Significant Improvement In Pain Severity Research Articles

Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial

BackgroundPatellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with patellofemoral pain syndrome.MethodsTwenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35 years old participated in this study. They were equally and randomly assigned into two groups; the study group which received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance was performed to compare the within and between groups effects for measured variables.ResultsThe within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed no significant statistical difference between both groups in all variables, except in pain, function, and mediolateral stability which showed better improvement compared to the control group.ConclusionsAdding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability in patients with patellofemoral pain syndrome.Trial registrationclinicaltrials.gov. NO: NCT05383781. Date 19/ 5/2022.

Effectiveness of a Core Stability Exercise Program on Pain and Function in Musicians with Chronic Low Back Pain: A Randomized Controlled Trial.

Low back pain (LBP) is relatively common among the musician population. Few studies have looked at the usefulness of a core stability exercise program in musicians suffering from LBP. The aim of this study was to investigate the effectiveness of a core stability exercise program on pain and improvement of function in musicians with LBP. A total of 41 university-level instrumental musicians with nonspecific LBP who played piano, violin, or cello were randomly allocated to one of two groups in a randomized controlled trial. One person from the control group was lost to follow-up. Thus, 40 participants (23 females and 17 males) completed the study. The intervention group received education and a 12-week core stability exercise program. The control group only received an educational brochure. A visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to determine the severity of pain and functional status, respectively. Data were collected by an independent, blinded evaluator at baseline and at 12 and 24 weeks after baseline. The intervention group showed a significant improvement in pain severity on the VAS and functional status on the ODI during all times of follow up, whereas the scores of pain and function worsened in the control group at 24 weeks. Between-group analysis showed significant difference in pain intensity at both weeks 12 and 24 of follow-up. However, for functional status, the difference was only significant after 12 weeks. A structured core stability exercise program supplemented with an educational brochure was effective to manage LBP in musicians.

Abstract P4-04-02: Evaluation of Dronabinol to Decrease Opioid Use for Cancer- Induced Bone Pain

Abstract Purpose Bone metastases (BM) from breast cancer cause significant complications including pain, hypercalcemia, spinal cord compression, and pathologic fractures, collectively referred to as skeletal related events (SREs). Of all SREs, bone pain impacts the quality of life (QOL) most significantly. Cancer- induced bone pain (CIBP) is difficult to treat with limited treatment options and requires a multimodal approach. Management of CIBP is primarily by opioids which have notable side effects like sedation, constipation, and concern for addiction. In addition, pre-clinical evidence suggests that opioids accelerate bone loss and increase risk of fractures. There is an unmet need for novel analgesic therapy interventions to optimize QOL for patients with BM from metastatic breast cancer. Preclinical studies have shown that the endogenous cannabinoid (CB) system is involved in pain modulation, bone regulation, immunity, and restraint of cancer pathogenesis. CB2 receptor activation has been shown to inhibit proinflammatory cytokines/chemokines in pre-clinical models. Treatment with selective CB2 agonist in mice with BM led to significant antinociception, decreased cancer-induced bone degradation, and reduced side effects of morphine. In addition to alleviating pain, CB2 agonists were shown to enhance bone growth/strength in these mice. Based on this pre-clinical data, we hypothesized that the addition of a CB2 agonist will improve pain symptoms and decrease opioid requirement in patients with bone metastases from breast cancer. We proceeded to conduct a pilot study by repurposing a clinically approved CB2/CB1 agonist, dronabinol. Methods We conducted a prospective, single site study among patients with BM from breast cancer at our center (NCT03661892). Patients had to have been on opioids for CIBP for at least 4 weeks and not using marijuana or CBD products. Patients were treated with 10mg dronabinol BID for 8 weeks. Our primary objective was to determine the proportion who decrease their opioid use by ≥ 20%. The null hypothesis value was 5% of women would have a 20% decrease. With 14 participants, we could detect an increase from 5% to 29% (n=4) with 80% statistical power using a one-sided alpha level of 0.05. Participants completed Brief Pain Inventory and the European Organization for Research and Treatment of Cancer quality of life questionnaires pre and post treatment. Results Twenty participants consented with 14 patients completing the study and evaluable for primary analysis. No patients received any palliative radiation therapy or other therapies for bone pain within 3 months prior to enrollment to this study. Four patients decreased their opioid use by ≥ 20% meeting the primary objective. Patients reported significant improvement in pain severity, interference scores, quality of life and insomnia based on the questionnaires. There were no grade 4 side effects and only 1 patient had grade 3 adverse event (dizziness) related to study drug. Of the 14 patients who completed the study, 9 desired to continue dronabinol therapy after completion. Conclusion Our pilot study shows that the addition of dronabinol resulted in decreased opioid requirements for CIBP in patients with metastatic breast cancer. Patient-reported outcomes also demonstrated improved pain and QOL with the addition of dronabinol. While we did not see any significant AEs tolerability may be of concern due to CB1 psychoactive effects. Our results are promising and warrant further investigation into evaluating CB2 agonists for improved pain control from CIBP and to decrease opioid use. Citation Format: Jennifer Segar, Kiah Farr, Mary Junak, Denise Roe, Sima Ehsani, Sao Jiralerspong, Ibrahim Mohab, Todd Vanderah, Pavani Chalasani. Evaluation of Dronabinol to Decrease Opioid Use for Cancer- Induced Bone Pain [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-04-02.

Prospective Observational Study of Pain Severity and Pain Interference Outcomes Following Percutaneous MRI-guided Laser Ablation or Cryoablation for Focal Painful Peripheral, Soft Tissue Vascular Malformations: 12-month Outcomes

Background: Percutaneous image-guided thermal ablation has emerged as a treatment option for vascular malformations (VM). However, prospective data on intermediate to long-term effectiveness with uniform follow-up are lacking. Purpose: To prospectively evaluate the 12-month pain severity and pain interference outcomes following percutaneous MRI-guided laser ablation and cryoablation of focal painful, peripheral soft tissue VM. Materials and Methods: Participants undergoing clinically indicated MRI-guided laser ablation and cryoablation for focal painful (worst pain ≥4 out of 10 on Visual Analog Scale), peripheral soft tissue vascular malformations (VM) were enrolled in an IRB-approved prospective, observational study after giving informed consent. Participants completed the Brief Pain Inventory questionnaire prior to ablation and 1, 3, 6, and 12-month postablation. Differences in pain severity and interference outcomes from baseline on a 0 to 10 scale were compared using a paired t-test. Results: Seventeen participants (15 female; mean age 28.3 ± 9.3 years) underwent 24 MRI-guided and monitored ablation sessions including laser (n = 21), cryoablation (n = 2), or both (n = 1) for treatment of painful slow-flow (n = 16) or high-flow (n = 1) VM. Median maximal VM diameter was 5.7 cm (range 1.1 to 31.0 cm). Mean (±SD) preablation worst pain score was 7.9 ± 1.4. There was a significant decrease in worst pain at 1-month postablation (–3.5 ± 2.9; P = .0007) that was sustained at 3 (–3.4 ± 3.2; P = .0007), 6 (–4.2 ± 3.6; P = .0003), and 12 months (–3.6 ± 3.9; P = .002), with similar results for average, current, and least pain scores. There was a significant improvement in pain interference outcomes at 12-month postablation: general activity (P = .018), walking ability (P = .008), work (P = .003), sleep (P = .007), and enjoyment of life (P = .033). Conclusions: These data suggest that MRI-guided and monitored thermal ablation is safe and provides early and sustained significant improvements in pain severity and pain interference outcomes during the first year of follow-up in participants with focal painful peripheral soft tissue VM.

Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service.

With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants. In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen. Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption. Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.

"Flower Power": Controlled Inhalation of THC-Predominant Cannabis Flos Improves Health-Related Quality of Life and Symptoms of Chronic Pain and Anxiety in Eligible UK Patients.

In November 2018, the UK’s Home Office established a legal route for eligible patients to be prescribed cannabis-based products for medicinal use in humans (CBPMs) as unlicensed medicines. These include liquid cannabis extracts for oral administration (“oils”) and dried flowers for inhalation (“flos”). Smoking of CBPMs is expressly prohibited. To date, THC-predominant cannabis flowers remain the most prescribed CBPMs in project Twenty21 (T21), the first multi-center, prospective, observational UK cannabis patient registry. This observational, prospective data review analyzes patient-reported outcome measures (PROMS) collected by T21 associated with the inhalation of KHIRON 20/1, the most prescribed CBPM in the project. PROMS collected at baseline and at subsequent 3-month follow-up included health-related quality of life (HRQoL), general mood, and sleep. Condition-specific measures of illness severity were performed with the Brief Pain Inventory Short Form (BPI-SF) and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Participants (N = 344) were mostly males (77.6%, average age = 38.3) diagnosed mainly with chronic pain (50.9%) and anxiety-related disorders (25.3%). Inhalation of KHIRON 20/1 was associated with a marked increase in self-reported HRQoL, general mood, and sleep (N = 344; p < 0.001). Condition-specific assessments showed significant improvements in pain severity (T = 6.67; p < 0.001) and interference (T = 7.19; p < 0.001) in patients using KHIRON 20/1 for chronic pain (N = 174). Similar results were found for patients diagnosed with anxiety-related disorders (N = 107; T = 12.9; p < 0.001). Our results indicate that controlled inhalation of pharmaceutical grade, THC-predominant cannabis flos is associated with a significant improvement in patient-reported pain scores, mood, anxiety, sleep disturbances and overall HRQoL in a treatment-resistant clinical population.

A Mobile Application to Help Self-Manage Pain Severity, Anxiety, and Depressive Symptoms in Patients with Fibromyalgia Syndrome: A Pilot Study.

Treatment for individuals with fibromyalgia syndrome (FMS) is complex and is not always accessible to those who could benefit. The aim of this study was to conduct a preliminary evaluation of a mobile-app-delivered, cognitive behavioral treatment (CBT)-based intervention in helping adults self-manage fibromyalgia symptoms. A total of 100 adults with FMS (M [SD] age = 49.81, [9.99] years; 94% women) were given access to the digital treatment program and downloaded the app. Pain severity, anxiety symptoms, depression symptoms, fatigue, and sleep quality were assessed at pre-treatment, post-treatment, and 3-month follow-up. Fifty-three of the potential participants completed the 47-day treatment. Data showed significant improvements in pain severity (p = 0.007, d = 0.43), anxiety (p = 0.011, d = 0.40) and depressive symptoms (p = 0.001, d = 0.50) from pre-treatment to post-treatment. The effect sizes associated with app use are consistent with improvements seen in previously published clinical trials of CBT for FMS. Improvements were generally maintained, although there was some decrease in the outcomes from post-treatment to the 3-month follow-up. Most participants reported that they were very satisfied with the app. The use of the app was associated with similar levels of improvements found with in-person CBT treatment for FMS. Research to evaluate the effectiveness of the app in a controlled trial is warranted.

Chronic pain experience through COVID-19: a comparison of reports prior and during the early stages of the pandemic.

The impacts of COVID-19 and imposed restrictions on individuals with chronic noncancer pain continue to emerge, varying across countries. More recent research (including with longitudinal designs) suggests that the pandemic may not have such a disproportionate effect on chronic noncancer pain and its management as first thought. This longitudinal study, with assessments before the pandemic (2019) and early during the pandemic (May-July 2020), examined changes in validated measures of pain severity, pain interference, prescription opioid misuse, and mental health symptoms. Patients (N = 236) self-reported significant improvements in pain severity, pain interference, pain self-efficacy, pain catastrophizing, prescription opioid misuse, depression, and anxiety symptoms over time. Approximately 30% and 33% of patients achieved minimally important reductions (10% change) in pain severity and pain interference, respectively. In follow-up exploratory analyses, prepandemic sociodemographic and psychological factors predictive of 10% improved (vs 10% worse) pain severity and interference were investigated in logistic regressions. Reduction in pain interference was predicted by current employment, older age, and higher pain self-efficacy. There were no significant predictors of reduction in pain severity. The impact of COVID-19 on patients' pain experience and mental health was negligible in the early stages of the pandemic, and findings suggest improvements through the period. Targeted interventions that promote the protective factor of pain self-efficacy and build resilience may buffer patients' future response to the pandemic because it evolves as a part of our new normal. Targeted social determinants of health interventions that direct resources toward maintaining employment could also be important.

A Pilot Study of Cancer-Induced Bone Pain Using Validated Owner Questionnaires, Serum N-Telopeptide Concentration, Kinetic Analysis, and PET/CT.

Cancer-induced bone pain, despite its frequency and severity, is a poorly understood phenomenon in people and animals. Despite excitement regarding translational osteosarcoma studies, there is a lack of attention toward examining cancer pain in dogs. In this pilot study, we used a multimodal pain assessment methodology to evaluate pain relief after therapeutic intervention in dogs with primary bone cancer. We hypothesized that intervention would cause objective evidence of pain relief. Evaluations of 8 dogs with primary bone cancer included 18F-FDG PET/CT scans, kinetic analysis, validated owner questionnaires (Canine Brief Pain Inventory, canine BPI), and serum N-telopeptide (NTx) concentration. Dogs were routinely staged and had 18F-FDG PET/CT scans prior to treatment with day 0, 7, 14, and 28 canine BPI, serum NTx, orthopedic exam, and kinetic analysis. Dogs treated with zoledronate and radiation underwent day 28 18F-FDG PET scans. All clinical trial work was approved by the University of Missouri IACUC. Four dogs underwent amputation (AMP) for their appendicular bone tumors; four received neoadjuvant zoledronate and hypofractionated radiation therapy (ZOL+RT). Canine BPI revealed significant improvements in pain severity and pain interference scores compared to baseline for all dogs. Positive changes in peak vertical force (+16.7%) and vertical impulse (+29.1%) were noted at day 28 in ZOL+RT dogs. Dogs receiving ZOL+RT had a significant (at least 30%) reduction in serum NTx from baseline compared to amputated dogs (p = 0.029). SUVmax (p = 0.11) and intensity (p = 0.013) values from PET scans decreased while tumor uniformity (p = 0.017) significantly increased in ZOL+RT-treated tumors; gross tumor volume did not change (p = 0.78). Owner questionnaires, kinetic analysis, and 18F-FDG PET/CT scans showed improved pain relief in dogs receiving ZOL+RT. Serum NTx levels likely do not directly measure pain, but rather the degree of systemic osteoclastic activity. Larger, prospective studies are warranted to identify the ideal objective indicator of pain relief; however, use of multiple assessors is presumably best. With improved assessment of pain severity and relief in dogs with cancer, we can better evaluate the efficacy of our interventions. This could directly benefit people with cancer pain, potentially decreasing the amount of subtherapeutic novel drugs entering human clinical trials.

Efficacy of physical therapy interventions on quality of life and upper quadrant pain severity in women with post-mastectomy pain syndrome: a systematic review and meta-analysis

PurposeTo determine the efficacy of physical therapy interventions on quality of life (QoL) and pain severity in post-mastectomy pain syndrome (PMPS).MethodsMultiple databases were searched from database inception to October 2020. Searches were limited to human studies published in either English or Chinese in peer-reviewed journals with full text available for randomized controlled trials conducted on females. Trials comparing the effectiveness of physical therapy interventions against control conditions on QoL and pain were included.ResultsEighteen trials were included in the review. The pooled analysis of the four exercise trials revealed a significant effect of the intervention on general [standardized mean difference [SMD]: 0.87 (95%CI: 0.36, 1.37); p = 0.001], physical [SMD: 0.34 (95%CI: 0.01, 0.66); p = 0.044], and mental health components [SMD: 0.27 (95%CI: 0.03, 0.51); p = 0.027] of QoL compared with the control condition. Meta-analyses of six exercise trials, two myofascial release trials, and two acupuncture trials revealed a significant improvement in pain severity in the treatment group than in the control group. However, meta-analyses of two studies revealed a non-significant effect of compression therapy compared to control on pain severity.ConclusionOur meta-analyses found that exercise is beneficial for improving the QoL and pain severity of women with PMPS. Future studies are needed to determine the optimal parameters for exercise interventions designed to improve QoL and pain severity in women with PMPS. The effect of acupuncture, myofascial release, and compression therapy remains inconclusive, and future research is required to validate the effect of these interventions on PMPS.

A mind-body program for pain and stress management in active duty service members and veterans.

The Mind-Body Medicine (MBM) program at the Naval Medical Center San Diego, created in collaboration with the Benson-Henry Institute for Mind Body Medicine and the Home Base Program at Massachusetts General Hospital, is a 7-week program designed to facilitate stress management habits into patient treatment plans. The aim of this study is to test the feasibility and acceptability of a mind-body program for service members and veterans. Participants (N = 239) were primarily active duty service members of the U.S. Navy and Marine Corps reporting significant perceived stress (Stress Resiliency (SR) group; n = 124), or meeting criteria for chronic pain (Pain Management (PM) group; n = 115). Participants completed measures at preprogram and post-program assessing for perceived stress, pain, functional impairment, quality of life, and psychological and somatic symptoms. Changes in self-reported psychological symptoms and knowledge and practice of mind-body principles were examined. Participants across groups had significant improvement in most outcomes (perceived stress, response to stressful experience, functional impairment, sleep disturbance, depression, PTSD, and anxiety symptoms; and each quality of life domain aside from social relationships), with p values < .0017 (Bonferroni corrected level of significance). The SR group demonstrated significant improvements in primary outcomes of perceived stress and response to stressful experience, and the PM group demonstrated significant improvement in pain severity, but not perceived stress. Significant change was observed in knowledge and practice of mind-body medicine principles, and high satisfaction was reported. Results suggest that a mind-body program may improve physical and psychological functioning for service members, including those facing significant perceived stress and chronic pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pulsed radiofrequency ablation of genicular nerve versus intra-articular radiofrequency ablation combined with platelets rich plasma for chronic kneeosteoarthritis

ABSTRACT Background knee osteoarthritis is considered as one of the most important causes of knee pain. Conventional noninvasive lines of treatment are several, including platelet-rich plasma (PRP) that has been revealed to be helpful in the management of knee osteoarthritis. The goal of this study is to appraise the PRP ultrasound-guided injection in the management of knee osteoarthritis. Settings and Design This study was a prospective randomised double blind study. Methods Sixty adult knee osteoarthritis patients were involved in the current study. They were randomly selected from the pain clinic Faculty of Medicine, Alexandria University. There were two groups ultrasound-guided (USG) pulsed waves radiofrequency (PRF) ablation on genicular nerve (group 1) or intra-articular PRP (group 2) injection under ultrasonography (US)-guidance and articular surface RF ablation. Assessment was done applying visual analogue scale (VAS) for pain intensity. Functionally, WOMAC and IKDC scores were used at baseline and 6th month after injection. Results Intra-articular PRP (group 2) showed a significant improvement in pain severity and physical limitations in patients with knee pain. It also showed significant improvement compared to genicular nerve RF considering VAS score with p value (0.012*) up to 12 months follow up, WOMAC, IKDC scores with p value (<0.001*) up to 12 months and US joint assessment with p value (0.028*) up to 6 months follow up. Conclusion The use of US IA-PRP injection combined to pulsed radiofrequency ablation of articular surface show significant improvement in pain compared to the genicular nerve PRF.

First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome.

IntroductionThe aim of this study was to determine the effects of first-line treatment posterior tibial nerve stimulation (PTNS), applied once a week for a 12 week period, as a treatment modality for patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS).Material and methodsA total of 39 female patients with IC/BPS were enrolled in the study. Patients had one 30-minute session of PTNS per week for 12 weeks and symptoms were assessed before and after the treatment sessions by the use of a voiding diary, visual analog scale (VAS) for pain, O'Leary-Sant interstitial cystitis symptom index (ICSI), and O'Leary-Sant interstitial cystitis problem index (ICPI).ResultsThe mean age of the patients was 38.9 ±7.1 years. The improvements in voiding diary parameters after 12 weeks of PTNS treatment were statistically significant compared to baseline but the changes in nocturia, and average voiding volume were not statistically significant. Mean parametric improvements after 12 weeks of PTNS treatment compared to baseline included a daytime frequency decrease by 3.8 voids daily, urgency episodes decrease by 4.7 episodes daily, nocturia decrease by 0.3 voids and voided volume improvement by a mean of 8.4 ml. The difference for ICSI, ICPI and VAS between baseline and the 12th week of PTNS treatment scores demonstrated statistically significant improvements in pain severity, symptom and problem index.ConclusionsThe findings in this study demonstrated the improvements of voiding diaries, ICSI, ICPI and VAS scores in patients with IC/BPS after 12 weeks PTNS. PTNS treatment is a beneficial firs-line treatment option to IC/BPS symptom amelioration.

Non-spesifik kronik bel ağrılı hastalarda aerobik egzersiz programının etkisi

Amaç: Egzersiz tedavisi, kronik non-spesifik bel ağrısı (NSKBA) tanısı alan hastalarda en yaygın önerilen tedavi şeklidir. Ancak bir egzersiz yönteminin başka bir egzersiz yöntemine üstün olup olmadığı tartışmalıdır. &#x0D; Gereç ve Yöntem: Bu çalışmada NSKBA olan hastalar deney grubu (gözetimli aerobik egzersiz + ev egzersizi) ve kontrol grubu (sadece ev egzersizi) olmak üzere iki gruba randomize edildi. Hastalar tedavi öncesi, tedavi bitimi ve tedavi bitiminden üç ay sonra ağrı şiddeti, spinal mobilite, lomber ektansör kas dayanıklılığı, depresif semptom varlığı ve şiddeti, özürlülük ve yaşam kalitesi bakımından değerlendirildi. &#x0D; Bulgular: Deney grubunda tüm değerlendirmelerde anlamlı düzelme saptanırken kontrol grubunda, ağrı, spinal mobilite ve yaşam kalitesinin fiziksel komponentinde anlamlı düzelme saptandı. Kontrol grubuna göre, deney grubunda değerlendirme parametrelerinde zamanla meydana gelen olumlu değişim anlamlı olarak daha yüksekti. &#x0D; Sonuç: Aerobik egzersiz, NSKBA olan hastaların yetersizliklerinin düzeltmesine, aktivite düzeylerinin ve katılım düzeylerinin arttırılmasına katkı sağlayabilir. Ancak hangi aerobik egzersiz tipinin (sıklığının, süresinin ve yoğunluğunun) daha etkili olduğuna yönelik çalışmalara ihtiyaç vardır.

Effects of biodex balance training on symptomatic knee osteoarthritis in Rawalpindi: A randomized control trial.

To determine the effect of Biodex training on lower limb functional performance, balance, pain and proprioception in symptomatic knee osteoarthritis patients. The randomised controlled study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from February to June 2018, and comprised patients of both genders aged 35-65 years with bilateral knee osteoarthritis. The patients were randomised using sealed envelope method into two equal control and experimental groups. The former received traditional exercise programme, while the latter received balance training on Biodex and traditional exercise programme. Assessment was done at baseline and post-intervention, and the two values were compared both intra-group and inter-group. Data was analysed using SPSS 21. Of the 48 patients, there were 24(50%) in each of the two groups. Experimental group showed significant improvement in pain severity, overall stability and in terms of anteroposterior stability (p<0.05). There was significant improvement in both groups from the baseline (p<0.05). Biodex balance training was found to be more effective in improving functional performance, stability, proprioception and in decreasing sway and pain compared to the traditional exercise programme.

Efficacy of Simultaneous Usage of Spinal Cord Stimulation and Intrathecal Therapy for Nonmalignant Chronic Neuropathic Pain

Some patients with chronic pain and implanted spinal cord stimulators or intrathecal (IT) pumps fail to obtain significant pain relief. The use of dual modality treatment with both therapies is understudied. This study evaluated comprehensive outcomes in this patient population and reported outcomes primarily using IT ziconotide. We retrospectively analyzed 11 patients with chronic pain treated with both spinal cord stimulation and IT therapy. When a primary treatment failed to achieve significant pain relief, a secondary device was trialed and implanted. Pain severity (measured by a numeric rating scale) was assessed by the change from baseline to after the first and second intervention. In a subset of patients (n= 6), quality-of-life metrics were also assessed. Outcome measures were analyzed closest to the 1-year follow-up date after implantation of the first modality and then at the most recent follow-up after implantation of the second modality. Spinal cord stimulation leads were percutaneous (n= 2) or paddles (n= 9) and commonly covered T8-10. IT medication included ziconotide (n= 8), baclofen (n= 1), hydromorphone (n= 1), and morphine/clonidine (n= 1). There was a mean of 19.64 ± 3.17 months between primary and secondary intervention. There was a significant improvement in pain severity from baseline to implantation of the second modality (P= 0.032) at a mean follow-up of 50.18 ± 11.83 months. Dual modality therapy is a potential treatment option in patients who have lost efficacy with a single neuromodulation modality. Further study is required to identify potential responders and nonresponders.

Endoscopic ultrasound-guided celiac plexus neurolysis improves pain in gallbladder cancer.

In gallbladder cancer (GBC), nearly 80% of patients present with pain in the upper abdomen. Narcotic analgesics are usually effective in relieving cancer pain, but induce adverse effects. Celiac plexus neurolysis (CPN) is an effective alternative to reduce pain caused by upper abdominal cancer; however, no published data is available on endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for pain relief in GBC. Patient with unresectable GBC with upper abdominal pain of severity ≥ 3 on visual analogue scale (VAS), not responding to non-steroidal anti-inflammatory drugs (NSAIDs) and tramadol were recruited prospectively over a 2-year period. EUS-CPN was done using the central approach in all thepatients. Pain severity was assessed using a VAS, prior to EUS-CPN and at 2, 4, and 8weeks after CPN. The technical success was achieved in 19 of 21 patients in whom the procedure was attempted. There was a significant improvement in pain severity as measured by VAS compared with the baseline at 2 and 4weeks aftertreatment (p < .001); at 8weeks, pain severity was less but was not statistically significant. At week 2, nearly 95% of patients had either complete or partial relief of pain. This response declined to 63% and 61% at 4 and 8weeks, respectively. There was a significant reduction in daily requirement of analgesics in all thepatients at 2 and 4weeks compared with baseline (p < .001); at week 8, there was no significant reduction in analgesic dose. EUS-CPN has a high technically success in mostpatients with GBC. It improved pain in about 60% to70% patients and lowered daily analgesic dose requirement for up to 4weeks. There was no procedure-related complication.

Evaluation of the autologous conditioned serum in the treatment of osteoarthritis

Aim: The present study was a retrospective study aiming to determine the effect of the autologous conditioned serum (ACS) on osteoarthritis (OA); we made this analysis by injecting it to a symmetrically involved knee.Methods: The present study comprised 33 patients (19 females, 14 males) with 66 knees and a mean age of 57.6±8.21 (range: 41-70). The patients included in the study had radiologically verified bilateral grade 2-3 OA of the knee according to Kellgren-Lawrence classification. Secondary arthritis, inflammatory joint diseases, clinically relevant hematologic or abnormal clinical chemistry values, joint instability, intra-articular corticosteroid injection within the previous 6 months, history of diabetes mellitus and body mass index greater than 30 kg/m2 were the exclusion criteria. Patients who had VAS difference more than 2 points between their knees were excluded from the study. ACS was injected twice a week for a total of 6 times in both knee joints for 3 weeks. The patients were analyzed with the Visual Analog Scale (VAS) (no pain was graded 0 and maximal pain was graded 10), the Knee Injury and Osteoarthritis Score (KOOS) (scoring ranges between 0 and 100. 0 indicates abnormally high level of knee problems, while 100 indicates a healthy knee with no problems) and the Knee Society Score (KSS) (Of the maximum 100 points, a possible 50 points are assigned to pain, 25 points to stability, and 25 points for range of motion) before the administration of the first injection and again 1 year after the last injection. Results: The pre-treatment and 1-year follow-up VAS values ​​of the patients were 7.36±0.93 (range: 5-9) and 3.27±1.23 (range: 1-6), respectively. ACS treatment showed a statistically significant decrease in VAS score (p &amp;lt;0.01). Pre-treatment and 1-year follow-up KOOS values ​​of the patients were 42.39±13.38 (range: 21-65) and 72.36±8.81 (range: 54-92), respectively. There was a statistically significant increase in the KOOS values of the patients (p &amp;lt;0.01). The pre-treatment and 1-year follow-up KSS values ​​of the patients were 42.79±10.26 (range: 14-61) and 70.61±9.32 (range: 49-84), respectively. There was a statistically significant increase in the KSS values of the patients (p &amp;lt;0.01). Conclusion: Intra-articular injection of ACS in patients with painful OA leads to significant improvements in pain severity, KOOS, KSS and DCS scores. In the light of these findings, ACS treatment may be considered as an effective and safe alternative treatment method in osteoarthritis.

The Effect of Once-Daily Gabapentin Extended Release Formulation in Patients With Postamputation Pain.

ObjectivesTo compare gabapentin extended-release, a gastro-retentive formulation, in relieving postamputation pain among gabapentin-experienced and gabapentin-naïve patients.DesignOpen-labeled pilot study.SubjectsSixteen patients with postamputation pain (8 patients in the gabapentin-experienced and 8 patients in the gabapentin-naïve groups).MethodsPatients were started on gabapentin extended-release and were followed up for 8 weeks. Patients reported their pain severity during rest and movement using a numeric rating scale (NRS), interference of pain with daily activities using the modified brief pain inventory (MBPI) questionnaire, and treatment satisfaction using the treatment satisfaction questionnaire for medication (TSQM).ResultsPatients from both gabapentin-experienced and gabapentin-naïve groups achieved a significant and sustainable pain relief over the course of therapy. The pain scores at rest decreased in both gabapentin-experienced and gabapentin-naïve groups from 5.88 ± 1.36 and 4.88 ± 2.95 to 1.88 ± 0.99 and 1.38 ± 1.51, respectively. An average percent of pain relief with gabapentin extended-release was noted to be significant (p < 0.01) after 8 weeks of therapy among gabapentin-experienced (81.25 ± 16.42%) and gabapentin-naïve groups (85 ± 17.73%) when compared to baseline for gabapentin-experienced (31.25 ± 29%) and gabapentin-naïve groups (36.25 ± 34.2%), respectively. Gabapentin-experienced and gabapentin-naïve groups had no significant difference in global satisfaction from treatment (79.14 ± 10.47 and 83.3 ± 20.82), convenience of treatment (73.78 ± 19.04 and 90.44 ± 11.66), effectiveness of treatment (72.6 ± 10.1 and 79.73 ± 11.6). The only statistically significant difference among gabapentin-experienced and gabapentin-naïve groups was found in adverse event tolerability (65.78 ± 10.36 and 85.8 ± 10.14, p < 0.01).ConclusionOnce-daily dosing of gabapentin-extended release showed significant improvement in pain severity and functional status, with no difference found between gabapentin-experienced versus gabapentin-naïve patients.

Efficacy of Methotrexate on Pain Severity Reduction and Improvement of Quality of Life in Patients with Moderate to Severe Knee Osteoarthritis.

BackgroundKnee osteoarthritis (OA) leads to low quality of life due to pain and limitation in daily activities. Recent studies indicated that Methotrexate (MTX) could reduce pain due to its anti-inflammatory effects.ObjectivesIn this study, the researchers aimed at evaluating the efficacy of MTX in pain control and improvement of quality of life in patients with moderate to severe knee OA.MethodsIn this randomized clinical trial, 100 patients with moderate to severe knee OA were allocated to receive MTX (n = 50) 7.5 mg weekly to be increased to 15 mg weekly after first months or placebo (n = 50) for six months. Pain severity was measured using the numerical rating scale (NRS), so was functional status by Western Ontario and McMaster Universities Arthritis Index (WOMAC) and quality of life by SF-12 questionnaire before the treatment, and three months and six months after the intervention. The results were compared between the groups subsequently. Nine patients from the MTX group were excluded due to the use of corticosteroids during the treatment period.ResultsThe MTX group compared to the placebo group had significant improvement in pain severity and quality of life during six months and WOMAC parameters at three and six months after the intervention. The need for NSAIDS was slightly higher in the placebo group with no significant difference (22% versus 36%, P = 0.14). The MTX adverse effects were not observed.ConclusionsTreatment of moderate to severe knee OA with MTX could reduce pain severity and improve functional status and quality of life in OA patients.