Significant Improvement In Pain Relief Research Articles

Intradiscal Autologous Biologics for the Treatment of Chronic Discogenic Low Back Pain.

PURPOSEOF REVIEW: The purpose of this narrative review is to evaluate the efficacy of the most commonly studied intradiscal biologics used for the treatment and alleviation of chronic intractable discogenic low back pain. Additionally, it explores the therapeutic potential and durability of these novel treatment options. RECENT FINDINGS: Recently published literature highlights the therapeutic potential of intradiscal biologics, such as mesenchymal stem cells, platelet-rich plasma, and alpha-2-macroglobulin, in promoting chondrogenesis within the lumbar intervertebral discs to treat discogenic low back pain. Studies demonstrate significant improvements in pain relief, physical function, and quality of life post-treatment. A comprehensive review of the literature evaluating the efficacy of intradiscal biologics suggests some evidence supporting its efficacy in treating discogenic low back pain. However, more rigorous studies into mechanistic modulation and large-scale randomized trials as well as a more thorough understanding of adverse events will be instrumental for including these therapies into clinical practice paradigms.

EXPLORING AYURVEDIC APPROACHES TO LOW BACK PAIN: A COMPREHENSIVE REVIEW

Introduction:Low back pain (LBP) is a common musculoskeletal disorder affecting individuals worldwide, causing significant disability and healthcare burden. While conventional treatments focus on symptomatic relief, Ayurveda, the ancient Indian system of medicine, offers a holistic approach that addresses the root cause of LBP. This comprehensive review aims to explore Ayurvedic perspectives, diagnostic methods, therapeutic interventions, and herbal formulations for managing LBP. Ayurvedic Perspective:Ayurveda views LBP as a manifestation of imbalances in the Tridosha (Vata, Pitta, and Kapha) and the Saptadhatus (seven body tissues). Vata dosha vitiation is predominantly implicated in LBP, leading to symptoms such as stiffness, spasms, and radiating pain. Pitta and Kapha imbalances may exacerbate inflammation and structural degeneration, respectively. Ayurvedic diagnosis of LBP involves assessing the individuals Prakriti (constitutional type), Vikriti (current imbalance), Agni (digestive fire), and Srotas (channels of circulation). Diagnostic Methods:Ayurvedic physicians employ a combination of clinical examination, palpation, and pulse diagnosis (Nadi Pariksha) to assess the underlying doshic imbalances and identify the specific etiology of LBP. Various factors such as lifestyle habits, occupation, dietary patterns, and psychological stressors are taken into account during the assessment. Therapeutic Interventions:Ayurvedic management of LBP is multifaceted, aiming to alleviate pain, reduce inflammation, restore musculoskeletal integrity, and prevent recurrence. Therapeutic interventions include: Panchakarma: Detoxification therapies such as Basti (medicated enema), Abhyanga (oil massage), and Swedana (herbal steam therapy) are utilized to eliminate ama (toxins) and pacify aggravated doshas. Ayurvedic Medications: Herbal formulations containing anti-inflammatory, analgesic, and muscle-relaxant herbs like Ashwagandha (Withania somnifera), Guggulu (Commiphora wightii), and Shallaki (Boswellia serrata) are prescribed to manage pain and inflammation. Yoga and Pranayama: Specific yoga asanas (postures) and pranayama (breathing exercises) are recommended to improve flexibility, strengthen the back muscles, and enhance prana (vital energy) flow to the affected area. Dietary Modifications: Dietary recommendations include consuming warm, light, and easily digestible foods, emphasizing anti-inflammatory spices like turmeric, ginger, and cinnamon, and avoiding cold, heavy, and processed foods that may aggravate Vata dosha. Lifestyle Management: Adopting a balanced daily routine (Dinacharya), practicing stress-reduction techniques such as meditation and mindfulness, and maintaining proper posture and ergonomics are crucial for long-term management of LBP. Clinical Evidence:Several clinical studies have investigated the efficacy of Ayurvedic interventions in LBP management. A randomized controlled trial comparing Ayurvedic treatment with conventional therapy demonstrated significant improvements in pain relief, functional disability, and quality of life among participants receiving Ayurvedic intervention. Furthermore, observational studies have reported favorable outcomes with Panchakarma therapies and herbal formulations in reducing pain intensity and enhancing mobility in patients with chronic LBP. Safety and Considerations:While Ayurvedic interventions are generally considered safe when administered under the guidance of a qualified practitioner, certain precautions should be observed. Individualized treatment plans based on the patients constitution, doshic imbalance, and overall health status are essential to optimize therapeutic outcomes and minimize potential adverse effects. Additionally, close monitoring and periodic reassessment are necessary to track progress and adjust treatment as needed. Conclusion:Ayurveda offers a holistic and individualized approach to managing low back pain, addressing not only the symptoms but also the underlying imbalances contributing to the condition. By incorporating Panchakarma therapies, herbal formulations, dietary modifications, and lifestyle interventions, Ayurvedic treatment aims to restore harmony within the body, promote self-healing, and prevent recurrence of LBP. Further research and collaboration between Ayurvedic and conventional healthcare systems are warranted to validate the efficacy and safety of Ayurvedic interventions and enhance their integration into mainstream healthcare for comprehensive LBP management.

A comparison of port-site infiltration with bupivacaine alone vs. bupivacaine plus dexemedetomidine after diagnostic staging laparoscopy.

To compare the effects of bupivacaine alone and in combination with dexmedetomidine following staging laparoscopies. This triple-blinded, prospective study was conducted from June to September 2021 at a tertiary care cancer hospital in Lahore, Pakistan, and comprised adult patients having American Society of Anaesthesiologists grade I-III, weighing >30kg and undergoing diagnostic staging laparoscopy. The subjects were randomised into two equal groups. Group A received 6ml of 2mg/kg bupivacaine at each of the four laparoscopic port sites before skin closure, while group B additionally received 2μg/kg dexmedetomidine. The presence and severity of pain were recorded and assessed at 15 min, 1, 2 and 4 hours as well as at the time of discharge from the post-anaesthesia care unit. The time to first request for rescue analgesia, total morphine consumption, and the occurrence of any side effects during their stay were also recorded. Data was analysed using SPSS 23. Of the 30 patients, 15(50%) were in group A; 10(66.6%) males and 5(33.3%) females with mean age 43.27±7.59 years. There were 15(50%) patients in group B; 12(80%) males and 3(20%) females with mean age 41.36±12.42 years (p>0.05). Of the total, 29(96.66%) patients were classified as American Society of Anaesthesiologists grade II, and 1(3.33%) patient in group A was grade III. There was no significant difference between the groups in any of the outcome measures assessed (p>0.05), and none of the patients experienced any side effect throughout the post-operative stay. The combination of dexmedetomidine and bupivacaine had no significant improvement in pain relief compared to bupivacaine alone.

Three once-weekly intra-articular injections of Hylan G-F 20 significantly improve pain relief compared with placebo in patients with chronic idiopathic knee osteoarthritis: a single-centre, evaluator-blinded and patient-blinded, randomized controlled trial.

Clinical trials on the use of viscosupplementation with hyaluronic acid (HA) in patients with knee osteoarthritis (KOA) are inconsistent, making it challenging to determine its value in clinical practice. One issue is the availability of various HA products on the market; differences in their chemical features can impact patient outcomes. Herein, we assess the efficacy and safety of three once-weekly intra-articular (IA) injections of Hylan G-F 20, a high-molecular-weight and highly crosslinked HA product, in patients with KOA. We hypothesized that Hylan G-F 20 would provide significant pain relief with no increased safety risk compared with IA saline (placebo). This was a 26-week, patient-blinded and evaluator-blinded, single-centre, randomized placebo- controlled trial. Men or women ≥18 years of age with Larsen grade II or III KOA were included. Patients received IA injections of either Hylan G-F 20 or placebo once a week for 3 weeks. The primary endpoints were the week 12 and 26 visits. Primary efficacy outcomes included visual analogue scale (VAS) pain scores, patient activity level and an overall assessment of clinical condition. Secondary outcomes included adverse events (AEs) that emerged during treatment. The primary analysis included the intention-to-treat population. An alpha level of 0.05 was used in the statistical analysis. Thirty patients were included in the intention-to-treat population (15 per group). All efficacy outcomes were statistically significant in favour of Hylan G-F 20, except night pain and inactivity stiffness, for both patient- assessed (all p=0.0001 at week 12) and evaluator-assessed (all p=0.0001 at week 12 and p=0.0004-0.0180 at week 26) measurements. There was also a greater proportion of symptom-free patients and those with a >50% improvement in their VAS scores, except night pain, in the Hylan G-F 20 group (p=0.001-0.003 in patient-assessed scores and p<0.0001 to 0.002 in evaluator-assessed scores at week 12). Two patients, one in each group, experienced an AE; no sequelae occurred, and no special treatment was required for either AE. No patients withdrew from the study prematurely due to an AE. In patients with chronic idiopathic KOA, Hylan G-F 20 provides significant improvements in pain relief compared with placebo with no added safety concerns.

Does Liquid/Injectable Platelet-Rich Fibrin Help in the Arthrocentesis Treatment of Temporomandibular Joint Disorder Compared to Other Infusion Options? A Systematic Review of Randomized Clinical Trials.

Temporomandibular joint disorders (TMDs) are prevalent musculoskeletal conditions involving pain and dysfunction of jaw mobility and function, which have proven difficult to treat satisfactorily. The present study aimed to assess the effectiveness of a liquid platelet-rich fibrin (i-PRF) infusion during arthrocentesis versus other options using coadjuvant materials to reduce TMD symptoms. A literature search was conducted using PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for RCTs published before January 2024, comparing i-PRF to any other TMD treatment. This systematic review was registered on PROSPERO (CRD42023495364). The searches generated several recent RCTs that compared i-PRF injection combined with arthrocentesis (AC) to AC-only or AC with platelet-rich plasma (PRP). The outcomes analyzed included measures of pain (visual analog scale, VAS), maximum mouth opening, joint sounds, and MRI-verified changes in joint structure. Across the RCTs, the addition of i-PRF injection to AC resulted in significant improvements in pain relief, joint function, mouth opening, and structural changes compared to AC-only or with PRP over follow-up periods ranging from 6 to 12 months. Current clinical evidence favors using i-PRF as an adjunct to AC rather than AC-only or AC with PRP for the treatment of TMDs. The improvements in subjective and objective outcome measures are clinically meaningful. Still, additional high-quality RCTs with larger sample sizes and longer follow-ups are required to strengthen the evidence base and better define the role of i-PRF in TMD management guidelines.

Surgical vs. Non-Surgical Management of Temporomandibular Joint Disorders: Clinical Outcomes

ABSTRACT Background: Temporomandibular joint disorders (TMDs) encompass a range of clinical conditions affecting the temporomandibular joint (TMJ) and associated structures. Management approaches for TMDs vary and include both surgical and non-surgical interventions. Materials and Methods: In this retrospective cohort study, medical records of 150 patients diagnosed with TMDs were reviewed. Patients were categorized into two groups: surgical intervention and non-surgical intervention. The surgical group underwent various surgical procedures, including arthroscopy, arthroplasty, and joint replacement, while the non-surgical group received conservative treatments such as physical therapy, pharmacotherapy, and occlusal splints. Pain levels, TMJ function, quality of life (QoL), and patient satisfaction were assessed at baseline and post-treatment (6 months and 1 year). Results: At the 6-month follow-up, both groups experienced a significant reduction in pain scores (surgical group: 6.3 ± 1.2 to 2.4 ± 0.9, non-surgical group: 6.1 ± 1.1 to 3.2 ± 1.0). TMJ function improved in both groups (surgical group: 2.5 ± 0.8 to 4.8 ± 0.6, non-surgical group: 2.6 ± 0.7 to 4.2 ± 0.9). QoL scores increased (surgical group: 35.2 ± 4.6 to 50.3 ± 5.1, non-surgical group: 35.5 ± 4.2 to 45.7 ± 4.8), and patient satisfaction rates were high (surgical group: 92%, non-surgical group: 87%) at the 1-year follow-up. Conclusion: Both surgical and non-surgical management approaches demonstrated significant improvements in pain relief, TMJ function, QoL, and patient satisfaction for individuals with TMDs.

Effectiveness of Hydrolyzed Collagen Peptide Injection for the Treatment of Collateral Ligament Pain: A Randomized Controlled Trial

Purpose: Collateral ligament pain is a musculoskeletal condition causing knee inflammation, often affecting athletes. Despite various treatments being available, there is failure in addressing the pathophysiologic collagen degradation. Hydrolyzed collagen peptides may help damage tissues in the repairment process, but until now no data is available on local injection of collagen peptides, with data available only on oral supplementation. Methods: A randomized controlled trial assessed the efficacy of hydrolyzed collagen peptide injections (Tiss’You, Republic of San Marino) for persistent collateral ligament pain. Sixty-two patients with ultrasound-confirmed inflammation were divided into two groups. The study group (31 patients) received oral painkillers and a collagen peptide injection, while the control group (31 patients) received oral painkillers and a depo-medrol injection. Results: The study group showed significant improvement in pain relief, functional status, and quality of life, measured by the Visual Analogue Scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) after six months. Ultrasound confirmed ligament healing in both groups with no observed differences. The study group reported higher satisfaction and no adverse effects. Conclusion: Hydrolyzed collagen peptide injections may effectively and safely treat collateral ligament pain. This study offers insights into this novel emerging treatment option, exploiting the ability of collagen peptides in helping tissue repair. Further research with larger samples and longer follow-up is necessary to validate these findings.

Comparative Analysis of Open Transforaminal Lumbar Interbody Fusion and Wiltse Transforaminal Lumbar Interbody Fusion Approaches for Treating Single-Level Lumbar Spondylolisthesis: A Single-Center Retrospective Study

Background: The aim of this study is to compare the surgical outcomes of two different surgical approaches, open transforaminal lumbar interbody fusion (TLIF) and Wiltse TLIF, in the treatment of single-level lumbar spondylolisthesis and also to provide the advantages and disadvantages of each approach. Methods: This retrospective study included 600 patients with single-level lumbar spondylolisthesis who underwent fusion surgery at a single academic institution between January 2018 and December 2022. Patients were divided into two groups: traditional open TLIF (group A; 300 patients) and the Wiltse TLIF approach (group B; 300 patients). Preoperative diagnostic tests were performed on all patients. Results: The fluoroscopy time for the Wiltse TLIF group was longer, whereas the mean blood loss for the Wiltse TLIF approach was less. Both techniques resulted in significant improvements in pain relief and functional disability, with no significant difference between the two groups in terms of their pre- or post-operative (Oswestry Disability Index) ODI scores. The Wiltse TLIF technique resulted in significantly shorter hospital stays and had a lower rate of complications compared with the open TLIF technique. Conclusion: The Wiltse TLIF approach showed advantages in shorter surgical times, reduced blood loss, and shorter hospital stays, whereas the traditional open TLIF approach exhibited shorter fluoroscopy times.

A Comparative Analysis Between Conservative Treatment, Arthroscopic Repair, and Biceps Tenodesis in Superior Labral Anterior-Posterior (SLAP) Lesions.

Background "Throwing shoulder" hinders athletes' shoulder functions, causing pain, weakness, and performance reduction due to anatomical, physiological, and biomechanical factors. Anatomical issues include superior labral anterior-posterior (SLAP) injuries, rotator cuff injuries, and glenohumeral instability. Methods This study compared arthroscopic labral repairs in patients under 40 years old with shoulder injuries between 2015 and 2017. Sixty eligible patients were divided into three groups: conservative treatment, arthroscopic repair, and tenodesis. Measures included pain, functional scores, and the range of motion pre-/post-operation. Results At the last follow-up, pain relief and functional improvement were most significant with tenodesis (97% pain relief, 95% functional improvement), followed by repair (85% pain relief, 70% functional improvement), and least in conservative treatment (45% pain relief, 40% functional improvement). While all treatments significantly reduced pain and improved function (p<0.001), tenodesis demonstrated the highest effectiveness, suggesting it as a potentially preferred method. Significant improvements in pain relief and function were observed across all methods; however, surgical options suggested improved outcomes. Conclusion Our study compares conservative treatment, arthroscopic labral repair, and biceps tenodesis (BT) for SLAP lesions, highlighting significant pain relief and functional improvement across all. Conservative treatment suits patients with milder symptoms, while arthroscopic repair addresses larger tears. As the effectiveness of arthroscopic treatment is not inferior toconservative one, BT excels in cases of substantial bicep involvement.

Patient-controlled analgesia for the management of adults with acute trauma in the emergency department: A systematic review and meta-analysis.

Patient-controlled analgesia (PCA) has potential as a form of analgesia for trauma patients in the emergency department (ED). The objective of this review was to evaluate the effectiveness and safety of PCA for the management of adults with acute traumatic pain in the ED. The hypothesis was that PCA can effectively treat acute trauma pain in adults in the ED, with minimal adverse outcomes and better patient satisfaction compared with non-PCA modalities. MEDLINE (PubMed), Embase, SCOPUS, ClinicalTrials.gov , and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception date to December 13, 2022. Randomized controlled trials involving adults presenting to the ED with acute traumatic pain who received intravenous (IV) analgesia via PCA compared with other modalities were included. The Cochrane Risk of Bias tool and the Grading of Recommendation, Assessment, Development, and Evaluation approach were used to assess the quality of included studies. A total of 1,368 publications were screened, with 3 studies involving 382 patients meeting the eligibility criteria. All three studies compared PCA IV morphine with clinician-titrated IV morphine boluses. For the primary outcome of pain relief, the pooled estimate was in favor of PCA with a standard mean difference of -0.36 (95% confidence interval, -0.87 to 0.16). There were mixed results concerning patient satisfaction. Adverse event rates were low overall. The evidence from all three studies was graded as low-quality because of a high risk of bias from lack of blinding. This study did not demonstrate a significant improvement in pain relief or patient satisfaction using PCA for trauma in the ED. Clinicians wishing to use PCA to treat acute trauma pain in adult patients in the ED are advised to consider the available resources in their own practice settings and to implement protocols for monitoring and responding to potential adverse events. Systematic Review/Meta-Analyses; Level III.

Oral Corticosteroids versus Exercises on Treatment of Frozen Shoulder: A randomized, Single-blinded study.

Many treatment strategies have been described for the management of frozen shoulder. However, to date no randomized controlled trial has directly compared the efficacy of exercise and oral corticosteroids. The aim of this study was to determine whether pain, range of motion, and function differ between patients with frozen shoulder randomized to treatment with exercise or oral corticosteroids. This prospective, randomized, assessor-blinded trial was performed to compare the effectiveness of exercise and oral corticosteroids in patients with frozen shoulder. Overall, 33 patients with FS were randomly assigned to receive either exercise (n=17) or oral corticosteroids (n = 16). The exercise was applied 2 times per week for 6 weeks for 12 visits and patients in oral corticosteroids group received prednisolone for 4 weeks. Participants were assessed at baseline, after 6-weeks and at the 12-week follow-up. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS). The secondary outcomes were American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), range of motion, and hospital anxiety and depression (HAD). scale. Repeated-measures analysis of covariance (ANCOVAs) with baseline scores as the covariates were used to determine between-group differences. An intention-to-treat analysis was performed using the multiple imputation method to impute values for all missing data. Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups at the 6- and 12-week follow-ups compared to baseline. There were no significant time-by-group interactions between-group differences noted for the DASH (F=0.470, p= 0.93), VAS (F=0.006, p=0.94), flexion range of motion (ROM) (F=2.78, p=0.1), internal rotation ROM (F=3.440, p=0.07) and ASES (F=0.470, p=0.49). The overall group-by-time interaction for the 2×3 mixed-model ANCOVA using baseline scores as a covariate was significant for the abduction range (F=4.460, p=0.04) and external rotation range of motion (F=12.100, p = 0.002) in favor of the exercise group CONCLUSIONS: The study demonstrated that while both groups achieved significant improvements at the 6-, and 12-week follow-ups, the exercise group was superior in terms of abduction and external rotation range of motion. Additionally, even though both groups were improved, the effect sizes were larger in the exercise group. Considering the systemic side effects of oral corticosteroids, even at low doses, a well-planned exercise program that considers pain may be a good option for frozen shoulder.

Role of arthroscopic knee lavage supplemented with intra-articular methy l prednisolone in osteoarthritis of knees

Pain, swelling, and stiffness in the knee joint due to degenerative knee disease (osteoarthritis in the knee, which affects the joint lining and menisci) are among the most prevalent causes of difficulty walking. Damage to the cartilage in the knee joint leads to increased friction and, in extreme situations, the development of new bone. It is widely prevalent in our country due to predominance of kneeling and other cultural habits. We hypothesized that if we could remove the debris of the cartilage and other degenerative tissue through knee lavage it would relieve the joint pain and stiffness. We further decided to augment this treatment with intra articular methyl prednisolone 80 mg to decrease the inflammation of the synovium and provide a prolonged relief. All patients will undergo arthroscopic knee lavage with 3000 milliliters of ringer lactate solution under sterile conditions in the operating room.As a local anesthetic, 10 milliliter of lignocaine 2% was used. Eighty milligrams of methyl prednisolone were injected through the arthroscopic cannula at the conclusion of the procedure. The patient was sent home with stringent activity restrictions for only 24 hours. For seven days following surgery, patients were prescribed a moderate analgesic and an antibiotic. After a week, the bandage was removed and a band-aid was affixed for the remaining five days. At 1 month, 3 months, and 6 months, patients were contacted for evaluation and the pre operative and post operative pain scales were compared. Patients with Kellgren and Lawrence grade 3 osteoarthritis reported a statistically significant improvement in pain relief from pre- to post-operative VAS scores (p 0.05) after three months, and 67 percent reported good or excellent results after six months. Knee lavage with methyl prednisolone 80mg under local anesthesia is an effective treatment option for patients with grades 1, 2, and 3 osteoarthritis who are unable to undergo surgery for economic or medical reasons or who have a substantial NSAIDS requirement.

Evaluating the Effectiveness of Intra-articular Platelet Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Systematic Review

Introduction: Osteoarthritis (OA) is the most frequently presented joint disorder, and its treatment is often challenging. Current literature has controversial results regarding the efficacy of Platelet Rich Plasma therapy (PRP) when compared to placebo injections. This systematic review investigates the role of intra-articular PRP injections as a recommended treatment option for knee OA with the potential to establish appropriate guidelines for treating physicians. Method: This review used PUBMED, Cochrane and CINHAL database. A thorough review of literature examining PRP injections as treatment options for knee OA was performed. Two independent reviewers evaluated the studies against inclusion and exclusion criterias. The WOMAC stiffness score, VAS Score, and KOOS score were used to assess efficacy of PRP treatment. Twelve articles met the criteria for inclusion and were analysed in this study. Results: PRP injections caused a significantly better improvement in WOMAC stiffness score (25.5%), VAS Score (31.7%), and KOOS score (6.2%) after six months of treatment. Conclusion: This review demonstrated significant improvement in pain relief and stiffness levels in patients with knee OA receiving intra-articular PPR when compared to placebo. Further research is required to establish the optimum dose and duration of treatment with PRP injections for knee OA.

Early cement augmentation may be a good treatment option for pain relief for osteoporotic compression fractures: a systematic review and meta-analysis.

The incidence of osteoporotic compression fractures (VCFs) have been rising over the past decades. Presently, vertebral cement augmentation procedures such as balloon kyphoplasty and vertebroplasty are common treatments allowing pain relief and functional recovery. However, there is controversy on whether different timeframes for cement augmentation affects clinical outcomes. Hence, this study aimed to compare pain relief and complication rates between early versus late cement augmentation. A comprehensive systematic review of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared early versus late cement augmentation for VCFs. As the definitions of "early" and "late" phases across studies are heterogenous, we established the cut-off between early and late phase as intervals to accommodate as many studies as possible for analysis. We conducted two separate analyses with different cut-off intervals and included studies that reported interventions within these respective time intervals. In analysis 1, we included studies which grouped patients into "early" and "late" group based on a cut-off time frame of 2-4weeks. On the other hand, in analysis 2, we included studies which grouped patients into "early" and "late" groups based on a cut-off time frame of 6-8weeks. Meta-analysis was conducted via random-effect models, comparing outcomes of interest between early and late groups. Eleven studies were included. The total cohort size was 712 and 775 patients in analysis 1 and 2 respectively. Mean follow-up was 12.9 ± 3.7months and 11 ± 0.6months respectively. VAS change at final follow-up was significantly greater in the early group for both analyses. (MD = - 0.66, p = 0.01; and MD = - 1.18, p < 0.005 respectively). There was no significant difference in post-operative absolute VAS score, number of cement leakage, number of adjacent compression fractures and local kyphotic angle, for both analyses. Patients in both groups experienced reductions in VAS score that exceeded the minimum clinically important difference. Both early and late timeframes for cement augmentation offered significant improvement in pain relief, with similar post-operative absolute pain score, kyphotic angle, cement leakage and adjacent vertebral fractures. Early surgery may offer substantial pain relief in patients presenting with pain as early as < 2-4weeks of VCFs.

Femoral Nerve Block and Local Instillation Analgesia Associated With More Reliable Efficacy in Regional Anesthesia Interventions Within 24 Hours Following Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis

To assess the relative effectiveness of different regional anesthetic techniques (peripheral nerve blocks, local instillation analgesia, including intra-articular, subcutaneous, and periarticular infiltration) in patients undergoing anterior cruciate ligament reconstruction (ACLR). PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to December 31, 2020. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants after ACLR that compared regional anesthesia interventions were selected. The 2 coprimary outcomes were (1) rest pain scores and (2) cumulative oral morphine equivalent consumption on day 1 (24 hours) post-ACLR. Data were pooled using a Bayesian framework. Of 759 records identified, 46 trials were eligible, evaluating 9 interventions in 3,171 patients. Local instillation analgesia (LIA), including intra-articular, subcutaneous, and periarticular infiltration, had significant improvement in pain relief as compared with placebo (-0.91; 95% CrI -1.45 to -0.37). Femoral nerve block (FNB) also showed significant effects in relieving pain as compared with placebo (-0.70; 95% 95% credible interval [CrI] -1.28 to -0.12). Compared with placebo, a significant reduction in opioid consumption was found in LIA (mean difference -13.29 mg; 95% CrI -21.77 to -4.91) and FNB (mean difference -13.97 mg; 95% CrI -24.71 to -3.04). Femoral and sciatic nerve block showed the greatest ranking for pain relief and opioid consumption without significant evidence (P > .05) to support superiority in comparison with placebo, respectively. Our meta-analysis shows that FNB and LIA can significantly diminish postoperative pain and reduce opioid consumption following ACLR compared with placebo in the setting of regional anesthesia, and femoral and sciatic nerve block may be the number 1 top-ranked analgesic technique despite high uncertainty. I, Systematic review of Level I studies.

Spinal Cord High-Frequency Stimulation. The Current Experience and Future Directions.

Spinal cord stimulation (SCS) is a neuromodulation technology that has emerged as a valid treatment for chronic intractable neuropathic pain. After conventional tonic SCS, new waveforms of stimulation, like high frequency (HF), have proved that they can provide safe and effective pain relief. In addition, SCS is now being utilized more broadly as a potential treatment for a range of indications, including motor disorders and spasticity. Our study presents a retrospective analysis of 20 patients with heterogenous aetiologies of neuropathic pain treated with HF stimulation, after a standardized protocol in a temporary trial. We observed a significant improvement in pain relief according to comparisons of numerical rating scale (NRS) scores before the procedure, after the clinical trial and at latest follow-up. Two unusual clinical cases were also reported, and the pertinent literature was discussed.

Survivorship of Allologous Structural Bone Graft at a Minimum of 2 Years When Used to Address Significant Glenoid Bone Loss in Revision Shoulder Arthroplasty: A Computed Tomographic and Clinical Review.

This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant. We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up. Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported. Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.

Agnikarma and Dashamoola Kwatha in the Management of De Quervain’s Tenosynovitis – Case Series

ABSTRACT De Quervain’s tenosynovitis is a common painful orthopedic entity that involves a thickening of retinaculum sheaths of tendons, which covers the first dorsal compartment of the forearm. This study is to explore noninvasive Ayurvedic management for De Quervain’s disease. In this series of cases, Ayurveda management of four diagnosed cases of Quervain’s disease (Snayugata Vata) was found to be effective. All patients were treated with four sittings of Agnikarma by Shalaka (~thermal cauterization) at the interval of 7 days. Dashmoola Kwatha 20 ml orally twice a day empty stomach for 1 month was prescribed to each patient. Results showed significant improvement in pain relief and functional movement of the thumb was achieved in all four patients. The quality of work of all four patients was not affected after 18 months of treatment, and they are now living symptom-free and without any recurrence. Based on this case series, it can be said that parasurgical management along with adjuvant Ayurvedic drugs showed a promising role in the management of De Quervain’s disease.

Outcomes of arthroscopic-assisted middle trapezius tendon transfer for isolated irreparable supraspinatus tendon tears: minimum 2-year follow-up.

Middle trapezius tendon (MTT) transfer has been proposed as a feasible option for managing isolated irreparable supraspinatus tears (IISTTs). However, no clinical study has been attempted. This study aimed to evaluate clinical and radiologic outcomes of arthroscopic-assisted MTT transfer in patients with IISTTs. This retrospective study included patients who underwent arthroscopic-assisted MTT transfer using fascia lata autograft for IISTTs. Clinical outcomes, including pain visual analog scale (VAS), Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA) shoulder scores and active range of motion (aROM), were assessed. Radiographic analyses included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at the final follow-up. Twenty-two patients (mean age: 63.3 ± 6.8 [51‒74] years; mean follow-up period: 28.9 ± 4.9 [24‒44] months) met the study criteria. The mean VAS, Constant, ASES, and UCLA scores improved postoperatively at the final follow-up (p < 0.001). The mean aROMs for forward flexion and abduction were significantly increased postoperatively. No significant changes of AHD (p = 0.105) and Hamada grade (p = 0.815) were observed postoperatively. One patient had a re-tear of the transferred tendon at the footprint site at the final follow-up. In this minimum 2-year follow-up study of the novel aMTT transfer using fascia lata autograft, we found significant improvement in pain relief, clinical scores, and active forward flexion and abduction. Additionally, no significant progression of cuff tear arthropathy was observed at the final follow-up. Therefore, aMTT transfer could be a promising treatment option for patients with IISTTs. However, further multicenter and long-term trials are needed to verify its effectiveness. Retrospective case series, level IV.

Total Wrist Arthroplasty with Integra Freedom® Implants: A Pilot Study with a New Evaluation System.

Recent innovations in wrist arthroplasty implants have led to remarkable improvements in terms of results with improved stability and preservation of bone stock. Despite the advances in such implants, poor outcomes and frequent complications still affect this procedure, not allowing a wider use of this treatment in wrist arthritis.The purpose of this study is to assess the preliminary mid-term results of a Wrist Arthroplasty System (Freedom®, Integra Lifesciences, Princeton, USA) in patients with rheumatoid arthritis or secondary osteoarthritis of the wrist and to propose a new classification system. We examined 12 patients (7 with rheumatoid arthritis and 5 with secondary osteoarthritis of the wrist) who underwent total wrist arthroplasties performed by a single surgeon using the fourth-generation prosthesis. Pre- and post-operative pain on a visual analogue score, functional parameters measured with Mayo Wrist score, patient-rated wrist evaluation score, range of motion, and radiographic analysis were collected. At a mean follow-up of 48 (SD 16.9) months a significant improvement (p < 0.0001) of the mean visual analogue, Mayo and PRWE scores following total wrist arthroplasty was observed. Wrist movements improved significantly (p < 0.001). We achieved significant improvements in pain relief, performance, and satisfaction both in rheumatic and non-rheumatic patients, confirmed by our scoring system. Level IV, case series.