods: Optimization was carried out through a systematic literature review, an expert focus group, and a Delphi study. The scale's validation was tested through observations of 50 care recipients at the center, with inter-rater reliability measured using Pearson's r correlation coefficient and Cohen's kappa. Results: The optimized pain scale demonstrated high inter-rater reliability, with a Pearson's r of 0.947 and a Kappa value of 0.867. These results indicate that the scale provides reliable results, even when observations are conducted by individuals unfamiliar with the care recipient. Conclusion: This study shows that the pain scale is useful, practical and adequate to use in practice. Furthermore, the findings suggest that this pain scale can also be used in other contexts. The scale enables accurate pain measurement in people with intellectual disabilities, regardless of the observer's knowledge of the patient. Further validation, including digitization and testing for responsiveness, is recommended to enhance the scale's usability.

ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P<.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Comparative effects of gong's mobilization and mobilization with movement in patients with adhesive capsulitis: a randomized clinical trial.

Adhesive Capsulitis results in a progressive contraction of the Glenohumeral joint capsule limiting active and passive range of motion, leading to functional disabilities. Joint mobilization plays a key role in the physical therapy treatment of Adhesive Capsulitis. A relatively new technique, Gong's Mobilization, has been introduced for the treatment of Adhesive Capsulitis. It is focused on the correction of positional faults through controlled dynamic motion of the Glenohumeral joint. The mainstay of this clinical trial is a comprehensive comparative evaluation of MWM with Gong's Mobilization as it remains insufficiently explored. The objective of this clinical trial was to compare the effects of Gong's Mobilization and Mobilization with Movement on pain, range of motion and functional disability in patients with Adhesive Capsulitis. In this triple blinded randomized clinical trial, sixty patients of Adhesive Capsulitis were enrolled within group A (Gong's Mobilization) and group B (Mobilization with Movement). The treatment protocol covered 12 treatment sessions for 4 weeks. Numeric Pain Rating Scale (NPRS), Goniometer, and Urdu version of Shoulder Pain and Disability Index (U-SPADI) were used to assess the pain, range of motion and functional status respectively. These outcome measures were assessed at baseline, after 6 treatment sessions (2 weeks) and conclusively after 12 treatment sessions (4 weeks). For data analysis, within the group differences were measured by Repeated Measure ANOVA and across the group differences were measured by independent t test. A significant difference within the mean values of baseline, week 2 and week 4 NPRS, ROM, and SPADI score was observed in both study groups (p < 0.001). Results of independent t test used to calculate across the group differences indicated that Gong's Mobilization was more effective in reducing disability (SPADI)(p < 0.001) and improving ROM(p < 0.001), meanwhile both groups were equally effective in reducing NPRS scores(p = 0.78). Moreover, a medium to large effect size was also observed for all the outcomes, pain(d = 0.5), ROM (d = 0.5-2.7), SPADI(d = 0.5). It was concluded that Gong's Mobilization is more effective than Movement with Mobilization. Following four weeks of treatment, it pronounced statistically significant and clinically relevant results in improving pain, ROM and functional status of patients with Adhesive Capsulitis. Trial Registration Trial was registered in IRCT (Trial registration number: IRCT20190717044238N4 Trial Registration Date: 01-03-2023).

Free Interleukin 18 (IL-18F) Blood Levels Following Midline Laparotomy: A Prospective Randomized Study of Patients With Benign Disease and Patients With Cancer.

The purpose of this work was to assess blood level correlations of free IL-18 (IL-18F) and various cytokines (CYTs), caspase-1 (Casp1), high sensitive C-reactive protein (hs-CRP), and 4-hydroxynonenal (4-HNE) in 56 patients subjected to midline laparotomy (MLa) and to investigate their link to pain scales. Blood levels of IL-18F and seven CYTs (IL-18, IL-18BP, IL-1ra, IL-6, IL-8, IL-10, IL-1β), Casp1, hs-CRP, and 4-HNE were measured and the pain surveys were reported using numerical rating scale (NRS) and the Brief Pain Inventory (BPI) scales conducted preoperatively (PRE) and postoperatively (POP). The IL-18F levels decreased at POP and the decrease between POP1 (immediately after MLa) and POP2 (24 hours after MLa) blood levels (26.5 versus 20.0) was significant (p<0.001). Moreover, the IL-18F levels at POP2 were slightly higher in patients with cancer than in patients with benign disease (21.2 versus 17.8). Interestingly, the IL-18F levels correlated to IL-18 (r=0.523, p<0.001), IL-18BP (r=-0.475, p<0.001), and 4-HNE (r=0.414, p<0.001) levels. Furthermore, the IL-18F levels correlated with BPI score values (r=-0.459, p=0.05). This is the first report to demonstrate a link between increased IL-18F levels and pain scales in MLa. IL-18F levels decreased significantly after operation and correlated with IL-18, IL-18BP, and 4-HNE blood levels, and inversely correlated with BPI pain scores. These results support the applicability of acute phase response biomarkers in understanding pain in patients subjected to MLa.

Abstract 24: Iron deposition changes of ipsilateral ventral posterolateral nuclei correlate with central post-stroke pain after thalamic infarction

Objectives: To investigate the correlation between iron deposition changes in the lesioned thalamic nuclei and the presence and severity of central post-stroke pain (CPSP) after thalamic infarction using quantitative susceptibility mapping (QSM) technique. Methods: We consecutively enrolled patients with unilateral chronic thalamic infarction with radiological examination conformed . Detailed and multidimensional pain characteristics measured as follows: Douleur Neuropathique 4 (DN4) questionnaire for validation of neuropathic pain diagnosis, Short-Form McGill Pain Questionnaire (SF-MPQ) for comprehensive representation of pain experience, Present Pain Intensity index (PPI) for current pain severity upon examination, and Visual Analogue Scale (VAS) for overall pain feeling since symptom onset. Age- and sex-matched stoke-free healthy controls were recruited simultaneously. High resolution structural image 3D-T1 BRAVO and QSM sequences were obtained with 3.0T MRI. The voxel-lesion-symptom-mapping (VLSM) was used to determine lesioned thalamic nuclei at the high risk for CPSP. Then ipsilateral QSM values of the whole thalamus and subregions were compared with contralateral side and healthy controls. Partial correlation analysis were performed to explore the relationship between QSM value and pain severity. Results: Finally, 28 CPSP patients, 33 non-CPSP patients and 55 healthy controls were included in the study. Our results indicated no significant difference in overall QSM values of the whole thalamus among the groups. The VLSM results showed lesion involving ventral posterolateral nuclei (VPL) was highly orrelaed with occurance of CPSP ( p FWE =0.0092.). The QSM values of each subnuclei in the thalamus ipsilateral to infarction were lower compared with the contralateral side and healthy controls ( p &lt;0.001). Nonetheless, the QSM values in ipsilateral VPL were higher in CPSP patients campared with non-CPSP patients( p =0.003). Notably, the QSM values in the ipsilateral VPL were significantly correlated to pain severity (all p &lt;0.05). Conclusions: The study showed that altered iron deposition in the VPL nuclei is associated with the occurrence and severity of CPSP following thalamic infarction. Aberrant iron deposition after ischemic thalamus stroke may play an important role in the pathogenesis of CPSP. Key words: Thalamic infarction; Central post-stoke pain; Iron deposition; VLSM; Quantitative susceptibility mapping

Are Stabilisation Exercises Effective After Epidural Steroid Injection in Patients With Cervical Radiculopathy? A Prospective Randomised Controlled Trial.

Cervical radiculopathy is caused by dysfunction of nerve roots in the cervical spine. While many studies have assessed the effectiveness of interlaminar epidural steroid injection (ILESI) and stabilisation exercises separately for this condition, our study aims to evaluate the impact of different stabilisation exercise programmes following ILESI on treatment outcomes in radiculopathy patients. Sixty-two patients with cervical radiculopathy were randomised into three groups: cervical ILESI-only (CO), neck stabilisation group (NSG) and scapular stabilisation group (SSG). The CO group received only ILESI, while NSG and SSG underwent stabilisation exercises following ILESI. Outcomes were assessed using the Numerical Rating Scale (NRS) for neck and arm pain, the Neck Disability Index (NDI) for functionality and the Short Form-12 (SF-12) for quality of life at baseline, 1 and 3 months posttreatment. When NRS, NDI and SF-12 parameters were analysed in all groups, a statistically significant improvement was observed in the 1st and 3rd months compared to the pretreatment period. While the improvement in SF-12 physical parameters was significant in SSG and NSG in the 1st month compared to the pretreatment period, no significant difference was found in the CO group in the posttreatment periods. When the 1st and 3rd month results were analysed in NSG, a greater improvement was observed in terms of NRSNECK parameter in both evaluations compared to the other groups. Stabilisation exercise programme, especially neck stabilisation, should be included after ILESI treatment due to positive effects on treatment outcomes. To the best of our knowledge, our study is the first to investigate the effect of a stabilisation exercise programme after ILESI on treatment outcomes in patients with radiculopathy due to cervical disc herniation. It is a valuable study in terms of its prospective design, its specific and homogeneous patient population and its results. Our study will help clinicians when prescribing exercise programmes for these patients. NCT05307211.

Comparative Evaluation of Intra-articular Ozone and Steroid Treatments in Patients with Coxarthrosis under Ultrasound Guidance: A Retrospective Study

Introduction: Osteoarthritis (OA) is the most common degenerative joint disease characterised by the loss of articular cartilage and synovial inflammation. This condition causes stiffness and swelling in the joint, as well as pain, loss of movement and disability. When performed under Ultrasound Guidance (USG), steroid treatments offer several advantages. On the other hand, ozone therapy accelerates anabolic mechanisms, provides vascularisation of cartilage and bone, and slows down the degenerative process. Additionally, it affects inhibitory cytokines, antioxidant enzymes, and neoangiogenesis. Aim: To evaluate and compare the effectiveness of USG intra-articular ozone therapy versus corticosteroid injections in managing hip OA (coxarthrosis) in patients who have not responded to conventional treatments. Materials and Methods: A retrospective comparative study was conducted at Ankara Training and Research Hospital, Ankara, Altındag, Turkey, from August 2021 to August 2022. Patients unresponsive to conventional treatments were divided into two groups: Group A (n=30) received intra-articular steroid (triamcinolone acetonide), and Group B (n=23) received three weekly ozone sessions (200 μg/20 mL), both under USG. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Harris Hip Score (HHS) for functional status, both pre- and post-treatment. Monthly analgesic use was monitored before treatment and at the 1st week, 1st month, 3rd month and 6th month. Statistical analysis were conducted using Unpaired t-tests and Chi-square tests. A p-value &lt;0.05 was considered statistically significant. Results: A total of 53 patients (mean age 63.23±10.50 years) participated in the study. Analgesic needs decreased in both groups, with no significant differences observed in the 1st week, 1st month, 3rd month, and 6th month (p-value=0.139, p-value=0.724, p-value=0.391, p-value=0.546). The most notable improvement occurred one month post-treatment, particularly in low-stage coxarthrosis. Increases in HHS scores and decreases in VAS values for stages 2-3 were statistically significant in both groups (p-value &lt;0.001). Conclusion: The effectiveness of steroid and ozone therapy for coxarthrosis varies by disease stage. Both treatments are more effective in the early stages, while ozone is ineffective and steroids offer limited benefits in advanced stages. Thus, treatment planning should consider the disease stage, and alternative strategies should be explored for advanced cases. Clinicians should prioritise early intervention and seek alternative options for better patient outcomes.

Single minimal conjunctival incision for rectus muscles: a pilot feasibility study.

Small conjunctival incision size is desirable in strabismus surgery under topical anesthesia. To study the feasibility and tolerability of a small bulbar conjunctival incision (SB). Non-randomized feasibility pilot study. After applying a 5-0 PGA (polyglycolic acid) traction suture, we did a 3-4 mm single conjunctival incision posterior and parallel to the rectus muscle insertion. A hang-back recession was done (6-0 PGA suture), and the conjunctiva closed (8-0 PGA suture). The outcome measures were feasibility, tolerability, and motor result. Twenty-five patients were included. The median pain scale score was 3/10, and the satisfaction Net Promoter Score was 72. Mean duration of a recession was 12 min (range: 9-14 min). Mean duration of inflammatory signs and hemorrhage were 2.2 days (95% CI, 1.4-2.9), and 8.5 days (95% CI, 7.1-9.9), respectively. Distance deviation at 2 months was 3.1 Prism Diopters (95% CI, 1.5-4.5). SB is feasible and well tolerated for extraocular rectus muscle surgery.

The effectiveness of using animal-themed vacutainers to reduce pain and fear in children during bloodletting

IntroductionThis study aimed to compare the effects of vacutainers of three different animal characters on pain and fear in children during bloodletting. MethodsThis randomized controlled trial included 180 children between the ages of 4 and 7 years who required bloodletting for routine control. Children were randomized into two groups: experimental and control groups. Routine bloodletting procedure was applied to those in the control group. Animal characters (butterfly, peacock and rabbit) chosen by children in the experimental group was attached to the vacutainer, and then their blood was drawn. The data were obtained by face-to-face interviews with the child, parent and observer before and after the procedure. Children’s pain and fear/anxiety levels were evaluated using the Wong-Baker FACES Pain Scale and the Children’s Fear Scale, respectively. ResultsThere was no statistically significant difference between the groups’ pre-test scores with respect to age, BMI, gender, fear/anxiety assessments of the child, parent, and observer. Children in the experimental group had significantly lower pain and fear/anxiety levels after the procedure compared to those in the control group(p < 0.000). ConclusionsAnimal characters (butterfly, peacock and rabbit) attached to the vacutainer is effective in reducing both fear and pain levels in children during bloodletting.

Nursing Care For The Application of Combined Deep Breath Relaxation Techniques and Lavender Aromatherapy in Post-Prostatectomy Patients with Acute Pain Problems at RSUD Jendral Ahmad Yani Metro City

Background &amp; Objective: The purpose of this study was to determine the effect of deep breath relaxation and lavender aromatherapy on reducing the pain scale of post-prostatectomy patients. Method: Descriptive type of research with a case study approach in multiple cases. Data collection methods using surgical nursing care assessment sheets and pain scale observation sheets using the Numeric Rating Scale. The study used 2 patients with the same criteria. Result: The results of this study are proven effectiveness in reducing pain intensity in both patients. There is a decrease between before and after being given deep breath relaxation techniques and lavender aromatherapy for 3 days, as evidenced by using the Number Rating Scale (NRS) score after being given deep breath relaxation techniques and lavender aromatherapy for 15 minutes for 3 days, the results showed a change in the pain scale in patient 1 and patient 2, with patient 1's pain scale from 6 to 3 and patient 2 from 5 to 2. Conclusion: Researchers advise nurses in overcoming pain with deep breath relaxation techniques and lavender aromatherapy as non-pharmacological therapy.

The Effectiveness of Active Range of Motion Exercises on the Pain Scale of Gouty Arthritis in the Elderly in the Working Area of the Gedong Tataan Health Center

Background &amp; Objective: Gouty arthritis is a condition that occurs when uric acid levels in the blood exceed normal limits, characterized by prolonged pain and impaired daily activities. Based on data at the Gedong Tataan Health Center, there were 26 elderly people with Gout Arthritis who experienced joint pain. Pain in patients with Gout Arthritis can be treated through pharmacological therapy, such as the administration of drugs, and non-pharmacological therapy, such as active range of motion exercises. This study aims to determine the effectiveness of active Range Of Motion exercises on the Gout Arthritis pain scale in the elderly in the Gedong Tataan Health Center Working Area. Method: Quantitative research method with quasy experiment type and pretest posttest control design approach. The population of this study was 26 elderly people while the sample used by the total sampling technique was divided into 2 groups, consisting of 13 intervention groups, and 13 control groups. The research instrument used SOP Range Of Motion and pain scale measurements, the data analysis test used in this study used Mann-Whitney. Result: The results of the study obtained a p-value of 0.004, meaning that there is an effectiveness of active Range Of Motion exercises on the Gout Arthritis pain scale in the elderly in the Gedong Tataan Health Center Working Area. Conclusion: It is hoped that this intervention can be applied at the health center in overcoming pain complaints in the elderly suffering from Gout Arthritis.

Effect of turmeric tamarind drink on pain scale changes in 12th grade female students at Fahd Islamic School Health Vocational High School with primary dysmenorrhea

Each woman experiences menstruation differently. Some undergo menstruation without complaints, while others face discomfort, including dysmenorrhea. This study employed a quasi-experimental design with a non-equivalent control group design. The subjects were divided into two groups: the treatment group and the control group, with both groups undergoing pretest and posttest evaluations. The data collection was conducted at SMK Kesehatan Fahd Islamic School during the 2023 period. A total of 32 female students participated in the study, with 16 students assigned to the treatment group and 16 to the control group. The sampling technique used was purposive sampling. The instruments included a general data sheet and the Numeric Rating Scale (NRS) for pain measurement. The general data sheet contained information such as age, age at menarche, menstrual dates, duration of menstruation, menstrual pain, pain duration, family health history, and therapies used. The reliability test results showed a coefficient of 0.820 for the knowledge questionnaire and 0.785 for the attitude questionnaire, indicating that the instruments were reliable. Data analysis was performed using the Wilcoxon Signed Rank Test (p ? 0.05) with SPSS 16 software at a significance level of ? = 0.05.

Effectiveness of Aromatherapy on Pain and Anxiety among Burns Patients at Public Hospital of Karachi

Aromatherapy is a safe supplement to reduce the pain and anxiety among burn patients. Objective: To determine the effectiveness of aromatherapy on pain and anxiety among burn patients at a public tertiary care teaching Hospital, Karachi, Pakistan. Methods: A quasi-experimental design was employed, on participants of both genders aged between 18-54 years and had burns that were less than 40% Total Body Surface Area. The sample size for this study was calculated through Open Epi version 3.0 with a proportion formula and the calculated sample size was 88. Two open accessed questionnaires Pain and Anxiety Symptom Scale (PASS-20) and Visual Analogue Scale (VAS) was used to collect the data. Wilcoxon signed-rank test was used to test the effect of the intervention (8.00 to 5.75). Results: The results showed that aromatherapy significantly reduced post-intervention pain (p-value0.001). The sub-scale “cognitive”, “escape avoidance”, and the global PASS score was significant after intervention with P-values &lt;0.0001, 0.039, and 0.025 respectively. The mean scores of PASS in all sub-scales and the global score was significantly decreased after the intervention with a large effect size (r&gt;0.5) using Cohen's (1988) criteria. Conclusions: The findings suggested that aromatherapy was a safe supplement to reduce the pain and anxiety among burn patients. Nurses can use at the clinical practice to enhance the use of aromatherapy by which the pain and anxiety can reduce among burn patients.

Effects of Instrument-Assisted Soft Tissue Mobilization and Extracorporeal Shock Wave Therapy in Individuals With Lateral Elbow Pain: A Randomized Single-Blind Clinical Trial.

In lateral elbow pain (LEP), it is important to improve pain, grip strength, and function. The aim of this study is to compare the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) methods on pain, grip strength, and function in LEP. Randomized single-blind clinical trial. Forty-eight adults with LEP were randomly assigned to the IASTM, ESWT, and control groups. Home exercise consisting of special static stretching and eccentric strengthening exercises was given to the control group. The ESWT group received a total of 8 sessions of ESWT in addition to home exercise. The IASTM group received a total of 8 sessions of IASTM in addition to home exercise. The visual analog scale for pain, hydraulic hand dynamometer for grip strength, and Patient-Rated Tennis Elbow Evaluation scale for functionality were used for assessment. Data were collected at baseline, after intervention, and at 4-weeks postintervention. At the end of the treatment and the 4-week follow-up, a decrease in pain scores and improvement in muscle strength and functionality was detected in all 3 groups (P < .001). IASTM applications were more effective than ESWT and control groups in reducing pain both after application and at follow-up (P < .001), whereas ESWT application was also effective compared with the control group (P < .001). IASTM applications were more effective than the ESWT and control groups in reducing Patient-Rated Tennis Elbow Evaluation total scores both after the applications and follow-up (P < .001). IASTM was more effective in grip strength than ESWT and control groups (P < .001). It was determined that IASTM and ESWT treatments were effective in reducing pain and increasing grip strength and functionality in both the short and long term in patients with LEP. It was determined that IASTM treatment was superior to ESWT treatment in reducing pain and improving grip strength and functionality.

Outcomes of open reduction and internal fixation using 2.0/2.4 mm locking compression plate in isolated greater tuberosity fractures of humerus

Background: The purpose of this study was to retrospectively evaluate the radiographic and clinical results of a small single or double low-profile plate fixation of 2.0/2.4 mm locking compression plate (LCP) in treating isolated greater tuberosity (GT) fractures of the humerus. Methods: From June 2015 to October 2022, patients who underwent LCP in treating isolated GT fractures of the humerus were included in this study. The radiological and clinical results were analyzed in 15 patients who underwent open reduction and internal fixation used 2.0/2.4 mm LCP. Results: Bone union was achieved in 14 patients (93.3%) and one failed case was treated with a 2.4 mm single LCP fixation. Radiological union was achieved within 10–20 weeks. Complications occurred in two patients (13.3%), including the reduction failure and shoulder stiffness. At the final follow-up, the average clinical scores were as follows: a visual analog scale for pain of 2.1 (range, 0–5) and a University of California, Los Angeles score of 27.2 (range, 18–31). Regarding range of motion (ROM), the average active ROMs were 142° for forward flexion (range, 120°–150°), 147.1° for abduction (range, 120°– 180°), and 59.3° for external rotation (range, 45°–80°). For internal rotation, the average was observed to reach the 10th thoracic vertebra (range, 1st lumbar vertebra–7th thoracic vertebra). Conclusions: The clinical and radiologic outcomes of treating isolated GT fracture using 2.0/2.4 mm LCP were favorable, and double low-profile plate fixation may be beneficial for sufficient fracture stability if possible. Level of evidence: Level IV, case series.

Objective assessment of acute pain in foals using a facial expression-based pain scale.

Pain assessment based on facial expressions has been described in foals. To extend previous pilot findings of the Equine Utrecht University Scale for Facial Assessment of Pain in Foals (EQUUS-FAP FOAL). Prospective blinded case-control study (known groups analysis). Video recordings (30-60 s) of n = 100 foals (38 patients and 62 controls) were collected. Videos were randomised and scored by two observers, blinded for the condition of the animals. Inter- and intra-observer agreement was tested by Intra Class Correlation (ICC) analysis. Differences between patients and controls were tested using Mann-Whitney U test, differences before and after analgesic treatment were tested with Wilcoxon signed rank test. Multilevel binomial logistic regression was performed for statistical weighting of each pain scale item. Receiver operating characteristic (ROC) analysis was performed to determine sensitivity, specificity and cut-off values. EQUUS-FAP FOAL showed good inter- and intra-observer reliability (ICC coefficient of 0.85 and 0.90 respectively, p < 0.001). Patients had significantly higher pain scores (median score 7, IQR 5.3-7.5) compared with controls (median score 2.5, IQR 1-3, p < 0.001) and the patient pain scores decreased after analgesic treatment (median score 6.5, IQR 5-8 vs. median score 4.5, IQR 3.5-6.5, p < 0.05). Multilevel binomial logistic regression showed the relative importance of the individual scale items. Using the original scale, sensitivity and specificity were 88.2% (95% CI 76%-96%) and 87.9% (81%-98%) respectively, with an area under the ROC curve of 94.9% (92%-98%), based on a cut-off value of ≥4. These values remained similar with the weighted scale based on logistic regression output. Videos of included patients were short and acquired by a person in front of the stable. The current study shows that EQUUS-FAP FOAL can be effectively used to assess acute pain in young foals.

An observational comparative study to evaluate the efficacy and safety of pregabalin and gabapentin in neuropathic pain- at a Teritiary Care Centre

Background: Millions of people around the world suffer from Neuropathic pain (Nep), a prevalent and debilitating condition. Treatment for NeP typically includes anticonvulsants, antidepressants, opioids, topical medications, and local anesthetics. Although Pregabalin and Gabapentin are commonly used for this purpose, there is a lack of conclusive evidence supporting their efficacy. NeP significantly diminishes patients' quality of life. This study aims to evaluate the safety and effectiveness of Gabapentin and Pregabalin in treating patients with NeP. Methods: Among a total of 100 patients 50 patients (Group A) were given Gabapentin and 50 Patients (Group B) were given Pregabalin. The efficacy of drug was measured on the basis of decrease in NeP based on Douleur Neuropathique 4 questions (DN4) pain scale measured at baseline, after one month and after two months. Adverse drug reaction (ADR) reported by the patient or observed by the clinician during the study was reported using ADR reporting form. Result: The mean reduction of the neuropathic pain score in Group A from baseline to 2 months was 2.15, while in Group B it was 3.49. Hence, pregabalin showed comparable pain reduction to gabapentin at the end of the 2-months study. Conclusion: Pregabalin 100 mg once daily brought better improvement of symptoms and signs than Gabapentin 300 mg administered once daily. The study found that Pregabalin is a better drug for the treatment of neuropathic pain than Gabapentin. Gabapentin had fewer adverse effects than Pregabalin.

Robot-assisted PFNA surgery improves clinical outcomes in the treatment of unstable femoral intertrochanteric fractures in elderly patients compared with traditional PFNA surgery

To assess the clinical outcomes of robot-assisted proximal femoral nail antirotation (PFNA) surgery in elderly patients with unstable femoral intertrochanteric fractures (UFIFs). 151 patients who underwent UFIF and PFNA surgery between January 2020 and May 2024 were analyzed retrospectively. Of these, 78 patients were treated with traditional PFNA surgery (control group), and 73 patients were treated with robot-assisted PFNA surgery (observation group). The observed indicators included visual analog pain scale (VAS) score, surgery time, PFNA operation time, tip-apex distance (TAD), intraoperative blood loss (IBL), perioperative hidden blood loss (PHBL), postoperative allogeneic blood transfusion rate (PABTR), hospital stay, time to first independent walking with crutches postoperatively, time to independent walking without crutches, and Harris hip function score (HHFS). There were no statistically significant differences in general condition between the two groups before surgery. Surgery time, PFNA operation time, IBL, PHBL, PABTR, TAD, hospital stay, time to first independent walking with crutches postoperatively, time to independent walking without crutches, VAS score, and HHFS were significantly improved in the observation group compared with the control group. Thus, compared with traditional PFNA surgery for UFIF in elderly patients, robot-assisted PFNA yields better outcomes in terms of the quality of PFNA surgery, surgical trauma, conserving clinical blood resources, and patient recovery.

Brazilian Portuguese Version of the Diagnostic Criteria for Temporomandibular Disorders Axis II: Translation, Cross-Cultural Adaptation and Measurement Properties.

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is a biaxial tool for TMD assessment. To implement a translated version in the Brazilian context, standardised adaptation and validation are necessary. To translate, adapt and verify the measurement properties of the DC/TMD Axis II instruments Pain Drawing (PD), Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS) and Oral Behaviours Checklist (OBC). The translation and cross-cultural adaptation processes of orofacial-related Axis II instruments followed the Guidelines for Establishing Cultural Equivalency. The validation research was carried out with 117 Brazilians with TMD, in two assessment days. Structural validity, internal consistency, test-retest reliability, measurement error, construct validity-hypothesis testing, and ceiling and floor effects were tested. PD showed substantial reliability (Kappa 0.63), and GCPS, JFLS and OBC showed excellent reliability over time (intraclass correlation coefficient > 0.85). The internal consistency was adequate for all instruments (Cronbach's alpha > 0.77) except for the functional activities domain of OBC (Cronbach's alpha = 0.48). Construct validity was good for all instruments (75% hypotheses confirmed), except for the OBC total score. Regarding parameters of structural validity, GCPS showed Goodness of Fit Index = 0.98 for the solution with two domains. JFLS and OBC presented Goodness of Fit Index < 0.90 for the solutions with three and two domains, respectively. The Brazilian Portuguese version of DC/TMD Axis II can be used in Brazil, but more studies are necessary to find an adequate structure for JFLS and OBC in a Brazilian sample.

Modified musculofascial lengthening technique for submuscular ulnar nerve transposition in cubital tunnel syndrome.

Cubital tunnel syndrome is a common peripheral neuropathy of the upper extremity. Anterior transposition of the ulnar nerve is an established surgical treatment option for this condition. This study aimed to introduce a novel musculofascial lengthening technique that uses only a portion of the flexor-pronator muscle mass for submuscular anterior transposition of the ulnar nerve and investigate its clinical outcomes. We evaluated 28 patients (29 cases; 1 patient had bilateral involvement) diagnosed with cubital tunnel syndrome who were treated with surgical decompression and submuscular anterior transposition of the ulnar nerve using our novel technique. Mean follow-up was 19.1 months (range, 12-31). Patient-reported outcomes were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and numeric rating scale (NRS) for pain. Objective outcomes including light touch perception, static two-point discrimination, and grip strength were also assessed. Modified Bishop score and postoperative complications were also evaluated. BCTQ symptom severity and functional status scores, DASH score, and NRS for pain score showed significant improvement after surgery. Light touch perception, static two-point discrimination, and grip strength also significantly improved after surgery. All patients showed excellent or good results according to the modified Bishop scoring system. No recurrence or complications occurred. Our novel musculofascial lengthening technique that uses only a portion of the flexor-pronator muscle mass for submuscular anterior transposition of the ulnar nerve reliably achieves good results with minimal complications in patients with cubital tunnel syndrome.