Significant Improvement In Pain Intensity Research Articles

Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic.

BackgroundCognitive behavioral therapy–pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas.ObjectiveThe study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment.MethodsWe conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%).ResultsParticipants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS −8.72, 42.25% reduction; WLC: PCS −2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness.ConclusionsZoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care.Trial RegistrationClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685

Flotation Restricted Environmental Stimulation Therapy for Chronic Pain

Flotation restricted environmental stimulation therapy (REST) is an emerging therapeutic intervention that, to our knowledge, has never been directly compared with an indistinguishable placebo in patients with chronic pain. To determine whether 5 flotation-REST sessions alleviate chronic pain. This single-blind, randomized clinical trial compared flotation-REST as an intervention for the treatment of chronic pain with indistinguishable placebo and wait-list control conditions at Hannover Medical School, Hannover, Germany. Men and women aged 18 to 75 years who had been diagnosed with chronic pain disorder with psychological and somatic factors (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification, code F45.41) by physicians at the study center were randomly assigned to 1 of the 3 groups. Data were collected from June 26, 2018, to June 18, 2020. Patients in the intervention and placebo groups underwent 5 treatment sessions lasting 60 to 90 minutes, each session separated by 4 days. The placebo treatment was delivered in the same floating tank but controlled for effortless floating and environmental stimulus restriction. Patients in the wait-list control group did not receive any additional treatment but were asked to continue any ongoing treatments at the time of enrollment. The primary outcome was a change in pain intensity 1 week after the last treatment session. The assessment was repeated at 12 and 24 weeks. Secondary outcomes included pain-related disability, pain area, pain widespreadness (number of body regions affected by pain), anxiety, depression, and quality of life, as well as several other short-term outcomes. A total of 99 patients (mean [SD] age, 51.7 [12.3] years; 80 women [81%]) were included in the study. No differences were found among the groups in the primary outcomes (mean [SD] change in maximum pain: -7.6 [19.7] for the intervention group, -5.8 [12.7] for the placebo group, and 0.4 [14.0] for the wait-list control group; mean [SD] change in mean pain: -2.1 [19.4] for the intervention group,-4.2 [16.2] for the placebo group, and 2.0 [12.6] for the wait-list control group). Long-term secondary outcomes did not show significant differences. In the short term, patients in the intervention group showed significant improvements in pain intensity (-17.0 [17.1]; P < .001), relaxation (23.9 [22.6]; P < .001), anxiety (-10.1 [8.4]; P < .001), pain area (-3.6% [7.4%]; P < .001), and widespreadness (-2.0 [3.0]; P < .001), and similar changes where observed in the placebo group. Patients with chronic pain experienced no long-term benefits from the 5 flotation-REST interventions. Clinically relevant short-term changes in pain in the placebo group suggest that improvements may not be caused by environmental stimulus restriction or effortless floating as previously thought. ClinicalTrials.gov Identifier: NCT03584750.

Effects of Sling Exercise for Neck Pain: A Systematic Review and Meta-Analysis.

The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases were searched from inception to July 2020. The reference lists of relevant articles to identify additional trials were also screened. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain, including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. The random-effects model was used to perform meta-analyses. Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD = 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = -1.23; 95% CI = -1.88 to -0.58) immediately postintervention compared with the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion and sustained effects on disability at intermediate-term follow-up. Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain.

Efficacy of Electromyographic-Biofeedback Supplementation Training with Patellar Taping on Quadriceps Strengthening in Patellofemoral Pain Syndrome among Young Adult Male Athletes

This study compares the effects of electromyographic-biofeedback (EMG-BF)-guided isometric quadriceps strengthening with patellar taping and isometric exercise alone in patellofemoral pain syndrome (PFPS) among young adult male athletes. Sixty young adult male athletes with PFPS participated in the study. Participants were randomly divided into two groups: (1) EMG-BF-guided isometric exercise training with patellar taping (experimental group, n = 30), and (2) sham EMG-BF training with an isometric exercise program (control group, n = 30). Participants conducted their respective exercise programs for five days per week across four weeks. Study outcomes were pain (measured by the visual analog scale), functional disability (measured by the Kujala Anterior Knee Pain scale), and quadriceps strength (measured by an ISOMOVE dynamometer). Measurements were taken at baseline, Week 2, Week 4, and during a follow-up at Week 6. The experimental group demonstrated significantly lower VAS score at Weeks 2 and 4 compared to that of the control group (p = 0.008 and 0.0005, respectively). The score remained significantly lower at the Week 6 follow-up compared to the control group (p = 0.0005). There were no differences in knee function at Weeks 2 and 4 between the two groups (p = 0.086 and 0.171, respectively); however, the experimental group showed significantly better knee function at Week 6 compared to the control group (p = 0.002). There were no differences in quadriceps strength at Week 2 between the two groups (p = 0.259); however, the experimental group demonstrated significantly higher quadriceps strength at Weeks 4 and 6 compared to the control group (p = 0.0008). Four weeks of EMG-BF supplementation training with patellar taping demonstrated significant improvements in pain intensity, functional disability, and quadriceps muscle strength in young adult male athletes with PFPS.

Mindfulness: Principles and Application to Decrease Opiate Use in Primary Care With an Osteopathic Component

Mindfulness is a focused approach toward accepting one’s thoughts without judgment or perseveration, with ancient Indo-Sino-Tibetan philosophical origins. Many variations exist; however, they typically include focused attention where one concentrates on a specific sensation such as breathing and open monitoring where one concentrates on consciousness itself. Mindfulness-based interventions (MBIs) are specific, organized, targeted methods to teach mindfulness with specific goals. &#x0D; MBIs have shown benefit in pain patients. MBIs teach the individual the concept of pain coping, encouraging cognitive flexibility and attempting to discourage the fear or alarm reaction of pain, instead focusing on the quality of life and functionality. Mindfulness-based stress reduction (MBSR) showed a 30% significant improvement in pain intensity and pain coping at six months in patients with chronic low back pain, compared to opiates and NSAIDs, which showed no benefit. &#x0D; MBIs have also shown benefit in addiction, as they help the individual relearn to control cravings, habit modification and attempt to restore the natural reward system while improving regulation of emotions. Applications to opiate use disorder are significant as patients learn to enjoy the lifestyle of recovery and learn to believe they can improve. Additionally, other comorbid conditions are known to improve with MBIs and mindfulness-based principles support the holistic principle of mind, spirit and body consistent with osteopathic medicine.

Study of functional outcome in low grade spondylolisthesis operated by pedicular screw instrumentation and fusion

Background: Functional outcome following instrumental spinal surgery for spondylolisthesis inphysically energetic patients is crucial. The present study was undertaken to evaluate the functionaloutcome of low-grade spondylolisthesis accompanied by low back pain with or without radiculopathy,with standard surgical procedure posterior lumbar interbody fusion with instrumentation. Method:In this study total of 40 patients were operated on for low-grade spondylolisthesis by posteriorstabilization using a pedicular screw rod system and posterior lumbar interbody fusion. All thepatients were followed up till 6 months after surgery and functional outcomes were noted. Results:Assessment of this series it was observed that, 57.5% of the patient had excellent outcome, 37.5%had a good outcome and 97.5% of the study population had satisfactory outcome (improvement inclinical results). There was a significant improvement in pain intensity, walking, lifting, standing,sleeping after surgery. The mean ODI difference between preoperative and post-operative at 6months follow up was 36.12% (16.75). In the outcome, 62.5% of the patient consisted of severedisability and 32.5% were with moderate disability (total-95%) while postoperative 87.5% were witha minimal disability and only 2.5% of the study population had worsened i.e crippled. Conclusion:The study concluded that surgery in form of decompression with instrumentation and posteriorlumbar interbody is a safe and effective method to treat spondylolisthesis.

Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses.

BackgroundTrigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN.MethodsReview authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker.ResultsMeta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain −3.8 points on a 0–10 scale (95% Cl = −4.653 to −2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of −32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average −6.1 points on a scale of 0–10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of −75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low.ConclusionFurther studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: a systematic review with meta-analysis.

BackgroundChronic neuropathic pain (NP) presents therapeutic challenges. Interest in the use of cannabis-based medications has outpaced the knowledge of its efficacy and safety in treating NP. The objective of this review was to evaluate the effectiveness of cannabis-based medications in individuals with chronic NP.MethodsRandomized placebo-controlled trials using tetrahydrocannabinol (THC), cannabidiol (CBD), cannabidivarin (CBDV), or synthetic cannabinoids for NP treatment were included. The MEDLINE, Cochrane Library, EMBASE, and Web of Science databases were examined. The primary outcome was the NP intensity. The risk of bias analysis was based on the Cochrane handbook.ResultsThe search of databases up to 2/1/2021 yielded 379 records with 17 RCTs included (861 patients with NP). Meta-analysis showed that there was a significant reduction in pain intensity for THC/CBD by -6.624 units (P < .001), THC by -8.681 units (P < .001), and dronabinol by -6.0 units (P = .008) compared to placebo on a 0–100 scale. CBD, CBDV, and CT-3 showed no significant differences. Patients taking THC/CBD were 1.756 times more likely to achieve a 30% reduction in pain (P = .008) and 1.422 times more likely to achieve a 50% reduction (P = .37) than placebo. Patients receiving THC had a 21% higher improvement in pain intensity (P = .005) and were 1.855 times more likely to achieve a 30% reduction in pain than placebo (P < .001).ConclusionAlthough THC and THC/CBD interventions provided a significant improvement in pain intensity and were more likely to provide a 30% reduction in pain, the evidence was of moderate-to-low quality. Further research is needed for CBD, dronabinol, CT-3, and CBDV.

CT-Guided Percutaneous Drainage of Pneumoperitoneum Presenting as Acute Abdomen

PurposeTo evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous drainage (PD) in patients with iatrogenic pneumoperitoneum presenting as acute abdomen. Materials and MethodsIn this retrospective, single-center cohort study, 16 consecutive patients (9 males, 7 females; median age, 67.5 [51–85] years) undergoing PD for managing acute abdomen caused by iatrogenic pneumoperitoneum between 2013 and 2019 were analyzed. Inclusion criteria were clinical signs of acute abdomen that was unresponsive to conservative management and pneumoperitoneum due to an iatrogenic cause after PD, observed using CT imaging. Volumetry of pneumoperitoneum was performed using computer-aided image segmentation. To evaluate the clinical outcome, the paired t-test was performed to analyze the course of pain intensity on the numerical pain rating scale (NPRS, 0–10). Patient records were reviewed to determine PD-related adverse events and median drain duration. ResultsThe median pneumoperitoneum volume was 891.1 (127.7–3,677.0) mL. All PD procedures were successfully performed, with symptom relief and immediate abdominal decompression (mean segmental volume reduction, 79.8% ± 13.5). Acute abdomen symptoms were resolved, with significant improvement in pain intensity between the day of the PD procedure and the first day after the procdure (mean NPRS scores, 3.3 ± 1.9 vs 0.8 ± 1.0; P < .001). The median drain duration was 2 (1–3) days. No PD-associated adverse events were observed. After PD, 14 patients required only conservative management, whereas 2 patients with anastomotic leakage required additional surgery as they showed signs of persisting sepsis and generalized peritonitis. ConclusionsPD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.

Patient Outcomes Following Polyvinyl Alcohol Hydrogel Implant of the Lesser Metatarsals

Category:Lesser Toes; OtherIntroduction/Purpose:Lesser toe metatarsal phalangeal (MTP) joint pathology presents a challenge for surgical treatment. Recently, synthetic cartilage implants have been shown to be safe and efficacious in treating hallux ridigus, offering pain relief while preserving motion at the MTP joint. At our institution, metatarsophalangeal joint arthroplasty using a polyvinyl alcohol (PVA) hydrogel implant has been utilized in the 2nd and 3rd MTP joints for advanced arthritis, failed management of Freiberg’s infraction, and osteochondral defects. We present a case series describing the clinical outcomes of 12 patients following PVA implantation of the 2nd or 3rd MTP.Methods:We retrospectively identified 12 consecutive patients (13 joints) who underwent PVA hydrogel implantation of the 2nd (n=12) or 3rd (n=1) metatarsal head between 2017 and 2019. PVA implant was indicated for advanced arthritis in 6 patients (7 joints), Freiberg’s infraction in 4 patients, and osteochondral defect in 2 patients. Average age was 51 years (range, 20-67), with 100% females. Patient-reported outcomes measurement information system (PROMIS) scores were collected preoperatively and at latest follow-up, with an average follow-up of 20.4 months (range, 8.3 to 29.2). Retrospective chart review was performed to evaluate postoperative complications, including need for revision, implant removal, and persistent pain.Results:Overall, patients demonstrated mean improvement in all PROMIS domains, with a significant improvement in Pain Intensity of 11.9 points (p=0.03) postoperatively. A total of 4 postoperative complications occurred in the 12 patients: one case of AVN at 2 years postoperatively, one revision with removal of the implant and bone grafting of the second metatarsal head at 1 year postoperatively, one periprosthetic fracture at 9 months postoperatively, and one recurrence of pain requiring ultrasound- guided injection at 7 months postoperatively. Three additional patients reported persistent pain postoperatively.Conclusion:This study represents the largest case series to date evaluating the use of PVA hydrogel implant in the surgical correction of lesser toe MTP joint pathology. While the PVA implant presents a viable option in the setting of advanced arthritis, Freiberg’s infraction, and certain osteochondral defects, it is not without complications. The specific indications for use of the PVA implant should be carefully considered before implantation.

Early surgical outcomes after total hip replacement in systemic lupus erythematosus patients

Objective. To analyze early surgical outcomes after total hip replacement in systemic lupus erythematosus (SLE) patients.Subjects and Methods. The study included 42 SLE patients with femoral head osteonecrosis (ON) undergoing 59 total hip replacement (THR) surgeries at the traumatology and orthopedics department of VA Nasonova Research Institute of Rheumatology during 1998-2013 yy. All patients were thoroughly evaluated at baseline and one year after surgery using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), damage index (DI) of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) to assess the degree of irreversible organ damage, Harris hip function scale, and VAS for pain intensity to assess early results of THR procedure.Results. Significant improvement of pain intensity was documented based on VAS assessments, as well as hip function improvement from 40,0±14,9 (13,8 – 82,7) to 80,8±12 (46,7-96,0) scores based on Harris scale, improvement of SLE activity based on SLEDAI-2K assessment: from 0 -20 scores (median 4[4;8]) at baseline to 0 – 43 scores (median 0[0;4]) at one year, and DI – from 0-12 (median 3[2;5]) to 0 -15 scores one year after THR procedure. Complications including dislocation of femoral component, peroneal nerve paralysis, periprosthetic fracture, venous thrombosis, and delayed wound healing were documented totally in 10,2% of patients. No post-surgery deaths occurred.Conclusion. The results obtained are indicative of better pain control and improved hip function following THR in SLE patients.

Outcomes of Polyvinyl Alcohol Hydrogel Implant of the Lesser Metatarsals.

Lesser toe metatarsophalangeal (MTP) joint pathology presents a challenge for surgical treatment. At our institution, arthroplasty using a polyvinyl alcohol (PVA) hydrogel implant has been utilized in the second and third MTP joints for advanced arthritis, failed management of Freiberg's infraction, and osteochondral defects. We present a case series describing the clinical outcomes of 13 patients following PVA implantation of the second or third MTP. We retrospectively identified 13 patients (14 joints) who underwent PVA hydrogel implantation of the second (n = 12) or third (n = 2) metatarsal between 2017 and 2019. The average age was 49 (range, 20-67) years, with 100% females. Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected preoperatively and at an average of 21.1 (range, 8.3-29.2) months postoperatively. Clinical outcomes were also evaluated. The average time to clinical follow-up was 24.7 (range, 7-35.8) months. On average, patients demonstrated pre- to postoperative improvement in all PROMIS domains, with significant improvements in Pain Intensity (P = .01) and Pain Interference (P = .01). Five postoperative complications were observed: 1 case of persistent avascular necrosis, 1 revision with implant removal and bone grafting, 1 periprosthetic fracture, and 2 recurrences of pain requiring ultrasound-guided injection. This study represents the largest case series to date evaluating the use of PVA implant in the surgical correction of lesser toe MTP joint pathology. While the PVA implant presents a viable option in the setting of advanced arthritis, Freiberg's infraction, and certain osteochondral defects, it is not without complications. The specific indications for use of the PVA implant should be carefully considered. Level IV, case series.

Noninvasive Cortical Stimulation for the Motor Function Rehabilitation of the Elderly with Chronic Back Pain: Preliminary Feasibility Study

Purpose: The purpose of this study is to investigate the effect of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (dlPFC) on pain intensity and functional strength in the elderly with chronic back pain. Methods: Sixteen elderly (72 ± 5.16 yrs) with chronic back pain participated in this randomized double-blinded crossover study. Each participant received both sham and 2-mA anodal currents over left dlPFC (cathode over the seventh cervical spinous process) for 20 min during 2 weeks for each current type with a washout period of 2 days between two different current stimulation periods. Pain intensity, functional lift strength, and the fear-avoidance response of all the participants were evaluated. Results: There were no significant differences in all pain-related variables between the 2mA stimulation period and the sham stimulation period. However, for results by within-group analysis in each stimulation period, we found significant improvements in pain intensity (p=.02), functional strength, (p=.006) and fear-avoidance response (p=.002) only after 2mA stimulation period, while there were no significant changes after sham stimulation. Conclusion: The current study demonstrated that anodal tDCS over dlPFC improve the painful feelings, followed by the functional strength for lifting task.

Economic evaluation alongside a randomised controlled trial to assess the effectiveness and cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy.

To assess the cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in Hong Kong. A within trial cost-utility analysis with the primary endpoint for the economic evaluation being the Quality Adjusted Life Year (QALY) and associated Incremental Cost Effectiveness Ratio (ICER) over 14 weeks of treatment. A secondary cost-effectiveness analysis was undertaken with the endpoint being change in pain as measured on the Brief Pain Inventory (BPI). Eighty-seven patients were randomised to acupuncture or usual care. Acupuncture resulted in significant improvements in pain intensity (8- and 14-week mean changes compared to usual care of -1.8 and -1.8, respectively), pain interference (8- and 14-week mean changes compared to usual care of -1.5 and -0.9, respectively) and indicators of quality of life and neurotoxicity-related symptoms. However, in the economic evaluation there was little difference in QALYs between the two arms (mean change 0.209 and 0.200 in the acupuncture and usual care arms, respectively). Also, costs yielded deterministic ICERs of HK$616,965.62, HK$824,083.44 and HK$540,727.56 per QALY gained from the health care provider perspective, the societal perspective and the patient perspective, respectively. These costs are significantly higher than the cost-effectiveness threshold of HK$180,450 that was used for the base case analysis. While acupuncture can improve symptoms and quality of life indicators related to CIPN, it is unlikely to be a cost-effective treatment for CIPN-related pain in health care systems with limited resources. NCT02553863 (ClinicalTrials.gov) post-results.

Efficacy of Acetaminophen Plus Amitriptyline Compared to Acetaminophen to Reduce Pain Intensity in Nonspecific Chronic Lower Back Pain

Background: There was 90% of Lower back pain (LBP) are non-specific. Acetaminophen is the first an analgesic in the treatment of LBP, but some cases of chronic LBP need additional antidepressant drugs. Amitriptyline is an antidepressant drug often used in cases of pain, but the evidence research in the case of non-specific chronic LBP is still a contradiction. Method: The study was a Double-Blind Randomized Controlled Trial using consecutive sampling admissions. The subjects were divided into 2 groups; acetaminophen plus amitriptyline group and acetaminophen plus placebo group. Results: There was no significant difference in pain intensity of acetaminophen plus amitriptyline and acetaminophen plus placebo groups either statistically or clinically (p = 0.498; OR = 0.667; CI 95% 0.20-2.16; ARR = -0.07 or -7%). The significant improvement of pain intensity in the treatment group Acetaminophen plus Amitriptyline was 24 (72.7%), while in the control group Acetaminophen plus Placebo was 24 (80.0%). In the treatment group was 9 (27.3%) who did not experience a significant improvement in pain intensity, and in the control group was 6 (20.0%). Conclusion: There was no difference in efficacy between acetaminophen plus amitriptyline with acetaminophen plus placebo to reduce pain intensity in non-specific chronic LBP

Clinical and Workplace Outcomes From a Virtually Delivered Cognitive Behavioral Therapy Program for Pain.

To evaluate clinical and workplace outcomes from an evidence-based virtual behavioral therapy program for individuals with pain and behavioral health issues. This was a retrospective de-identified data analysis among a cohort of 1,086 participants enrolled in a standardized, evidence-based telebehavioral therapy program between September 1, 2016, and August 31, 2017 (mean age 53±11.5years; 29% male). The program was delivered over approximately 8weeks by licensed therapists and behavior coaches by telephone or video, and tailored to the pain management and behavioral health goals of each participant. Structured measurements were documented in the electronic clinical record, including demographics, comorbidities, pain severity (Pain Intensity, Enjoyment of Life, General Activity tool), behavioral health symptoms (Depression, Anxiety and Stress Scale short form), and productivity (Work Productivity and Activity Impairment survey). At baseline, participants had high average pain severity (5.8/10 points), high frequencies of behavioral health symptoms (68%), and activity impairment (90%); absenteeism (34%) and presenteeism (75%) were observed among employed individuals. Pain severity and pain interference improved by 17% and 27%, respectively, over 8weeks (P<0.0001). Reductions in depression, anxiety, and stress symptoms were significant and associated with reductions in pain interference (P<0.0001). Absenteeism, presenteeism, and activity impairment ratings each improved by more than 25% (P<0.0001). Participants in a virtually delivered behavioral therapy program for pain experienced significant improvements in pain intensity, pain interference, behavioral health symptoms, and work productivity.

Immediate Effects and Acceptability of an Application-Based Stretching Exercise Incorporating Deep Slow Breathing for Neck Pain Self-management.

ObjectivesThis study evaluated the immediate effects and acceptability of a smartphone application named NeckProtector to promote neck pain self-management through stretching incorporating deep slow breathing, among smartphone users with neck pain.MethodsOne-hundred participants were recruited in the study. Participants were divided into two groups by block randomized allocation. The researchers gave the NeckProtector application to all participants for acceptability testing by navigation of the application for 20–30 minutes. Next, the treatment group (n = 50) conducted the exercise program via smartphone application for 15–20 minutes, while the control group (n = 50) rested for 20 minutes. Evaluations were performed at baseline and after intervention for pain intensity, muscle tension, pressure pain threshold (PPT), and cervical range of motion (CROM). Quantitative and qualitative feedback was then obtained by an acceptability survey and open-ended questionnaires.ResultsThe immediate effects showed statistically significant improvements in pain intensity, muscle tension, PPT, and CROM in the treatment group in comparison to the control group. Participants reported a high level of acceptability through ratings on a Likert scale. The qualitative questionnaires received positive responses that the application was easy to use and the exercise program was useful to cope with neck pain.ConclusionsNeckProtector can be an alternative treatment for neck pain self-management via smartphone application among smartphone users with neck pain. Further studies should examine the long-term effectiveness (Clinical trials registry: TCTR20160523001).

Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review.

To systematically review and evaluate the efficacy and complication profile of prolotherapy using hyperosmolar dextrose solution injection for rotator cuff tendinopathy. MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (from inception to 1 July, 2019). A comprehensive search was completed to identify randomized controlled trials addressing prolotherapy using hyperosmolar dextrose solution for rotator cuff tendinopathy. Two reviewers independently screened the titles, abstracts, and full texts, and then extracted data from eligible studies. All reported outcome measures and complications were analyzed descriptively. Five studies satisfied inclusion criteria. Included studies analyzed a total of 272 participants with a final follow-up ranging from 6 weeks to 12 months. Prolotherapy differed greatly among studies. Two studies used a multisite enthesis injection protocol while the other three used ultrasound-guided protocols. Two of the studies used an intrasubstance supraspinatus injection and three used a supraspinatus enthesis injection. Control groups consisted of nonoperative rehabilitation including physical therapy and medical management in three studies, supraspinatus saline enthesis injection in one study, and corticosteroid injection in one study. There was statistically significant improvement in pain intensity with multisite injection protocols compared to physical therapy and medical management in both studies. Ultrasound-guided supraspinatus injection trials did not find any statistically significant difference in pain intensity, range of motion, strength, function, or ultrasound characteristics compared to controls of enthesis saline injection or corticosteroid. The complication rate was low, with only 6/272 participants experiencing adverse events consisting of transient increase in pain for 1 to 2 days postintervention. Prolotherapy with hyperosmolar dextrose solution is a potentially effective adjuvant intervention to physical therapy for patients with rotator cuff tendinopathy ranging from tendinosis to partial-thickness and small full-thickness tears. Further studies are necessary to determine effects in subpopulations as well as optimal technique including dextrose concentration, volume, and location.

Improved Pain and Function in Knee Osteoarthritis with Dexamethasone Phonophoresis: A Randomized Controlled Trial.

Background:Intraarticular corticosteroid injection is an adjunct to core treatments for relief of moderate-to-severe pain in osteoarthritis (OA) patients. This randomized controlled trial was conducted to determine the effect of dexamethasone phonophoresis (DxPh) on knee OA.Patients and Methods:Forty six female patients with knee OA were randomized into two equal groups. The study group received DxPh over the medial side of the knee, transcutaneous electrical nerve stimulation (TENS), and quadriceps strengthening exercises. Control group received ultrasound therapy and the same TENS and exercise program. Pain was assessed using the visual analog scale (VAS) and the pain subscale of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pre- and posttreatment. Functional mobility was assessed by the Timed Up and Go (TUG) test, total WOMAC, and the joint stiffness and physical function subscales of WOMAC. The minimal clinically identifiable difference was used to calculate treatment effect sizes of both modalities, which was compared to intraarticular steroid injections.Results:The VAS, TUG, and WOMAC scores improved with both modalities. Pain intensity improved by 50.6%–58.0% in the study group (VAS and pain subscale of WOMAC, respectively) compared to 17.8%–28.6% for the control group. Functional mobility showed a higher rate of improvement in the DxPh group compared to control (37.7 vs. 17.5% for TUG and 53.2 vs. 23.0 and 56.1 vs. 26.4% for the joint stiffness and physical function subscales of WOMAC, respectively). Posttreatment results revealed statistically and clinically significant improvement in pain intensity and functional mobility in the DxPh group.Conclusion:DxPh resulted in a greater improvement in pain and function in patients with knee OA than therapeutic ultrasound combined with exercise and TENS. The effect size of phonophoresis was clinically significant and higher than that reported for intraarticular steroid injection from pooled data in the literature.

Management of Lumbar Spondylolysis

Background: Spondylolysis is a fatigue fracture which occur in the pars interarticularis due to repetitive mechanical stresses on the lumbar spine. Objective: This work was aimed to discuss the different methods in management of spondylolysis, regarding the conservative treatment and surgical procedures. Patients and methods: This study included 30 cases with spondylolysis at Al-Azhar University Hospitals. 13 cases were operated upon in El-Sayed Galal Hospital of Al-Azhar University and 12 cases were operated upon in El-Hussin Hospital of Al-Azhar University with 5 cases were managed by conservative treatment between August 2017 and July 2019. Follow up was done for average one year. Results: The improvement of radiculopathy in our study was ranging into 3 category: Fair improvement (2 cases, 20%) with conservative treatment, Good improvement (2 cases, 20%) with decompression and fixation, and Excellent improvement (6 cases, 60%) also with decompression and fixation, so there was a statistical significant relation between both strategy (p-value=0.007), which indicate that the spondylolysis with radicular pain is better managed by decompression and fixation. In our study, we used the Visual Analogue Scale (VAS) in the all cases pre management and post management to assess the outcome. In our study, there was a significant change in Mean VAS score with mean VAS pre-management 7.1, mean VAS post management 2.6 and mean difference in VAS 4.5. Indicating a significant improvement of pain intensity (P<0.001). Conclusion: Spondylolysis is common in young females at L5 pars and presented with LBP in most cases. Different surgical procedure is safe and effective in management than conservative treatment.