Significant Reduction In Pain Scores Research Articles

Efficacy of repetitive transcranial magnetic stimulation for phantom limb pain- a meta analysis of randomized controlled trials.

Phantom limb pain (PLP) is a neuropathic syndrome experienced by the majority of amputees. Various treatment options are available for amputees suffering from PLP including pharmacological, psychological and neuromodulation techniques. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has proven its efficacy in alleviating PLP. Hence, we aimed to conduct a meta-analysis to evaluate the effectiveness of rTMS in improving pain in patients with PLP. Literature search was carried out on 5 electronic databases from the inception of the paper till 13th August, 2024. Randomized Controlled Trials evaluating the efficacy of rTMS in patients with PLP against a control group were included in our study. The Visual Analogue Scoring (VAS) system was used to evaluate the severity of pain. Quality assessment was performed with the Cochrane bias assessment tool and data was pooled on Review manager using the Mantel-Haenszel Random-effects model. 5 RCTs included in this paper were included and consisted of 140 participants experiencing PLP. There was a significant reduction in pain score in the rTMS group at the end of treatment when compared to the control group (P = 0.00001). A drop out sensitivity analysis significantly improved the results by reducing the heterogeneity to null (P = 0.00001). After 30 days of treatment, there was a significant difference of pain score from baseline in rTMS groups. Our meta-analysis demonstrates the role of rTMS in significantly reducing VAS score in patients with PLP. In the future, larger clinical trials are required that evaluate the long-term efficacy profile of rTMS to establish it as a mainstay of therapy in patients with PLP.

5.6% lidocaine aerosol anesthesia for supragingival ultrasonic scaling in patients with chronic periodontitis or dental plaque-induced gingivitis

The aim of this study was to evaluate the efficacy and patient satisfaction of lidocaine aerosol for pain management during periodontal scaling and root planning in patients with chronic periodontitis or dental plaque-induced gingivitis. This study specifically concentrated on comparing the effectiveness of lidocaine aerosol as a topical anesthetic against a placebo, assessing its impact on pain perception during the procedure. Additionally, the relationship between periodontal treatment and the reduction of oxidative stress markers in these patients was assessed. Eighty-six patients with chronic periodontitis or dental plaque-induced gingivitis were included. Notably, 5.6% lidocaine and placebo aerosols were randomly applied to the labial (buccal) and lingual (palatal) sides, approximately 3 mm from the gingival surface, with three sprays on each side, prior to supragingival ultrasonic scaling in these patients. In this controlled, double-blind study, the effectiveness of a 5.6% lidocaine aerosol in reducing pain during supragingival ultrasonic scaling was evaluated. The study involved 50 patients who divided into two groups: one receiving the lidocaine aerosol and the other a placebo. Pain was assessed using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). The results revealed a statistically significant reduction in pain scores in the lidocaine group compared with the placebo group. Specifically, the mean VAS score in the lidocaine group was 2.1 ± 1.3, compared with 5.6 ± 1.7 in the placebo group (P < 0.01). Similarly, the NRS scores were significantly lower in the lidocaine group (2.3 ± 1.2) compared with the placebo group (5.9 ± 1.8, P < 0.01). No adverse reactions were found in none of the groups. 5.6% lidocaine aerosol holds promise as an effective anesthetic option for reducing pain during supragingival ultrasonic scaling procedures in patients with chronic periodontitis or dental plaque-induced gingivitis. Chinese Clinical Trial Registry (No. ChiCTR2000029831, date: 2020-02-15).

Platelet-Rich Plasma versus Corticosteroid Injection for the Treatment of de Quervain Tenosynovitis: A Randomised Control Open Label Equivalence Trial.

Background: De Quervain (DQ) tenosynovitis is a frequent source of wrist pain amongst middle-aged adults. Steroid injections are recommended after conservative methods fail, despite unclear mechanisms. The effectiveness of platelet-rich plasma (PRP) for DQ is not well-studied. To address this gap, we conducted a randomised controlled trial comparing the efficacy of PRP and corticosteroid (CS) injections for treating DQ. Methods: This prospective, randomised and open-label trial was conducted at a tertiary care hospital in India. Adult patients aged 18-60 were randomly assigned to receive either ultrasound-guided triamcinolone acetonide injections or autologous PRP in the first extensor compartment. Outcomes were measured at baseline and at 1, 4 and 12 weeks using the VAS and quick disabilities of arm, shoulder and hand (QuickDASH) questionnaires. Results: Eighty-six age- and sex-matched patients, with an average disease duration of 14 weeks in both groups, were enrolled. Both the CS and PRP groups demonstrated a significant reduction in pain scores and improvement in functions at 1, 4 and 12 weeks. However, between the groups, the degree of improvement in pain was more in CS group at 1 week and similar improvements between the groups at 4 and 12 weeks. Regarding hand function, the CS group exhibited notable at 1 and 4 weeks based on the QuickDASH scale. Yet, by the 12th week, hand function improvements were comparable between both groups. Conclusions: This study suggests that PRP is equivalent to CS in reducing pain in DQ tenosynovitis. Hand function improved more significantly in the CS group at 1 and 4 weeks post-injection. Both PRP and CS are safe and equally effective treatments for DQ. Level of Evidence: Level I (Therapeutic).

Comparison of the Effect of Adding Dexmedetomidine as an Adjuvant to Bupivacaine for Postoperative Pain Management in Patients Undergoing Shoulder Rotator Cuff Repair – A Randomized Clinical Trial

Background: Shoulder rotator cuff repair postoperative pain management is more critical than orthopedic surgeries in other limbs. This study aimed to investigate the effect of adding dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management. Materials and Methods: This double-blind, randomized clinical trial was performed on 80 patients aged 20 to 60 with ASA I and II who were candidates for elective shoulder rotator cuff repair. Forty candidates in the control group received 0.1% bupivacaine intra-articular and extra-articular before surgical wound closure, and 40 patients in the intervention group received 0.1% bupivacaine and dexmedetomidine 1 µg/kg intra-articular and extra-articular. Postoperative sleep disturbance and pain intensity were measured at recovery, 4, 8, 12, 18, and 24 hours after surgery. The results were analyzed by SPSS software version 23, and a P value ≤0.05 was considered significant. Results: There were no significant differences between the two groups regarding the hemodynamic variations (P &gt; 0.05), except 4 hours after surgery when the mean arterial pressure in the intervention group was significantly lower than the control group (P = 0.026). There was a significant reduction in pain scores at 8 and 12 hours after surgery in the intervention group. The night after surgery, sleep quality and the overall RCSQ score in the intervention group were significantly higher than those in the control group. Conclusion: Administering 0.1% bupivacaine and dexmedetomidine 1 µg/kg intra-articular and extra-articular before surgical wound closure effectively reduced the pain intensity and analgesic consumption. Also, it maintained patients’ hemodynamic stability and enhanced sleep quality without significant adverse effects.

Sublingual Sufentanil Tablet for Analgesia in Emergency Medical Services and Search and Rescue Agencies

Objectives Pain management in the potentially austere search and rescue (SAR) and emergency medical services (EMS) environments can be challenging. Intravenous (IV) and intramuscular (IM) routes of administration may be less practical. This study assesses the efficacy and safety of the sublingual sufentanil tablet (SST) in prehospital settings and hypothesizes that its use will reduce pain while maintaining a reasonable safety profile. Methods This was a retrospective case analysis examining patient records from Teton County Search and Rescue, Grand Teton National Park EMS, and Jackson Hole Fire/EMS from 2021-2023, based on the criteria that they were administered SST in a prehospital setting. Cases in which SST was used were examined to assess patient characteristics, injury classification, patient reported pain scale before and after SST, other medications administered, and vital signs. Results Seventy patients met the inclusion criteria. Six individuals were excluded due to missing one or more of the key variables, and the analysis was carried out with the remaining (N = 64 cases). The mean pain score decreased from 8.0 ± 1.9 before medication administration to 5.5 ± 2.5 after administration, reflecting a statistically significant difference of 2.6 ± 2.1 (p < 0.001). The results also revealed statistically significant reductions in heart rate (HR) and systolic blood pressure (SBP) following SST administration (mean HR dropped by 4.2 ± 9.1 beats/min, p = 0.004, and mean SBP dropped by 11.1 ± 21.8 mmHg, p = 0.01). Changes in vital signs, although statistically significant, were not clinically significant and did not necessitate additional monitoring or intervention in any patients. Conclusions Our study demonstrated that SST administration led to a significant reduction in pain scores and exhibited a favorable safety profile regarding vital signs, including SBP, HR, respiratory rate (RR), and O2 saturation. These findings support the utilization of SST for pain management in the prehospital setting, particularly in austere environments where traditional routes of administration may be impractical.

Quasi-Experimental Study: Evaluating the Effectiveness of Jacobson Relaxation Techniques on Pain Among Post-COVID Geriatrics with Co-morbid Illness

Introduction: Jacobson's progressive muscle has been widely recognized for its potential benefits in pain management, particularly in populations experiencing high levels of stress and anxiety, which are common in post-COVID patients. Objectives: This study aimed to evaluate the effectiveness of Jacobson Relaxation Techniques on pain among post-COVID geriatrics who had co-morbid illness. Methods: Quantitative study was selected for the study. A total of 82 participants were selected using purposive methods allocated to either the intervention group (n=41) or the control group (n=41). Pain levels were assessed using the Numeric Pain Rating Scale (NPRS) at baseline and after a week of intervention. Descriptive statistics and inferential analysis were employed to analyze the data. Results: The study finding revealed that the intervention group had a pre-intervention pain score of 7.2 ± 1.5, which reduced to 4.5 ± 1.2 post-intervention, indicating a noticeable reduction in pain levels following the intervention. In contrast, the control group had a pre-intervention pain score of 7.0 ± 1.4, which showed a minimal reduction to 6.8 ± 1.3 post-intervention, suggesting that the control condition had little to no impact on pain levels. The intervention group demonstrated a significant reduction in pain scores compared to the control group post-intervention (p &lt; 0.05), indicating the efficacy of Jacobson Relaxation Techniques in pain management among post-COVID geriatrics with co-morbid illness. Conclusions: Jacobson Relaxation Techniques offer a valuable non-pharmacological approach for alleviating pain in post-COVID geriatrics with co-morbid illness. Further study recommended on the integration of these techniques into clinical practice can improve the quality of life for this vulnerable population, addressing a critical aspect of post-COVID care.

Impact of intrathecal infusion port system on patients with advanced cancer pain and their caregivers

Objective The impact of the intrathecal infusion port system on patients with advanced cancer pain and the nursing workload on their primary caregivers was investigated in this study. Methods Between January 2018 and December 2021, a total of 26 patients with advanced cancer pain who received intrathecal infusion in our hospital, were enrolled in this study along with their primary caregivers. Assessments of patients’ pain levels, adverse reactions, and quality of life, as well as the nursing workload of primary caregivers were evaluated. Results The findings revealed a significant reduction in pain scores, decreasing from (7.42 ± 0.58) one week before treatment to (2.00 ± 0.56) one week after treatment, and maintaining a similar level at (2.07 ± 0.56) one month post-treatment, with a concomitant decrease in associated complications. Moreover, an improvement in overall quality of life was observed, as evident in the total physical health scores, which increased from (33.97 ± 7.14) one week prior to treatment to (47.44 ± 10.14) one week post-treatment and (48.56 ± 9.35) one month post-treatment. The total psychological health scores exhibited a positive trajectory, rising from (52.50 ± 23.55) one week before treatment to (65.00 ± 16.55) one week after treatment, ultimately reaching (69.42 ± 15.64) one month post-treatment. Furthermore, the primary caregivers’ nursing workload experienced a consistent decline, decreasing from (51.54 ± 7.30) one week before treatment to (46.54 ± 5.57) one week after treatment and further diminishing to (45.32 ± 6.41) one month after treatment. Repeated measures of variance showed that there were significant differences in pain, quality of life, and primary caregivers’ nursing workload at different time points ( P &lt; 0.05). Conclusion The intrathecal infusion port system can effectively reduce the pain level of patients with advanced cancer pain, improve their quality of life, and reduce the nursing workload of their primary caregivers.

The Association of the Changes in Pain Severity and Cervical Cobb Angle before Versus After Anterior Cervical Discectomy With Fusion Surgery

Background and Aim: Axial neck pain due to degenerative cervical myelopathy can be improved after repairing anterior cervical discectomy with fusion (ACDF) surgery. However, whether changes in postoperative pain can be associated with improvement in the Cobb angle following surgery is still controversial. This study aims to assess the trends of the changes in pain severity and also Cobb angle and then test the relationship between the changes in two parameters. Methods and Materials/Patients: This longitudinal study was performed on 60 consecutive patients who were scheduled to undergo ACDF surgery due to neck disc or degenerative cervical myelopathy (DCM) and had axial neck pain before the operation. Before operation as well as 2 weeks, 2 months and 6 months after surgery, the pain score and value of Cobb angle were measured. Results: Before surgery, the patients suffered from significant axial neck pain with a mean pain score of 7.47±2.02, but after surgery, patients experienced a downward trend of changes in pain score as the mean pain score of 0.92±1.46 at two weeks, 1.31±1.63 at two months and 1.32±1.64 at six months after operation. The repeated measure analysis of variance (ANOVA) test showed a significant reduction in pain scores within follow-up time (P&lt;0.001). A significant improvement was also revealed in the Cobb angle after the operation and the mean value of this angle was significantly lower at two weeks, two months, and six months after surgery than before surgery. Using the multivariate linear regression modeling with the presence of baseline parameters, the relationship between pain score and Cobb angle remained insignificant (P=0.387). Conclusion: Following ACDF surgery, the improvement in axial neck pain and Cobb angle is predictable, but the relationship between these two indicators will not necessarily be significant.

Supra-inguinal fascia iliaca block versus peri-capsular nerve group (PNEG) block for pain management in patients with hip fracture: A double-blind randomised comparative trial

BackgroundRegional analgesia has been recommended to alleviate pain caused by hip fractures. Both the supra-inguinal fascia iliaca block (S-FIB) and the peri‑capsular nerve group (PENG) block provide better analgesia than conventional fascia iliaca block for patients with hip fractures, but which one is superior remains equivocal. This study aimed to determine the superiority of S-FIB or PENG block for patients awaiting hip surgery. MethodsIn this prospective, double-blind, randomised comparative trial, patients with hip fractures awaiting operation were randomly allocated to receive either S-FIB with 30 ml 0.35 % ropivacaine or PENG block with 20 ml 0.35 % ropivacaine. Primary outcomes were pain scores (numeric rating scale, NRS, 0–10) at rest and during passive movement 30 min after nerve block. Secondary outcomes included pain scores at rest and during movement 10 and 20 min after nerve block and during positioning for spinal anaesthesia, time spent for performing nerve block and spinal anaesthesia, and the quality of positioning for spinal anaesthesia. ResultsOne-hundred patients were enrolled and 91 patients completed the trial (S-FIB group n = 46, PENG group n = 45). No significant difference was noted between these two groups in the pain scores (median [interquartile range]) either at rest (0 [0–0] vs 0 [0–0], P = 0.151) or during passive movement (3 [1-6] vs 3 [2-5], P = 0.99) at 30 min after nerve block. However, within-group analysis revealed that a significant reduction in pain score at rest was noted as early as 20 min after PENG block while that was noted only at 30 min after S-FIB. In addition, less time was required to perform PENG than S-FIB the block (3.1 [2.3–3.9] vs. 4.6 [3.1–5.6] minutes, P < 0.001). ConclusionsOur result suggests that with a lower dose of local anaesthetic, a shorter procedure time and earlier analgesic effect, PENG block may be preferred to S-FIB for patients with hip fracture awaiting surgery.

Enhanced Recovery after Elective Cesarean Delivery at Ain Shams University Maternity Hospital: A Randomized Controlled Trial

Abstract Background Enhanced recovery after cesarean delivery (ERAC) is perioperative care program to fasten patients recovery. ERAC protocols intended to improve patient outcomes and fasten return to normal function before surgery by standardization of practice at all stages: preoperative, intraoperative and postoperative. Aim of the Study The aim of this study was to evaluate whether the implementation of enhanced recovery after cesarean (ERAC) would decrease the length of hospital stay and pain score and improve postoperative patient satisfaction and breastfeeding and its effect on postoperative complications and hospital readmission. Patients and Methods 86 pregnant women undergoing uncomplicated elective cesarean delivery were enrolled in this study. patients were randomized to two groups: 43 patients in the Enhanced recovery after cesarean delivery (ERAC) group and 43 patients in the standard care group. Enhanced recovery after cesarean involved multiple evidence-based interventions and were divided into the three major phases of patient care: antepartum, intrapartum and postpartum. The primary outcome was the length of hospital stay after cesarean delivery. Secondary outcomes included pain medication requirements and pain scores, breastfeeding and first time of start breastfeeding, maternal satisfaction, postoperative complications and hospital readmission. Results Enhanced recovery after cesarean delivery was associated with a highly significantly shorter length of hospital stay when compared to standard care (p- value &amp;lt;0.001). There was a highly significant reduction in pain scores at 2h, 4h, 6h and 12h in the ERAC group in comparison to standard care group (p-value &amp;lt;0.001). There was no statistically significant difference between the two groups of studied participants regarding breastfeeding (p-value=0.5). However, there was statistically highly significant difference between the two groups of studied participants regarding the time of starting breastfeeding (p-value &amp;lt;0.001). The participants were more significantly satisfied in the ERAC group than in the standard group (p-value&amp;gt;0.001). Conclusion Implementation of enhanced recovery after elective cesarean delivery (ERAC) pathway lead to significantly shorter length of hospital stay, lower pain scores, better patient satisfaction and earlier start of breastfeeding.

Prongs or Mask for Nasal Continuous Positive Airway Pressure in Neonates: Which One Is More Comfortable?

Nasal continuous positive airway pressure (NCPAP) is a common mode of respiratory support in neonatal intensive care units. Our objective was to compare whether NCPAP given with nasal prongs compared with a nasal mask reduces the pain scores in preterm infants with respiratory distress. Preterm infants on NCPAP due to respiratory distress were included in the study. All infants received NCPAP via the Infant Flow SiPAP. The COVERS pain scale was used to score the infants' pain. Each infant was studied alternating between nasal prongs and a nasal mask. Heart rate, respiratory rate, oxygen saturation, and transcutaneous CO 2 (tcCO 2 ) were monitored. Blood pressure and the infants' pain scores were determined every 30 minutes and the average of measurements was taken. The median (interquartile range) values of pain scores, respiratory rates, oxygen saturations, tcCO 2 levels, and systolic blood pressures differed significantly and favored the nasal mask. This study demonstrates that continuous positive airway pressure via a nasal mask leads to a significant reduction in pain scores without altering the respiratory parameters of babies. On the basis of this study, it is possible to conclude that NCPAP applied via nasal mask may be a good alternative to NCPAP applied via nasal prongs.

Evaluation of the efficacy of ultrasound-guided maxillary and mandibular nerve pulsed radiofrequency treatment for trigeminal neuralgia and factors associated with successful response: a retrospective study.

This study aimed to investigate the treatment efficacy and clinical and demographic characteristics affecting treatment success in patients who underwent ultrasound (US)-guided pulsed radiofrequency (PRF) to the maxillary and/or mandibular nerves for trigeminal neuralgia. The data of patients with trigeminal neuralgia who underwent US-guided maxillary and/or mandibular nerve PRF between September 2022 and December 2023 were reviewed and the study was retrospectively designed. Good analgesia was defined as ≥ 50% reduction in pain score at 3 months after the procedure, and the demographic and clinical characteristics of the patients were assessed. Among the 72 included patients, 39 (54.2%) and 33 (45.8%) were classified as responders and non-responders, respectively. The age, pre- and post-procedural Numerical Rating Scale (NRS) scores, pain duration, and presence of constant pain were significantly lower in the responders. Logistic regression analysis revealed that older age (OR = 0.899, p < 0.001), high pre-procedural NRS scores (OR = 0.177, p = 0.009) and non-idiopathic (secondary or classic) etiology (OR = 0.062, p = 0.048) were significantly associated with an unsuccessful response to maxillary/mandibular PRF treatment. This study is the first clinical trial to evaluate the efficacy of PRF therapy of the maxillary and mandibular nerves in the treatment of trigeminal neuralgia and demonstrated a significant reduction in pain scores at 3 months. Older age, high pre-procedural NRS scores, and non-idiopathic (secondary or classical) etiology are independent predictors of poor response to ultrasound-guided maxillary/mandibular nerve pulse radiofrequency treatment.

Targeted Radionuclide Therapy for the Treatment of Metastatic Bone Disease: A Retrospective Analysis in Moscow, Russia

Introduction: Metastatic bone disease (MBD) is a common complication of advanced cancer, causing significant morbidity and negatively impacting patients' quality of life. Targeted radionuclide therapy (TRT) has emerged as a promising treatment modality for MBD, offering targeted delivery of therapeutic radiation to bone metastases while minimizing damage to healthy tissues. Methods: A retrospective cohort study was conducted at leading oncology centers in Moscow, Russia, between 2018 and 2023. Patients with MBD who received TRT with either Strontium-89 or Samarium-153 were included. Data on patient demographics, primary tumor type, number of bone metastases, pre-treatment pain scores, performance status, and survival outcomes were collected. Results: A total of 150 patients were included in the study (mean age 62 years, 55% female). The most common primary tumor types were prostate (35%), breast (25%), and lung (15%). The median number of bone metastases was 5 (range 1-20). Pre-treatment pain scores were high (median 7 on a 0-10 scale). A significant reduction in pain scores was observed post-TRT (median 3, p&lt;0.001). Overall survival at 1 year was 75%, with a median survival of 18 months. Favorable prognostic factors included a lower number of bone metastases, good performance status, and absence of visceral metastases. Conclusion: TRT is a safe and effective treatment option for patients with MBD in Moscow, Russia, offering significant pain palliation and improved quality of life.

Cognitive functional therapy for lower back pain: A meta-analytical assessment of pain and disability outcomes in randomized controlled trials

BACKGROUND: Cognitive functional therapy (CFT) aims to address low back pain (LBP) comprehensively by considering physical, psychological, and social factors. OBJECTIVE: The objective was to evaluate the effectiveness of CFT in reducing pain and disability in individuals with LBP over various time intervals. METHOD: A comprehensive literature search was conducted to identify relevant randomized controlled trials (RCTs) assessing the effects of CFT on LBP. RESULTS: In this study, 1510 records were initially identified, and 7 studies were included in the analysis. Disability scores were significantly reduced after CFT had been applied for 6 to 8 weeks (SMD =-0.46, 95% CI [-0.74, -0.19]), 12 weeks to 3 months (SMD =-0.54, 95% CI [-0.72, -0.36]), 6 months (MD =-5.82, 95% CI [-9.82, -1.82]), and 12 months (SMD =-0.4, 95% CI [-0.55, -0.26]). There were also significant reductions in pain scores observed after 12 weeks to 3 months (SMD =-0.49, 95% CI [-0.68, -0.3]), 6 months (MD =-0.75, 95% CI [-1.5, -0.0001]), and 12 months (SMD =-0.27, 95% CI [-0.42, -0.12]). CONCLUSION: CFT showed potential for improving disability scores for individuals with LBP across various time intervals. However, its impacts on pain scores varied.

Effectiveness of subacromial steroid injection and hydrodilatation in the treatment of adhesive capsulitis: A comparative analysis.

Objective: To compare the effectiveness of Subacromial Steroid Injection (SAI) and Hydrodilatation in treating adhesive capsulitis (frozen shoulder). Study Design: Observational study. Setting: Department of Orthopedic, Dr. Ziauddin Hospital, Located in North Nazimabad, Karachi, Pakistan. Period: March 2023 to September 2023. Methods: Included 138 participants with primary adhesive capsulitis. Participants were divided into two groups: one received hydrodilatation and the other received SAI. The Disability of Arm, Shoulder, and Hand (DASH) Score and Visual Analogue Scale (VAS) were used for pre and post-treatment assessments at intervals of 2 weeks, 6 weeks, and 6 months. SPSS version 23 was used to analyze the data. Results: Both groups show significant reductions in pain scores and DASH scores over time (p-value&lt;0.05 for changes within each group). There are significant differences in pain scores and DASH scores between the groups at 6 weeks, 12 weeks, and 6 months (p-value&lt;0.05), with the hydrodilatation group showing better outcomes. Moreover, the mean reduction in pain scores and DASH scores from pre-treatment to 6 months is significantly greater in the hydrodilatation group compared to the SAI group (p-value&lt;0.05). Conclusion: While both Hydrodilatation and SAI are effective in reducing pain and improving functionality in patients with adhesive capsulitis, Hydrodilatation appears to be more effective in achieving these outcomes, particularly in terms of pain management and functional improvement.

Automated line-clearing chest tubes reduce postoperative pain and atrial fibrillation after cardiac surgery

ObjectiveRecent advancements in chest tube technologies have gained interest for their ability to enhance postoperative recovery via reduction of retained blood syndrome after cardiothoracic surgery. The present study investigates the effect of the Centese Thoraguard automated line-clearance chest tube system on postoperative pain and recovery after cardiac surgery. MethodsThis was a single-center retrospective review of 1771 adult patients undergoing nonemergency cardiac surgery between January 2021 and December 2022. Perioperative data were analyzed in 184 patients undergoing surgery with Thoraguard automated clearance chest tubes and 1587 patients with conventional chest tubes. Postoperative outcomes were compared in a propensity-matched cohort of 133 patient pairs with similar preoperative characteristics. ResultsPatients undergoing cardiac surgery with automated clearance chest tubes demonstrated significant reductions in pain scores (0-10) compared with conventional chest tubes on the third postoperative day (5 vs 6, P = .02) and at hospital discharge (0 vs 3, P = .04). Automated clearance chest tubes were associated with a shorter time on the ventilator (5.3 vs 5.8 hours, P < .001). There was a significant reduction in postoperative atrial fibrillation (18.1% vs 30.8%, P = .02) in patients receiving automated clearance chest tubes. There were no significant differences in mortality, myocardial infarction, or stroke between automated line-clearing and conventional chest tubes. ConclusionsThe use of the Thoraguard automated line-clearing chest tube system in routine cardiac surgery was associated with improved postoperative pain control, decreased ventilator duration, and decreased postoperative atrial fibrillation without increased morbidity or mortality.

Comparing the Effectiveness and Salivary Levels of TNF-alpha in Patients with Oral Lichen Planus Treated with Topical Clobetasol Propionate and Fluocinolone Acetonide

Objectives: The purpose of this study was to compare the effectiveness and salivary levels of tumor necrosis factor-alpha (TNF-α) in patients with oral lichen planus (OLP) treated with topical clobetasol propionate (CP) and fluocinolone acetonide (FA). Methods: A total of 26 patients diagnosed with erosive-atrophic OLP were randomlydivided into 2 groups: the first group received CP 0.05%, and the other received FA 0.1%. Pain scores, clinical scores, and saliva samples from the patients were collected for analysis both prior to treatment initiation and after 4 weeks. Salivary TNF-α levels were evaluated using an immunology multiplex assay. The Wilcoxon signed-rank test and the Mann-Whitney U test were used for intra-group and inter-group comparisons, respectively. Results: Both treatments showed significant reductions in pain scores, clinical scores, and salivary TNF-α levels compared with the pre-treatment values (p&lt;0.05). After 4 weeks of treatment, CP 0.05% demonstrated a greater reduction in clinical score compared with FA 0.1% (p&lt;0.05). Conclusions: CP 0.05% and FA 0.1% effectively treat OLP. CP 0.05% demonstrated a quicker clinical score reduction than FA 0.1% over four weeks. Additionally, both steroids reduced salivary TNF-α levels, which could indicate the possibility of using diseaserelated biomarkers for monitoring.

Clinical and Epidemiological Profile of Patients Presenting With Acute Abdomen to the Emergency Department of a Tertiary Care Hospital.

Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital. To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen. This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs(NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management. The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001). The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen.

The Effect of Virtual Reality Application on Pain and Anxiety During Episiotomy Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

There is a rising trend among women towards nonpharmacological approaches owing to their minimally invasive nature and limited adverse effects. Virtual reality (VR) has recently gained popularity as a new technology for reducing pain and anxiety in medical settings. Our research sought to investigate the impact of VR on pain and anxiety levels while undergoing episiotomy repair. A comprehensive search was carried out across PubMed, Scopus, Cochrane Library, and ISI Web of Science to find relevant randomized clinical trials (RCTs) up to January 2024. These trials investigated the use of VR as a treatment during episiotomy repair compared with a control group that did not receive VR intervention. Meta-analysis was performed using Review Manager software to analyze the data collected. Our primary outcomes were pain scores reported during and after episiotomy repair measured by a visual analog scale. Secondary outcomes analyzed included anxiety scores during and after the procedure, as well as the duration of episiotomy repair. Seven RCTs, involving 578 patients, met the inclusion criteria. VR resulted in a significant reduction in pain scores both during and after episiotomy repair (p < 0.001). Additionally, anxiety levels during and after the procedure were significantly reduced in the VR group compared with the control group. Moreover, the duration of episiotomy repair was significantly shorter in the VR group. Using VR has proven to be an effective technique in reducing pain and anxiety during and after episiotomy repair, as well as potentially speeding up the procedure.

Neuromodulation in Management of Patients with Failed Back Surgery Syndrome. An Outcome Assessment Study

Abstract Background Failed back surgery syndrome (FBSS) is a constellation of conditions that describes persistent or recurring low back pain following spine surgeries with a reported point prevalence in the general adult population of 37% and a lifetime prevalence of between 60% and 85%. It always has a significant impact on patients’ quality of life. Neuromodulation such as spinal cord stimulation has been showing significant effect and improvement in pain scores and functional capacity of the FBSS patients with a reflected effect on their daily activities and quality of life. Aim and Objectives Our aim in this study is to assess the change in pain scores, quality of life and opioid medications intake as an outcome of neuromodulation procedures performed to patients diagnosed with failed back surgery syndrome, and to detect the post procedure complications. Subjects and Methods This is a mixed prospective-retrospective study conducted at Ain Shams University (ASU) hospital and Oregon Health and Science University (OHSU) hospital during the period from September 2019 till December 2022. Patients who are 18 years old or older diagnosed with FBSS for more than 6 months and treated with spinal cord stimulation with successful trials during this time frame were included in the study. Results 34 patients were included in this study who had successful SCS trials and underwent a permanent implantation of SCS devices with post procedure follow up period of 12 months. Patients showed median pain numerical rating scale (NRS) of 7/10 at baseline with median NRS of 4/10 through the follow up period, also, there was a significant improvement of functional capacity using metabolic equivalent assessment with 74% of patients became moderate capacity compared to 32% at baseline. Quality of life assessed by activity measure of post-acute care (AM-PAC) showed significant improvement from mean of 16.87 ± 2.74 at baseline to mean of 19.97 ± 2.93 through follow up. Also there was a significant reduction of opioid medication usage. Post procedure complications was of low percentage with the most commonly detected were battery dysfunction in 7 patients and pocket pain in 6 patients. Reoperation was needed in 13 patients with 4 needed just revision and 9 patients required a complete removal of the device. Conclusion Failed back surgery syndrome is a widely described chronic pain condition which has a negative impact on the patients’ quality of life and daily activities with an evidenced effect on chronic use and abuse of opioid analgesic medications. We presented in our study that SCS could be offered as an effective modality of treatment with a statistically significant reduction in pain scores and a significant improvement in functional capacity and quality of life. Also, it has a recognizable but not statistically significant reduction in opioid analgesic medications and a very low percentage of procedure related complications.