Significant Increase In Pain Research Articles

Assessing Menstrual Changes Among Young Indian Females Post-SARS-CoV-2 Vaccination.

Background The rollout of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has significantly enhanced immunity against coronavirus disease 2019 (COVID-19), leading to a reduction in the severity of illness, hospitalizations, and deaths. While various side effects of the vaccine have been reported, its impact on the menstrual cycle remains unclear. Methods We conducted a cross-sectional study involving university students who had received either partial or full vaccination against SARS-CoV-2. Data was gathered through a questionnaire designed to assess the relationship between menstrual changes and the SARS-CoV-2 vaccination. Results A total of 773 participants, with a mean age of 20.6 ± 1.7 years, were included in this study. The participants reported a significant increase in the irregularity of the menstrual cycle. We observed a slight increase in the length of the menstrual cycle, from 30.0 ± 4.0 days (pre-vaccination) to 30.5 ± 5.6 days (post-vaccination), which was statistically significant (p<0.001). The duration of menstruation also increased, from 4.9 ± 1.7 days (pre-vaccination) to 5.0 ± 1.7 days (post-vaccination). However, this increase in menstrual length due to vaccination was not statistically significant (p = 0.898). Notably, there was a significant increase in pain reported by the participants after receiving the SARS-CoV-2 vaccine (p = 0.004). Conclusion The SARS-CoV-2 vaccination significantly impacted the regularity of the menstrual cycle, length of the menstrual cycle, and pain during menstruation, though temporarily. Our study found no significant differences in menstrual changes or the type of vaccine administered (Covishield and Covaxin).

Comparisons of lumbosacral kinematics among non-specific chronic low back pain subgroups and healthy during prolonged sitting: A cross-sectional observational study

BackgroundThe literature has suggested a variety of postural changes of the spine that possibly contribute to the increase in back pain during sitting in persons with non-specific chronic low back pain (NS-CLBP). However, the heterogeneity of NS-CLBP persons has made the ability to attribute pain increase to a particular sitting posture very difficult. Therefore, the purpose of this study was to compare lumbosacral kinematics and their roles in pain increase among homogenous NS-CLBP subgroups and healthy controls over a 1-h sitting period. MethodsTwenty NS-CLBP subjects with motor control impairment [10 classified as having flexion pattern (FP) disorder, and 10 with active extension pattern (AEP) disorder], and 10 healthy controls participated in the study. Subjects underwent a 1-h sitting protocol on a standard office chair. Lumbosacral postures including sacral tilt, third lumbar vertebrae (L3) position, and relative lower lumbar angle were recorded using two-dimensional inclinometers over the 1-h period. Perceived back-pain intensity was measured using a visual analog scale every 10 min throughout the sitting period. ResultsAll study groups (FP, AEP and healthy controls) significantly differed from each other in the measured lumbosacral kinematics at the beginning as well as at the end of the sitting period (p ≤ 0.05). Only the NS-CLBP subgroups showed significant changes in the lumbosacral kinematics across the 1-h sitting period (p < 0.01), and that the directions of change occurred toward end spinal postures (lumbar kyphosis for FP subgroup and lumbar lordosis for the AEP subgroup). In addition, both NS-CLBP subgroups reported a similarly significant increase in pain through mid-sitting (p < 0.001). However, after mid-sitting, the AEP subgroup reported much less increase in pain level that was accompanied by a significant decrease in the lumbar lordotic postures (p = 0.001) compared to FP subgroup. ConclusionThe present study's findings suggest that each NS-CLBP subgroup presented with differently inherent sitting postures. These inherently dysfunctional postures coupled with the directional changes in the lumbosacral kinematics toward the extreme ranges across the 1-h sitting period, might explain the significant increase in pain among subgroups.

Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Congenital Inguinal Hernia Repair

Abstract Background Inguinal hernia is the most common lower abdominal surgery of childhood. It results from a small sac that comes through the inguinal ring that is normally open during fetal life and closes around the time of birth. For reasons we don't understand, it does not close in some infants. This sac then makes a pathway for abdominal organs to come through the inguinal ring into the groin. Analgesic techniques in pediatric patients having surgery are often delayed by the inherent difficulties of conducting a large randomized clinical trial in those patients. TAP block and caudal epidural block are two anesthetic techniques that are commonly used in pediatric age group for lower abdominal surgeries. Aim of the Work Compares the efficacy of Dexmedetomidine as an adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for postoperative analgesia in children undergoing congenital inguinal hernia repair especially to provide prolonged post-operative analgesia and decrease opioid consumption. Patients and Methods We conducted a prospective, randomized, controlled and comparative study in Ain shams university hospitals in a period of 6 months including 50 patients divided on 2 groups; group A 25 of them received ultrasound guided transversus abdominis plane block with 0.3 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 2.5-8 years and they were 6 females (24%) and 19 were males (76.0%) and group B 25 patients received caudal epidural block with 0.6 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 3 – 9 years and they were also 4 females (16%) and 21 were males (84.0%). Results In the present study there was statistically significant increase in pain at 1 hr, 2 hrs and 4 hrs in caudal block group and increase in pain score at 12 hrs in tap block group but there was no statistically significant difference found between them at 6 hrs, 18 hrs and 24 hrs. There was statistically significant increase in rescue analgesia in caudal block group at 4 hr with p-value &amp;lt;0.001; also there was statistically significant increase in rescue analgesia in tap block than caudal block at 12 hr with p-value = 0.009 while no statistically significant difference found between both groups at the other times of follow up. Conclusion TAP block was superior to caudal epidural anesthesia in terms of early postoperative pain, less need for rescue analgesia and need for less potent analgesia e.g. Paracetamol and NSAID. Addition of dexmedetomidine to conventional regional anesthetic protocol showed significant reduction of postoperative pain and the need for rescue analgesia.

The Effectiveness of Trans-Electrical Nerve Stimulation (TENS) in Reducing Pain Caused by Orthodontic Movement; A Randomized Controlled Trial

Objective: To check the effectiveness of TENS therapy in reducing pain caused by orthodontic movement. Methods: This was a single-blinded parallel-arm randomized controlled trial among patients presented for treatment of increased overjet using the split-mouth technique. Ethical consent was obtained from 45 patients. An initial levelling and alignment of dentition were achieved, followed by extraction of maxillary pre-molars, and canines were distalized, maintaining 100grams of force. The TENS pads were placed on the cheeks. One side was supplied with active impulses, considered an interventional side, while the other was not supplied with impulses and was marked as the control side. Pain intensity was measured on the tested tool (NRS scale) during resting and clenching (T1). The patient was instructed to use the device the same way for a total of five more times, at T2 (2hrs), T3 (6hrs), T4 (24hrs), T5 (48hrs), and T6 (72hrs). The data were analyzed using SPSS version 24, Chi-square test was applied to compare the pain intensity. Results: Among 45 patients (77.8% female and 21.2% male), the mean age of 19.0 ± 4.13 years. The average pain intensity on rest at 0 and 2 hours was 1.33 ± 1.108, which was at peak T3 (6 hours) 1.87 ± 1.546 and T4 (24 hours) 1.71 ± 1.359. However, it significantly decreased at T5 (48 hours) and T6 (72 hours) of intervention, which were 1.38 ± 0.8 and 1.31 ± 1.04, respectively. This difference was statistically significant (p&lt;0.05). The same pattern of pain reduction was seen in patients with clenching (p&lt;0.05). This showed that the pain intensity was decreased, but the pattern was not linear, as indicated that the pain at T3 and T4 was increased, but later, it was significantly decreased at T5 and T6. A negative correlation was observed between pain intensity and interval of TENS applied onward from the 4th interval in both groups (TENS applied on rest and TENS applied on clenching). Pain score at 72 hours was significantly low compared to post TENS applied (p&lt;0.001). Conclusion: TENS efficacy is insignificant at T1 and T2, with a significant increase in pain during T3 and T4; however, at T5 and T6, there was a significant reduction in pain which indicates a greater efficacy of the device reducing pain compared to the placebo. Key Words: Orthodontic, Pain, Periodontal and Trans-electrical nerve stimulation

When Two Is Better Than One: A Pilot Study on Transcranial Magnetic Stimulation Plus Muscle Vibration in Treating Chronic Pelvic Pain in Women.

Chronic pelvic pain syndrome (CPPS) affects about 4–16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4–21.6) at T7 (t = 6.3, p = 0.001; ES = 2.3 (1.1–3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3–10.7) at T30 (t = 3.1, p = 0.02; ES = 1.5 (0.2–2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials.

Sacrospinous Ligament Fixation Using an Anchor Versus Suture-Capturing Device: A Prospective Cohort Study.

The aim of the study was to compare rates of persistent gluteal and posterior thigh pain, procedural efficacy, and postoperative complications at 1 year after sacrospinous ligament fixation using either an anchor-based or suture-capturing device. This prospective cohort study evaluated outcomes 1 year after operation in patients previously enrolled in a randomized controlled trial comparing an anchor-based versus suture-capturing device for sacrospinous fixation. Symptom scores were evaluated via Pelvic Floor Distress Inventory 20 and Pelvic Floor Impact Questionnaire 7. Pain was evaluated using the Numerical Rating Scale. Composite surgical failure was defined as prolapse beyond the hymen or C-point greater than one half down the vagina, vaginal bulge symptoms, or a need for prolapse retreatment via surgery or pessary management. Descriptive and bivariate statistics were performed. Forty three (21 anchors, 22 sutures) of the original 47 patients (91%) returned for follow-up. The mean follow-up time was 15.4 months, age was 69 years old, body mass index was 30, and preoperative Pelvic Organ Prolapse Quantification stage was 2.7. No patients reported significant increase in pain at sacrospinous fixation site above baseline, and there was no significant difference in posterior thigh or gluteal pain on the side of fixation compared with baseline in the anchor-based or suture-capture groups (-0.2 ± 0.9 and -0.5 ± 1.6, respectively, P = 0.719). Two patients demonstrated surgical failure (anchor group) due to bulge symptoms (P = 0.233). The devices similarly improved Pelvic Floor Distress Inventory 20 (-71.0 ± 45.5 vs -66.3 ± 64.4, P = 0.652) and Pelvic Floor Impact Questionnaire 7 (-40.6 ± 62.4 vs -26.4 ± 65.7, P = 0.768) scores. Persistent gluteal or posterior thigh pain and surgical failure is uncommon 12 months after sacrospinous fixation and was not associated with the type of fixation device.

Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Intensity of Pain during 1-h Laboratory-Based Standing in Office Workers.

This study with 40 office workers investigated (a) the effect of time spent standing on low- back and lower limb pain during a 1-h laboratory-based task; (b) the standing time after which a significant increase in pain is likely; and (c) the individual, physical and psychosocial factors that predict pain. The primary outcome was bodily location of pain and pain intensity on a 100-mm Visual Analogue Scale recorded at baseline and every 15 min. Physical measures included trunk and hip motor control and endurance. Self-report history of pain, physical activity, psychosocial job characteristics, pain catastrophizing and general health status were collected. Univariate analysis and regression models were included. The prevalence of low-back pain increased from 15% to 40% after 30 min while feet pain increased to 25% from 0 at baseline. The intensity of low-back and lower limb pain also increased over time. A thirty-minute interval was identified as the threshold for the development and increase in low-back and feet pain. Modifiable factors were associated with low-back pain intensity—lower hip abductor muscle endurance and poorer physical health, and with feet symptoms—greater body mass index and less core stability.

Orthodontic pain control following arch wire placement; a comparison between pre-emptive tenoxicam and chewing gum: a randomized clinical trial.

BackgroundPain during fixed orthodontic treatment can have a detrimental effect on patient treatment compliance. To overcome this, there is a definite need to establish the best pain-relieving methods suitable for orthodontic patients in terms of efficacy and use. The objective of this study was to compare the effect of chewing gum and pre-emptive tenoxicam on pain after initial archwire placement and to evaluate the pain perceptions of orthodontic patients in the two groups while performing various functions at specific time intervals.MethodsForty-two patients were selected and randomly divided into two groups: group A (chewing gum) and group B (pre-emptive tenoxicam). Pain perception was documented by patients immediately; at 4 h; at bedtime on the day of archwire placement; the next morning; at 24 h; and at bedtime on the 2nd, 3rd, and 7th day after the initial archwire placement. Pain scores were noted during fitting of the posterior teeth, biting, and chewing using a visual analog scale. The data obtained were subjected to statistical analysis.ResultsGroup A showed a significant increase in pain until the next morning while fitting the posterior teeth, biting, and chewing [36.2, 52.0, 33.4, respectively]], followed by a gradual decrease by the 7th day. Group B showed a significant increase in pain at bedtime on biting, with a peak value of 47.5. Pain on chewing, fitting posterior teeth, peaked the morning of the next day (100.0, 45.0). The Freidman test showed a statistically significant difference with a p-value of < 0.01. Higher pain scores were observed while chewing and biting compared with that while fitting the posterior teeth in both groups. The overall comparison of pain control between the two groups was not statistically significant [P > 0.05] between the two groups.ConclusionsChewing gum was not inferior to pre-emptive tenoxicam. Thus, chewing gum is a non-pharmacological alternative to analgesics for orthodontic pain control that eliminates the chance of adverse reactions and can be used in the absence of adult observation.

Pain, Drug Leakage and Inflammation Associated with Intramuscular Injections of Magnesium Sulfate in Preeclamptic Women: A Descriptive Study

Introduction: Magnesium sulfate (MgSO4) is the drug of choice for preventing and treating convulsions in severe preeclampsia and eclampsia by intramuscular (IM) and IV (IV) regimen. Repeated IM injections of MgSO4 at the same site causes pain, drug leakage, and injection site inflammation. To manage IM injection-related complications, it is important to have an estimation of these adverse effects. Objective: To evaluate the pain, drug leakage, and inflammation associated with IM injections of MgSO4. Material and Methods: A longitudinal descriptive study was carried out in the labor room, PGIMER, Chandigarh. Thirty study participants diagnosed and admitted with preeclampsia were recruited by the total enumeration sampling technique. Each patient received eight IM injections of MgSO4 on the dorsogluteal site as prescribed by the obstetrician. Identification details, clinical, and biophysical characteristics were collected. The pain was assessed by a numerical rating scale (NRS). Sterile blotting paper was used to assess the drug leakage by measuring the wet area of the blotting paper and recording in cm2. A gridded transparent sheet was used for measuring inflammation. The area of the swelling marked and measured by placing the gridded transparent sheet over the swelling and recording in cm2. Results: Pain and drug leakage was significantly increased from the first injection to the eighth injection ( P &lt; .05) and inflammation of 100.60 ± 21.23 (Right), 102.07 ± 21.23 (left) cm2 recorded over the buttocks. Conclusion: Significant increase in pain, drug leakage, and inflammation were recorded during the IM administration of MgSO4. For reducing the pain, drug leakage, and inflammation, nonpharmacological interventions and different techniques of IM injections are recommended.

Music's effect on pain relief during outpatient urological procedures: a single center, randomized control trial focusing on gender differences.

BackgroundListening to preferred music can provide distraction and reduce the feeling of pain and negative emotions associated with an uncomfortable experience. Several studies have examined how music can reduce pain and anxiety related to urological procedures that are not typically performed under anesthesia, such as cystoscopy, cystoscopy with stent pull, and urodynamic studies. To our knowledge, no studies have been done to examine the effect of listening to preferred music generalized across a variety of these procedures. Therefore, we looked to combine multiple factors from prior studies to determine if listening to music of a patient’s choice would decrease pain during various outpatient clinic urological procedures, and to examine differences between men and women.MethodsThis was a single investigator series randomized controlled trial with 91 subjects in an academic outpatient urology clinic. After applying exclusion criteria, eligible patients were randomized to a music group or non-music group via coin flip. Fifty-three patients were in the music group (16 men, 37 women) and 38 patients were in the non-music group (16 men, 22 women). Subjects in the music group selected a song to play during the procedure, which was stopped at the conclusion of the procedure. Pre- and post-procedure Visual Analog Pain Scale were completed by the subjects of each group and subsequently analyzed. Where appropriate either Pearson’s Chi-Square or Independent-Sample t-test were used to compare the groups as well as randomized-repeated analysis of variance (ANOVA).ResultsFor men, pain scores worsened in both groups, however the music group experienced a statistically significant increase in pain (mean change =1.0, P=0.05), while the non-music group only clinically worsened (mean change =0.38, P=0.459). For women, the music group noticed an improvement in the pain score (mean change =−0.14, P=0.590), while the non-music group significantly worsened (mean change =1.14, P=0.008).ConclusionsWomen who listened to music of their choosing experienced significant improvement in overall perceived pain compared to women who did not listen to music. Women may benefit from music as a novel tool to alleviate pain during outpatient clinic urological procedures.

Patient and Provider Acceptability of a Patient Preauthorized Concealed Opioid Reduction.

Limited research of how to best taper opioids brings about an ethical and clinical dilemma. Experiments using overt and concealed administration of opioids have demonstrated the benefits of a concealed reduction to eliminate negative expectations and prolong analgesic benefits. This may allow for opioid tapering without significant increases in pain. Based on this, we investigated patient and provider acceptance of a concealed opioid reduction for chronic pain. We conducted a cross-sectional survey via REDcap with 74 patients, who are currently taking or have taken high dose opioids, and 49 providers using a validated questionnaire based on two hypothetical clinical trials comparing a patient preauthorized concealed opioid reduction vs standard tapering. We found that patients and providers have positive attitudes toward a concealed reduction of opioid dosages. More than 60% of providers and patients surveyed viewed the hypothetical clinical trial as helpful to reduce pain, side effects, and withdrawal symptoms. Sixty-one percent of patients and 77.6% of providers recognized that there would be differences in pain relief depending upon which group the hypothetical participants would be enrolled in. Patients and providers appear to understand the benefits of a concealed opioid reduction. Our findings support future randomized controlled trials that compare concealed and overt opioid tapering in patients with chronic pain. More research is needed to understand the difference in attitudes between research and clinical practice and to test the acceptability of a concealed reduction following a participation in an active clinical trial.

Pain catastrophizing in athletes correlates with pain and cardiovascular changes during a painful cold pressor test.

Athletes are often exposed to pain due to injury and competition. There is preliminary evidence that cardiovascular measures could be an objective measure of pain, but the cardiovascular response can be influenced by psychological factors such as catastrophizing. The purpose of our study was to use a painful cold pressor test to measure the relationship between catastrophizing, pain, and cardiovascular variables in athletes. Pre-post test. We completed all measures in a laboratory setting. Thirty-six male rugby athletes participated in the study. We measured catastrophizing with the Pain Catastrophizing Scale and pain with a Numeric Pain Rating Scale. Cardiovascular measures included heart rate, systolic, and diastolic blood pressure, and heart rate variability. During the cold pressor test, participants experienced a significant increase in pain (0 to 4.1±2.2), systolic blood pressure (126.7±16.5mm Hg to 149.7±23.4mm Hg), diastolic blood pressure (76.9±8.3mm Hg to 91.9±11.5mm Hg) and heart rate variability (from 0.0164ms±0.0121 to 0.0400ms±0.0323) (all p<.001). In addition, there was a significant decrease in heart rate after the cold pressor test (p=0.04). There was a significant correlation between athlete's pain catastrophizing to both pain intensity and change in heart rate during the cold pressor test (p=.017 and p=.003 respectively). A significant linear regression indicated pain and catastrophizing explained 29% of the variance of the change in heart rate (p=.003). Athletes who have catastrophizing thoughts are more likely to experience higher levels of pain and a greater cardiovascular response during a painful stimulus. The change in cardiovascular variables may be a good alternative for an objective measure of pain in athletes in the future.

Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery.

Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting results on the physical and mental workload assessed. Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intraoperative workload and to identify risk factors for surgeons using objective and subjective measures. Data from 49 cases (27 open and 22 laparoscopic surgeries performed by 13 male and 11 female surgeons) were assessed. More than half the surgeons reported a clinically relevant post-surgical fatigue score. The surgeons also self-reported a significant increase in pain for the neck, upper back, and lower back during/after surgery. Procedural time had significant impacts on fatigue, body part pain, and subjective (NASA-TLX) workload. The objectively assessed intraoperative work postures using wearable sensors showed a high musculoskeletal risk for neck and lower back based on their posture overall. Open surgeries had significantly larger neck angles (median [IQR]: 40 [28-47]°) compared with laparoscopic surgeries (median [IQR]: 23 [16-29]°), p < 0.001) and torso (median [IQR]: 17 [14-22]° vs. 13 [10-17]°, p = 0.006). Surgeons reported significantly higher levels of fatigue and pain in the neck and lower back during or after performing a surgical case. Longer procedural time resulted in more self-rated fatigue, pain, and subjective workload. Open surgery had higher postural risk. Overall, surgeons spent a disturbingly high percentage of time during surgery in high-risk musculoskeletal postures, especially the neck. These results show that intraoperative postural risk is very high and that interventions are necessary to protect surgeon musculoskeletal health for optimal surgeon performance and career longevity.

S0974 Post-Procedure Pain and Complications From Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous Liver Biopsy for Benign Parenchymal Liver Disease

INTRODUCTION: Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a viable method for core tissue acquisition. Because EUS-LB avoids puncture of the skin and underlying muscle and fascia, we hypothesized the technique would result in less post-procedure pain than percutaneous Liver biopsy (P-LB). METHODS: The study was a retrospective review of prospectively maintained EUS-LB and P-LB databases. Exclusion criteria were liver biopsy of a mass lesion, ascites, or coagulopathy (platelets < 50,000 or International Normalized Ratio > 1.5). EUS-LB was performed with a 19-gauge needle using wet suction with heparin or saline. P-LB was performed using a 16-gauge spring-loaded core biopsy needle. Following EUS-LB and P-LB, patients were monitored for 30 and 60 minutes respectively before discharge. Pre- and post-procedure pain location, severity (10-point numeric scale), and use of analgesics was documented in all patients. Patients were contacted within 1 week post-procedure, and the medical records were reviewed for up to 30 days-post procedure to assess for complications. The primary outcome was incidence of increased post-procedural pain. Secondary outcomes were proportion of patients who required analgesics post-procedure, or developed a complication within 30-days post-procedure. RESULTS: 217 patients met inclusion criteria (152 P-LB, 65 EUS-LB). American Society of Anesthesiologists (ASA) classification was higher in the EUS-LB group (3 vs. 2, P < 0.001). Non Alcoholic Fatty liver disease was the most common indication for the procedure in both groups. Other baseline variables did not differ significantly in the 2 groups (Table 1). In the EUS-LB group, 28 patients underwent biopsy of a single lobe, while 37 patients underwent biopsy of both right and left lobesTable 1.: Baseline variables – EUS-liver biopsy (EUS-LB) vs. percutaneous liver biopsy (PLB) patientsTable 2.: Comparison of outcomes between EUS guided liver biopsy (EUS-LB) and percutaneous liver biopsy (PLB) patients. The incidence of post-procedure pain and need for analgesics was higher with P-LB compared to EUS-LB, but the differences were not statistically significant (Table 2). There was 1 complication in the EUS-LB (abdominal pain requiring admission) and 1 complication in the P-LB group (gallbladder hematoma). CONCLUSION: Both EUS-LB and P-LB with moderate sedation appear to result in acceptably low rates of post-procedure pain and complications. EUS-LB allows for biopsy of left and right liver lobes without significant increase in pain or complications. P-LB with moderate sedation permits safe discharge from the endoscopy unit within an hour post-procedure.

Comparison of Nitric Oxide Changes in Hippocampal Tissue and Pain Sensation in Male Rats Parkinson's Model Following 6 Weeks of Continuous and Intermittent Training

Introduction: Despite the beneficial roles of nitric oxide, its excessive synthesis causes neurodegenerative diseases. Therefore, the aim of the present study was to compare the nitric oxide changes in the hippocampal tissue and the pain sensation of male Parkinson's rats after 6 weeks of continuous and interval training. Methods: In this experimental study, 24 Wistar male rats were used. Rats were treated with Parkinson's using reserpine, and then divided into four groups (n=6). Aerobic exercise was performed for 6 weeks and 5 sessions per week. The duration of training increased from the first to the sixth week, it increased from 15 minutes on the first day to 40 minutes in the sixth week. The interval group performed the specified duration of the exercise twice in the first week, four times in the second to fourth weeks, and six times in the fifth to sixth weeks. At the end of 6 weeks, pain sensation was measured using formalin test and then rats were sacrificed. The tissue of the hippocampus was separated, and nitric oxide was measured using the ELISA method and special kits. The results were analyzed using one-way analysis of variance and LSD follow-up. Results:The results showed that Parkinson's disease increased nitric oxide levels (p ≤0.05). Continuous and interval aerobic exercise reduced nitric oxide (p ≤0.05). There was no significant difference between the two training groups (p ≤0.68). In addition, Parkinson's control group showed a significant increase in pain compared to the control group (p ≤0.01). Two types of exercise reduced pain (p ≤0.05), but there was no significant difference between the two groups (p≤0.23). Conclusion:According to the findings of this study, continuous and periodic aerobic exercise reduced nitric oxide levels and pain in the rats of the Parkinson's model.

Repetitive Transcranial Magnetic Stimulation for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Pilot Study.

PurposeTo evaluate the feasibility, efficacy, and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with treatment-resistant chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).MethodsEleven patients with CP/CPPS were enrolled in this prospective clinical study. rTMS was performed for 5 consecutive days in 20-minute sessions. Patients were evaluated at baseline, after treatment, and at 1, 4, 8, and 12 weeks after the last session with questionnaires concerning pain (numerical rating scale [NRS], the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI], and the Short Form-36 [SF-36]), urinary symptoms (NIH-CPSI, Danish Prostatic Symptom Score [DAN-PSS-1]), quality of life (NIH-CPSI, SF-36), and psychometrics (Beck Depression Index [BDI]). Telephone-based interviews were used to evaluate side effects, subjective response, and changes in drug consumption.ResultsAll patients completed the planned treatment and follow-up according to protocol. No patients experienced serious side effects or significant pain increase during or after treatment. Mild transient tension headache responsive to oral pain medication was reported by 2 patients. Decreased pain was observed on the NRS after treatment and at 1 and 8 weeks (P=0.019, P=0.006, P=0.042, respectively) and on the NIH-CPSI pain domain at 1 week (P=0.04). Improvement in lower urinary tract symptoms was observed after treatment in the NIH-CPSI urinary domain (P=0.02) but not with the DANPSS-1. No significant changes in the BDI were observed. Nine patients reported a positive overall subjective response (82%) and 6 patients (55%) were able to reduce pain medication. Higher age was associated with lower NRS scores after treatment (R=0.605, P=0.048) and at 8 weeks (R=0.659, P=0.028).ConclusionsrTMS for patients with CP/CPPS seemed to be well tolerated, at least moderately effective in pain reduction, and might be of interest in patients with chronic pelvic pain resistant to conventional treatment. These findings remain to be confirmed by a randomized trial.

Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial

Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes. From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of -0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ. In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention. · Virtual reality (VR) represents a nonpharmacologic option for pain relief.. · VR has been little studied in pregnant or laboring women.. · VR was associated with a reduction in pain in nulliparous women in labor..

Patient Perception and Duration of Pain after Microdirect Laryngoscopy.

Postoperative pain is an important part of the patient's surgical experience. The objective was to evaluate patient perception and duration of pain after microdirect laryngoscopy (MDL). Case series with planned data collection. Tertiary care, academic center. Adult patients undergoing MDL were administered the short-form McGill Pain Questionnaire (SF-MPQ) before surgery and on postoperative days (PODs) 1, 3, and 7. Demographic and clinical data were collected. In total, 130 patients (mean age 52.6 years, 84 male) participated in the study. About 46.2% required analgesia on POD 1, but only 23.1% required opioids. Overall, mild levels of pain were reported on the SF-MPQ: sensory score, affective score, total score, present pain intensity (PPI), and visual analog scale (VAS). Patients reported a significant increase in pain on POD 1, with decreases in pain on PODs 3 and 7. Pain score returned to preoperative values for total score and affective score on POD 7 but remained significantly elevated for PPI, VAS, and sensory score. None of the following factors were associated with increased pain: age, sex, body mass index, Mallampati score, Cormack score, laryngoscope used, type of MDL, time under anesthesia, employment status, intubation, Voice Handicap Index 10, and chronic pain history. Although mild levels of pain were reported after MDL, the pain persisted for up to 7 days. No demographic or clinical factors were found to be associated with increased pain. This study was one of the few prospective studies evaluating pain after MDL.

39: Virtual Reality reduces pain in laboring women: a randomized controlled trial

Virtual reality (VR) represents a potential method for easing labor pain. By stimulating the visual cortex while engaging other senses, VR modulates the user’s processing of nociceptive stimuli; head-to-head trials show that VR achieves similar or greater analgesia as hydromorphone. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. We conducted an open-label, RCT of nulliparous, term women in labor. We included women with a pain score of 4-7 having contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including epidural or with contraindications to VR use. Participants were randomized to up to 30 minutes of either VR or no intervention (Control). Our primary outcome was the difference in differences from pre to post intervention pain score. Prespecified secondary outcomes included pain scores, duration of intervention use, pharmacologic analgesia use, vitals, and obstetric outcomes. We used minimum clinically important difference for sample size calculations which for subjects starting with a baseline pain score of 40-70 mm is 13 mm. With an 80% power and 2-sided alpha 0.05 starting from a baseline median pain of 55 mm, we would require 40 total subjects. From 3/2018 to 2/2019, 40 patients were enrolled in and completed the study; 19 were randomized to Control and 21 to VR. Half were inductions and all were latent phase with mean dilatation pre-intervention of 2.5 cm (Control) and 2.8 cm (VR). For the primary outcome – difference in pain score following the intervention – those assigned to the Control arm had a statistically significant increase in pain of +0.58 while receiving VR had a significant reduction in pain of -0.52. (p = 0.03) (Figure 1). Post-intervention heart rate was also higher in the Control arm (86.8 vs 76.3, p = 0.01). Other secondary outcomes did not differ (Table 1). In our study, we found that VR was effective for reducing pain in women in labor compared to those receiving no intervention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Temporal Summation in Chronic Pelvic Pain.

This study sought to characterize central sensitization further among women with chronic pelvic pain by identifying temporal summation using a cotton-tipped applicator test that can be used at the bedside. A total of 36 women (18 with chronic pain and allodynia; 18 without pain) were recruited. Both groups were randomly assigned to receive 3 strokes of a benign stimulus on the abdomen at differing frequencies: 10, 30, or 100 seconds. Each group included 6 women. Pain was assessed using a rating scale of 1 to 10. Data were analyzed using the multivariate approach to repeated measures analysis of variance. The pattern of pain scores differed significantly between women with and without chronic pain (P = 0.002). Women with chronic pelvic pain and allodynia showed a statistically significant increase in pain with successive strokes of the cotton-tipped applicator (P = 0.012 for stroke 1 vs. 2, P = 0.026 for stroke 2 vs. 3, and P = 0.005 for stroke 1 vs. 3). Women with chronic pelvic pain and allodynia showed significant worsening of pain with successive strokes of a cotton-tipped applicator. This finding indicates that pain wind-up and central sensitization are present in women with chronic pelvic pain and allodynia. Identification of summation is further evidence of neuroplasticity, which is helpful in innovative therapies for chronic pelvic pain.