Pain Scores Research Articles

Palmitoylethanolamide (Levagen+) for acute menstrual pain: a randomized, crossover, double-blind, placebo-controlled trial

ABSTRACT Palmitoylethanolamide (PEA) is a well-tolerated compound effective in reducing pain. This randomized, double-blind, placebo-controlled crossover study investigated PEA for menstrual pain relief. Conducted in Australia from May to December 2023, the study included adults over 18. Participants consumed 300 mg of PEA or a placebo at menstrual pain onset. Pain scores were recorded on the numerical pain rating scale (NRS) every 30 minutes for up to 4 hours. If pain persisted, a second dose was permitted after 2-hours. The primary outcome measure was the reduction in acute menstrual pain scores from the NRS. Secondary outcome measures included the Treatment Satisfaction Questionnaire for Medication, rescue medication use and adverse events. Pain scores were analyzed using repeated measures analysis of variance. PEA resulted in a significant reduction in pain scores at 1 (p = .045), 1.5 (p = .009), 2 (p = .015) and 2.5 (p = .039) hours post dosage compared to placebo. No difference was seen for the Treatment Satisfaction Questionnaire for Medication, rescue medication used, or adverse events. This study demonstrates PEA supplementation is a safe and effective option for reducing menstrual pain compared to a placebo, with significant pain reduction observed at multiple time points post-dosage.

Effects of balanced opioid-free anesthesia on post-operative nausea and vomiting in patients undergoing video-assisted thoracic surgery: a randomized trial

ObjectivesPostoperative nausea and vomiting (PONV) is common after video-assisted thoracic surgery, which may be associated with the use of intraoperative opioids. We tested the hypothesis that balanced opioid-free anesthesia (OFA) might reduce the incidence of PONV after video-assisted thoracic surgery.MethodsOne hundred and sixty-eight adults undergoing video-assisted thoracic assisted surgery were randomly assigned to receive balanced opioid-free anesthesia or balanced opioid-based anesthesia (OBA). The primary outcome was the incidence of PONV, which was assessed with the Myles’s simplified PONV impact scale during the initial 24 h after surgery.ResultsCompared with OBA group, the overall incidence of PONV in OFA group was significant reduced (14.6% vs. 30.1%, P = 0.017), and OFA reduced the risk of PONV events within 24 h of surgery (HR, 0.44; 95%CI: 0.22–0.87, P = 0.018). The incidence of other postoperative complications in OFA group was lower than that in OBA group (19.5% vs. 33.7%, P = 0.039). The quality of recovery, distance of 6-minute walk test, pain scores, and 36-item short form survey were comparable at each time points.ConclusionIn patients undergoing video-assisted thoracic surgery, the use of balanced OFA anesthesia can help reduce the incidence of PONV events. This anesthetic regimen has shown good feasibility without significantly increasing the patient’s pain score and complications.Clinical trial registration numberClinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022.

Assessment of oral health-related quality of life and oral side effects of radioactive iodine therapy

ObjectivesTo evaluate the impact of oral health problems on oral health-related quality of life (OHRQoL) among female patients received Radioactive iodine (131I) therapy.Materials and methodsThis unmatched case-control study was conducted on 40 female patients (20 cancer free controls and 20 patients treated with 131I therapy). Data were collected via clinical examination, self reported questionnaire including the Oral Health Impact Profile-14 (OHIP-14), salivary tests, socio-demographic and behavioural characteristics. Data were analyzed using descriptive, bivariate and multivariate statistics.ResultsThere were significant differences in the total number of decayed, missing and filled surfaces, stimulated and unstimulated salivary flow rates, and periodontal indices between the study and control groups in the unadjusted analysis. Age adjusted analysis revealed significant differences in the stimulated and unstimulated salivary flow rates, periodontal indices, physical pain domain scores between groups. No significant differences were observed between groups in the xerostomia severity and OHRQoL. In study group, the score for the OHIP-14 psychological discomfort domain was negatively correlated with both stimulated and unstimulated salivary flow rates. The total OHIP-14 score and its domain scores of physical pain and psychological disability were correlated positively with the severity of xerostomia, but negatively correlated with number of the repeated 131I therapy.ConclusionsDue to xerostomia, patients reported worse OHRQoL in the domains of physical pain, psychological discomfort and disability. They had worse periodontal status and tooth brushing habits than healthy controls.Clinical relevanceThe findings of this study may provide a valuable insight on the oral health problems and needs of target group when planning a a team-based care.

The Effect of Three Different Sensory Interventions (Mother's Voice, Mother's Milk, and Mother's Holding) During Heel Lance on Pain Level in Term Newborns: A Randomized Controlled Trial.

Background: Pain management is an important issue in newborns. This study aimed to compare the effects of three different sensory interventions (mother's voice [hearing], mother's milk smell [smell], and mother's holding [touch]) during heel lance on pain levels in term newborns. Methods: In this randomized controlled trial, 120 term newborns included in the study were divided into four groups. Pain scores were assessed with Neonatal Infant Pain Scale during and after the procedure. Results: When compared in terms of interventions, newborns in mother's voice and mother's holding groups showed statistically significantly less pain response during the procedure compared with the control group (p = 0.005). But no significance was found in terms of mother's milk smell. Conclusion: In conclusion, mother's holding and mother's voice are effective methods to reduce pain during heel prick procedure in newborns. In addition, both maternal smell and maternal touch may have had an effect in the mother's holding group. Nevertheless, future studies with different designs on the effect of breast milk smell are recommended. (Trial registration: https://clinicaltrials.gov/study/NCT05526378.).

Ultrasound-guided bilateral Erector Spinae Plane Block (ESPB) for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled trial

Background Laparoscopic cholecystectomy is a commonly performed procedure with significant postoperative pain, leading to potential complications such as delayed recovery and opioid-related side effects. Regional anesthesia, particularly the Erector Spinae Plane Block (ESPB), has shown promise in improving postoperative analgesia. This study investigates the effectiveness of ultrasound-guided bilateral ESPB for pain management in LC, compared to standard multimodal analgesia. Materials and methods This double-blind randomized controlled trial included 48 patients undergoing LC at a tertiary hospital between June 2022 and June 2023. Patients were randomly assigned to two groups: 24 received ultrasound-guided bilateral ESPB with 0.25% ropivacaine, and 24 received standard multimodal analgesia. Statistical analysis was conducted using t-tests, ANOVA, and chi-square tests, with a p-value of less than 0.05 considered significant. Results The ESPB group experienced significantly prolonged analgesia, with a mean time to rescue analgesia of 11.2 hours compared to 0.5 hours in the control group (p < 0.001). Pain scores were consistently lower in the ESPB group for the first 6 hours postoperatively. Additionally, total tramadol consumption in the ESPB group was significantly reduced (172.92 mg vs. 245.83 mg, p < 0.001). Patient satisfaction was higher in the ESPB group. Conclusion Ultrasound-guided bilateral ESPB significantly enhances postoperative pain management in Laparoscopic Cholecystectomy, reducing both pain intensity and opioid consumption. It represents a safer alternative to opioid-based analgesia, improving recovery and patient outcomes.

Effects of the length of preoperative conservative management on postoperative outcomes after primary microvascular decompression for trigeminal neuralgia.

Although trigeminal neuralgia (TN) is initially managed conservatively, approximately half of all patients will eventually undergo surgery. Despite this outcome, there is limited understanding of the relationship between preoperative length of conservative management and pain outcomes after microvascular decompression (MVD). In this study, the authors aimed to describe the relationship between the duration of preoperative conservative management and postoperative outcomes in patients undergoing MVD for TN. The electronic medical records of 381 patients with TN who underwent primary MVD at the authors' institution between 2007 and 2023 were reviewed. Patients were dichotomized based on whether the duration of conservative management, defined as the duration of anticonvulsant use, was greater than, or less than or equal to, the median duration of conservative management for the entire cohort. For adjusted analysis, duration of conservative management was also assessed as a continuous variable. Demographic information, comorbidities, clinical TN characteristics, pain recurrence, and pre- and postoperative modified Barrow Neurological Institute (BNI) pain and numbness scale scores were recorded and compared between groups. Differences in pain outcomes were assessed via multivariate ordinal regression, Kaplan-Meier analysis, and Cox proportional hazards analysis. The median preoperative duration of conservative management was 1.74 years. Patients with a prolonged duration of conservative management were significantly more likely to be male (p = 0.028) and less likely to preoperatively use opioids (p = 0.037). At final follow-up, those with a prolonged duration of conservative management had significantly higher reported BNI pain scores (p = 0.021) and higher rates of pain recurrence (p = 0.021). On multivariable ordinal regression analysis, younger age (p < 0.001) and prolonged duration of conservative management, which was assessed as both a dichotomized (p = 0.002) and continuous variable (p = 0.011), were associated with higher BNI pain scores at final follow-up. Patients with a longer duration of conservative management also had a significantly shorter time to pain recurrence, as assessed by Kaplan-Meier survival analysis (p = 0.0037) as well as Cox proportional hazards analysis (p = 0.001, dichotomized; p = 0.008, continuous). In the setting of primary MVD for patients with TN, a longer duration of preoperative conservative management was associated with higher postoperative BNI pain scores and increased risk of pain recurrence. These findings suggest a potential beneficial role for early surgical intervention.

The effect of nursing care provided to coronary intensive care patients according to their circadian rhythms on sleep quality, pain, anxiety, and delirium: a randomised controlled trial

AimThis study carried out to examine the effects of nursing care given to coronary intensive care patients according to their circadian rhythms on sleep quality, pain, anxiety, and delirium.Study DesignThis study was designed as a randomised controlled, clinical investigation. The study population consisted of patients treated in the coronary care unit of a training and research hospital between September 2022 and February 2023. Total of 44 participants were included. The included participants were followed up for 3 days in the coronary intensive care unit. Data were collected using “Patient Information Form, Sleep Quality Scale in Coronary Intensive Care Patients (SQ-CC), Visual Analogue Scale (VAS), Morningness-Eveningness Questionnaire (MEQ), Hospital Anxiety and Depression Scale (HADS), Intensive Care Delirium Screening Checklist (ICDSC).” In addition, melatonin and cortisol measurements were made, and sleep data were taken with a smartwatch. Patients with intermediate chronotype, delirium, on ventilator support, or using sedative drugs were excluded. The chronotypes of the participants were determined, and the patients in the intervention group were given nursing care by their circadian rhythms. No intervention was made to the control group, and their routine care was continued in accordance with intensive care unit functioning. Frequency distribution, dependent and independent sample t-test, Wilcoxon test, repeated measures analysis of variance, Mann Whitney U, and chi-square analysis were used to evaluate the data. The study has been registered in ClinicalTrials.gov (Identifiers: NCT04934436). During statistical analysis, the groups were coded as Group A and Group B, ensuring blinding for the statistician.ResultsThe intervention group’s sleep quality increased compared to the control group (post-test SQ-CC total scores: intervention group 22.41 ± 6.67 vs. control group 50.45 ± 10.63, p < 0.001). Although no significant difference was found between the groups as a result of the study, there was a significant decrease in the pain score in the intervention group (VAS pre-test: 1.55 ± 2.15, post-test: 0.68 ± 2.21, p = 0.036). The anxiety of the intervention group decreased significantly compared to the control group (post-test HADS-Anxiety scores: intervention group 3.18 ± 3.29 vs. control group 8.50 ± 5.66, p = 0.001). The post-test delirium score was higher in the control group compared to the intervention group (post-test ICDSC scores: intervention group 0.32 ± 0.48 vs. control group 1.18 ± 0.50, p < 0.001). Melatonin increased and cortisol decreased in both groups without statistically significant differences between them (melatonin and cortisol levels: p > 0.05). Considering the sound levels in the environment, the first-night decibel mean was significantly higher in the intervention group than in the control group (first-night decibel mean: intervention group 56.58 ± 2.43 dB vs. control group 54.51 ± 2.41 dB, p < 0.05). Finally, the smartwatch data show no significant difference in sleep times between groups (p < 0.05), but the intervention group had more deep and total sleep, while the control group had less deep sleep.ConclusionsNursing care given in accordance with the circadian rhythm increases sleep quality and reduces the risk of delirium and anxiety in patients followed up with acute coronary syndrome in the coronary intensive care unit.

Effectiveness of intravenous lidocaine in treatment of burn pain: a systematic review and meta-analysis of randomised controlled trials

Background: Burns are among the most agonizing injuries encountered in the clinical setting. Protocols for effective management of burn pain vary and mostly rely on opioids, a drug class well-known for dependence and adverse effects from misuse. Lidocaine, the most commonly used local anesthetic has shown potential to reduce the amount of opioids required. This study aims to assess the effectiveness of lidocaine infusion in reducing opioid use in patients with burn injuries. Materials and methods: This systematic review was conducted according to PRISMA guidelines. A comprehensive search of the electronic databases was carried out using the keywords “lidocaine,” “lignocaine,” “xylocaine,” “burn,” and “analgesia.” Eligible studies were randomised control trials (RCTs) from peer-reviewed journals or registries. Two independent reviewers conducted the screening. The Cochrane ROB-2 Tool was used to assess the quality of the included studies. Meta-analysis was conducted using Revman software. Results: We included four RCTs with 152 burn patients with total body surface area (TBSA) burned ranged from 3% to 68%. Morphine use had a standardized mean difference (SMD) of −0.47 [−1.18 to 0.24], which was not significant (p = 0.19). The changes in pain score weren’t significant (SMD = − 0.01, CI = [−0.37; 0.34], p = 0.94). Nausea had RR of 1.06 (CI = [0.80; 1.40], p = 0.700). No serious adverse event was reported. Conclusion: Our findings were inconclusive about the safety and effectiveness of lidocaine as an adjunct in the analgesia of burns and reducing the required opioid dosage. Large-scale clinical trials are needed.

Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane vs Epidural Catheter: A Retrospective Cohort Analysis.

Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental hip dysplasia. Epidural analgesia is traditionally used for perioperative pain management but may have negative secondary effects, including distal motor and sensory deficits, and hypotension which delays rehabilitation and prolongs discharge. One alternative is Erector Spinae Plane Block (ESPB), an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, ESPB use during PAO has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of ESPB compared to epidural analgesia for PAO pain control. Patients at a single site received preoperative epidural (n=73) or ESPB (n=73) for PAO pain management. Data including pain scores, morphine equivalents, complications, and discharge details was retrospectively reviewed. Welch's t test, Glass' Delta, and Fisher exact tests were utilized, with an alpha level of 0.05 to indicate statistical significance. There were no significant differences in patient populations, catheter use duration, or length of stay between groups (p>0.05). Patients reported slightly more pain with ESPB on postoperative day 0 (4.5 [CI: 4.0,4.9]) compared to epidural (3.5 [CI: 2.9,4.0]), p=0.008. Patients who received ESPB required fewer morphine equivalents than epidural patients on postoperative day 0, postoperative day 1, and postoperative day 2 (p<0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the ESPB cohort (4.11%, 9.59%, 1.37% respectively, p=0.03, p<0.001, p=0.03). Epidural patients were more likely to report adverse events (17.81% vs 43.16%, p<0.001). ESPB provides an effective method of pain control for PAO patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. ESPB is an attractive option in multimodal pain protocol for PAO.

Comparative Study of Open and Laparoscopic Appendectomy with Complications in Government and Private Sector Hospitals

Background: Patients face a 6% lifetime probability of undergoing appendectomy as an emergency surgical treatment. The surgical treatment methods known as Open Appendectomy (OA) and Laparoscopic Appendectomy (LA) represent the standard approaches for clinical use but each brings specific benefits and restrictions. Significant progress has been made but additional comparative studies are necessary to assess the treatment results together with surgical complications and recovery in different hospital facilities. The research examines outcomes between Open Appendectomy (OA) and Laparoscopic Appendectomy (LA) across government institutions along with private healthcare facilities. Objectives: This project examines the clinical results between OA and LA through evaluations about procedural difficulties alongside pain intensity levels and treatment duration measurements. The secondary analysis measures both surgical operation duration and patients' clinical course by charting hospital stay duration and activity restoration period and adopting patient-based results evaluation. This evaluation seeks to discover whether organizational sector impacts patient results from government sectors compared to private institutions. Methods: This prospective comparative research took place between District Headquarter Hospital and Sandhu Medicare Hospital in Toba Tek Singh, Pakistan. The researcher enrolled 108 appendectomy patients aged between 18 and 50 through random sampling for the study. Patients were divided into two groups based on the surgical approach: OA (n=54) and LA (n=54). A structured questionnaire gathered data for demographic information alongside pre-operative and post-operative metrics and duration of surgery and complications from all participants. The researchers used SPSS software version 24 to run their statistical analysis. Results: Patients within the OA group presented with a mean age of 44.20 years while patients in the LA group maintained a mean age of 44.19 years. Stone operations showed higher male participation than female (62.96% in OA and 61.11% in LA). The duration of surgical procedures measured at 89.22 ± 15.48 minutes in OA and 88.65 ± 18.64 minutes in LA with no significant difference comparison (p=0.8621). The length of hospital stay was comparable between the patients having Open Appendectomy (OA) who spent 5.31 ± 1.04 days (p=0.2364) and patients having Laparoscopic Appendectomy (LA) who stayed 5.56 ± 1.06 days. The incidence of postoperative wound infection reached 37.04% in patients receiving open appendectomy whereas the patients undergoing laparoscopic appendectomy showed no infections (p&lt;0.05). A greater percentage of patients received general anesthesia during Open Appendectomy (54%) compared to Laparoscopic Appendectomy (46%) representation (p=0.0101). Alternative methods for postoperative pain control revealed equivalent results between groups according to assessments of pain scores and administered analgesic dose measurements. Conclusion: The surgical procedure Laparoscopic Appendectomy performed better after operations due to its decreased wound infections and equal recuperation results which established it as a safer choice than Open Appendectomy. The study reveals that patient outcomes differ significantly between government facilities and private hospitals pointing to a need for common operating standards. The study establishes that surgical methods should adapt to match patient characteristics along with facility operational capabilities.

Impact of topical cetylated fatty acid cream on hand osteoarthritis: a randomized, double-blind clinical trial

In addition to topical non-steroidal anti-inflammatory drugs that are used in hand osteoarthritis, there are other drugs that can reduce pain in osteoarthritis, such as topical cetylated fatty acids. Previous studies have reported that topical CFAs are effective in all knee OA patients, with slightly higher evidence for those with advanced disease. The mechanism of pain in OA knee and OA hand is similar. Furthermore, there are no previous studies on CFAs in OA hand. Patients fulfilling the American College of Rheumatology criteria for hand OA participated in this randomized, double-blind, placebo-controlled study. Eligible patients were over 40 years of age, had at least one tender joint, and had a joint pain visual analog score of 30–60 mm. Patients received topical CFA (n = 36) or placebo (n = 36) twice daily for six weeks. The primary outcome was the Functional Index for Hand Osteoarthritis (FIHOA) at 2, 4, and 6 weeks. The secondary outcome measures included the Visual Analog Score (VAS), Patient Global Assessment (PGA), and skin irritation at 2, 4, and 6 weeks. At baseline, no statistically significant differences were observed among the assessment parameters. Upon concluding the 6-week study period, it was evident that patients in the CFA group exhibited a notably lower mean pain score compared to those in the placebo group (2.2 ± 1.9 vs. 3.2 ± 2.2, P < 0.05) and achieved superior PGA scores (2.1 ± 1.7 vs. 3.1 ± 2.2, P < 0.05). However, no significant disparity was detected in terms of FIHOA between the two groups. Additionally, adverse reactions were reported by two patients in the placebo group, whereas no such reports were documented in the CFA group. Topical CFAs demonstrate efficacy in alleviating pain and enhancing patient global satisfaction in the treatment of hand osteoarthritis. However, a more extended follow-up period is imperative to ascertain whether disparities exist in the safety profile and functional outcomes between topical CFAs and a placebo.

Efficacy and Safety of Aspiration and Intra-Articular Injection of Tranexamic Acid in Acute Knee Hemarthrosis of Adult Haemophilic Patients: A Randomized Clinical Trial Study.

Hemarthrosis, particularly in the knee, accounts for most bleeding episodes in haemophilia. While joint aspiration has proven effective, the role of intra-articular (IA) tranexamic acid (TXA) in managing acute hemarthrosis remains unexplored. To assess the efficacy and safety of knee aspiration followed by IA TXA injection in acute haemophilic knee hemarthrosis. Forty-four adult haemophilia patients with acute knee hemarthrosis (< 24 h) were randomized to undergo joint aspiration with (TXA group) or without (non-TXA group) IA TXA (1.5g/15mL) injection. Both groups received 75mL injections, including 5mL of 2% lidocaine and additional 0.9% saline. Ultrasound confirmed hemarthrosis, and standardized factor replacement was given pre-procedure. Primary outcomes included knee range of motion (ROM) and visual analogue scale (VAS) for pain. The significance was set at p < 0.05. Final analysis included 21 and 17 male patients in the TXA and non-TXA groups, respectively. The TXA group showed a significantly greater knee ROM on days 3, 7, and 14 (p < 0.05), with no differences beyond Day 14. VAS pain scores were significantly lower in the TXA group at 24 h, 3 days, and 7 days post-procedure (p < 0.05). TXA patients reported faster return to work (p = 0.004) and higher satisfaction (p = 0.01). Hemarthrosis recurrence was lower in the TXA group (5.9%vs. 14.3% at 6 weeks; 64.7%vs. 90.5% at 6 months), though differences were not statistically significant. No complications were observed. Joint aspiration with IA TXA is safe and effective for short-term ROM improvement and pain relief in acute haemophilic knee hemarthrosis.

A Randomized Controlled Trial of Sublingual Sufentanil in Early Management of Pain in Trauma.

Pain management is essential in trauma. Sufentanil is a potent sublingual opioid analgesic with no active metabolites and rapid onset relative to oral medications. We hypothesize that compared to standard care, Sufentanil reduces the verbally administered numerical pain scale (VNRS) at 30 minutes. We performed a prospective multicenter, open-label, randomized trial utilizing level-1 trauma centers from within the Linking Investigator in Trauma and Emergency Services (LITES) network. Participants were randomly assigned in a 1:1 ratio to either sublingual sufentanil or standard care. We enrolled 150 patients from July 2022 to January 2024. The study was approved by the human subjects research protection offices of the University of Pittsburgh and the Department of Defense. Subjects were eligible if they had a trauma evaluation, were 18 to 70, had a VNRS (0-100) score ≥50, and remained in the ED for at least 30 minutes. We excluded patients who were prisoners, pregnant, allergic to opioids, required airway management, body mass index (BMI) >40, significant respiratory depression, suspected gastrointestinal obstruction, or other contraindication to analgesics. The primary outcome was the VNRS for clinical pain measurement (0-100) at 30 minutes after treatment. Secondary outcomes included adverse events (hypoxia, hypotension, need for airway management) and the incidence of nausea/vomiting/headache/dizziness requiring treatment. We hypothesize that sublingual sufentanil as compared to emergency department standard care, will reduce the VNRS at 30 minutes. The study population had a mean age of 48 years (standard deviation [SD] 15) and was 32% female. The mechanism of injury was mostly blunt (96%). The VNRS at 30 minutes was 67 (SD 25) for the entire cohort, 66 (SD 23) in the sufentanil group, and 68 (SD 27) in the standard care group (P = .37). The Health care Professional Global Assessment (HPGA) at 30 minutes showed decreased pain scores in the standard care group compared to sufentanil, with standard care having more patients scored as good or excellent (P = .009). There was no difference in the incidence of nausea, vomiting, headache, dizziness, hypoxia, hypotension, or need for an advanced airway. In this cohort of trauma patients with moderate to severe pain, the VNRS at 30 minutes after administration of analgesics did not differ between sublingual sufentanil and standard care. Adverse events did not differ between the groups suggesting the sublingual sufentanil in this population.

Efficacy and safety of intravesical alkalinized lignocaine for cystoscopy: a retrospective analysis.

To study the effect of intravesical instillation of alkalinized lignocaine (AL) solution on pain scores and patient tolerance in patients undergoing cystoscopy. Bladder distension, trigonal irritation, and bladder neck irritation during cystoscopy under local anesthesia contribute significantly to patient discomfort. This was a retrospective case-control study performed at a single center from January 2023 to July 2023 (Institutional Ethics Committee approval: T/IM-NF/Urol/23/194). Prior to cystoscopy, patients in control group (Group A) (LG group) received only 10ml of 2% lignocaine HCl gel (LG) per-urethrally, while intervention group (Group B) (AL group) also received 30ml of AL solution intravesically (20min prior). Postoperative pain scores were compared using visual analog scale (VAS). The patient tolerance, postoperative hematuria, experience with the procedure, persistent LUTS, and incidence of UTI after 1week were also compared. The study included 50 male patients in each group undergoing cystoscopy for LUTS under evaluation, unexplained hematuria and check cystoscopy for Ca bladder; the median age was comparable between the groups. The VAS scores at 0h [2(2-3) vs. 5(4-5); p < 0.001], 1h [1(1-2) vs. 3(3-4); p < 0.001], and 2h [0 vs. 1(1-1); p < 0.001] were better in Group B. Patient tolerance and experience with the procedure, assessed 1week postoperatively, were significantly better in Group B. Postoperative clinical features and incidence of LUTS at 1week postoperatively were significantly less in Group B. Using intravesical AL solution significantly reduces pain and improves patient tolerance and satisfaction during cystoscopy; also, it is safe and well-tolerated.

Efficacy and safety of ketamine and esketamine in reducing the incidence of postpartum depression: an updated systematic review and meta-analysis

BackgroundPostpartum depression (PPD) is categorized by the Disorders-Fifth Edition as depression that begins during pregnancy or within the first month after giving birth. Ketamine and esketamine have shown promising results in the treatment of several depressive disorders, which suggests that they may have a role in the prevention of PPD. This systematic review and meta-analysis aim to update evidence about the efficacy and safety of using ketamine and esketamine to reduce PPD incidence.MethodsWe searched four databases, PubMed, Scopus, Web of Science, and Cochrane, to collect relevant studies. We included studies which investigated the preventive effect of ketamine or esketamine on PPD among women after giving birth through caesarean or vaginal delivery. We extracted PPD occurrence rate, PPD score, pain score and side effects. Finally, a meta-analysis was conducted using RevMan software.ResultsTwenty-one eligible studies were incorporated in the current systematic review and meta-analysis involving 4,389 pregnant women. Esketamine was the intervention in 14 studies, and ketamine was used in 7 studies. In subgroup analysis, both ketamine and esketamine were significantly effective in reducing the incidence of short-term PPD (ketamine: RR = 0.72, 95% CI [0.56, 0.93], P = 0.01; esketamine: RR = 0.43, P < 0.0001). Esketamine only significantly reduced the incidence of long-term PPD (RR = 0.44, P < 0.00001). Low doses and high doses were effective in reducing the incidence of both short-term (high dose: RR = 0.48, P = 0.0005; low dose: RR = 0.46, P = 0.002) and long-term PPD (high dose: RR = 0.54, P < 0.0001; low dose: RR = 0.61, P = 0.009). Regarding the risk of side effects, patients in the Ketamine/esketamine group showed statistically significant higher rates of developing dizziness (P = 0.0007), blurred vision (P = 0.02), vomiting (P = 0.004) and hallucinations (P = 0,002) than women in the control group.ConclusionBoth ketamine and esketamine are effective in lowering the incidence of short-term PPD. On the other hand, only esketamine is effective in reducing the incidence of long-term PPD. It is recommended to use smaller doses for a more tolerable treatment period since doses less than 0.5 mg are significantly effective. Temporary side effects such as dizziness, blurred vision, vomiting and hallucinations were reported.

Continuous ropivacaine wound infiltration versus epidural morphine after unplanned caesarean delivery: A noninferiority randomised controlled study.

Treatment programs designed to enhance recovery after caesarean delivery include multimodal analgesia to ensure optimal analgesia while reducing exposure to systemic opioids. Evidence for the effectiveness of continuous wound infiltration with local anaesthetic after unplanned caesarean delivery is needed. To determine whether continuous ropivacaine wound infiltration has noninferior analgesic properties compared to epidural morphine, while reducing side effects related to opioids. Triple-blinded, noninferiority, randomised controlled trial. One university hospital, between February 2015 and August 2021. Eighty-one women undergoing unplanned lower segment caesarean section under epidural anaesthesia. At the end of the procedure, randomly assigned patients received either an epidural bolus of 0.9% saline with 48 h continuous ropivacaine wound infusion (ropivacaine group) or an epidural bolus of morphine with 48 h 0.9% saline wound infusion (morphine group). Pain during mobilisation at 24 h postsurgery was assessed using the visual analogue pain scale (VAS 0 to 10) with no indication of the allocated group. Pain scores were 4.4 (95% CI, 3.6 to 5.1) in the ropivacaine group versus 3.1 (95% CI, 2.4 to 3.9) in the morphine group. The mean VAS pain difference between the two groups was 1.2 (95% CI, 0.2 to 2.3), which exceeded the prespecified noninferiority margin of 1. The differences between the two groups at rest and during mobilisation at 6 and 24 h were statistically significant. The ropivacaine group received rescue morphine more frequently, and were less satisfied despite fewer morphine-related side effects. Continuous wound infiltration was not technically feasible in 18% of the patients. We failed to show that continuous ropivacaine wound infiltration was noninferior to epidural morphine in providing analgesia after unplanned caesarean delivery. Because of a significant rate of technical failures, continuous wound infiltration should only be considered when neuraxial morphine is contraindicated.

Abnormal Alterations of the White Matter Structural Network in Patients with Herpes Zoster and Postherpetic Neuralgia.

PHN is one of the most common clinical complications of herpes zoster (HZ), the pathogenesis of which is unclear and poorly treated clinically, and many studies now suggest that postherpetic neuralgia (PHN) pain may be related to central neurologic mechanisms. This study aimed to investigate the white matter structural networks and changes in the organization of the rich-club in HZ and PHN. Diffusion imaging (DTI) data from 89 PHN patients, 76 HZ patients, and 66 healthy controls (HCs) were used to construct corresponding structural networks. Using graph-theoretic analysis, changes in the overall and local characteristics of the structural networks and rich-club organization were analyzed, and their correlations with clinical scales were analyzed. Compared with HCs, PHN patients had reduced global efficiency (Eg), reduced local efficiency (Eloc), a reduced clustering coefficient (Cp), a longer characteristic path length (Lp), and reduced nodal efficiency (Ne) in several brain regions, including the right posterior cingulate gyrus, the right supraoccipital gyrus, the bilateral postcentral gyrus, and the right precuneus; HZ patients had reduced Eg, a longer Lp, and reduced right orbital frontalis suprachiasmatic Ne. Moreover, HZ and PHN patients showed a significant reduction in the strength of rich-club connections. Compared with HZ patients, the intensities of the rich-club and feeder connections were lower in the PHN patients. Moreover, the changes in the structural networks and rich-club organization topology indices of the patients in the HZ and PHN patients were significantly correlated with disease duration, pain scores, and emotional changes. The structural networks of HZ and PHN patients exhibited reduced network transmission efficiency and rich-club connectivity, possibly due to structural damage to the white matter, and this was more obvious in PHN patients. The rich-club connectivity of HZ patients showed incomplete compensation in the acute pain stage.

Piano level laser therapy versus epidermal growth factor injection for painful myogenic temporomandibular disorder (a randomized clinical trial)

ObjectiveThe aim of this clinical trial was to evaluate the effectiveness of Piano level laser therapy using Nd-YAG laser and intramuscular EGF injection in pain alleviation, function, and quality of life improvement in patients suffering from myogenic TMD.Materials and methodsA randomized clinical trial was performed on 29 patients suffering from chronic painful myogenic TMD based on diagnostic criteria for temporomandibular disorders. Group I (n = 13patients) was treated using 1064 nm Nd-YAG Laser (4 sessions once/week). Group II (n = 14 patients) was treated by intramuscular injection of EGF. Pain using numerical rating score, pain free opening and unassisted maximum opening were measured at baseline, 7,14,21 days, 1 and 3 months. Quality of life using OHIP-14 was assessed at baseline, 1 and 3 months.ResultsResults showed that there was a significant pain reduction (P < 0.000) and increase in pain free opening (P < 0.0001) in both test groups. However, only group I showed a significant increase in maximum opening (P = 0.007). Quality of life significantly improved in both groups (P = 0.0001). There was no significant difference between the two treatments in pain scores, pain free opening, maximum opening nor quality of life.ConclusionBoth treatment modalities offered effective and cost-effective non- to minimally invasive treatment options for myogenic TMD with no side effects.Clinical relevanceMyogenic TMD forms a public health issue and is a common musculoskeletal problem causing pain and disability. The proposal of effective, non-invasive, and affordable treatment options can help solve this issue.

Non-inferiority study to compare the efficacy of relugolix with dienogest for endometriosis-associated pain and usefulness of administering relugolix prior to dienogest (READY study): study protocol for a multicenter randomized controlled study

BackgroundEndometriosis presents as endometrial tissue growths outside the uterine cavity with its major symptoms including dysmenorrhea and infertility. Progestin preparations, such as dienogest, are the first-line therapy for endometriosis symptoms, but may cause abnormal uterine bleeding. A gonadotropin-releasing hormone (GnRH) agonist may also be used to ease symptoms, but may induce flare-ups. Relugolix is a non-peptide GnRH antagonist that does not induce flare-ups. This study aims to compare the efficacy of relugolix with that of dienogest for reducing endometriosis-associated pain, and to evaluate if relugolix, administered prior to dienogest, decreases abnormal uterine bleeding.MethodsA multicenter, open-label, active-controlled, non-inferiority randomized study will be conducted at 11 sites in Japan. A total of 100 premenopausal patients aged ≥ 18 years with endometriosis, a maximum visual analog scale (VAS) score > 30 for endometriosis-associated pain, and dysmenorrhea or pelvic pain of at least moderate severity on the Biberoglu & Behrman (B&B) scale will be randomized in a 1:1 ratio to either a relugolix group or dienogest group. Patients in the relugolix group will receive 40 mg oral relugolix once daily for 16 weeks, followed by 1 mg oral dienogest twice daily for 24 weeks. Patients in the dienogest group will receive oral dienogest 1 mg twice daily for 24 weeks. The primary outcome will be change in maximum VAS score for endometriosis-associated pain from baseline to 13–16 weeks after start of treatment. The secondary outcomes will include VAS score for dyspareunia, B&B score for dysmenorrhea, severity of induration in the pouch of Douglas, restricted uterine mobility, pelvic tenderness, quality of life, analgesic use, and ovarian endometrioma diameter. The safety outcomes will include treatment-emergent adverse events, bone density, bone markers, menstrual status, genital bleeding, and endometrial thickness.DiscussionThis study will determine the efficacy of relugolix for improving endometriosis-associated pain and dienogest-induced abnormal uterine bleeding. The results will support treatment decisions regarding endometriosis-associated pain, and the introduction of new treatments to reduce dienogest-induced abnormal uterine bleeding.Trial registrationJapan Registry of Clinical Trials ID jRCTs061230064. Registered on 29 September 2023.

MRI Fusion Cryoablation: Is There an Outcome Difference Between Anterior and Posterior Lesions?

Introduction: Cryotherapy pioneered ablation therapy for prostate cancer (PCa), initially using larger ablations. As the technique advanced, a more targeted approach was developed irrespective of lesion location. However, some clinical guidelines have addressed concerns for treating posterior areas. This study evaluates the validity of these concerns. Materials and Methods: We retrospectively studied 814 Magnetic Resonance Imaging Fusion Target Cryotherapy (MRFTC) treatment-naïve patients with PCa with a single index lesion (2013-2023) under local anesthesia. We grouped by treatment location: anterior, anterior-posterior, and posterior. Disease progression, defined as conversion to radical treatment, initiation of hormonal therapy, or development of metastases, was evaluated with survival analysis via the Kaplan-Meier log-rank test. Univariate and multivariable analyses were employed to compare outcomes among different treatment groups and other risk factors. Functional outcomes were evaluated using the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score questionnaires, with comparisons made over time and by lesion location through t-tests. Complication rates were documented across the various treatment areas. Results: The distribution of patients' characteristics across treatment groups was similar. Procedure pain scores were similar irrespective of lesion location. Five years post-MRFTC, 87%, 89%, and 90% of patients treated for anterior, anterior-posterior, and posterior lesions, respectively, remained progression-free with no significant variation between groups (p = 0.22). For all groups, there were significant improvements in urinary function (baseline vs. 3 months). The posterior group showed a marginal, yet statistically significant negative difference in SHIM scores at 3 months. However, the score recovered by 1 year where no additional significant changes were noted. The most common complication was urinary retention and no cases of rectal fistula were reported. Conclusions: Our findings challenge clinical guidelines suggesting avoidance of focal cryoablation for posterior lesions. Using MRFTC, cryotherapy has proven to be safe and effective, regardless of lesion location.