Significant Difference In Pain Research Articles

Clinical Outcome of Lumbar Hybrid Surgery in a Consecutive Series of Patients with Long-term Follow-up.

This was a retrospective study combined with attempted prospective patient contact to collect current data. The purpose of this study was to investigate long-term clinical outcome of patients undergoing lumbar hybrid surgery (total disc replacement (TDR) at one level and fusion at an adjacent level. Many patients with symptomatic lumbar disc degeneration are affected at more than one level. Lumbar TDR was introduced as a fusion alternative; however, some disc levels are not amenable to TDR and fusion is preferable at such levels. Hybrid surgery was introduced as an option to fusing multiple levels. A consecutive series of 305 patients undergoing lumbar hybrid surgery was identified beginning with the first case experience in 2005. Operative and clinical outcome data including visual analog scales (VAS) assessing back and leg pain, Oswestry Disability Index (ODI), and re-operations were collected. The mean follow-up duration was 67.1 months. There were statistically significant improvements (P<0.01) in the mean values of all three clinical outcome measures: VAS back pain scores improved from 6.7 to 3.3; leg pain improved from 4.3 to 2.0; and ODI scores improved from 45.5 to 24.6. There were no significant differences in pain and function scores for patients with minimum 10-year follow-up vs. those with shorter follow-up duration. Re-operation occurred in 16.1% of patients, many of which involved removal of posterior instrumentation at the fusion level (6.2% of study group, 38.8% of re-operations). Re-operation involving the TDR level occurred in 9 patients (2.9%), only 3 of which (1.0%) involved TDR removal/revision. This study supports that for many patients with multilevel symptomatic disc degeneration, hybrid surgery is a viable surgical option. Significant improvements were demonstrated in pain and function scores with no diminished improvement in scores among patients with more than 10-year follow-up.

Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain

Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70–80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland–Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p &lt; 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p &lt; 0.05). There were significant differences in pain and quality of life (p &lt; 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.

A first-in-human clinical study investigating the safety and tolerability of stabilized hypochlorous acid in patients with chronic leg ulcers.

Biofilm infections in chronic wounds are common and pose a significant clinical challenge. This challenge was addressed by developing the SoftOx Biofilm Eradicator (SBE) composed of hypochlorous acid and acetic acid with strong broad-spectrum antimicrobial activity. First-in-human study investigating the safety and tolerability as primary endpoints, wound size effect and antimicrobial efficacy as secondary endpoints of SBE treatment in chronic leg wound patients. The study was divided into two: a randomized, double-blinded, Single Ascending Dose (SAD) phase (n=16 SBE; n=4 placebo), where patients were treated with SBE or saline (placebo) only once, followed by an open label, Multiple Ascending Dose (MAD) phase (n=8), where patients were treated with SBE once-daily or twice-daily over five days. Reporting according to CONSORT guidelines. SBE was safe and well-tolerated in chronic leg wound patients. There were no significant differences in pain during and after treatment with SBE or the placebo. The SBE treatment reduced bioburden in wounds compared to baseline, with 98 % and 49 % median reduction after SBE or placebo treatment, respectively. A dose dependent trend in absolute wound size reduction was observed in the MAD groups with a median (min, max) change of -2.99 (-14.25, -1.5) cm2 in the once-daily and -10.48 (-17.95, -0.38) cm2 in the twice-daily group, respectively. This study demonstrated the safe use of hypochlorous acid-based SBE in chronic leg wounds with promising trends of immediate antimicrobial action and beneficial effect on wound healing.

Comparing the efficacy of Agnikarma with therapeutic ultrasound in the management of tennis elbow - A randomised controlled preliminary study

BackgroundTennis elbow is a common musculoskeletal disease of elbow and causes restricted movement of forearm. Various treatment modalities like NSAID, corticosteroid injection, counter bracing, physiotherapy, surgery etc are available but safety and efficacy of one treatment over another is under research. Ayurveda classifies this condition as Snayugata vata. According to Sushruta, Agnikarma (thermal cautery) is the one among the treatment modalities for Snayugata vata. Previously published randomised controlled trials have shown that therapeutic ultrasound is safe and effective for tennis elbow. However, the comparative efficacy of these two treatment modalities is unknown. ObjectiveThis study compares the effects of Agnikarma (AGK) with Therapeutic Ultrasound (TUS) in reducing pain, tenderness and restores the ability to do various tasks. Materials and methodsA total of 30 patients were enrolled in the study as an open-label, double-armed, prospectively designed comparative clinical study, with 15 patients in each group. Group AGK received two sittings of Agnikarma and Group TUS received therapeutic ultrasound. To analyze the patients, three outcome measures were adopted: pain intensity, assessed with a Numerical Pain Rating Scale, tenderness – Grade 0 to Grade 4 (mentioned in Hutchinson's clinical methods) and pain and functional Disability assessed with the Patient Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Assessment was done on 0th, 8th, 15th, 30th and 60th day. ResultTennis elbow can be effectively treated with AGK and TUS. (p < 0.001 for pain, tenderness and PRTEE). While comparing between the groups, on 8th day and 15th day statistically significant difference in pain and PRTEE (p < 0.05) was noted between AGK and TUS groups. Agnikarma showed better results than therapeutic ultrasound in pain management and showed an improved quality of life from 8th day onwards and for a period up to 2 months. ConclusionBoth Agnikarma and therapeutic ultrasound have roles in the management of tennis elbow. However, starting on the 8th day and continuing for up to 2 months, Agnikarma showed a significant benefit in pain management and improved status for quality of life.

COMPARING EXERCISE AGAINST A PLACEBO FOR PAIN AND DISABILITY OUTCOMES IN MUSCULOSKELETAL CONDITIONS: A SYSTEMATIC REVIEW &amp; META-ANALYSIS

BACKGROUND Musculoskeletal conditions are the leading cause of years lived with disability globally, with pain and disability being two of the most important patient-reported outcomes. Exercise is a commonly recommended treatment for musculoskeletal conditions, though it is unclear whether exercise outperforms sham for improving pain and disability. AIM: To determine if exercise improves pain and disability more than sham for people with musculoskeletal conditions. METHODS We searched 5 databases and 3 clinical trial registers for randomised controlled trials comparing exercise against sham in people with a musculoskeletal condition. The co-primary outcomes were pain and disability. Data were analysed using random effects meta-analysis or narrative synthesis if &amp;lt; 5 studies were available to be pooled. The certainty of findings was assessed using the Grading of Recommendations, Assessment, Development and Evaluations tool. Data are presented as mean difference [95% CI], with a difference of &amp;gt;10/100 for pain and &amp;gt;14.5/68 for disability (WOMAC physical function sub-scale) considered clinically meaningful. RESULTS Within the 15 included studies, all reported pain intensity and 13 reported disability. There was low certainty evidence that exercise was more efficacious than sham for lowering low back pain (-5.94 [-7.74, -4.15], n=1091), osteoarthritis pain (-6.19 [-14.36, 1.97], n=447) and osteoarthritis disability (-7.95 [-11.45, -4.46], n=211). Narrative synthesis showed varied effects of exercise versus sham on pain and disability in neck pain, as well as on disability in low back pain and other measures of disability in osteoarthritis. No studies were located for rheumatoid arthritis. CONCLUSION Based on low certainty evidence from a limited number of studies, exercise may not cause clinically significant differences for pain and disability compared to sham in adults with osteoarthritis and back pain. Further research is needed to confirm this for low back pain and osteoarthritis and to extend the findings other musculoskeletal conditions.

The effect of refined psychological pain nursing combined with IMB nursing on the pain, sleep and quality of life of patients after cervical cancer surgery.

To explore the effect of refined psychological pain nursing combined with information-motivation-behavioral (IMB) care model on the pain, sleep and quality of life of patients after cervical cancer surgery, so as to provide reference and basis for the nursing of patients after cervical cancer surgery. The clinical data of 798 postoperative cervical cancer patients who were nursing in our hospital from January 2018 to December 2022 were included in this retrospective study and divided into the control group (n = 382) and observation group (n = 416) according to the different care methods. The control group used refined psychological pain nursing, and on this basis, the observation group used IMB nursing to observe and compare the differences in pain, sleep and quality of life between the 2 groups. There was no significant difference in pain between the 2 groups before nursing (P > .05). After nursing, the pain of both groups was significantly improved. The scores of NRS, VAS, and PSEQ of the observation group were significantly better than those of the control group (P < .001). After nursing, the quality of life scores such as emotion, cognition, society, and overall health were significantly higher in the observation group than those of the control group, while physical, fatigue, nausea, vomiting, and pain were significantly lower than those of the control group (P < .05). The negative emotion score of the observation group was significantly lower than that of the control group (P < .001). The residual urine volume and urinary tract infection rate of the observation group were significantly lower than those of the control group (P < .05). The bladder function was significantly better than that of the control group (P < .05). The analgesic effect of refined psychological pain nursing combined with IMB nursing on patients after cervical cancer surgery is better than that of refined psychological pain nursing alone, which can promote pain recovery and further improve the quality of life and sleep quality of patients.

Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation

Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package (‘Responsive CARE’) was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of ‘Responsive CARE’. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in ‘Responsive CARE’. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours.

Effects of Eccentric Tyler Twist Extensor-Strengthening Exercises in Lateral Epicondylitis

Background: Lateral epicondylitis, commonly known as tennis elbow, is characterized by pain and functional limitations at the elbow due to overuse. This study focuses on evaluating the effects of Tyler twist wrist extensor-strengthening exercises, aiming to provide insights into an effective intervention for this condition. Objective: This study aimed to determine the effects of Tyler twist wrist extensor strengthening exercises on pain, disability, and grip strength in patients with lateral epicondylitis. Methodology: A randomized controlled trial was conducted at Cina Medical Center Rawalpindi from February 2022 to January 2023. Fifty-two participants meeting the inclusion criteria were assigned to either Group A or Group B. Group A received eccentric Tyler twist exercises in addition to conventional physiotherapy, while Group B received conventional physiotherapy alone. Pain, functional disability, and grip strength were assessed at baseline, the second week, and the fourth week. Data was analyzed with SPSS version 25. Demographics and descriptive data is presented in form of percentages, frequencies and mean + SD. Normality of the data is determined via Shapiro Wilk Test. We applied mixed-way ANOVA to find the interaction between two groups. R e s u l t s : Within-group analysis demonstrated a significant improvement in pain, functional disability, and grip strength for both groups (p-value &lt; 0.01). Between-group analysis revealed a significant difference in pain, functional disability, and grip strength. Conclusion: The addition of eccentric Tyler twist exercises to conventional therapy showed a statistically significant difference in terms of pain, functional disability, and grip strength in patients with lateral epicondylitis.

Clinical comparative study on resection and non-resection of the fifth metatarsal to rheumatoid forefoot deformity

To explore clinical effect of the fifth metatarsal head excision and non-excision in rheumatoid arthritis (RA) forefoot deformity reconstruction. Retrospective analysis was performed on 50 patients (76 feet) with moderate to severe forefoot deformity caused by RA treated from May 2015 to January 2019. According to degeneration of the fifth metatarsophalangeal joint,the fifth metatarsal head was retained or excised by wind-like forefoot reconstruction,and divided into the fifth metatarsal head preservation group (preservation group) and the fifth metatarsal head resection group (resection group). Twenty-four female patients in preservation group,aged from 47 to 81 years old with an average of (60.37±8.60) years old;the course of disease ranged from 13 to 22 years with an average of (19.00±3.06) years;body mass index (BMI) ranged from 21 to 28 kg·m-2 with an average of (23.53±2.47) kg·m-2;six patients (6 feet) with moderate hallux valgus deformity and 18 patients (30 feet) with severe hallux valgus deformity;treated with the first metatarsophalangeal joint fusion combined with the second th the fourth metatarsophalangeal joint arthroplasty and the fifth metatarsophalangeal joint cleanup. Twenty-six female patients in resection group were female,aged from 30 to 80 years old with an average of (58.53±13.70) years old;the course of disease ranged from 8 to 25 years with an average of (17.94±3.92) years;BMI raged from 20 to 28 kg·m-2 with an average of (24.60±2.03) kg·m-2;4 patients (4 feet) with moderate bunion valgus deformity and 22 patients (36 feet) with severe bunion valgus deformity;treated by the first metatarsophalangeal joint fusion combined with the second th the fifth metatarsophalangeal joint resection of the metatarsophalangeal head. Operation time and postoperative complications between two groups were observed,hallux valgus angle (HVA),intermetatarsal angles between the first and the second metatarsals (IMAFS),intermetatarsal angles between the first and fifth metatarsals (IMAFF),Japanese Society for Surgery of Foot (JSSF) score before surgery and at the latest follow-up were compared. Fifty patients were followed-up from 14 to 46(25.30±8.83) months in resection group and 12 to 48 with an average of (24.30±11.12) months in preservation group,while no significant difference between two groups (P>0.05). There were no significant difference in operation time and postoperative complications between two groups (P>0.05). JSSF scores,HVA,IMAFS and IMAFF in fesection group were improved from (45.09±3.35) points,(38.90±13.67) °,(12.88±1.72) °,(32.50±2.99) ° before operation to (81.60±3.27) points,(15.40±0.90),(9.06±2.27) °,(22.20±1.98) ° at the latest follow-up (P<0.05);preservation group were improved from (47.09±3.96) points,(43.30±12.65) °,(13.99±3.13) °,(33.20±6.14) ° to (83.10±3.66) points,(15.20±1.54) °,(8.99±1.02) °,(24.70±1.88) °,respectively. There were no significant difference in JSSF score,HVA,IMAFS and IMAFF between two groups before operation and the latest follow-up (P>0.05). At the latest follow-up,there were statistically significant differences in pain and deformity in JSSF scores between two groups (P<0.05). Both rheumatoid anterior foot reconstruction and anterior foot reconstruction fifth metatarsophalangeal joint debridement showed significant improvement in clinical efficacy and imaging results. Compared with rheumatoid prefoot reconstruction,the fifth metatarsophalangeal joint reconstruction for the treatment of moderate and severe deformity of rheumatoid prefoot showed better improvement in pain,but worse improvement in deformity. For the moderate to severe deformity of the forefoot caused by rheumatoid disease,patients with mild to moderate degenerative deformity of the articular surface of the fifth metatarsal phalanges may be considered for use.

Efficacy of Intra-Articular Corticosteroid Injection for Nonsurgical Management of Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA. A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded. The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma. Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. Therapeutic II.

Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial

ObjectiveThe objective of the study was to evaluate the efficacy of Maitland accessory mobilization and neural mobilization in patients with tennis elbow. MethodTwenty-five patients meeting the selection criteria were randomly assigned to three experimental groups: Group C (conventional treatment), Group B (neural mobilization), and Group A (Maitland mobilization). Quality of life was assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE), while pain, range of motion, and grip strength were evaluated using the Visual Analog Scale (VAS), a universal goniometer, and a handheld dynamometer. The interventions were administered three times per week for four weeks to the respective groups. ResultsNon-parametric tests were employed to analyze the results due to the non-normal distribution of the data (p < 0.05). Both the Wilcoxon signed-rank test and the Kruskal-Wallis test were utilized to assess differences within and between groups. The results of the between-group analysis demonstrated significant differences in pain (p = 0.018) and quality of life (p = 0.045) among the three groups. ConclusionAfter a 4-week intervention, all three groups exhibited notable improvements in discomfort levels, grip strength, and quality of life. Notably, Group B demonstrated the most substantial increase in range of motion (ROM) compared to Groups A and C. Consequently, incorporating neural mobilization into the treatment plan is recommended for patients experiencing Tennis Elbow.

Comparison of General Exercises, Motor Control Exercises and Spinal Manipulation in Chronic Low Back Pain Patients

Objective: To compare the effects of motor control exercises, general exercises and spinal manipulative therapy on pain, functional status and disability in chronic low back pain patients. Study Design: Randomized Clinical Trial (IRCT:20200511047391N1) Place and Duration of Study: Riphah International University, Islamabad Pakistan, from Jun to Nov 2020. Methodology: Study was conducted on 36 chronic low back pain patients aged 18-50 years. All were randomly allocated to three groups: general exercises group, motor control group, and manipulative therapy; all were treated with eight sessions in four weeks. Numerical pain rating scale, Patient-specific functional scale and Oswestry disability index were used. Results: Findings revealed that differences between the three groups were statistically significant (p&lt;0.05) concerning pain score, patient-specific functional scale, and Disability index. Conclusion: It was concluded that motor control exercises are most effective in treating chronic low backache. The results of our study showed that there is a significant difference in pain, function and disability in all the groups.

The Effects of Foot Reflexology and Simple Foot Massage on Fatigue and Pain in Children With Leukemia: A Randomized Control Trial

Background and Purpose: Chemotherapy is one of the main options in treating childhood cancers. Fatigue and pain are common symptoms of cancer and one of the major complications experienced during chemotherapy. This study aimed to determine the effect of foot reflexology and simple foot massage on fatigue and pain in children with leukemia. Materials and Methods: This randomized clinical trial was performed on 99 children with leukemia aged 4-14 years, undergoing chemotherapy in the oncology departments of Hazrat Ali Asghar Hospital and Children’s Medical Center, Tehran City, Iran, in 2019. The sampling was sequential, and participants were assigned into three groups by block randomization: Foot reflexology, simple foot massage, and control group. The foot reflexology and simple foot massage were performed for 5 consecutive days. Participants were asked to report the intensity of pain and fatigue over the past 48 hours using the pain visual and child fatigue scales. Statistical analysis was conducted with SPSS software, version 22. Quantitative variables were reported as the Mean±SD. The chi-square test, analysis of variance, and repeated measures tests were used for data analysis. Results: Demographic characteristics in three groups were not significantly different except for gender (P=0.011). There was no significant difference in pain (P=0.67) and fatigue (P=0.45) before the intervention. The Mean±SD pain scores on the third day in foot reflexology, simple foot massage, and control group were 4.4±1.9, 5.2±1.79, and 6.3±1.76, respectively (P&lt;0.001). The Mean±SD pain scores on the fifth day in foot reflexology, simple foot massage, and control group were 2.7±1.4, 3.9±1.83, and 6.7±1.5, respectively (P&lt;0.001). The Mean±SD fatigue scores on the third day in foot reflexology, simple foot massage, and control group were 2.36±0.55, 2.95±0.6, and 3.65±0.32, respectively (P&lt;0.0001). The Mean±SD fatigue scores on the fifth day in foot reflexology, simple foot massage, and control group were 2.14±0.42, 2.67±0.73, and 4.12±0.16, respectively (P&lt;0.0001). Conclusion: Our results showed that foot reflexology and simple foot massage can decrease pain and fatigue in children with leukemia. Performing foot reflexology could be recommended as a complementary intervention to reduce pain and fatigue in children with leukemia.

Distraction Technique using a Cooling Vibrator Reduces the Pain of Vein-puncture in Children

Background: Typhoid fever is commony found disease at the hospital. One of the treatments for typhoid fever is intravenous fluid therapy. This procedure certainly causing pain. Actions to minimize pain to children when infusion is carried out are part of the principles of atraumatic care. One of the atraumatic principle can be performed on children is the use of vibrators and cold compresses to minimize pain.Purpose: To determine the effectiveness of vibrator and cold compress against pain in children when taking venous blood.Methods: This research using true experimental with a post-test in control group and divided into 2 groups, intervention and control groups. This research will determine the effectiveness of cooling vibrator. Assessing children's pain using the FLACC instrument. The study was conducted at Tidore Islands Hospital. Data processing was tested with Mann-Whitney test.Result: Mostly respondents are 4 years old. both of them experiencing of having blood drawn before. Most of the control and intervention groups were women. There are differences pain scores founded, in the intervention group was 3.13 and in the control group was 7.87. The results of statistical tests showed that there was a significant difference in pain during venipuncture in the intervention group and the control group.Conclusion: The statistical test show there was a significant difference in intervention group and the control group. The use of a cooling vibrator can be an alternative to reduce pain in children during venipuncture.

Analgesia in Transcutaneous Laryngeal Botulinum Toxin Injections: A Randomized Crossover Trial.

There is an absence of data in the literature regarding methods to improve the patient experience during the performance of awake in-office laryngeal injections. This study sought to evaluate whether the use of local anesthetic or a vibrating instrument decreased overall pain experienced by patients with laryngeal dystonia, frequently referred to as spasmodic dysphonia (SD), undergoing transcervical botulinum toxin injections. This was an unblinded, prospective randomized control trial with a crossover design where each patient received transcutaneous transcricothyroid injection of botulinum toxin with alternating use of no anesthesia, local anesthesia (2% lidocaine in 1:100,000 epinephrine), and vibrating instrument in three consecutive laryngeal injections to treat adductor SD. Patients were randomized to the order they received these treatments. Patients measured pain on a 0-10 visual analogue scale (VAS) and selected their preferred technique after receiving all three analgesic modalities. Thirty-two patients completed the study. There was no statistically significant difference in pain between the three analgesic techniques (p = 0.38). The most preferred analgesic technique was the vibrating wand (44% (14/32)). Lidocaine was the second most preferred (37% (12/32)) and 19% (6/32) of patients preferred nothing. When combining the wand and nothing groups, 63% of patients preferred one of these two methods (95% exact CI: 44%-79%). There was no statistically significant difference in median pain experienced by patients during laryngeal botulinum toxin injection between these different analgesic modalities. More than half of the patients selected a preference for a technique that did not include lidocaine. This data supports individualization of analgesia during transcutaneous laryngeal injections. 2 Laryngoscope, 134:2277-2281, 2024.

The reliability and validity of the isixhosa version of the euroqol toddler and infant populations (EQ-TIPS) health related quality of life instrument

Background: Considering the high burden of disease in young children measurement of Health-Related Quality of Life is needed to evaluate the burden of morbidity. This study aims to report on the validity and reliability of the isiXhosa EuroQol Toddler and Infant Populations (EQ-TIPS) measure for South Africa.Methods: A sample of 181 caregivers of children 0-36 months were recruited from a hospital in-patient (inpt) and outpatient (outpt) facility and crèches. The EQ-TIPS, Ages and Stages Questionnaire (ASQ), Faces, Leg, Activity, Cry, Consolability (FLACC) and dietary information were administered at baseline. EQ-TIPS was administered one week later in crèche children for test-retest reliability.Results: Known groups showed significant differences for pain (X2=37.21, p&lt;0.001), and EQ-TIPS level sum score (KWH=25.9, p&lt;0.001) between health groups. The Visual Analogue Scale was unable to discriminate general health between groups (KW-H=3.92, p=0.141). Concurrent validity was weak to moderate and significant for all dimensions hypothesised to correlate. There was significant fair to moderate test-retest reliability for EQ-TIPS dimensions of movement, play, pain and eating.Conclusion: The isiXhosa EQ-TIPS is valid and reliable for very young children in South Africa and we suggest that it be included in the assessment of children with health conditions within this context.

Does the Use of Botulinum Toxin in Treatment of Myofascial Pain Disorder of the Masseters and Temporalis Muscles Reduce Pain, Improve Function, or Enhance Quality of Life?

The efficacy of botulinum toxin for management of myofascial pain disorder (MPD) remains controversial. The purpose was to determine if the use of onabotulinumtoxinA (onabotA) in patients with MPD reduces pain, improves function, or enhances quality of life (QoL). This is a multicenter, prospective, randomized, double-blinded, placebo-controlled clinical trial. Subjects with orofacial pain were screened for MPD as defined by the Diagnostic Criteria for Temporomandibular Disorders. The primary predictor variable was MPD treatment with random assignment to onabotA or placebo (saline). The primary outcome variable was pain before treatment (T0) and at 1month (T1) using a visual analog scale. Secondary outcome variables included pain at 2months (T2) and 3months (T3), maximal incisal opening (MIO), jaw function (jaw functional limitation scale), and QoL (Short Form 36) measured at T0, T1, T2, and T3. Covariates included subject demographics, prior treatments, and temporomandibular joint signs/symptoms. Descriptive and bivariate statistics included χ2 test, Fisher's exact test, or t-test. Seventy five subjects with a mean age of 37 (±11) and 35 (±12) years in the onabotA and placebo groups, respectively (P=.6). Females represented 32 (86%) and 29 (76%), respectively (P=.3). Mean visual analog scale pain score in the onabotA group was 58 (±15), 39 (±24), 38 (±23), and 38 (±20) at T0, T1, T2, and T3, respectively; and the placebo group was 54 (±14), 40 (±23), 34 (±20), and 36 (±22) at T0, T1, T2, and T3, respectively. There was no statistically significant difference in pain between groups at any time point (P=.36). There was no statistically significant difference between groups in MIO (P=.124), jaw function (P=.236), or QoL domains (P>.05) at any time point. Within-group improvement in pain was seen in both groups (P<.005). Within-group improvement in jaw function was seen in the onabotA (P=.007) and placebo (P=.005) groups. There was no within-group improvement in MIO or QoL with either group (P>.05). OnabotA and saline (placebo) injections both decrease pain and improve jaw function in subjects with MPD.

Enhanced Empathic Pain by Facial Feedback.

The facial feedback hypothesis states that feedback from cutaneous and muscular afferents affects our emotion. Based on the facial feedback hypothesis, the purpose of this study was to determine whether enhancing negative emotion by activating a facial muscle (corrugator supercilii) increases the intensity of cognitive and emotional components of empathic pain. We also assessed whether the muscle contraction changed the pupil size, which would indicate a higher level of arousal. Forty-eight individuals completed 40 muscular contraction and relaxation trials while looking at images of five male and five female patients with neutral and painful facial expressions, respectively. Participants were asked to rate (1) how much pain the patient was in, and (2) how unpleasant their own feelings were. We also examined their facial muscle activities and changes in pupil size. No significant differences in pain or unpleasantness ratings were detected for the neutral face between the two conditions; however, the pain and unpleasantness ratings for the painful face were considerably higher in the contraction than relaxation condition. The pupils were considerably larger in the contraction than relaxation condition for both the painful and neutral faces. Our findings indicate that, by strengthening the corrugator supercilii, facial feedback can affect both the cognitive evaluative and affective sharing aspects of empathic pain.

“The Utility of Preoperative Acetaminophen in Reducing Postoperative Pain and Narcotic Use in Patients Undergoing Cosmetic Breast Augmentations, During a National Opiate Crisis”

Background:Preoperative use of acetaminophen has become widely adopted across the surgical subspecialties in attempt to maximize analgesia and minimize postoperative narcotic requirements. Whether or not acetaminophen use has an influence on these outcomes in cosmetic breast augmentation needs to be studied. Objectives: The aim of this study was to compare the differences in reported pain and narcotic use between patients undergoing breast augmentations who received preoperative oral acetaminophen and those who did not. Methods: This was a prospective, single-center study including 59 patients undergoing primary breast augmentation which were divided into 2 groups: control group (did not receive acetaminophen) and a study group (received 1000 g PO acetaminophen), all medications were administered prior to surgery. A self-reported survey was received from all patients which included pain scores as well as number of narcotics taken. Results: Data analysis indicated that the only statistically significant difference in pain was on postoperative day 2 (POD2), with patients who did not receive PO tylenol reporting more pain. There was no significant difference in the number of narcotics required between either group. Conclusions: It appears that preoperative PO acetaminophen did not significantly influence the amount of postoperative narcotic use. The only difference in reported pain was on POD2 and was higher in those who did not receive preoperative acetaminophen. It seems that PO acetaminophen is an inexpensive way of improving postoperative pain in patients undergoing cosmetic breast augmentation; however, it does not reduce narcotic use.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.&#x0D; Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.Methodology: This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).&#x0D; Results:A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.&#x0D; Conclusion:LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.