Significant Decrease In Visual Analogue Scale Research Articles

Efficacy of gabapentin phonophoresis on post mastectomy intercostobrachial neuralgia

Aim. To investigate the efficacy of gabapentin phonophoresis for neuropathic pain management in intercostobrachial neuralgia cases. Material and methods. Fifty-seven females with intercostobrachial neuralgia were randomly collected then allocated into two groups, Study group (gabapentin phonophoresis) and Control group (gabapentin gel). Study group: received gabapentin phonophoresis 4 times/week for 4 weeks (a total of 16 sessions) using continuous ultrasound (1 MHz, 1.5 W/cm², for 5 minutes). Control group: received topical 6% w/w gabapentin gel three times per day for 4 weeks on the affected site. The methods of assessment included visual analogue scale (VAS) and Neuropathic pain scale (NPS). All measurements were collected before the beginning of the study and after the end of the treatment (after 4 weeks). Results. There was no significant difference between both groups in VAS (= 0.43) and NPS (= 0.46) pre-treatment. Comparison between groups post treatment revealed a significant decrease in VAS and NPS of study group compared with that of control group (p < 0.001). The percentage of decrease in VAS of study group and control group was 51.32% and 43.03% respectively while the percent of decrease in NPS was 50.79% and 45.05% respectively. Conclusion. It was concluded that conduction of gabapentin gel topically or by using phonophoresis is safe and effective method for neuropathic pain management and can alleviate pain intensity; however, phonophoresis achieved better results and was superior to traditional gel application.

Is Teriparatide Superior in Treating Osteoporotic Vertebral Compression Fractures in Comparison to Bisphosphonates Treatment Alone: A 2-Year Retrospective Analysis.

Retrospective cohort study. This study aimed to compare the efficacy of bisphosphonates and teriparatide in the management of osteoporotic vertebral compression fractures with regard to pain management, prevention of nonunion, and radiological as well as clinical outcomes. Osteoporosis refers to a skeletal disorder characterized by decreased bone strength caused by poor bone density and quality causing fragility, resulting in long periods of pain-related immobilization. In a 24-month follow-up retrospective study, 191 patients with osteoporotic vertebral compression fractures were randomly assigned to the bisphosphonate group (n=104) or the teriparatide group (n=87), with patients opting for their treatment between January 2016 and October 2020. Demographic data and patient-reported outcomes scores, including the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), union rates, and kyphosis progression, were assessed at baseline, 6 months, 1 year, and 2 years after treatment. Both groups had a significant decrease in VAS, from 8.38±0.74 to 3.15±1.40 in the bisphosphonate group and from 8.49±0.73 to 1.11±0.31 in the teriparatide group. The ODI scores reduced significantly at 2-year follow-ups, recording 25.02±13.94 and 15.11±2.17 in the bisphosphonate and teriparatide groups, respectively. Risks of nonunion development were slightly higher at 11.53% in the bisphosphonate group and 8.63% in the teriparatide group required operative intervention. The kyphosis progression angles were also significantly lower in the teriparatide group (4.97°±0.78°) than in the bisphosphonate group (8.09°±1.25°). Over time, numerous studies have demonstrated the efficacy of bisphosphonates and teriparatide in ameliorating pain. In this study, the efficacy of teriparatide surpassed that of bisphosphonates in certain aspects, such as the initial 6-month union rates and reduction in the progression of segmental kyphosis. However, bisphosphonates and teriparatide yield similar and favorable union rates at 1 year and final follow-up.

"SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU).

Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.

Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial

ObjectiveThis study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain. MethodsWe performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks. ResultsIn the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only. ConclusionIn this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.

Effects of the TENS device, Exopulse Mollii Suit, on pain related to fibromyalgia: An open-label study

Fibromyalgia is characterized by diffuse and chronic pain, that is often only partially alleviated by the available pharmacological treatments. Therefore, nonpharmacological interventions such as transcutaneous electrical stimulation (TENS) are highly needed to improve the quality of life of this population. However, the classical TENS devices offer a limited number of electrodes and are not adapted to this diffuse painful condition. For these reasons, we aimed to assess the effects of a new TENS device, the Exopulse Mollii Suit, that can stimulate up to 40 muscle groups integrated into pants and jackets and connected to a control unit. We report the data of 50 patients who received one session of active stimulation (pulse intensity 2 mA, and pulse frequency 20 Hz). Pain intensity was evaluated by means of the visual analogue scale (VAS), before (T0) and after the session (T1), and 24 h later (T24). Compared to baseline scores, a significant decrease in VAS was observed after the session (p<0.001), and 24 h later (p<0.001). T1 scores were significantly lower than T24 scores (p<0.001). Therefore, this new system seems to exert analgesic effects whose mechanisms primarily evoke the theory of "gate control". The effects were transient and started to decrease the following day, highlighting the need for additional studies to better evaluate the long-term effects of this intervention on pain, mood, and quality of life.

Low Level Laser Versus Transcutaneous Electrical Nerve Stimulationon Post Herpetic Neuralgia

Background: Post herpetic neuralgia (PHN), a common neuropathic pain syndrome, usually occurs in patients with acute herpes zoster after resolving skin eruption. Persistent severe pain has a huge impact on a patient's physical function, mental health, and social communication ability, and also places a heavy burden on patients' families and on society. Objective: The current study was conducted to compare the efficacy of low level laser therapy (LLLT) versus transcutaneous electrical nerve stimulation (TENS) in the treatment of post-herpetic neuralgia Subjects and Methods: Fifty patients suffering from pain post herpetic neuralgia .Their ages ranged from 40 to 80 years.They were selected randomly from outpatient clinic in Deraya university referred by dermatologist then divided into two equal groups. Group (A) composed of 25 patients with post herpetic neuralgia and they received low level laser therapy LLLT in addition to traditional medical treatment and Group (B) composed of 25 patients with post herpetic neuralgia and they received Transcutaneous electrical nerve stimulation in addition to traditional medical treatment .Both modalities were applied once daily, 3 times a week for 20 minutes for 4 successive weeks. Visual analog scale (VAS) and pain pressure threshold (PPT) had been assessed before and after interventions. Results: There was a significant decrease in VAS and a significant increase in PPT post treatment compared with that pre treatment in group A and B (p &gt; 0.001). The percent of change in VAS and PPT in group A was 88.97 and 522.22% respectively, while that in group B was 82.39 and 462.79% respectively. Conclusion: Both LLLT and TENS were effective improving the post-herpetic neuralgia but LLLT was more effective. Keywords: Low level laser therapy, transcutaneous electrical nerve stimulation, post herpetic neuralgia, visual analog scale and pain pressure threshold

Efficacy of kinesio taping versus extracorporeal shock wave therapy in the short term for the calcaneal spur

The calcaneal spur is a common cause of heel pain, and there are various approaches to its treatment. Our aim in this study is to investigate the effectiveness of kinesio taping against Extracorporeal Shock Wave Therapy (ESWT) in the treatment of calcaneal spur. This study was designed as a randomized controlled, prospective and single-center clinical trial. A total of 93 patients with calcaneal spur (18 men, 75 women) were included. Patients were divided into two groups (based on gender, age, BMI, and pain duration) by stratified randomization (kinesio tape group=46, ESWT group=47 patients). 3 sessions of ESWT were applied to the heels of the patients in the 1st group with an interval of 1 week. Kinesio taping was applied to the 2nd group. It was applied once a week, for 3 weeks. Visual Analogue Scale (VAS) and Foot Function Index (FFI) scores of the patients in both groups before the treatment and 1 week after the end of the treatment were recorded. When we evaluated the pre-treatment and post-treatment parameters, we found a significant decrease in VAS, FFI-pain, FFI-disability and FFI-activity restriction scores in both groups (p=0.0001). We also found that kinesio taping was more effective than ESWT in reducing FFI-pain (for after treatment FFI-pain inter group p=0.005, for FFI-pain difference inter group p=0.002) and FFI-disability (for after treatment FFI-disability inter group p=0.023, for FFI-disability difference inter group p=0.0001) scores. To conclude, although both kinesio taping and ESWT treatments reduced patients' pain, disability and activity limitation, kinesio taping was found to be more effective in reducing pain and disability. Studies with longer follow-up are needed to clarify our results.

Recent Efficacy of Oblique Lateral Interbody Fusion Combined With Wiltse Approach Pedicle Screw Fixation for Degenerative Single-Level Lumbar Spondylolisthesis

The study aimed to explore the recent efficacy of oblique lateral interbody fusion (OLIF) combined with Wiltse approach pedicle screw fixation in the treatment of single-level degenerative lumbar spondylolisthesis (DLS). This is a retrospective study. The study enrolled 54 patients with single-level DLS who were treated at the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University from May 2018 to June 2020. (OLIF group) 24 cases operated using OLIF combined with Wiltse approach pedicle screw fixation, and (PLIF group) 30 cases operated by PLIF. The primary outcome measures were visual analog scale (VAS) pain scores, Oswestry dysfunction index (ODI), and the lower lumbar spine anterior convexity angle. There were significant differences in VAS (2.63±0.58 vs. 3.57±0.63, P < 0.001) and ODI (9.67±0.92 vs. 10.63±1.40, P < 0.05) between the OLIF group and PLIF group on postoperative 3days. And there was a significant decrease in VAS (2.63±0.58 vs. 1.08±0.28, P < 0.05) and ODI (3.57±0.63 vs. 1.10±0.31, P < 0.05) in both groups on postoperative 3days and at 6months postoperative comparisons. OLIF group showed better intervertebral space height and the lower lumbar spine anterior convexity angle scores on postoperative 3days and 6months, the difference was statistically significant(all P < 0.05). OLIF combined with the Wiltse approach pedicle screw fixation can achieve good short-term clinical results in the treatment of single-level DLS. This surgical approach is less invasive, promotes early functional recovery, shortens hospitalization time, and improves the quality of life.

Comparison of immediate and delayed effects of superficial and deep dry needling in patients with upper trapezius myofascial trigger points

BackgroundDry needling is one of the most common treatments for this condition. In this study the immediate and delayed effects of superficial dry needling (SDN) and deep dry needling (DDN) on upper trapezius muscle function and patients' pain and disability was evaluated. MethodsIn this quasi-experimental study, 47 women with active MTrPs were randomly divided into SDN and DDN groups and received one session treatment. Pain and disability were assessed before and one week after intervention with visual analogue scale (VAS) and neck disability index (NDI) questionnaire. Muscle activity was assessed by surface electromyography (sEMG) before, immediately and one week after intervention. ResultsBoth groups showed significant decrease in VAS (p < 0.001) and NDI (p < 0.001) after one week, however no significant difference were found between the groups (p > 0.05). A significant increase in sEMG activity was observed only in DDN group after one week (p < 0.007), but there were no significant differences in sEMG activity in SDN group after intervention and between the two groups (p > 0.05). ConclusionBoth SDN and DDN could be effective in reducing pain and disability in patients with active MTrPs of upper trapezius muscle. Regarding muscle function DDN seems to be more effective. So that based on evaluation of the therapist in some cases with not significant muscle dysfunction SDN as a gentle and less invasive method could be used but for long term effectiveness and in those with significant muscle dysfunction DDN could be used.

Efficacy of Dry Needling Under EMG Guidance for Myofascial Neck and Shoulder Pain: A Randomized Clinical Trial.

PurposeTo determine the difference in maintenance of improvement of pain and disability for dry needling (DN) under needle electromyography (EMG) guidance technique in myofascial neck and shoulder pain patients, compared with DN alone.Patients and MethodsIn this randomized single-blind clinical trial, 30 participants with myofascial pain in the neck and shoulder were randomly allocated to two groups: myofascial trigger points (MTrPs) DN with EMG guided (DN-EMG) group and MTrPs DN without EMG (DN) group. Needling treatment lasted for 2 weeks, twice a week. The primary outcome was pain intensity as assessed by visual analogue scale (VAS) and neck disability index (NDI). A number of mappings referred to pain and spontaneous muscle activity (SEA) were considered secondary outcomes. VAS and NDI were measured before treatment, after 2 weeks of intervention and at 4-, 6- and 12-week follow-up periods after the intervention. Secondary outcomes were assessed before each treatment (T1–T4). Data were analysed using mixed-model analyses of variance (ANOVA) with time as a within-subject variable and groups as between-subject variables followed by Bonferroni’s post-hoc test.ResultsMixed-model ANOVA revealed significant time-by-group interaction effects (F = 3.49, P = 0.01) for VAS. Post-hoc analysis showed a significant decrease in VAS and NDI after 2 weeks of intervention and at all follow-up periods compared with baseline in both groups (p < 0.01). The DN-EMG group exhibited higher improvements in VAS at 6- and 12-week follow-up period than the DN group (p < 0.05). In the SEA of MTrPs, we found positive sharp waves, fibrillation and fascicular potentials. DN-EMG group exhibited lower amplitudes at T2–T4 and frequencies at T2 and T3.ConclusionDN under needle EMG guidance technique exhibited greater improvements in maintenance of improvement of pain and lower SEA value than the DN group due to sufficient MTrPs inactivation.

Efficacy and safety of a bioadhesive gel containing propolis extract, nanovitamin C and nanovitamin E on desquamative gingivitis: a double-blind, randomized, clinical trial

ObjectivesTo evaluate the efficacy of a gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to professional plaque removal on desquamative gingivitis (DG).Materials and methodsA randomized clinical trial was conducted on patients suffering DG due to mucocutaneous diseases. Patients received professional supragingival prophylaxis with oral hygiene instructions and were randomly assigned to use test or control gels as toothpaste and to apply it on DG lesions 3 times/day for 4 weeks. DG clinical score (DGCS), clinical periodontal variables, and visual analog scale (VAS) for pain and oral health impact profile (OHIP-14) were collected at baseline, 2 and 4 weeks.ResultsTwenty-two patients were randomly assigned to test (n = 11) or control group (n = 11). Eighteen had diagnosis of oral lichen planus and four of mucous membrane pemphigoid. DGCS statistically decreased in both groups after treatment with no significant differences between groups. Clinical periodontal outcomes decreased in both groups, but no significant differences were observed. Periodontal variables statistically improved only in test group after treatment. VAS and OHIP-14 scores decreased in test and control groups without significant differences. However, only one test group showed a statistically significant decrease in VAS and OHIP-14 scores after treatment. No adverse effects were reported.ConclusionsTest gel may alleviate DG and improve quality of life without side effects.Clinical relevanceA gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to mechanical debridement may improve both clinical and patient related outcomes in DG patients without side effects.Clinical trial registration.The study protocol was registered at clinicaltrials.gov with the following number: NCT05124366 on October 16, 2021.

Effects of proximal fibular partial excision on medial compartment knee osteoarthritis.

This study aimed to investigate the clinical and radiological progression of the patients who underwent proximal fibular partial excision (PFPE) for medial compartment knee osteoarthritis. Patients with medial compartment knee osteoarthritis who did not benefit from conservative treatment and accepted the PFPE surgery were involved in this study. Patients with traumatic arthritis, inflammatory arthritis, previous lower extremity fractures, valgus malalignment of the knee, and infection at the planned surgical site, however, were kept apart. Patients were assessed both clinically by Visual Analog Scale (VAS) and American Knee Society Score (AKSS), radiologically by Kellgren Lawrence classification, tibiofemoral angle, and joint-line convergence angle (JLCA). The patients were systematically assessed especially in the sixth month and first, second, and third years of the post-operative period. A total of 35 patients (mean age: 56.5, min: 45, max: 79) were involved in this study. The mean follow-up period was 22.4months (min: 6, max: 36). It has been observed that: Statistically significant decrease in VAS and increase in AKSS after PFPE (p < 0.001) No statistically significant improvement in preoperative and postoperative tibiofemoral angle and JLCA measurements CONCLUSIONS: The PFPE is a safe and effective surgical treatment for pain relief and functional improvement in medial compartment knee osteoarthritis. More studies are needed on its mechanism of action, long-term effects, and comparison with other treatment options.

The clinical impact of lumbar epidural steroid injections prior to spine surgery for lumbar spinal stenosis

IntroductionLumbar spinal stenosis is a common finding in the adult population. Lumbar Epidural Steroid Injections (ESIs) are often used in management of this condition, with conflicting evidence regarding their efficacy. Previous research has suggested a negative impact of ESIs on the postoperative outcomes when ESIs are administered preoperatively prior to spine surgery in this population. Our retrospective study was performed to gain greater insight into the impact of preoperative ESIs on postoperative outcomes following spine surgery in management of lumbar stenosis. ObjectiveOur objective is to determine how preoperative ESIs impact postoperative outcomes following spine surgery in management of lumbar stenosis. DesignRetrospective cohort involving 95 patients (39 patients who received ESI in the preoperative timeframe and 56 patients who did not) who underwent surgical management of lumbar stenosis. Data for patients with preoperative ESI was compared to those without preoperative ESI administration. SettingInstitutional. InterventionsNot Applicable. Main outcome measuresPROMIS (Patient-Reported Outcomes Measurement Information System) scores, VAS (Visual Analog Scale) pain scores, ODI (Oswestry Disability Index), NDI (Neck Disability Index). ResultsAt baseline (time of surgery), the ESI group had significantly higher ODI, PROMIS pain, PROMIS pain interference, VAS leg and lower PROMIS physical function, but no significant difference in PROMIS satisfaction, VAS back and NDI, compared to the Non-ESI group. At 3 months after surgery, both the ESI and Non-ESI groups demonstrated a significant decrease in VAS back, VAS leg, PROMIS pain and ODI from baseline scores. The improvement in PROMIS pain at 3 months after surgery was larger in the ESI group than the Non-ESI group. ConclusionsPreoperative ESI administration did not lead to worsening of disability, function, or pain symptoms in the short-term postoperative period following surgical management of lumbar stenosis. Patients had short term improvements in radicular pain following surgical management of lumbar stenosis, regardless of preoperative ESI administration.

Radiofrequency Ablation in Cooled Monopolar or Conventional Bipolar Modality Yields More Beneficial Short-Term Clinical Outcomes Versus Other Treatments for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

To evaluate various radiofrequency ablation (RFA) treatments for knee osteoarthritis (OA) and determine the best modality, target, number of electrodes, and image guidance for improving knee pain and function. Electronic databases were searched for randomized controlled trials (RCTs) comparing the efficacy of RFA treatments for knee OA from inception up to September 30, 2021. The primary outcome was the visual analog scale (VAS), and the secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Bayesian network meta-analysis was performed to synthesize the mean difference (MD) and rank the comparative effectiveness of treatments. A total of 21 eligible RCTs (from 2011 to 2021, involving 1,818 patients) with 8 RFA treatments, 6 intra-articular injections, NSAIDS, exercise, and placebo were assessed. Conventional bipolar genicular nerve RFA (GNRFA) had the greatest net benefit on the VAS at 6 months (MD,-5.5; 95% confidence interval [CI],-4.3 to-6.7; SUCRA, .98). And cooled monopolar GNRFA had the greatest net benefit on the WOMAC at 6 months (MD,-33; 95% CI,-37 to-29; SUCRA, .99). In conventional and pulsed modalities, bipolar RFA was associated with a significant decrease in VAS and WOMAC than monopolar RFA. Combining pulsed intra-articular RFA and platelet-rich plasma injection had no additional positive effects on VAS or WOMAC at 3 months. RFA is effective in improving both knee pain and function in patients with OA, at least in the short term (6 months). Patients respond better to the cooled modality than the conventional and pulsed modalities. Bipolar is more effective than monopolar for improving pain and function in conventional and pulsed modalities. Fluoroscopy and ultrasound guidance showed no differences in improving pain and function. The effectiveness of RFA in cooled modality using bipolar or in combination with various intra-articular injections remains to be compared. II, systematic review and meta-analysis of Level I and II studies.

A comparative study between platelet-rich plasma, corticosteroid, and autologous whole blood injection in patient of plantar fasciitis

Introduction: Majority of the patient with heel pain are diagnosed with plantar fasciitis (PF). PF is the condition characterized by isolated inferior heel pain particularly with the first steps of the day or after sitting for hours and the reason is due to degeneration of the plantar fascia and perifascial structures. Regular walking on hard surfaces, wearing hard sole footwear, and obesity are the risk factors for this condition. Injecting steroids is the most popular method of treating the condition but has its own advantages and disadvantages. There have been cases reported of rupture of plantar fascia after giving corticosteroid injections, especially when it was given repeatedly. Platelet-rich plasma (PRP) is known to enhance the healing process of the body as it has platelet-derived growth factors that boost the healing of soft tissue, bone healing, and also tendon healing. Aims and Objective: The objective of our study was to know among the PRP injection, autologous whole blood steroid injection which is a superior mode of intervention in PF management. Materials and Methods: A sample size of 225 was taken and patients were divided into 3 groups, in which Group A was given PRP injection, Group B was given steroid injection, and Group C was given whole blood. The follow-up was done on 2 weeks, 4 weeks, and 12 weeks. Patients of age more than 18, those who were clinically diagnosed PF, and those who were not improving with 3 months of conservative management were included in the study. Patients with any ligament injury or with Buerger’s disease, pseudo-gout, and Haglund disease were excluded from the study. All patients were asked for their pain to quantify it according to visual analog scale (VAS) scale and the score was noted on pre-injection follow by on 2 weeks, 4 weeks, and 12 weeks. Results: The VAS score before infiltration was almost similar (P > 0.05) in Group A (7.8 ± 1.26), Group B (7.5 ± 1.05), and Group C (7.8 ± 0.87). The VAS score significantly decreased in Group B who were injected steroids in the initial 2 weeks when compared to that of Group A who were injected PRP and Group C who were injected whole blood. A significant decrease in VAS was seen in Group A at after 12 weeks when compared to Group B and Group C. Conclusion: Our study showed that autologous PRP therapy can lead to a sustained reduction in symptom complaints when compared to corticosteroid injections and autologous whole blood. PRP injection holds promise as a potential therapy to hasten the healing of chronic PF.

Improvement of Inflammation and Pain after Three Months' Exclusion Diet in Rheumatoid Arthritis Patients.

Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting the synovial joints and causing severe disability. Environmental and lifestyle factors, including diet, have been proposed to play a role in the onset and severity of RA. Dietary manipulation may help to manage the symptoms of RA by lowering inflammation and potentially decreasing pain. Methods: In 40 patients with long-standing RA with stable symptoms and treated with conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs), the effect of a 3-month diet avoiding meat, gluten, and lactose (and all dairy products; privative diet) was evaluated in comparison with a control balanced diet including those foods. Both diets were designed to reduce weight since all patients were overweight or obese. Patients were randomly assigned to one of the diets, and RA was clinically assessed at Time 0 (T0), through the Visual Analogue Scale (VAS), for pain, and the Disease Activity Score of 28 joints (DAS 28) for RA activity. Patients were also administered the Short Form Health survey (SF-36) and the Health Assessment Questionnaire (HAQ). At T0, a blood sample was collected for laboratory tests and adipokines measurements, and anthropometric measurements were compared. These evaluations were repeated at the end of the 3 months’ dietary regimens. Results: A significant decrease in VAS and the improvement of the overall state of physical and mental health, assessed through SF-36, was observed in patients assigned to the privative diet. Both dietary regimens resulted in the improvement of quality of life compared to baseline values; however, the change was significant only for the privative diet. With either diet, patients showed significant decreases in body weight and body mass index, with a reduction in waist and hips circumference and lower basal glucose and circulating leptin levels. A privative diet was also able to significantly reduce systolic (p = 0.003) and diastolic (p = 0.025) arterial pressure. The number of circulating leukocytes and neutrophils, and the level of hs-C-Reactive Protein also decreased after 3 months of the meat-, lactose-, and gluten-free diet. Conclusions: Our results suggest that a privative diet can result in a better control of inflammation in RA patients under stable optimized drug treatment.

Effect of Transcutaneous Electrical Nerve Stimulation and Cupping Therapy in The Treatment of Tennis Elbow: A Randomized Controlled Trial

Background: Tennis elbow (TE) is a common disorder of the upper extremities that occurs due to powerful grip and repetitive motions in the wrist joint during various activities. Although several management strategies have discussed some of the methods used to reduce pain and improve elbow and wrist movements, the use of new approaches remains a vigorous option to reach the maximum degree of improvement and complete recovery.Aim: The current study aimed to investigate the effect of Transcutaneous electrical nerve stimulation (TENS) and cupping therapy in treating TE.Methods: One hundred and twenty patients between the ages of 20 and 50 years of both sexes complained of tennis elbow. They were divided randomly into four groups. Group A (n=30) received conventional treatment, group B (n=30) received TENS in addition to conventional treatment, group C (n=30) received cupping therapy with conventional treatment, and group D (n=30) received TENS and cupping therapy plus conventional treatment. Visual analog scale (VAS) was used to assess pain intensity, a hand dynamometer was used to measure pain-free grip strength (PFGS), and a patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to measure pain and disability of the forearm before and after four weeks.Results: There was a significant decrease in VAS, PRTEE score, and an increase in PFGS favoring group D compared to the other groups post-treatment (p &lt; 0.001).Conclusion: The combination of TENS and cupping therapy results in better improvement in TE treatment than conventional therapy, TENS, and cupping therapy alone.

The effect of desensitizing dentifrice with or without diode laser therapy in the management of dentinal hypersensitivity of teeth with Miller’s Class I or Class II gingival recession

Introduction: Dentinal Hypersensitivity (DH) is characterized by short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical. Most common modality for treatment of DH is desensitizing dentifrices through combined use of Diode laser along with desensitizing tooth paste which has shown encouraging results. The present study evaluated and compared the efficacy of toothpaste containing 10% Strontium Chloride (SrCl2) with or without Diode laser in the treatment of DH in the teeth with Miller’s Class I or II gingival recession. Materials and Method: The study included patients (aged 18 to 50 years) with chief complaint of dentinal hypersensitivity having Miller’s Class I or Class II gingival recession. A total of 20 sites equally and randomly divided into two groups; Test group (Diode+ Sensoform®-SrCl2 Toothpaste) and Control group (Sensoform®-SrCl2 Toothpaste). Pre and Post treatment VAS for DH was recorded at baseline, 7, 15 & 30 day using air blast test for both the groups. Result:Patients in both the groups reported reduced dentinal hypersensitivity. However, DH was significantly reduced in test group as compared to control group at all the intervals as measured using Visual analogue scale (VAS). Also, the test group showed statistically significant decrease in VAS, post treatment at baseline itself. Conclusion:Within the limitations of the present study, it can be concluded that combined use of desensitizing toothpaste (SrCl2) and diode laser therapy can be effective in providing immediate relief from DH in patients with Miller’s Class I or Class II recession. Keywords: Diode laser, Dentinal hypersensitivity, Gingival recession, Visual analogue scale, Strontium chloride, Tactile

Effect of core muscles strengthening exercises on pelvic pain caused by copper intrauterine device

Background: Pelvic pain is the most frequently intrauterine device (IUD) associated complications. Aim of work: The purpose of this study was to investigate the effect of core muscles strengthening exercises on the pelvic pain caused by IUD. Methods: 30 women complained of pelvic pain after IUD insertion were participated in this study. They were divided into two groups, equal in number. Group (A) received core muscles strengthening exercises and supportive advice (as heating application, hot cinnamon drinks & diaphragmatic breathing) at the painful episodes. Group (B) received the same supportive advice as group (A) at the painful episodes. Both groups were assessed before and after treatment period (10 weeks) for pain degree by visual analogue scale (VAS) and menstrual pain severity by verbal multidimensional scoring scale (VMSS) to assess pain severity experienced through the activities of daily living. Results: The results of this study revealed that, there was a significant decrease in VAS and VMSS values post treatment in group (A) compared with that pre treatment values, while there was no significant difference between pre and post treatment values in VAS and VMSS in group (B). when comparing both groups there was a significant decrease in the post treatment values of VAS and in the median values of VMSS of group (A) compared with that of group (B). Conclusion: Core muscles strengthening exercises is considered as an effective modality in reducing pelvic pain caused by IUD.

Long-term clinical outcome of the Charit\xe9 III total lumbar disc replacement

PurposeTo compare the long-term clinical results and complications of two revision strategies for patients with failed total disc replacements (TDRs).MethodsIn 19 patients, the TDR was removed and the intervertebral defect was filled with a femoral head bone strut graft. In addition, instrumented posterolateral fusion was performed (removal group). In 36 patients, only a posterolateral instrumented fusion was performed (fusion group). Visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed.ResultsThe median follow-up was 12.3 years (range 5.3–24.3). In both the removal and fusion group, a similar (p = 0.515 and p = 0419, respectively) but significant decrease in VAS- (p = 0.001 and p = 0.001, respectively) and ODI-score (p = 0.033 and p = 0.013, respectively) at post-revision surgery compared to pre-revision surgery was seen. A clinically relevant improvement in VAS- and ODI-score was found in 62.5% and 43.8% in the removal group and in 43.5% and 39.1% in the fusion group (p = 0.242 and p = 0.773, respectively). Removal of the TDR was associated with substantial intra-operative complications such as major vessel bleeding and ureter lesion. The percentage of late reoperations for complications such as pseudarthrosis was comparable for both revision strategies.ConclusionsRevision of a failed TDR is clinically beneficial in about half of the patients. No clear benefits for additional TDR removal as compared to posterolateral instrumented fusion alone could be identified. Particularly, when considering the substantial risks and complications, great caution is warranted with removal of the TDR.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.