Significant Improvement In Pain Research Articles

232 A Comparative Study Between Stapled Hemorrhoidopexy and Harmonic Scalpel Hemorrhoidectomy in Management of Third and Fourth-Degree Piles: A Randomized Clinical Trial

Abstract Aim This study compares the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of Grade III and Grade IV piles. Method The current study is a single-blind, prospective, randomized, controlled, single-center trial at Ain Shams University Hospitals. Results There were 70 patients in our study 35 patients in each group. Group(I) underwent stapled hemorrhoidopexy (SH) and Group (II) underwent harmonic scalpel hemorrhoidectomy (HSH). The mean time of the procedure in SH was 24.42 mins ± 2.367. While in HSH was 31.48 mins ± 2.21. Post-operative pain in SH showed to be less painful during the first two weeks. However, there is persistent mild pain in most of the patients of SH postoperative during and after two weeks. However, in HSH there was significant improvement in pain after two weeks. Wound infection was detected in 3(5%) patients in group (I) and no patients in group (II) (p=0.077). Postoperative bleeding occurred in 4(11.4%) patients in group (I), While no patients were detected in group (II) (p=0.039). there were 3(15%) cases of incontinence to gases only scored by Wexner score 3/20 in group (II). Recurrence in one-year follow-up occurred in 7 (20%) patients in group (I). While in group II 1(2.9%) patient was reported with recurrence (p=0.024). Conclusions HSH was determined to be safer, easier, and associated with a lower incidence of recurrence in one-year follow-up as compared to the SH technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of hemorrhoids.

Obesity Does Not Negatively Affect Patient-perceived Outcomes After Cervical Disc Replacement for Disc Herniation.

Retrospective review. To assess the impact of Body Mass Index (BMI) on patient-reported outcome measures (PROMs) after cervical disc replacement (CDR). BMI may affect PROMs after spine surgery. Primary CDR recipients for herniated disc(s) with BMI <40 were retrospectively selected from a single-surgeon registry. Cohorts were divided into non-obese (BMI <30) and obese (BMI ≥30). Intercohort in-hospital complication rates were compared through independent samples t tests. Pre/postoperative PROMs were compared between cohorts through multivariable regression accounting for demographic differences. Final follow-up dates between patients averaged 11.8 ± 9.3 months. PROMs assessed included Patient-reported Outcomes Measurement Information System-Physical Function, Neck Disability Index, Visual Analog Scale-Neck, Visual Analog Scale-Arm, and the 9-item Patient Health Questionnaire. Improvements in PROMs were evaluated and compared at each follow-up within cohorts through paired t tests. The magnitude of improvement in PROMs from preoperative baseline at 6-week follow-up (∆PROM-6W) and final follow-up (∆PROM-FF) along with achievement rates of minimum clinically important differences were compared between cohorts through multivariable regression accounting for demographic differences. Of 153 patients, 53 patients were noted as obese. Demographic differences included age, prevalence of hypertension and diabetes, and comorbidity burden scores ( P ≤ 0.011, all). No significant variations in in-hospital complications were found. The non-obese cohort demonstrated improvements in all PROMs at 6 weeks and final follow-up periods ( P ≤ 0.005, all). The obese cohort demonstrated improvements in all postoperative PROMs besides 9-item Patient Health Questionnaire at 6 weeks ( P ≤ 0.015, all). After accounting for age and comorbidity variations, there were no significant intercohort differences in raw PROM scores, ∆PROM-6W, ∆PROM-FF, or minimum clinically important difference achievement rates. Regardless of BMI, patients experience significant improvements in physical function, disability, pain, and mental health after CDR for disc herniation. Patients with obesity do not suffer inferior patient-perceived outcomes after CDR. These findings may help surgeons counsel patients in the preoperative period.

Turmeric, black pepper, and lemon hot infusion for joint and musculoskeletal pain: A Case Report

Arthritis, affecting over 58.5 million adults in the U.S., is characterized by joint inflammation, leading to pain and reduced mobility. While common treatments like NSAIDs and DMARDs help, they often have serious side effects and don't halt disease progression. Herbal remedies like turmeric and ginger offer promising alternatives with fewer side effects, supporting their increasing use in managing arthritis symptoms effectively. Further research is needed to integrate these treatments into mainstream care. This case report investigates the therapeutic effects of a homemade infusion consisting of turmeric powder, black pepper, and lemon in hot water on joint and musculoskeletal pain. A summary of studies regarding the efficacy of these herbs shows that they are promising. Several clinical studies support their role as an anti-inflammatory alternative for patients with arthritis. In this paper, the history of a 57-year-old female who experienced significant improvement in pain and mobility after daily consumption of this infusion over two weeks is discussed. This case suggests potential anti-inflammatory and analgesic properties of the ingredients involved, supporting further clinical investigation.

THE IMPACT OF A SENSOR BASED PLATFORM ON THE OUTCOME OF MEDIAL OFF-LOADER BRACING IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS: A PILOT RANDOMIZED CLINICAL TRIAL.

Determine the effectiveness of a medial off-loader brace with sensor monitoring capabilities and associated phone application in improving outcomes for individuals with knee osteoarthritis (OA). Randomized clinical trial of participants with knee OA, aged 40-75 with two groups: 1) brace-only 2) brace+sensor (sensor providing walking time, knee range of motion and 7-day activity streak). Both groups received a prefabricated custom-fitted medial off-loader brace and 12-week self-guided exercise therapy program. Baseline and post-intervention assessments included subjective and objective outcomes. 60 participants were recruited (n = 30/group). The brace+sensor group demonstrated higher study retention(88.89%) compared to the brace-only group(73.33%). Significant improvement in KOOS knee pain and other KOOS sub-scores compared to baseline was observed for both groups. However, only the brace+sensor group improved beyond the established minimal clinically important difference for KOOS pain(11.31+/-13.87). KOOS ADL was also significantly improved in the brace+sensor group compared to brace only group(p = 0.049). Both treatment groups had significant improvement in functional outcomes(10 m walk, 5x sit-to-stand, p < 0.05). Only the brace+sensor group had significant improvements in the 6-minute walk test(p = 0.02) and reduction in participant weight(p = 0.01) at 12 weeks. Incorporating wearable technology in standard bracing for individuals with knee OA has potential in improving clinical outcomes.

The Effect of Intra-Articular Injection of Hypertonic Saline Versus Dextrose Prolotherapy for Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is the most common chronic arthritis worldwide, often causing knee stiffness, pain, and functional impairment. This study aims to compare the effects of Dextrose prolotherapy and Hypertonic saline prolotherapy on knee pain, stiffness, and function in patients with knee OA. Methods: The study was conducted as a randomized clinical trial. Patients meeting radiological and clinical criteria for knee OA were sequentially contacted and provided written informed consent. Participants were randomly assigned to receive injections of Hypertonic saline (n = 30) or dextrose prolotherapy (n = 33). The primary outcome measure was clinical manifestations assessed using the compound score of the Western Ontario and McMaster University Arthritis Index (WOMAC). Results: Within-group analysis revealed significant differences in outcome scores for both treatments after 6 months. Both Hypertonic saline and dextrose prolotherapy showed significant improvements in the Visual Analog Scale (VAS), WOMAC composite score, pain, stiffness, and function. In the first month, VAS scores were higher with hypertonic saline compared to dextrose. Additionally, stiffness decreased more with dextrose than with hypertonic saline. After 6 months of treatment, although not statistically significant, hypertonic saline showed better outcomes in the mean WOMAC composite score and pain sub-score compared to dextrose. Conclusions: Among patients with knee OA, Hypertonic saline prolotherapy administered by a trained specialist yields safe and significant improvements in knee pain, stiffness, and function. Our results suggest no significant difference in VAS and WOMAC scores between hypertonic saline and dextrose prolotherapy.

Effects of E4/DRSP on self-reported physical and emotional premenstrual and menstrual symptoms: data from the phase 3 clinical trial in Europe and Russia

Purpose To describe the effects of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg on physical and emotional premenstrual and menstrual symptoms. Materials and Methods We used Menstrual Distress Questionnaire (MDQ) data from a phase-3 trial (NCT02817828) in Europe and Russia with participants (18 − 50 years) using E4/DRSP for up to 13 cycles. We assessed mean changes in MDQ-t-scores from baseline to end of treatment in premenstrual (4 days before most recent flow) and menstrual (most recent flow) scores for 4 MDQ domains in starters and switchers (use of hormonal contraception in prior 3 months) and performed a shift analysis on individual symptoms within each domain. Results Of 1,553 treated participants, 1,398(90.0%), including 531(38%) starters, completed both MDQs. Starters reported improvements for premenstrual Pain (−1.4), Water Retention (−3.3) and Negative Affect (−2.5); and for menstrual Pain (−3.5), Water Retention (−3.4), and Negative Affect (−2.7) (all p < 0.01). For switchers, no changes were significant except an increase in premenstrual (+1.0, p = 0.02) and menstrual (+1.5, p = 0.003) Water Retention. We observed a change in symptom intensity in >40% of participants for Cramps, Backache and Fatigue (domain Pain), Painful or Tender Breast and Swelling (domain Water Retention) and Mood Swings and Irritability (domain Negative Affect). Conclusion E4/DRSP starters experienced significant improvements in the domains Pain, Water Retention and Negative Affect particularly benefiting those with more severe baseline symptoms. Switchers showed minimal changes.

Efficacy of Ultrasound-Guided Hydrodissection for Treating De Quervain's Tenosynovitis

ObjectiveThis study evaluated the effectiveness of ultrasound-guided hydrodissection treatment for De Quervain's stenosing tenosynovitis, characterized by the narrowing of the first extensor compartment of the wrist. Notably, approximately 2% of cases involve a fibrous septum that divides the compartment. Subjects and MethodsNinety-five patients diagnosed with De Quervain's disease using ultrasound underwent hydrodissection treatment. When a septum was present, the needle was redirected into each sub-compartment to distribute the therapeutic solution evenly and facilitate the breaking of the septum. ResultsNinety patients reported significant improvements in pain and functionality within 2 months of the initial treatment, with a marked decrease in the mean visual analog scale score from 7.65 ± 1.31 to 1.65 ± 2.32. A second infiltration, administered 2 months later, further alleviated pain and enhanced hand functionality. However, 5 patients with septum required surgical intervention after nonconclusive results from the infiltrative treatment. ConclusionsThis study confirms that ultrasound-guided hydrodissection is an effective treatment for approximately 95% of patients with De Quervain's disease, achieving substantial pain relief and improved joint mobility after the first treatment. These findings support the continued use of ultrasound guidance to enhance the precision and efficacy of treatment in complex cases.

Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: Secondary analysis of data from a randomised controlled trial

BackgroundThe aims were to assess whether a specific subgroup(s) of patients had a clinically significant benefit in their knee specific outcome or health-related quality of life (HRQoL) when undergoing robotic total knee arthroplasty (rTKA) when compared to manually performed TKA (mTKA). MethodsOne hundred patients were randomised to either rTKA or mTKA, 50 to each group, of which 46 and 41 were available for functional review at 6-months, respectively. Subgroup analysis was undertaken for sex, age (<67-years versus ≥ 67-years), preoperative WOMAC score (<40 versus ≥ 40) and EQ-5D utility (<0.604 versus ≥ 0.604). ResultsMale patients undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (mean difference (MD) 16.3, p = 0.011) at 2-months, function (MD 12.6, p = 0.032) and total score (MD 12.7, p = 0.030), and OKS (MD 6.0, p = 0.030) at 6-months. Patients < 67-years old undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 10.3, p = 0.039) at 2-months, and function (MD 12.9, p = 0.040) and total (MD 13.1, p = 0.038) scores at 6-months. Patients with a preoperative WOMAC total score of < 40 points undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 14.6, p = 0.044) at 6-months. Patients with a preoperative EQ-5D utility of <0.604 undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 15.5, p = 0.011) at 2-months. ConclusionPatients of male sex, younger age, worse preoperative knee specific function and HRQoL had a clinically significantly better early functional outcome with rTKA when compared to mTKA.

The efficacy of ketamine for pain management in patients with cancer: A systematic review.

e24069 Background: Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as the study of ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. Methods: We conducted a literature review in MEDLINE, EMBASE, and Scopus, spanning from January 1, 1982, to October 20, 2022. Abstracts were screened against inclusion criteria, and eligible studies underwent a thorough full-text review. Data were extracted from the included studies, and a framework analysis approach was employed to summarize the evidence regarding ketamine's use in patients with cancer. The quality of included studies was assessed using the NIH Quality Assessment Tool for controlled intervention studies. Results: A total of 22 studies conducted between 2001 and 2019 were included, all assessed as having good quality. Three studies focusing on intrathecal administration of ketamine following oncological surgery demonstrated a substantial improvement in pain scores and a reduction in postoperative morphine requirements. Two studies exploring intramuscular use concluded that it led to improved pain scores. In contrast, three studies on subcutaneous administration and two studies on topical ketamine did not exhibit a significant impact on reducing pain scores or alleviating chemotherapy-induced peripheral neuropathy. Findings from two studies on oral administration and eight studies on intravenous administration indicated that intravenous ketamine reduced postoperative morphine requirements, while oral ketamine had no discernible effect on lowering pain scores. Conclusions: The use of intrathecal ketamine demonstrates significant improvement in post-op oncological pain and refractory cancer pain, resulting in lowered pain scores and decreased morphine requirements. Further research is essential to ascertain the extent to which incorporating ketamine with opioids in cancer pain treatment can enhance pain outcomes, especially in morphine-tolerant patients.

Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity.

The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD. A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate. Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102). Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal. IV.

ADIPOSE CELLULAR INJECTION IN THE TREATMENT OF AN INTRASUBSTANCE ACHILLES TENDON TEAR

Introduction: We describe a case report of a patient who presented with chronic right Achilles tendon pain and weakness. Without contrast, magnetic resonance imaging of the right Achilles tendon revealed significant expansion of the Achilles tendon in the traverse and anteroposterior dimension with extensive increased T2 signal consistent with large partial-thickness Achilles tendon tear. A musculoskeletal ultrasound using a linear transducer demonstrated an anechoic tendon defect measuring 0.97 cm in the longitudinal axis with a total tendon length measuring 1.53 cm, as well as a 0.9 cm defect in the transverse axis surrounded by homogenous tendon fibers consistent with a large defect involving the distal Achilles tendon proximal to the distal insertion. The patient underwent an ultrasound-guided adipose cellular procedure using micronized fat to fill in the defect and facilitate pain reduction and tissue healing.Conclusion: Ultrasound-guided injection of micro-fragmented adipose tissue of Achilles tendon defect can result in significant improvement in pain and function

Effect of amniotic suspension allograft in a rat destabilization of medial meniscus osteoarthritis model.

Placental-derived allografts have been of interest as a potential nonsurgical treatment to reduce pain and improve function in knee osteoarthritis (OA). The purpose of this study was to evaluate the effect of single and repeat injection of amniotic suspension allograft (ASA) on pain, function, and cytokine levels using a destabilization of the medial meniscus (DMM) rat model of OA. Post-DMM surgery, animals were treated with a single injection of either ASA, vehicle, or triamcinolone, or repeated injection of either ASA or vehicle. Behavioral testing including knee swelling, pain threshold, dynamic weight bearing (DWB), and gait analysis were evaluated during the in-life phase. Postsacrifice, histopathology and serum and synovial fluid analyses were evaluated. Significant improvements in both DWB differentials and pain threshold were seen in response to repeated injection of ASA, while a single injection of ASA and triamcinolone resulted in significant improvements in pain threshold. Histopathology analysis found no significant differences regardless of treatment compared to vehicle, except for an increase in synovitis following repeated injection of ASA. A single injection of ASA and triamcinolone resulted in increased anti-inflammatory cytokines; repeated ASA injection resulted in significant increases in several immune-modulating factors relevant to OA. When comparing the impact of single and repeat ASA treatments on behavioral testing, repeated injection provided significant additional improvements in both pain and function. This study provides evidence demonstrating the impact of a second injection while also providing additional data for evaluating the use of ASA as a nonsurgical treatment for knee OA.

Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis.

Evidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). To investigate the efficacy of SWT on pain and function in the management of GTPS. A systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow-up were considered for inclusion. Meta-analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria. Twelve articles (n=1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non-RCTs. No statistical differences were observed for pain over time f(1,5)=1.349 (p=0.298) or between SWT and control f(1,5)=1.782 (p=0.238). No significant differences in functional outcomes in short- (H=2.591, p=0.181) and medium-term follow-up (H=0.189, p=0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges-G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow-up time-points in SWT groups compared to control. Moderate-quality evidence demonstrated no statistically significant improvements in pain and function post-SWT compared to control. Low-quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta-analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.

Feasibility study of a novel digital template-guided flapless extraction for maxillary palatal impacted teeth.

With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth. This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique. The experimental group can significantly reduce the localization time of palatally impacted teeth (P < 0.001), with total surgery times of 18.15 ± 4.88min and 22.00 ± 7.71min for the experimental and control groups, respectively (P = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain (P < 0.05), swelling (P < 0.001), and patient satisfaction (P < 0.001) compared to the control group. Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Efficacy of massage versus massage with post isometric relaxation in temporomandibular disorders: a randomized controlled trial

BackgroundTemporomandibular joint disorder (TMD) is a common condition affecting the masticatory muscles and joint mobility.ObjectivesThe primary objective was to compare the effects of massage therapy alone and massage therapy combined with post-isometric relaxation exercises in patients with TMD for pain and maximal mouth opening.DesignAssessor-blinded randomized controlled trial.SettingSir Ganga Ram Hospital, Chaudhry Muhammad Akram Dental Hospital, Lahore Medical and Dental Hospital.SubjectsTemporomandibular joint disorder patients.InterventionGroup A (n = 23) received conventional treatment including massage and therapeutic exercises consecutively for 2 weeks. Group B (n = 23) received post-isometric relaxation technique along with conventional treatment for consecutive 2 weeks.Main measuresThe main outcome measures were pain and maximal mouth opening. Pain was measured using the Visual Analogue Scale (VAS) and maximal mouth opening (MMO) was measured using the TheraBite Scale.ResultsBoth groups demonstrated significant improvements in pain and MMO scores post-treatment. However, Group B (massage with post-isometric relaxation exercises) showed significantly better outcomes compared to Group A (massage alone). There was a statistically significant difference in post-treatment pain scores (P = 0.000) and MMO scores (P = 0.000) between the two groups.ConclusionThe results suggest that massage therapy combined with post-isometric relaxation is more effective than massage therapy alone in managing pain and improving mouth opening in TMD patients. The study provides evidence supporting the use of these therapies in TMD management.Trial registry numberNCT05810831. Date of registration/First submission: 15 March 2023.

Medical Cannabis for Patients Over Age 50: A Multi-site, Prospective Study of Patterns of Use and Health Outcomes

Objective: Cannabis is being used as a therapeutic option by patients around the globe, and older patients represent a rapidly growing subset of this population. This study aims to assess the patterns of medical cannabis use in patients over 50 years of age and its effect on health outcomes such as pain, sleep, quality of life, and co-medication. Method: The Medical Cannabis in Older Patients Study (MCOPS) is a multi-site, prospective observational study examining the real-world impact of medical cannabis use on patients over age 50 under the guidance of a health care provider. The study included validated instruments, with treating physicians collecting detailed data on participant characteristics, medical cannabis and co-medication use, and associated impacts on pain, sleep, quality of life, as well as adverse events. Results: Inclusion criteria were met by 299 participants. Average age of participants was 66.7 years, and 66.2% of respondents identified as female. Approximately 90% of patients used medical cannabis to treat pain-related conditions such as chronic pain and arthritis. Almost all patients reported a preference for oral cannabis products (e.g., extracts, edibles) rather than inhalation products (e.g., flower, vapes), and most preferred oral formulations high in cannabidiol and low in tetrahydrocannabinol. Over the six-month study period, significant improvements were noted in pain, sleep, and quality of life measures, with 45% experiencing a clinically meaningful improvement in pain interference and in sleep quality scores. Additionally, nearly 50% of patients taking co-medications at baseline had reduced their use by the end of the study period, and quality of life improved significantly from baseline to M3 and from baseline to M6, with an incremental cost per quality-adjusted life-year (QALY) of $25,357.20. No serious adverse events (SAEs) were reported. Conclusions: In this cohort of older patients, most of whom suffered from pain-related conditions, medical cannabis seemed to be a safe and effective treatment. Most patients experienced clinically significant improvements in pain, sleep, and quality of life and reductions in co-medication. The cost per QALY was well below the standard for traditional pharmaceuticals, and no SAEs were reported, suggesting that cannabis is a relatively safe and cost-effective therapeutic option for adults dealing with age-related health conditions.

Potential Stem Cell Treatment for Common Hip Conditions: Osteoarthritis, Osteonecrosis and Gluteal Tendinopathy

Hip pathology, encompassing common conditions such as Osteoarthritis (OA), Osteonecrosis (ONFH) and gluteal tendinopathy, presents significant challenges in clinical management which often necessitate innovative treatment modalities. Stem cell therapy has emerged as a promising approach for addressing these complex hip conditions by promoting tissue regeneration and modifying disease progression. This paper aims to review the current literature on stem cell therapy for hip pathology, focusing on its application in OA, ONFH and gluteal tendinopathy. A comprehensive review of relevant studies and clinical trials was conducted by examining the safety, efficacy and potential mechanisms of action of stem cell therapy in hip conditions. Studies investigating the use of Bone Marrow-Derived Mesenchymal Stem Cells (BMMSCs), Adipose-Derived Mesenchymal Stem Cells (ADMSCs) and Tendon-Derived Stem Cells (TDSCs) were included in the analysis. The reviewed studies demonstrate promising outcomes of stem cell therapy in improving pain, functionality and halting disease progression in patients with hip OA. Intra-articular injections of MSCs have shown sustained benefits and arrested the progression of osteoarthritis. Stem cell therapy has also shown effectiveness in delaying the progression of ONFH, reducing femoral head collapse and decreasing the need for total hip replacement. Furthermore, in cases of gluteal tendinopathy, stem cell therapy has exhibited significant improvements in pain and functionality in a limited number of studies on the topic and also offers sustained relief in patients unresponsive to conventional treatments. Stem cell therapy holds immense potential as a safe and effective intervention for hip pathology and offers disease-modifying effects and sustained clinical benefits in these prevalent conditions. Further research is warranted to optimize treatment protocols, clarify mechanisms of action and validate long-term efficacy in larger cohorts.

Diet modification reduces pain and improves function in adults with osteoarthritis: a systematic review.

The effect of dietary modifications on pain and joint function in adults with osteoarthritis (OA) is an emerging area of study. This systematic review aimed to evaluate if adults with OA who consume diets with a higher proportion of plant phenols and omega-3 fatty acids would have less pain and improved joint function than those with a higher proportion of saturated fatty acids, omega-6 fatty acids and refined carbohydrates. Database searches of CINAHL (EBSCO), Clinical Trials (NIH-NLM), Cochrane Library (Wiley), Dissertation & Thesis Global (ProQuest), Embase (Elsevier), Medline (OVID), PubMed (NLM), Scopus (Elsevier), Web of Sciences (Clarivate) for clinical trials identified 7763 articles published between January 2015 and May 2023. After an independent review of the articles, seven randomised clinical trials and one nonrandomised clinical trial were included in the analysis. Because of the heterogeneity of the outcome measures, a meta-analysis was not possible. Participants who were instructed to consume high-phenol/high-omega-3 fatty acid diets reported significant improvements in pain and physical function scores. The greatest improvement was reported by those who consumed a diet that had the most omega-3 fatty acids. Because of the high risk of bias, the strength of the evidence is limited. However, there is evidence that counselling adults with OA to replace refined grains and processed foods with whole plant foods, fish and plant oils may have a favourable effect on pain and physical function. Routine follow-up care regarding these diet modifications may be necessary to ensure adherence to this therapy.

BIOPATCH GRAFTING OF LARGE OR RECALCATRANT OSTEOCHONDRAL DEFECTS OF THE TALUS

IntroductionLarge osteochondral defects (OCD) of the talus present a difficult management conundrum. We present a series of Maioregen xenograft patches applied through an open approach, early lessons from the technique and good early outcomes, in patients who are otherwise looking at ankle salvage techniques.Results16 patients underwent open patch procedures, performed by a single surgeon, over a 30 month period. 12 males, and 4 females with age at presentation from 21–48. The majority were young, male, in physical employment with active sporting interest. MoxFQ, and E5QD were collected preop, 3, 6, 12 month postoperatively. There were significant improvements in ROM, pain, and scores in the cohort. 3 cases returned to Theatre, 1 for a concern about late infection, which settled with good outcome, and a further 2 with metalwork / adhesions.ConclusionEarly results suggest that this patch technique may be useful in prolonging the longevity of the TTJ, where micro fracture has failed, or the lesion is so large that it would likely be futile. Patients rescoped demonstrated good integration of the patch material, with stability and functional improvement. There may be a place for this technique in the management of large lesions, particularly in young patients where preservation is desired over joint salvage.

Comparison between Effectiveness of Mets and Static Stretching on Trapezius in Upper Cross Syndrome

Background: Upper cross syndrome involves an imbalance between the muscles of the anterior and upper trunk and the posterior skeletal muscles, leading to postural and functional issues. Muscle Energy Techniques (METs) and stretching exercises are common interventions, but their comparative effectiveness remains unclear.Objective: The study aimed to compare the effectiveness of METs and stretching in treating pain and improving functional status in patients with upper cross syndrome.Methods: This randomized clinical trial was conducted at the Physical Therapy Department of Mayo Hospital, Lahore, over six months. Sixty-two patients with upper cross syndrome were randomly assigned to two groups, each consisting of 31 participants. Group 1 received METs and conventional therapy, while Group 2 received static stretching and conventional therapy. The primary outcome measures were pain intensity, measured by the Visual Analogue Scale (VAS), and functional status, assessed using the Neck Disability Index (NDI). The intervention period lasted four weeks, and statistical analyses were performed using SPSS version 25.Results: In Group 1, the pre-treatment VAS score was 7.41 (± 1.08), decreasing to 3.41 (± 1.11) post-treatment, while in Group 2, the VAS score dropped from 7.16 (± 1.50) to 4.87 (± 1.56). The pre-treatment NDI score in Group 1 was 40.19 (± 6.15), which improved to 32.51 (± 6.16) post-treatment. In Group 2, the NDI score improved from 40.06 (± 5.88) to 35.74 (± 5.82). Both groups demonstrated significant improvement in pain and functional status, with METs showing greater effectiveness (p &lt; 0.05).Conclusion: Muscle Energy Techniques were more effective in reducing pain and improving functional status in patients with upper cross syndrome compared to stretching exercises.