Significant Difference In Pain Research Articles

Symptom Screening for Hospitalized Pediatric Patients With Cancer: A Randomized Clinical Trial.

Pediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer. To determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days. This randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023. Intervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care. The primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups. A total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, -2.5; 95% CI, -3.8 to -1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care. In this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care. ClinicalTrials.gov Identifier: NCT03593525.

Impact d’HypnoVR©, associé à une anesthésie locale, sur la douleur et l’anxiété ressenties lors d’une ponction ovocytaire

Objective : Virtual reality with Snow World shows a 45% decrease in painful peaks during the care of burn victims. Hypnosis has anxiolytic effect and modulate the response to pain. HypnoVR© is based on many concepts recognized in medicine accessible without specific training. In our practice, 95% of oocyte pick-up are made with local anesthesia and simple premedication, whereas conscious sedation is recommanded in Europe. HypnoVR© is systematically offered during oocyte pick-up. Our study had to compare the pain felt between the 2 group with or without HypnoVR©, also anxiety, tolerance and satisfaction of patients.Method : It was a prospective comparative, non-randomized, single-center, open-label study. We included all patients who were to benefit from an oocyte pick-up from 18 to 43 years-old. The usual protocol of pick-up was used and it was possible to add HypnoVR©. A questionnaire was distributed to each patient to collect their opinion.Results : A total of 112 patients were included, 60 without HypnoVR© and 52 with HypnoVR© ; 2 were excluded from the main analysis for missing data. There is no statistically significant difference in pain and anxiety between the groups. Patients are satisfied : 90.20% (n=46/52) would like to use it again and 98.04% (n=50/52) would recommend it.Conclusion : Despite the absence of a statistically significant difference, patients are satisfied with HypnoVR© and tolerance is good. It seems interesting to be able to offer it during oocyte pick-up.

Outcome of Transanal suture haemorrhoidopexy and Stapled haemorrhoidopexy -A prospective observational study

Background: Transanal suture haemorrhoidopexy is the preferred treatment due to its low cost, less post operative complication and decreased chance of recurrence in grade II and grade III Hemorrhoids. Objective: To compare the post-operative outcome of transanal suture haemorrhoidopexy and stapled haemorrhoidopexy in patients with grade II and III haemorrhoids. Methods: This study was conducted in the Department of Colorectal Surgery, Shaheed Suhrawardy Medical College hospital over a period of one-year. Sixty-two patients with haemorrhoids were enrolled in this study according to selection criteria. Data were collected, compiled and tabulated according to key variables. Qualitative data were expressed as frequency with percentage and quantitative data as mean with standard deviation. Quantitative data were analyzed by student’s t-test and qualitative data by Chi-square test. Data were processed and analyzed by using software SPSS 22.0. For all analyses p-value <0.05 was considered statistically significant. Result: Mean age of the patients was 49.38 ± 7.17 years and 52.45 ± 6.17 years in Stapled hemorrhoidopexy and Trans anal suture hemorrhoidopexy group respectively (p>0.05). Males were predominant in both the two groups. In stapled hemorrhoidopexy group, grade of hemorrhoids was II (51.6%) and III (48.4%) whereas in Transanal suture hemorrhoidopexy group, grade of hemorrhoids was II (38.7%) and III (61.3%) (p>0.05). Operative time was lower in Stapled hemorrhoidopexy (26.93 ± 1.59 min) than Transanal suture hemorrhoidopexy (27.74 ± 1.63 min). Per operative bleeding was found more in stapled group. Most of the patients stayed in the hospital only one day in both the two groups. Only four patients in Stapled hemorrhoidopexy group and one patient in Transanal suture hemorrhoidopexy group stayed more than one day. Post-operative pain according to VAS was lower in Stapled hemorrhoidopexy group (1.90 ± 0.54) than Transanal suture hemorrhoidopexy group (2.09 ± 0.30) after 24 hours of the surgery. But there was no significant difference in pain after 7 days of surgery between the two groups. Post-operative complications were more in stapled hemorrhoidopexy than Trans anal suture hemorrhoidopexy, but not statistically significant. Recurrence (bleeding & prolapse) found more in stapled group than suture hemorrhoidopexy group. Treatment cost was significantly lower in trans anal suture hemorrhoidopexy. Conclusion: Based on this study, transanal suture hemorrhoidopexy showed less intra and post-operative hemorrhage, shorter duration of hospital stay, lower post-operative complications, and lower recurrence rate when compared to stapled hemorrhoidopexy. However, these differences were not statistically significant. The only statistically significant difference was in the operative cost, which was in favor of transanal suture hemorrhoidopexy. J Shaheed Suhrawardy Med Coll 2023; 15(1): 45-49

Comparison and Evaluation of The Pain Experience between Vitamin D and Injectable Platelet Rich Fibrin - A Randomised Controlled Trial

Introduction Orthodontic discomfort is a major barrier to treatment compliance, with pain being a common reason for patients to discontinue. Pain often originates from the periodontal ligament due to pressure, ischemia, and swelling, and is influenced by individual factors like age, gender, and stress. Vitamin D and Platelet-Rich Fibrin (PRF) have emerged as non-invasive methods to accelerate orthodontic tooth movement while potentially reducing treatment pain. Materials and Methods This split-mouth, randomized control trial involved 20 adult patients undergoing canine retraction post-premolar extraction. PRF and Vitamin D were administered in different quadrants, with saline serving as the control. PRF was prepared using the double centrifugation technique and injected into the periodontal ligament. Vitamin D was prepared as a 50 pg dose and administered similarly. Canine retraction forces were applied using 150 grams of elastomeric chains, and pain was assessed using a Visual Analog Scale (VAS) immediately, after 24 hours, and at one week. Results PRF showed significantly higher pain scores than the control group after 24 hours and one week. In contrast, no significant difference in pain perception was observed between Vitamin D and control groups. Additionally, there was no significant difference in pain between PRF and Vitamin D groups at any time point.

Virtual reality for the management of pain and anxiety during outpatient manual vacuum aspiration for miscarriage or incomplete abortion: a mixed methods trial.

To evaluate the efficacy and acceptability of virtual reality (VR) as a distraction technique in the management of acute pain and anxiety during outpatient uterine aspiration using a manual vacuum aspirator (MVA). This mixed methods study included a prospective multi-centre randomised controlled trial and structured individual interviews. Of the 72 patients approached, 50 consenting, eligible participants were randomised to VR intervention (immersive video content 'The Forest of Serenity') or standard care during MVA for the management of miscarriage or incomplete abortion from July 2021-July 2022 across two university hospitals in London, UK. Expected and actual pain scores, and anxiety before and after the procedure were measured as numeric rating scores (0-10). Structured interviews were undertaken after the procedure in women randomised to VR. Statistical analysis of pain and anxiety scores were by intention-to-treat including all randomised participants, using Stata-12 software. Qualitative analysis was achieved by thematic analysis of transcribed interviews. There was no significant difference in pain or anxiety scores reported by participants randomised to VR compared with standard care. Mean worst pain scores were 5.98 and 6.88 in the standard care and VR groups respectively (p-value 0.13), with corresponding anxiety scores at the end of the procedure 3.94 and 3.3 (p-value 0.57). Qualitative analysis from interviews was highly favourable from women randomised to VR with all participants reporting a positive experience. 90% (18/20) of participants reported that VR reduced their anxiety and 71% (15/21) stated that it helped to reduce or distract from their pain. While virtual reality did not decrease pain or anxiety scores during MVA, it is a feasible and acceptable option that may improve patient experience. Randomisation to VR during MVA did not reduce pain or anxiety scores. However, at structured interview most participants reported that VR reduced their anxiety and reduced or distracted them from their pain. VR is a feasible and acceptable option that may improve patient experience during MVA.

A Randomized, Double-Blind, Placebo-Controlled Study Investigating the Safety And Efficacy of a Herbal Formulation on Knee Joint Function in Adults with Knee Osteoarthritis.

Background: Current treatments for osteoarthritis (OA) pain and stiffness have limitations, including adverse effects. Therefore, effective and safe complementary or alternative therapies are needed. Dietary supplement GJ 191, comprising Epimedium, Dioscorea, and Salvia miltiorrhiza extracts, may address this need. Methods: This randomized, double-blind, placebo-controlled study investigated GJ 191 supplementation on knee OA symptoms. Seventy-two adults (40-75 years) with mild to moderate knee OA and mild to moderate knee pain were enrolled. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Pain Visual Analog Scale (VAS), Quality of Life questionnaire, knee joint range of motion, serum C-reactive protein, and rescue medication use were assessed. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores were computed using KOOS scores. Results: Decreases in WOMAC pain scores were reported by both GJ 191 and placebo groups after 6 (-1.78 ± 2.71 and -1.34 ± 1.93, respectively; p < 0.01) and 12 (-2.31 ± 2.83 and -1.59 ± 2.69, respectively; p < 0.01) weeks, with no significant difference between groups. There were decreases in WOMAC stiffness scores for participants supplemented with GJ 191 by 0.53 ± 1.22 and 0.72 ± 1.46 (p ≤0.02) after 6 and 12 weeks, respectively, with respective decreases of 0.81 ± 1.51 and 0.75 ± 1.85 (p ≤0.03) for those on placebo. Significant improvements in current pain, as assessed by the Pain VAS, and bodily pain were reported by the GJ 191 group after 6 and 12 weeks, while the placebo group only reported significant improvements in these measures after 12 weeks. GJ 191 supplementation was safe and well tolerated. Conclusion: There was no significant difference in pain and stiffness scores between GJ 191 and placebo over the 12 weeks. While both groups reported improvements in WOMAC pain from baseline, improvements in current and bodily pain were experienced sooner with GJ 191 than placebo and were sustained over the study period. GJ 191 supplementation was safe and well tolerated. (CTR#: NCT04395547).

Liquid nitrogen cryotherapy effectively and safely improves response of thick Actinic Keratoses lesions by 5-aminolevulinic acid-based photodynamic therapy: a randomized, prospective, single-blind trial

BackgroundActinic keratoses (AK) may progress into squamous cell carcinoma. Many combination therapies were used to improve the clearance rate. However, there are limited studies on the efficacy and safety of lesion-directed Liquid nitrogen cryotherapy combined with field-directed photodynamic therapy (PDT). ObjectiveThis study is aimed to determine the efficacy and safety of Liquid nitrogen cryotherapy combined with PDT in Chinese patients with actinic keratosis. MethodsA total of 61 patients with AK were selected at the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College between August 2018 and August 2023. They were randomly divided into PDT plus Liquid nitrogen cryotherapy group(LN-PDT)and control PDT group(C-PDT)with 30 patients and 31 patients, respectively. 27 patients in the LN-PDT group and 28 patients in the C-PDT group completed the clinical sessions. Efficacy, adverse effects, and cosmetic outcomes were recorded and compared between the two groups. Results3 months after the final treatment, the clearance rates for total AK lesions were 97.4%(449/461) in the LN-PDT group and 93.4%(456/488)in the C-PDT group (P < 0.05). For grade I AK lesions, the clearance rates were 99.2% (234/237) for the LN-PDT group and 98.3% (237/241) for the C-PDT group (P >0.05). For grade II lesions, the clearance rates were 97.5% (156/160) for the LN-PDT group and 91.9% (172/186) for the CPDT group (P < 0.05). For grade III lesions, the clearance rates of the LN-PDT and C-PDT groups were 87.5% (58/64) and 78.7% (47/61), respectively (P < 0.05). The two groups had no significant differences in pain, erythema, edema, hyperpigmentation and scarring. Cosmetic outcomes mainly were excellent or good in both groups with no significant difference. ConclusionLiquid nitrogen cryotherapy combined with PDT showed higher efficacy on grade II and grade III AK lesions than PDT alone. The two groups have similar adverse effects and cosmetic outcomes.

The impact of intravenous versus submucosal dexamethasone on short-term patient response: A randomized controlled trial.

The purpose of this randomized, cross-over trial was to determine if a preoperative dose of dexamethasone administered submucosally is as effective as intravenous (IV) dexamethasone in reducing pain, swelling, and analgesic consumption after periodontal flap surgery. Thirty-nine patients planned for two similar flap surgeries under IV sedation were included. Before the first surgery, patients were randomized to receive 8mg of IV or submucosal dexamethasone. Via the alternate route, 0.9% sodium chloride (placebo) was administered. Dexamethasone was administered via the opposite route during the second surgery. A standardized regimen of 600mg ibuprofen and 325mg acetaminophen was used to manage postoperative pain. Patients recorded pain and swelling levels on a 21-point numerical rating scale (NRS-21) and a four-point visual rating scale (VRS-4), as well as analgesic usage via a phone application at 12, 24, 48, 72, and 168h postoperatively. While NRS-21 and VRS-4 data suggest a trend toward decreased pain and swelling with IV administration, there were no significant differences in analgesic usage or pain at any time and a significant difference in swelling only at 72 h in favor of IV administration (p=0.047). There was no significant difference in pain or analgesic usage following periodontal flap surgery comparing IV and submucosal dexamethasone. A statistically significant difference in swelling between groups at 72 h is likely of limited clinical relevance. Submucosal dexamethasone is an effective way to mitigate pain following periodontal surgery, particularly when IV access for sedation is not required.

Closed-incision negative-pressure wound therapy after Bascom's cleft lift surgery for pilonidal sinus disease: A randomized study comparing healing.

Despite favourable outcomes in recurrence after off-midline closure techniques in pilonidal surgery, between 18% and 40% of patients suffer from prolonged postoperative wound healing. The aim of this work was to investigate if closed-incision negative-pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery for complicated pilonidal sinus disease compared with conventional drainage and dressing. Patients were randomized to either NPWT for 4-7 days or loop-vessel drain for 24 h and a dry dressing postoperatively. Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint). Healing was defined as one or no closing defects of ≤5 mm and with no undermining. Although we had wanted to recruit 200 patients, the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58) after interim analysis. Patients were comparable by age, sex, body mass index, previous smoking status and indication for BCL surgery. At 2 weeks 12% of patients were healed in both the NPWT and control groups [risk difference = 0.00(95% CI -0.12 to 0.11), p = 1.00]. After 12 weeks, 68% of patients were healed in the NPWT group and 72% in the control group [risk difference = -0.03 (95% CI 0.19 to 0.13), p = 0.82]. There was no significant difference in pain experienced postsurgery. In a symptom-based questionnaire, the control group reported self-esteem to be less affected (p = 0.015). Closed-incision negative-pressure wound therapy did not significantly improve healing after BCL surgery for complicated pilonidal sinus disease.

Effects of scapular motion control training on treatment of patients with scapular fractures: An observational study.

To explore the effect of scapula motion control training on the rehabilitation effect of patients with scapular fracture. According to the random number table method, 61 patients were evenly divided into observation group 30 cases and control group 31 cases. The control group received routine postoperative functional exercise, and the observation group received functional exercise by adding scapula motion control training to the routine postoperative functional exercise. The pain, daily activity, range of shoulder movement, strength test, and total score were compared between the 2 groups of patients at 4 and 12 weeks after surgery. After 4 and 12 weeks of treatment, compared with the control group, the daily activities, range of shoulder movements, and total scores of the observation group increased, and there were no significant differences in pain and strength tests. After 12 weeks of treatment, compared with the control group, the daily activity, range of shoulder movements, and total score of the observation group were higher than those of the control group. Scapular motion control training can effectively improve the treatment of patients with scapular fractures and has clinical application value.

Comparison of WALANT versus locoregional nerve block in staged bilateral endoscopic carpal tunnel release

BackgroundCarpal tunnel release can be performed as open or endoscopic surgery. In WALANT (wide awake local anesthesia no tourniquet) a tourniquet is not used, ensuring less discomfort for the patient. In locoregional distal nerve block, on the other hand, a tourniquet is needed and can be painful. This raises the question as to which method of anesthesia is actually preferred for the patient and the surgeon. Patients undergoing staged bilateral carpal tunnel release present a unique opportunity to study this question. MethodsFifteen patients were included in this prospective study. The primary endpoint was the preference for anesthesia type in patients and surgeons. Surgeon preference was based on the visibility and fluency of the procedure. Secondary endpoints for patients comprised pain scores for performing surgery and anesthesia and pain caused by the tourniquet. ResultsBaseline demographic and clinical information was collected. There was no significant difference in pain for performing local anesthesia or surgery. Surgeons may find that performing endoscopic release under WALANT is more challenging, as visibility tends to be significantly poorer. The mean pain caused by the tourniquet used during the wrist block procedure was rated as 3.6. In both surgeries, 77% (10/13) of the patients preferred the WALANT anesthesia. ConclusionIn general, endoscopic carpal tunnel release was better tolerated under WALANT than locoregional distal nerve block. Although statistical analysis showed no significant difference in visibility and fluency for the surgeon between the two anesthesia techniques, we do not recommend endoscopic release under WALANT due to the consistent report of reduced visibility in the surgical field. This limitation, likely related to the presence of anesthetic fluid, may have failed to reach statistical significance due to small sample size, but is nevertheless a considerable challenge in practice. Level of evidence1B.

Effectiveness of Pilates compared with home-based exercises in individuals with chronic non-specific low back pain: Randomised controlled trial

Objective To investigate the effectiveness of a Pilates exercise program compared with home-based exercises in individuals with chronic non-specific low back pain. Design A randomised controlled trial with a six-month follow-up. Setting Rehabilitation clinic. Participants One hundred and forty-five individuals (18–50 years of age) with low back pain for ≥ 12 consecutive weeks were enrolled and randomly allocated to either Pilates (n = 72) or home-based exercise groups (n = 73). Interventions Method Pilates (Mat Pilates exercises using accessories) versus home-based exercise (postural exercises, muscle stretching and strengthening, and spine stabilisation/mobilisation), twice a week, for 6 weeks. Main measures Assessments were performed at baseline, post-intervention, and six months follow-up. Outcomes were pain intensity, disability, and health-related quality of life. Results At post-intervention, the Pilates group had significantly lower pain intensity (mean difference = −1.14; 95% CI −2.05; −0.23), less disability (mean difference = −6.7; 95% CI −11.3; −2.0), and higher health-related quality of life (mean difference = 0.102; 95% CI 0.054; 0151) compared to the home-based exercise group. At follow-up, the Pilates group had a significantly higher health-related quality of life (mean difference = 0.055; 95% CI 0.003; 0.106) compared with the home-based exercise group but there were no significant differences in pain and disability. A significant overall effect of Pilates compared to home-based exercise was found for disability (mean difference = −4.4; 95% CI −7.6; −1.1), and health-related quality of life (mean difference = 0.049; 95% CI 0.022; 0.076), but not for pain. Conclusion Although Pilates was significantly superior to home exercise for pain and disability, the differences were not considered clinically relevant. However, Pilates did provide significant and clinically relevant differences in utility.

Topical lidocaine for pessary removal and reinsertion pain reduction: a randomized clinical trial

BackgroundVaginal pessaries are an inexpensive non-surgical treatment for pelvic organ prolapse and stress urinary incontinence. Pessary maintenance includes periodic removal, cleaning, and reinsertion, which can be painful. Lidocaine-prilocaine cream has been shown to significantly reduce pain during pessary maintenance exams. In some practices, Lidocaine HCl 2% jelly may be more readily available and serve as an alternative to lidocaine-prilocaine cream. However, the effect of Lidocaine HCl 2% jelly use during pessary maintenance exams has not been tested. ObjectiveTo estimate the effect of Lidocaine HCl 2% jelly versus lubricating jelly on pain at the time of office pessary removal and reinsertion. Study DesignThis study is a single-blind, randomized clinical trial among patients presenting to a urogynecology office at a tertiary care center. Participants were randomized to the application of 5cc of Lidocaine HCl 2% jelly or a water-based lubricating jelly five minutes before pessary removal. Visual analog scale pain scores were collected from the participants at baseline, at pessary removal, and at pessary reinsertion. The primary outcome was the visual analog scale pain score at the time of pessary removal. A sample size of 33 per group (n=66) was planned to estimate an absolute mean difference in visual analog pain scale of 2.05 cm at the time of pessary removal. ResultsBetween September 2022 and June 2023, 192 women were screened, and 66 were enrolled. Thirty-three participants were randomized into the lubricating jelly group and 33 participants were randomized into the Lidocaine HCl 2% jelly group. The two groups were similar in baseline characteristics. Most participants were postmenopausal, using vaginal estrogen, wearing a 70 mm ring pessary with support for pelvic organ prolapse, and reported being very satisfied with the pessary. Other pessaries worn included ring without support, incontinence rings with and without support, Gellhorn, and donut. The pessary sizes ranged from 51 mm to 96 mm. There was no significant difference in pessary type and size between groups. Visual analog scale pain scores at pessary removal were low in both groups: 3.23±3.00 cm in the lubricating group and 2.66±2.77 cm in the lidocaine group. After adjusting for baseline pain, there was no significant difference in pain at pessary removal between the lidocaine jelly and the lubricating jelly groups (mean difference=-0.56 cm, 95% CI: -1.97 to 0.85; p=0.44). Despite no significant difference in visual analog scale pain scores, 71.2% of participants reported a desire for numbing jelly at future pessary examinations. ConclusionPain during pessary removal and reinsertion is low. Compared to lubricating jelly, lidocaine jelly did not further reduce pain during pessary examinations.

Specific therapeutic methods in lumbar facet syndrome tratment: prliminary study

Introduction: Specific therapeutic methods (STM) are manual techniques used to treat tissue blockade.Aim of this research is to determine efficacy of STM in treatment of lumbar facet syndrome (LFS).Patients and methods. The study included 60 patients suffering from LFS (65% women) aged ~47. The patients were treated ~24 days with the following 2-8 procedures: osteopathy, “myofascial release”, acupuncture, acupressure, “cupping”, neurodynamic, proprioceptive neuromuscular facilitation, kinesiotherapy, “kinesio-type taping”, homeopathy and electrotherapy. All patients were evaluated at admission and discharge through: a. pain scale with visual analogue scale (VAS) marked with numbers 1 to 10 (1 being state of no pain, 10 being state of maximum pain); b. disability with so-called Oswestry index (ODI) expressed in percentages (0-20% being minimum, 80-100% being complete disability); c. quality of sleep, rated through modified Pittsburgh index of sleep quality (PSQI) expressed between 0 (very poor) and 4 (very good). The assessment of improvement in pain intensity and level of disability was conducted via subtraction of values noted before treatment from values at the end of treatment, while the assessment of sleep quality improvement was conducted via subtraction of values noted at the end of treatment from the values noted before treatment. Non-parametric statistical analyses were used. Results: significantly lower values of VAS (p&lt;0.0001) and ODI (p?0.0001), significant increase in PSQI (p?0.0001) at the end in relation to the beginning of treatment, as well as significant correlation between decrease in pain and disability (r=0.3292, p=0.0105). No significant difference in pain (p=0.9856) and disability (p=0.9171 decrease was noticed between sexes.Conclusion: STM is efficient in the treatment of pain attacks in patients of both sexes suffering from LBS.

Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial

BackgroundIn recent years, obstructive sleep apnea (OSA) has been increasingly recognized as a significant health concern. No previous studies assessed the effect of recommended treatment modalities of patients with OSA on the temporomandibular joint (TMJ). The current study aimed to evaluate the effect of different treatment modalities of OSA, such as continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and oral myofunctional therapy (OMT) on subjective symptoms, clinical, and radiographic signs of temporomandibular disorders.Patients & MethodsThis hospital-based prospective randomized controlled clinical trial study was approved by the institutional review board and formal patient consent, 39 OSA patients, ranging in age from 19 to 56 after confirmation with full night Polysomnography (PSG) with healthy TMJ confirmed clinically and radiographically with magnetic resonance imaging (MRI) were randomly allocated into three treatment groups. Group 1: 13 patients were managed with CPAP after titration, group 2: 13 patients were managed with digitally fabricated MAD, and group 3: 13 patients were managed with OMT. The following parameters were evaluated before and 3 months after the intervention. Pain using a visual analogue scale (VAS), maximum inter-incisal opening (MIO), lateral movements, and clicking sound of TMJ. MRI was done before and 3 months after the intervention.ResultsOut of the 83 patients enrolled, 39 patients completed the treatment. There were no statistically significant differences in lateral jaw movements or clicking, and no significant difference in MRI findings between the three studied groups before and after the intervention. The OMT group showed a statistically significant difference in pain (p = 0.001), and MIO (p = 0.043) where patients experienced mild pain and slight limitation in mouth opening after 3 months of follow-up in comparison to MAD and CPAP groups.ConclusionCPAP and MAD are better for preserving the health of TMJ in the treatment of OSA patients. While OMT showed mild pain and slight limitation of MIO (that is still within the normal range of mouth opening) compared to CPAP and MAD.Trial registrationThe study was listed on www.clinicaltrials.gov with registration number (NCT05510882) on 22/08/2022.

Corticosteroid Injection With and Without Local Anesthetic for the Treatment of Trigger Finger: A Randomized Clinical Trial

This study aimed to report pain during and following injection for trigger finger as well as failure to resolve triggering. We hypothesized that a corticosteroid injection alone would be equally or less painful compared with the standard combination of corticosteroid and lidocaine for the treatment of trigger fingers, and there would be no difference in the resolution of triggering. Our study was a prospective, single-blinded, randomized controlled trial at a single institution, comprising 76 patients with a diagnosis of trigger finger. Each treatment group consisted of 38 patients. Patients were randomized to receive either a betamethasone (1 mL, 6 mg) injection without lidocaine or a betamethasone injection (1 mL, 6 mg) with 1% lidocaine (1 mL). Patients were assessed during injection and at 1 hour, 6 hours, 2 days, and 6 weeks after the injection. The primary outcome was pain measured using a numerical rating scale. The secondary outcome was the rate of failure to resolve symptoms at 6 weeks. There was a statistically significant difference in pain scores between the lidocaine and betamethasone versus betamethasone-only injections during administration (4.6 vs 6.2) and after 1 hour (1.3 vs 2.5). There was no statistically significant difference in pain scores after 6 hours (1.5 vs 2.0) and 2 days (0.7 vs 0.6) or in failure rate at the 6-week time point (21% vs 18%). This study showed that there is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone for the treatment of trigger finger, but that difference may not be clinically relevant. There was no significant difference in the failure rate between the treatments. Therapeutic II.

Hypnosis and nitrous oxide impact on the school aged patients’ anxiety and cooperation candidate for tooth extraction: A randomized clinical trial

BackgroundThis randomized clinical trial (RCT) investigated whether hypnosis would lead to favorable outcomes in reducing anxiety, enhancing cooperation, and improving physiological responses in school-aged children undergoing tooth extraction compared to nitrous oxide/oxygen (N2O/O2) and conventional behavior guidance (CBG). MethodsSixty-six school-aged children (mean age: 7.87 ± 1.18 years) who needed one posterior primary tooth extraction were included. Children with low-to-moderate anxiety were randomly divided into three groups (n = 22 each): hypnosis, N2O/O2, and CBG. Anxiety levels during and after anesthetic injection and tooth extraction were assessed using the Venham Clinical Anxiety Scale (VCAS) and the Venham Picture Test (VPT). Changes in heart rate (HR) and oxygen saturation (SpO2) were monitored. Children's cooperation levels were measured using the Venham Clinical Cooperation Scale (VCCS). ResultsThe VPT scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.001). The VCAS scores in the N2O/O2 group were lower than those in the CBG group (p < 0.05) and were comparable to those in the hypnosis group. The VCCS scores were significantly higher in the CBG group than in the N2O/O2 and hypnosis groups (p < 0.05). HR changes in the N2O/O2 group were significantly lower than in the hypnosis and CBG groups (p < 0.05). No significant difference in pain was observed between the groups the day after the intervention. ConclusionN2O/O2 inhalation and hypnosis are effective in reducing self-reported and observed anxiety and improving cooperation levels in pediatric patients during dental extraction. Moreover, the frequency of reported pain was lower in the hypnosis group compared to the other groups.

Is cervical sagittal alignment associated with pain and disability in myofascial pain syndrome?: A cross-sectional study

ObjectiveTo elucidate the role of cervical sagittal alignment in the pathophysiology of cervical myofascial pain syndrome(MFPS) and its impact on pain levels and disability status among patients. MethodsThis prospective cross-sectional study included participants aged 18–64 years experiencing neck pain for more than 3 months and diagnosed with MFPS. Cervical sagittal parameters (C0–2 cervical lordosis(CL) angle, C2–7 CL angle, cervical sagittal vertical axis (cSVA), T1 slope, T1 slope minus CL mismatch(T1S-CL), and cervical tilt) were measured using Surgimap software by an expert physiatrist. Pain levels were assessed using the Numerical Pain Rating Scale(NRS), and neck disability was evaluated using the Neck Bournemouth Questionnaire(NBQ). ResultsOut of 200 initially assessed participants with cervical MFPS, 133 were included after excluding ineligible individuals. The mean age of the participants was 35.3±8.2 years. Participants categorized by pain severity (moderate vs. severe) showed no significant differences in cervical range of motion, C0–2 angle, cSVA, T1 slope and T1S-CL. However, significant differences were observed in C2–7 angle (p=0.008), cervical tilt (p=0.006), and NBQ scores (p<0.001) between the two pain severity groups. Grouping based on T1S-CL compliance showed no significant differences in pain and disability effects. Correlation analysis revealed weak negative correlations between pain levels and C2–7 Cobb angle (p=0.009, r=0.226) as well as cervical tilt (p=0.005, r=0.243). No correlations were found between cervical sagittal parameters and NBQ scores. ConclusionsDecreased C2–7 CL angle and cervical tilt angle are associated with increased pain levels; however, cervical sagittal alignment was not found to be associated with disability.

Methoxyflurane analgesia for outpatient hysteroscopy: A double-blind, randomised, controlled trial.

Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic. To study the efficacy and safety of methoxyflurane analgesia during OPH. A single-centre, randomised, double-blind, placebo-controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post-procedure; participant and clinician-reported adverse effects and events; and participant-reported procedure acceptability, adjuvant nitrous oxide (N2O2) use and a composite of 'distress'. During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08-22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71-28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post-procedure, participant- and clinician- reported adverse effects and events, procedure acceptability and the 'distress' composite. Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events.

Efficacy of self-care foam rolling intervention on muscle function and pain conducted by postoperative patients who underwent total knee arthroplasty from the second to the third postoperative week

BackgroundThis study aimed to investigate whether self-care foam rolling (FR) intervention, in addition to regular physical therapy, effectively improves pain, knee joint range of motion (ROM), muscle function (knee extension strength and gait speed), and balance function in patients who underwent total knee arthroplasty (TKA) during the second and third postoperative weeks. MethodsA total of 15 patients admitted to the hospital and who underwent TKA for knee osteoarthritis were enrolled. FR was performed for more than 10 min in the morning and 10 min in the afternoon each day from the second to the third postoperative week. Knee flexion and extension ROM, pain (resting and stretching position), 10 m walk speed, timed up-and-go test (TUG), one-leg stand, and maximal voluntary isometric contraction torques of knee extensors were assessed. ResultsSignificant improvements in knee flexion pain, knee flexion ROM, knee extension ROM, knee extension strength, 10 m walk speed, TUG, and one-leg stand were observed from the second to the third postoperative week. However, at rest, no statistically significant differences in pain were found. ConclusionsMuscle function of the knee extensors improved following the self-care FR intervention probably attributed to the adjusted pain level.