Pain Scale Research Articles

Effect of postoperative peripheral nerve blocks on the analgesia nociception index under propofol anesthesia: an observational study.

The analgesia nociception index (ANI), also referred to as the high frequency variability index (HFVI), is reported to be an objective measure of nociception. This study investigated changes in ANI after peripheral nerve blocks (PNB) under general anesthesia. Understanding these changes could enhance assessment of PNB efficacy before emergence from general anesthesia. This study enrolled 30 patients undergoing elective upper limb surgery. After surgery, median and maximum ANI values were recorded during two periods: a 5-minute period before PNB and a 20-minute period after PNB. The numeric rating scale (NRS) for pain was assessed twice: immediately after emergence from general anesthesia (N1) and the maximum pain experienced by the following morning after PNB effects subsided (N2). The difference in ANI before and after PNB was tested using the Wilcoxon signed-rank test. Statistical significance was set at P < 0.05. The ANI significantly increased after PNB in both the median (pre vs. post PNB value: 53.5 [44.0-68.0] vs. 59.0 [47.0-78.3], median [interquartile range]; P < 0.05) and maximum values (64.0 [56.3-79.5] vs. 74.5 [61.5-85.3]; P < 0.01). Secondary analysis revealed that significant ANI increases in both median (48.0 [42.3-66.5] vs. 61.0 [50.0-76.5]; P < 0.01) and maximum values (58.5 [50.3-75.3] vs. 76.0 [71.8-83.5]; P < 0.01) in the 18 cases with N2 ≥ 4 whereas no statistical differences were observed in the 12 cases with N2 < 4. The increased ANI value after PNB under propofol anesthesia may be a valuable indicator for assessing PNB efficacy. UMIN000050334. February 28, 2023.

P-1703. Evaluation of Antibiotic Use for Dental Infections in Dental Clinics Associated with an Academic Safety Net Institution

Abstract Background In 2019, the American Dental Association (ADA) issued guidance on diagnostic criteria and appropriate antibiotic regimens for dental pain and swelling. Limited data exists on adherence to these guidelines. This study aimed to evaluate adherence to these guidelines within outpatient dental clinics. Figure 1 A flowchart for assessing antibiotic indication, selection, dose and duration adapted from the 2019 American Dental Association (ADA) guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling Methods We electronically identified all antibiotic prescriptions written by dentists in seven outpatient dental clinics in Denver Health, an integrated academic safety net institution, from July 2022 to November 2023. Detailed medical record review was performed for 200 randomly selected patients who were prescribed an antibiotic to examine antibiotic indication, selection, dose, and duration. Assessment of whether the prescribed regimens adhered to guidelines was conducted using a flowchart adapted from the ADA guidance (Figure 1). Results Forty-nine dentists dispensed a total of 1,874 prescriptions at 114,231 clinic visits (1.6% of visits). In the 200 patients whose medical records were reviewed, common prescription indications were irreversible pulpitis (15.8%), pulp necrosis with apical abscess (14.3%), caries (14.3%), and concern for post-operative infection (12.8%). Pain was noted in 85.2% of cases, with a median pain scale score of six. Due to incomplete documentation, 46.9% of prescriptions were deemed as "indeterminate" for guideline-directed indication. Only 5.6% of the documented cases met full indication criteria for antibiotic use per ADA guidance. Antibiotic selection was consistent with ADA guidance in 81.6% of cases; amoxicillin was the most prescribed antibiotic (79% of cases), followed by clindamycin (9.5%) and amoxicillin-clavulanate (8%). Durations of therapy were longer than recommended in ADA guidance in 23% of cases. In total, only 3.1% of prescriptions adhered to ADA guideline-directed antibiotic indication, selection, dose, and duration. Conclusion An antibiotic was prescribed in &amp;lt; 2% of dental clinic visits; while this rate aligns with previous literature, there is opportunity to improve adherence to ADA guideline-directed therapy for dental infections. Evaluation of effective stewardship interventions reinforcing these guidelines is warranted. Disclosures All Authors: No reported disclosures

The impact of sleep interventions combined with enhanced nutritional support on sleep quality, nutritional status, pain management, psychological well-being, and quality of life in postoperative colon cancer patients

ObjectiveTo investigate the synergistic effects of combined sleep interventions and enhanced nutritional support on postoperative recovery in colon cancer patients, with a focus on sleep quality, nutritional status, pain management, psychological well-being, and quality of life.MethodsThis randomized controlled trial included 290 postoperative colon cancer patients admitted to the First Affiliated Hospital of Soochow University between May 2021 and May 2023. Participants were randomized into two groups: the intervention group, which received standard care supplemented with sleep and nutritional interventions, and the control group, which received standard care alone. Outcomes were assessed pre- and post-intervention, including the Pittsburgh Sleep Quality Index (PSQI), nutritional markers (serum albumin, prealbumin, body weight, etc.), Visual Analog Scale (VAS) for pain, Self-Rating Anxiety and Depression Scales (SAS, SDS), and EORTC QLQ-C30 quality of life scores.ResultsThe intervention group demonstrated significantly greater improvements across all assessed domains compared to the control group ( P < 0.005 after Bonferroni correction). Sleep quality (PSQI: 7.81 vs. 10.43, d = 0.81) and nutritional markers (e.g., prealbumin: 230.19 mg/L vs. 188.01 mg/L, d = 1.21 ) improved markedly. Similarly, reductions in pain (VAS: 2.65 vs. 5.19,d = 1.09 ), anxiety (SAS: 42.03 vs. 49.45, d = 0.88), and depression (SDS: 38.17 vs. 49.77,d = 1.02 ) were observed. Quality of life scores significantly increased in the intervention group compared to the control group (EORTC QLQ-C30: 99.29 vs. 88.41, d = 0.92).ConclusionThe combined intervention of sleep enhancement and nutritional support significantly accelerated postoperative recovery in colon cancer patients, demonstrating synergistic effects that improved physical, psychological, and quality-of-life outcomes. These findings underscore the value of integrating multifaceted interventions into standard postoperative care to optimize recovery trajectories and overall well-being.

User-friendliness of the pain assessment in impaired cognition (PAIC15) in persons with aphasia: a pilot study.

Persons with aphasia have difficulties communicating pain symptoms. Thirteen observers performed multiple observations using the Pain Assessment in Impaired Cognition (PAIC15) scale for persons with aphasia during rest and transfer in persons with aphasia. This pilot study examined the user-friendliness of PAIC15 and preference for type of self-report pain scales with a questionnaire. The PAIC15 was considered user-friendly for persons with aphasia: items were clear and not difficult to score. When self-report is possible, the combined scale with verbal, visual, and numerical elements is preferred for persons with aphasia. PAIC15 is a helpful instrument to aid clinical judgment and to screen for the presence of pain in persons with aphasia. There were mixed opinions, but most observers preferred to use the combined self-report scale for persons with aphasia.

The efficacy of manual therapy and therapeutic exercise for reducing chronic non-specific neck pain: A systematic review and meta-analysis

Background Chronic non-specific neck pain (CNSNP) is a highly prevalent musculoskeletal disorder associated with significant disability, resulting in growing recourse to healthcare providers, huge cost for society and a great number of workdays lost. Objective By this systematic review and metanalysis we aimed to assess the effects of different physical therapy techniques in patients with CNSNP. Methods PubMed, Scopus, and Web of Science databases were regularly used to search for articles published from 1st January 2010 until 31st January 2024. All RCTs were assessed for eligibility, including studies on: patients with diagnosis of CNSNP; physical therapy approaches such as manual therapy (MT) and therapeutic exercise (TE); waiting list, sham treatments, as comparison; Visual Analogue Scale, Numerical Rating Scale, Numerical Pain Rating Scale, and Numerical Pain Scale, as outcomes. Results At the end of the search, 14025 studies were identified. After the removal of duplicates, 10,852 were considered eligible according to title and abstract screening, while 10,557 papers were excluded after this process. Therefore; a total of 11 RCTs were included in this systematic review. A decrease of pain intensity was observed in all groups, albeit in patients being treated with TE and MT. Besides this, the combination of TE and MT demonstrated a 91% of probability to be the best choice in patients with CNSNP at the first visit. Only the combination of TE plus MT/cognitive behavioral therapy and MT as a single treatment showed a reduction in pain score. Overall, 3 studies (27.2%) showed a low risk of bias, 6 (54.5%) showed some concerns in bias assessment, and 2 (19%) a high risk of bias. Conclusion Collectively, the findings of this systematic review showed that MT and TE might be considered as effective rehabilitation approaches for treatment of pain in patients with CNSNP.

Cost-Effectiveness Analysis of Photobiomodulation After Third Molar Extraction for Pain Control

This study aims to evaluate the cost-effectiveness of photobiomodulation applied after third molar extraction. Materials and Methods: To evaluate cost-effectiveness, 15 studies were selected for a systematic review and 8 studies for a meta-analysis to determine the effectiveness of photobiomodulation after surgery. In the present study, as a measure of effectiveness, the pain scale (visual analog scale) was used. The laser value was extracted from the Unified Terminology of Supplementary Health (Brazilian Health System) according to the laser application protocol most common among the clinical trials selected for the meta-analysis. As for drugs, they were determined from those most used among the works included in the meta-analysis and within the protocols established by the Brazilian Ministry of Health. Results: The results of the overall analysis show a significant reduction in pain on the second day after surgery for the experimental group compared to the control (MD, −1.15; 95% CI, −1.73, −0.57). The control group has a lower cost and lower effectiveness, while laser treatment has a higher cost and higher effectiveness. Faced with this situation, the professional must clinically assess whether the cost of USD 34.62 for controlled pain intensity using the laser is worth the extra health benefit. Conclusions: Regarding the cost-effectiveness assessment, the control group has a lower cost and lower effectiveness, while laser treatment has a higher cost and higher effectiveness The decision of which treatment to choose must consider whether the cost of the therapeutic alternative outweighs the clinical gain caused by the treatment. Clinical Relevance: One of the most executed procedures in dentistry is the extraction of third molars. To reduce the negative post-surgical effects, anti-inflammatory drugs are prescribed, which can generate unwanted effects. Photobiomodulation is a technique to modulate inflammation, accelerate tissue repair, and reduce pain and discomfort in different clinical situations.

Differential effects of sound interventions tuned to 432 Hz or 443 Hz on cardiovascular parameters in cancer patients: a randomized cross-over trial

BackgroundThis study investigated whether a sound intervention tuned to 432 Hz (Hz) yields differential effects on cardiovascular parameters and psychological outcomes compared to 443 Hz, which is the concert pitch in German professional orchestras.MethodsUsing a randomized cross-over design, patients with cancer were recruited to receive both a 15-minute sound intervention with a body monochord tuned to 432–443 Hz. Before (pre) and after (post) intervention, cardiovascular parameters were measured using the VascAssist2.0. In addition, visual analogue scales (VAS) for emotional well-being, anxiety, stress, pain and sadness were also assessed pre and post intervention.Results43 patients (8 male, 35 female) with a median age of 61 years (range 35–86) were included. Both interventions led to a significant reduction in heart rate with a more pronounced effect for 432 Hz (median reduction − 3 bpm (432 Hz) vs. median reduction − 1 bpm (443 Hz), p = 0.04). While heart rate variability was increased exclusively by 432 Hz (median increase + 3 ms, p = 0.01), both vascular resistance (median reduction − 5%, p = 0.008) and stiffness (median reduction %, p = 0.04) were significantly reduced by 432 Hz, which was not observed at 443 Hz. Nevertheless, these effects were not significantly different compared to 443 Hz. On the other hand, 432 Hz led to a reduced pulse wave velocity (median reduction − 0.5 m/s, p < 0.001), which was also significantly different compared to 443 Hz (p < 0.001). Improvement in VAS was observed for both groups, with significant increases in emotional well-being and reduction in fatigue, anxiety and stress for both intervention timepoints, although the majority showed no increased VAS scores even before the intervention (median values 0 for anxiety and stress).ConclusionSound interventions tuned to 432–443 Hz exert both positive effects in cancer patients. While psychological outcomes are improved by both interventions, 432 Hz leads to a more pronounced but not significantly different effect to 443 Hz on objective cardiovascular parameters, which reflect deeper relaxation.

Arthroscopic Microdrilling for Full-thickness Trochlear Cartilage Defects in Patients Undergoing High Tibial Osteotomy Confers Improved Cartilage Status at 1 year and Rate of Minimal Clinically Important Difference at Short-term Follow-up.

To compare the patient-reported outcome improvements and cartilage status of trochlear cartilage defects (TCDs) after additional arthroscopic microdrilling versus no treatment for TCDs during medial open-wedge high tibial osteotomy(MOWHTO) METHODS: Patients who underwent MOWHTO with either microdrilling (Group M) or no treatment (Group N) for near full-thickness TCDs (International Cartilage Repair Society[ICRS] grade≥3B) from March 2010 to September 2022 were retrospectively reviewed, with a minimum 2-year follow-up. 1:1 Propensity score matched-Group N was created. Comparative analyses were conducted using patient-reported outcomes(PROs) and minimal clinically important difference (MCID). Trochlear cartilage status was visually assessed via second-look arthroscopy 1 year postoperatively and categorized as deteriorated, maintained, or improved. Overall, 30 for group M and 84 patients for group N were included. The mean follow-up period of the matched groups was 32.8 and 32.0 months for groups M and N. The preoperative and postoperative radiographic parameters did not differ between the groups (Kellgren-Lawrence grade, pre- and postoperative alignment, medial proximal tibia angle). Both groups achieved significant clinical improvement in patients with medial compartment osteoarthritis and combined full-thickness TCD (p<0.001). PROs and improved PROs at final follow-up were not significantly different between groups, except for the Final Kujala anterior knee pain scale (70.4 [95% CI: 66.0-74.8] vs. 59.8 [95% CI: 53.0-67.6], p=0.018). MCID achievement rates in pain visual analogue scale (VAS), Knee injury and Osteoarthritis Outcome Scores (KOOS)-Pain, and KOOS-activity of daily living (ADL) were significantly higher in group M compared to group N (VAS, 93.3% vs. 63.3%, p=0.005; KOOS-Pain, 96.7% vs. 80.0%, p=0.044; KOOS-ADL, 86.7% vs. 63.3%, p=0.037). A significantly larger proportion of patients in group M demonstrated improvement in their TCD status compared to those in group N (93.1% vs. 44.8%, p<0.001). Arthroscopic microdrilling for near full-thickness TCD during MOWHTO improved trochlear cartilage status at 1 year but did not enhance final PROs at short-term follow-up, though it increased MCID achievement rates in some PROs (VAS, KOOS pain, KOOS ADL) compared to untreated patients. Level III, therapeutic retrospective cohort study.

Use of peri-incisional liposomal bupivacaine was not different than placebo regarding pain score or rescue analgesia in a randomized clinical trial of 83 dogs.

To evaluate the impact of peri-incisional liposomal bupivacaine (LB) on postoperative pain scores, opioid use after soft tissue surgeries, and incidence of incision site complications in dogs. Client-owned dogs (n = 83) were enrolled in a randomized, blinded, placebo-controlled clinical study for dogs undergoing a variety of soft tissue surgical procedures between March 31, 2021, and August 18, 2022. After incision closure, an injection of a placebo (0.9% NaCl) or LB was administered into the peri-incisional subcutaneous tissues. Pain was assessed via the Glasgow Composite Measure Pain Scale (CMPS-SF) preoperatively, at extubation, and at 2, 4, 8, 12, 24, 30, 36, 48, 54, 60, and 72 hours postoperatively or until time of discharge. The need for rescue analgesia was assessed based on CMPS-SF guidelines. The effect of LB on pain scores was analyzed with mixed-model linear regression, and the χ2 test was used to examine effects on incision complications and need for rescue analgesia. 83 dogs were enrolled. There was no significant difference in CMPS-SF scores between LB and placebo groups at any time period. Rescue analgesia was administered to 21 dogs in each group and was not significantly different. There was no significant difference in incision site complications. The incidence of surgical site infections was 6.0% for all procedures. Peri-incisional LB did not significantly decrease the use of rescue analgesia for postoperative soft tissue surgeries in a clinical setting with the use of multimodal analgesia. This is consistent with findings in human literature. Clinicians should not rely on LB used in the peri-incisional subcutaneous tissue to improve analgesia in patients undergoing soft tissue surgery.

Pain in very preterm infants-prevalence, causes, assessment, and treatment. A nationwide cohort study.

Studies on pain in preterm infants have usually been confined to observations of painful procedures, and information from extremely preterm infants is limited. Using registry data from a Swedish nationwide cohort, this study explored the epidemiology of pain in very preterm infants, its causes, assessments, and treatment strategies. We included liveborn infants <32 weeks' gestational age (GA) discharged between January 2020 and June 2024. Proportions of infants exposed to potentially painful procedures, experiencing pain, assessed with pain scales, and receiving pharmacological treatment were calculated by each postnatal day. Among 3686 infants (mean birthweight 1176 g, GA 28.2 weeks), 11.6% had a painful condition and 84.1% were exposed to at least 1 potentially painful procedure. In total, 74.6% experienced pain, corresponding to 28,137/185,008 (15.2%) days of neonatal care. For every 2-week increase in GA, significantly lower proportions of infants experienced pain. In infants <28 weeks of GA, proportions with reported pain were approximately half the rate of painful procedures, while in infants born at 28 to 31 weeks, reported pain closely matched exposure to painful procedures. Pain scales were used in 75.0% of the infants. Pharmacological pain treatment was administered to 81.7% of infants, primarily topically or orally. Among infants with pain, proportions treated intravenously were larger at higher GAs. Despite effective analgesia/anesthesia, many very preterm infants experience pain. Visualizing pain epidemiology, procedures, conditions, and treatment by postnatal and gestational age may guide clinical management and generate research hypotheses to reduce short- and long-term adverse effects.

Assessing the effectiveness of the SOLIO Alfa Cure Plus device in treating low back pain: a randomized controlled study

BackgroundNonspecific low back pain (LBP) has become a significant worldwide public health problem. It is estimated that 84% of people present it at some point in their lives, in which 23% experience its chronic form, negatively affecting their daily lives. Because pain management tool that doesn’t require a firm diagnosis, the development of a device, as SOLIO Alfa Cure Plus, that emanates low level laser therapy, radio frequency and heat with the goal of easing chronic back pain was highly expected.Methodsrandomized, single blinded, controlled trial. Measures: Numeric Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI) and the Schober’s test. Thirty-seven patients completed pain, disability, and lower back flexibility scales. Randomization was obtained by having an equal amount of sham and real devices and distributing them randomly to patients out of a box where the devices were.ResultsWe observed a larger pain relief in the SOLIO group (42% vs. 23% p = 0.03), and a higher improvement in flexibility (13%) compared to a worsening in the sham group (6.5%; p = 0.04).ConclusionWe concluded that utilizing the SOLIO Alfa Cure Plus device may dramatically reduce back pain and allow patients to experience an improvement in quality of life as a result. Trial registration: The clinical trials registration is 8475-21-SMC.

Association between Physical Therapists' Attitudes and Beliefs and the Functional Outcomes of Patients with Low Back Pain: A Multilevel Analysis Study.

This study aimed to investigate the association of physical therapists' attitudes and beliefs about low back pain treatment outcomes within a publicly funded health care system. Data from a national outpatient physical therapist service provider were analyzed. Functional status data were collected at intake and discharge. The Attitudes to Back Pain Scale in Musculoskeletal Practitioners Questionnaire was used to assess physical therapists' attitudes. Multilevel regression models were employed to examine the effects of physical therapists' attitudes while controlling for patient and physical therapist characteristics. The study included 68 physical therapists and 1043 patients. The physical therapist level explained a small portion of the variance in patients' function (2%-4%). A more biomedically oriented attitude was associated with a slightly lower patient function level (β = -.08), but patient characteristics largely influenced this effect. Other attitude factors were not significantly associated with function. Sensitivity analyses aligned with the main findings. The study suggests that physical therapists' attitudes have a limited impact on low back pain treatment outcomes within a publicly funded health care system. While a more biomedically oriented attitude was associated with slight negative effects, the clinical relevance is questionable. Further research in diverse settings is needed to validate and contextualize these findings. The study underscores the importance of considering patient-level factors and health care system context in interpreting practitioner effects on treatment outcomes. Patient characteristics are more significant in explaining functional outcomes than physical therapists' characteristics and attitudes. A marginally small association was observed, indicating that a more biomedically oriented attitude among physical therapists was linked to slightly lower patient functioning. Despite the observed association, the clinical relevance of physical therapists' attitudes in low back pain treatment outcomes remains modest.

Outcomes of Osteosynthesis of Os Subfibulare for Chronic Lateral Ankle Instability With Large Os Subfibulare.

Os subfibulare (OS) is commonly found in patients with chronic lateral ankle instability (CLAI). When performing lateral ligament reconstruction for CLAI, excision of a large OS can cause substantial lateral ligament defects making anatomic repair challenging. This study analyzed clinical and radiologic outcomes among patients who underwent osteosynthesis of the OS for chronic lateral ankle instability and a large OS. 28 ankles with CLAI and a large OS (≥10 mm) that underwent osteosynthesis of the OS between June 2007 and July 2021 were included in the study and followed for ≥24 months. Visual analog scale (VAS) for pain, Karlsson-Peterson ankle score, and Medical Outcomes Study Short Form Health Survey-36 physical component summary (SF-36 PCS), talar tilt angle, and anterior displacement of the talus were used to assess clinical and radiologic outcomes. All reoperations and complications were also evaluated. The mean OS size was 15.4 mm (range, 12.2-21.0 mm). The mean follow-up period was 78.9 months (range, 24.0-177.0 months). Mean VAS score, Karlsson-Peterson ankle score, SF-36 PCS, talar tilt angle, and anterior displacement of the talus all improved significantly, from preoperative values of 5.3 ± 1.8, 38.4 ± 10.6, 45.6 ± 10.8 points, 11.1 ± 5.7 degrees, and 7.3 ± 1.9 mm, to 0.9 ± 1.4, 88.7 ± 12.6, 80.2 ± 12.3 points, 3.9 ± 2.0 degrees, and 4.8 ± 1.3 mm, respectively, by the last follow-up. The overall complication rate was 10.7% (3 ankles); the reoperation rate was 7.1% (2 ankles). Osteosynthesis of the OS produced satisfactory outcomes in patients with CLAI and a large OS. This method may be a viable surgical option for patients with this condition.

Comparative approach for abdominal wall reconstruction after ventral hernia: open versus minimally invasive surgery.

The classic open ventral hernia repair provides excellent results in recurrences. However, wound complications are the Achilles heel for a good overall clinical outcome. Laparoscopic surgery is in general associated with less pain, better esthetic results, faster recovery, and lower incidence of wound complications. Robotic procedures provide increased degrees of freedom, may improve ergonomics, and allow scaling and performance of finer movements deemed difficult through alternate surgical approaches. The aim of this study is to compare outcomes between open and minimally invasive approaches, with the primary objective of determining differences in postoperative course and hospitalization. Patients underwent any of the three procedures: open Rives-Stoppa, laparoscopic eTEP or robotic eTEP between June 2020 and January 2024 for the treatment of one or more midline abdominal wall hernias alongside rectus abdominis diástasis. The width diameter of the hernias was between 3 and 10cm and techniques that did not place the mesh in a retromuscular position or required component separation are excluded. Robotic surgery had a lower score on the visual analogue scale for pain at discharge (p-value < 0.00). Minimally invasive surgery allows for the placement of larger meshes compared to the open approach (p < 0.05), although the surgical time is longer (p-value < 0.00). There were no statistically significant differences for hospital stay (p-value = 0.46), complications (p-value = 0.52) or recurrence (p-value = 0.70). Minimally invasive surgery allows for the placement of larger meshes compared to the open approach without increasing the morbidity of the procedure or the immediate postoperative pain, despite generally having longer operative times.

Comparison of Tibiofemoral and Patellofemoral Mobilization in Improving Pain, Rom and Functional Disability in Patellofemoral Pain Syndrome

Patellofemoral pain syndrome significantly impacts daily activities in adults. Physical therapy, including targeted exercises and both patellofemoral and tibiofemoral mobilization techniques, is a primary treatment approach for managing this condition.This study aimed to compare the effects of tibiofemoral and patellofemoral mobilization on pain, range of motion (ROM), and functional disability in patients with patellofemoral pain syndrome.A randomized controlled trial was conducted on 68 participants (n=34) at the Physiotherapy Department of Doctors Clinic, Samnabad, Lahore. The patients were randomly assigned into two groups: Group A received conventional treatment along with patellofemoral mobilization, while Group B received conventional treatment combined with tibiofemoral mobilization. The study spanned six months, with assessments conducted prior to treatment and weekly thereafter. Numeric Pain Rating Scale (NPRS) for pain, a goniometer for knee range of motion, and the Kujala scoring system for functional status used for assessment. The study results demonstrated significant improvements in NPRS scores, range of motion, and Kujala scores in both groups, with a p-value of 0.000. However, a comparison between the groups confirmed that conventional physiotherapy combined with patellofemoral mobilization yielded superior outcomes in reducing pain, improving range of motion, and enhancing functional status compared to tibiofemoral mobilization, with a p-value of &lt;0.05.The study concluded that patellofemoral mobilization, when combined with conventional physiotherapy, is an effective approach for reducing pain, improving range of motion, and enhancing functional status in individuals with patellofemoral pain syndrome.

Postoperative Pain Following Vital Pulp Therapy in Carious Permanent Teeth of Children and Adolescents: A Prospective Cohort Study.

Vital pulp therapy (VPT) is one of the treatments recommended for vital deep carious permanent molars. However, postoperative pain remains underexplored in children and adolescents who have undergone VPT. This study investigated the incidence, intensity, duration, temporal pattern, and analgesic intake of postoperative pain following VPT in children and adolescents. Additionally, factors associated with postoperative pain incidence were explored. A prospective cohort study was conducted in 159 patients aged 6-18 years, involving 174 VPT-treated teeth. Pain intensity, measured with the Wong-Baker FACES Pain Scale (WBFPS), and analgesic intake were recorded daily for 7 days post treatment. Over the 7-day period, 40.23% of patients experienced postoperative pain. Mean pain intensity decreased from 3.43 ± 1.96 on Day 1 to 1.26 ± 1.71 on Day 2. About 52.86% of patients were pain-free between Days 1 and 2, and over 97% were pain-free by Day 7. Analgesics were taken by 25.86% of patients. Compared with the protective liners group, the more invasive types of VPT were associated with higher odds of pain. Postoperative pain following VPT was common; however, it was mild, controllable with analgesics, and resolved in most patients. The more invasive VPT types were linked to an increased incidence of pain.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison

Background: Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. Purpose: To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. Results: A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: –4.6 ± 2.7 vs −3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. Conclusion: After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Characterizing Parkinson's Disease-Associated Pain in Native Patients with Malayalam Version of the King's Parkinson's Disease Pain Scale.

Pain is an important non-motor symptom in Parkinson's disease (PD) and is often under-recognized. Pain is also a symptom frequently reported by non-PD elderly subjects. The King's Parkinson's Disease Pain Scale (KPPS) is a valid tool to characterize and quantify pain in PD and has been translated into several languages. We translated KPPS to Malayalam for native patients with PD and examined the pain characteristics in consecutive patients. Correlations with comprehensive disease-specific rating scales, including the Movement Disorder Society-Sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS), were explored. A group of age- and gender-matched subjects without PD were interviewed using KPPS to examine how the pain reported by the non-PD aging population is different from that in PD. In this study, 82% of patients with PD reported at least one type of pain, compared to 31.3% of age- and gender-matched control subjects (P < 0.001). KPPS total scores (18.2 ± 14.0 vs. 1.8 ± 3.2; P < 0.001) and all the individual domain scores were significantly higher in patients. Pain scores correlated with age in control subjects (R = 0.46, P < 0.001), but not in patients; females reported more pain in both groups. Patients' pain scores were higher in the postural instability and gait difficulty subtype and showed significant correlations with MDS-UPDRS and NMSS scores. Pain is a prevalent symptom in PD and differs from the pain reported by a non-PD aging population. The Malayalam version of KPPS is a valid tool to characterize pain in native, Malayalam-speaking patients.

Clinical and radiographic comparison of robot-assisted single-position versus traditional dual-position lateral lumbar interbody fusion.

The potential of robot-assisted (RA) single-position (SP) lateral lumbar interbody fusion (LLIF) warrants further investigation. This study aimed to assess the efficacy of RA-SP-LLIF in improving both clinical and radiographic outcomes in patients undergoing lumbar spinal fusion surgery. A total of 59 patients underwent either RA-SP-LLIF (n = 31 cases) or traditional LLIF (n = 28 cases). Surgical parameters including operative duration, estimated blood loss, and fluoroscopy duration were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 36-item Short-Form Health Survey (SF-36). Radiographic parameters were also evaluated. There were no significant differences between the two groups in terms of postoperative and last follow-up times, but both groups demonstrated significant improvements in VAS scores. Similarly, ODI and SF-36 scores showed comparable improvements. Radiographic parameters did not significantly differ between the groups preoperatively, postoperatively, and at last follow-up (p > 0.05). Neither group showed significant improvements in pelvic tilt and sacral slope parameters compared to baseline postoperatively and at last follow-up (p > 0.05). However, the RA-SP-LLIF group exhibited significantly greater improvements in lumbar lordosis (LL; p < 0.01), segmental lordosis (SL; p < 0.01), and pelvic incidence-LL mismatch (PI-LL; p < 0.01) immediately postoperatively compared to baseline, although these differences were not significant at subsequent evaluations. Similarly, the traditional LLIF group improved the LL, SL, and PI-LL parameters postoperatively. Importantly, there was no statistically significant difference in the Bridwell grade and complications between the two groups (p = 0.83 and p = 0.88, respectively). However, the RA-SP-LLIF group had significantly shorter operative and fluoroscopy durations compared to the traditional LLIF group (p = 0.04 and p < 0.01, respectively). Both RA-SP-LLIF and traditional LLIF surgeries achieved satisfactory lordotic correction. However, RA-SP-LLIF surgery demonstrated shorter operative and fluoroscopy times compared to traditional LLIF surgery. Therefore, RA-SP-LLIF is a promising technique for enhancing surgical efficiency, safety, and precision in lumbar spinal fusion procedures.

Mid- to Long-Term Outcomes of Two-Stage Revision Arthroplasty for Periprosthetic Joint Infection of the Shoulder.

Background/Objectives: Periprosthetic joint infection (PJI) after shoulder arthroplasty is often treated with a two-stage approach, but the data on the mid- to long-term outcomes remain scarce. This study aimed to evaluate the clinical outcomes of two-stage revision arthroplasty for shoulder PJI with a minimum follow-up of five years. Methods: This retrospective study identified 59 shoulders in 58 patients who underwent the first stage of a two-stage revision arthroplasty for shoulder PJI at our institution between 2007 and 2018. Of these, 29 shoulders in 29 patients (49.2%) did not undergo reimplantation or the patient passed away before reaching five years of follow-up. The remaining 30 shoulders in 29 patients were included in the study. The clinical assessments included the active range of motion, the visual analogue scale (VAS) for pain, the Subjective Shoulder Value (SSV), the Constant Score (CS), and the 12-Item Short Form Survey (SF-12), supplemented by detailed clinical and radiological evaluations. Results: The mean age of the 29 patients was 75.9 ± 10.4 years. The average follow-up duration was 8.3 ± 2.8 years. The most common indications for primary shoulder arthroplasty were primary osteoarthritis (n = 12, 40%) and fractures (n = 12, 40%). At the first stage, nine cases (30%) showed negative cultures, while C. acnes and S. epidermidis were each identified in eight cases (26.7%). Four shoulders (13.3%) experienced recurrent infections. At the follow-up, the mean abduction was 86 ± 48.1°, the mean forward flexion was 97.8 ± 50.1°, the mean external rotation was 20.5 ± 19.9°, and the internal rotation reached the lumbosacral region. The mean VAS pain score was 1.5 ± 2.1, the mean SSV was 51.8 ± 28.4%, the mean CS was 54.6 ± 21.0, and the mean SF-12 was 81.0 ± 16.0. Conclusions: Two-stage revision arthroplasty for shoulder PJI results in satisfactory subjective and objective outcomes, with a low overall reinfection rate. However, the high rates of mortality and failure to reimplant must be carefully considered when managing expectations in this challenging cohort.