Significant Reduction In Pain Research Articles

Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled study

PurposeRefractory cancer-induced bone pain (CIBP) affects a patient’s functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort.MethodsAdults with CIBP and worst pain intensity ≥ 4/10 and/or opioid toxicity graded ≥ 2 on the Common Terminology Criteria for Adverse Events were randomised 1:1 to methadone or another opioid rotation. Standardised assessment tools were used at pre-defined study time points up to 14 days.ResultsOf 51 eligible participants, 38 (74.5%) consented, and 29 (76.3%, MR: 14, OOR: 15) completed the fourteen days follow-up post-opioid rotation. Both groups displayed significant reduction in average (MR: d = − 1.2, p = 0.003, OOR: d = − 0.8, p = 0.015) and worst pain (MR: d = − 0.9, p = 0.042, OOR: d = − 0.6, p = 0.048) and total pain interference score (MR: d = − 1.1, p = 0.042, OOR: d = − 0.7, p = 0.007). Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = − 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group (d = 0.9, 95% CI 0.1,1.7, p = 0.022). There were no within-group or between-group differences in satisfaction with analgesia at the end of the study.ConclusionThis pilot study demonstrated that MR and OOR in patients with refractory CIBP are feasible, safe and acceptable to patients. Appropriately powered multi-centre randomised controlled studies are needed to confirm the efficacy of MR and OOR in this cohort.Trial registrationACTRN12621000141842 registered 11 February 2021.

Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical benefit of botulinum toxin for treatment of persistent TMD-related myofascial pain: A randomized, placebo-controlled, cross-over trial.

Injections of botulinum toxin type A (BoNT-A) have been proposed as an additional treatment modality for patients suffering chronic temporomandibular disorder (TMD)-related myofascial pain (MFP). BoNT-A impairs muscle function, along with its analgesic effect, and a minimal effective dose should be used. The objective of this randomized placebo-controlled crossover study was to evaluate the clinical benefit of a moderate dose (50 U) of BoNT-A. Sixty-six subjects were randomized into two groups, one which received BoNT-A first and a second which received a saline solution (SS) first. Follow-ups were performed 2, 11, and 16 weeks after the injections. Diagnostic criteria for temporomandibular disorders (DC/TMD) diagnostic algorithms were used to evaluate characteristic pain intensity (CPI) and pain-related disability based on the Graded Chronic Pain Scale (GCPS). Electromyographic and bite force were also evaluated. The within-group analysis showed a significant improvement in pain intensity and pain-related disability after BoNT-A (p < 0.001, p = 0.005, p = 0.011) and SS (p = 0.003, p = 0.005, p = 0.046) injections up to week 16. The between-group analysis of pain-related variables revealed no differences between groups at any time. Nonetheless, BoNT-A, but not SS, caused a significant decline in muscle performance. The number needed to treat (NNT) regarding a clinically significant pain reduction (≥30%) was 6.3, 57.0, and 19.0 at 2, 11, and 16-week follow-ups favoring BoNT-A. Injections of 50 U of BoNT-A might improve MFP symptoms, but the specific effect of the drug on pain compared to the placebo is not obvious.

Treatment of Congenital Ulnar Impingement Syndrome by Corrective Osteotomy of the Distal Radius - Clinical Results

In 2016, a new method was described to treat the painful impingement syndrome of the DRUJ: decompression corrective osteotomy of the distal radius. Clinical symptoms are based on a positive compression test; pain occurs with weight-bearing on the forearm. This phenomenon is seen in conjunction with a deformed sigmoid notch together with ulna minus-variance, which leads to increased tension in the distal oblique bundle of the interosseous membrane. The etiology of the condition can be either congenital, post-traumatic, or iatrogenic. Through the proposed osteotomy, decompression in the DRUJ is achieved. This study summarises the results of these surgical procedures performed in our hand centre exclusively in cases of congenital origin. Remodelling of the DRUJ is achieved through the shortening of the distal radius together with closed wedge osteotomy. Relief of the interosseous membrane is accomplished by ulnar translation of the radial shaft. This study only included patients with congenital incongruency in the DRUJ. The results were evaluated using a visual analogue scale (VAS) and the Krimmer Wrist Score and by measuring the preoperative and postoperative range of motion as well as grip strength. Within 11 years, 45 procedures were performed with our method on 38 patients, of which 17 were treated on the right side, 14 on the left side, and 7 bilaterally. In cases of bilateral incongruency, only the symptomatic side was treated. The statistical evaluation showed a significant reduction of pain on the VAS from 7.2 to 2 (p<0.001). No significant changes were seen in the range of motion (p=0.812). The Krimmer Wrist Score showed good to excellent results in almost 90% of cases. If the indication criteria are met, contraindications are avoided and the osteotomy is correctly performed, this technique leads to an improvement of patients' functionality and quality of life. From a preventive viewpoint, the influence on the progression of the degenerative changes is yet to be demonstrated in further studies. At any rate, this is a safe procedure, which leaves the path open for other possible options.

Noninvasive transcranial brain stimulation in central post-stroke pain: A systematic review.

The aim of this systematic review is to analyze the efficacy of noninvasive brain stimulation (NBS) in the treatment of central post-stroke pain (CPSP). We included randomized controlled trials testing the efficacy of transcranial magnetic stimulation (TMS) or transcranial direct current stimulation versus placebo or other usual therapy in patients with CPSP. Articles in English, Portuguese, Spanish, Italian, and French were included. A bibliographic search was independently conducted on June 1, 2022, by two authors, using the databases MEDLINE (PubMed), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science Core Collection. The risk of bias was assessed using the second version of the Cochrane risk of bias (RoB 2) tool and the certainty of the evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation. A total of 2,674 records were identified after removing duplicates, of which 5 eligible studies were included, involving a total of 119 patients. All five studies evaluated repetitive TMS, four of which stimulated the primary motor cortex (M1) and one stimulated the premotor/dorsolateral prefrontal cortex. Only the former one reported a significant pain reduction in the short term, while the latter one was interrupted due to a consistent lack of analgesic effect. NBS in the M1 area seems to be effective in reducing short-term pain; however, more high-quality homogeneous studies, with long-term follow-up, are required to determine the efficacy of this treatment in CSPS.

Effectiveness of the Specific Mobility Exercises on Pain Intensity and Quality of Life Among Stoma Patients: A Quasi-experimental Study.

An intestinal stoma is a surgically created artificial opening in the abdominal wall that helps the largeor small intestine end to divert the faecal matter for stoma patients with an underlying condition of inflammatory bowel disease and colorectal cancer.When a stoma is formed following surgery, one of the difficulties stoma patients confront has been identified as prolonged immobilization, which can eventually result in muscle inactivity that results due to their illness. Patients with stoma often experience an increase in pain and a decrease in quality of life. Patients can be mobilized and their muscles can be activated with the help of an early intervention calledspecific mobility exercises. The present study aimed to explore thespecific mobility exercises that reduce pain and improve quality of life among stoma patients. This quasi-experimental study involved 21 patients who underwent stoma surgery and were selected according to the inclusion and exclusion criteria. The experimental procedures were explained to all the patientsand their written informed consent was obtained. The patients performed specific mobility exercises for 30 minutes per day. Treatment was given for four weeks every day after three to four days of stoma surgery. The patient's pain and quality of life were assessed using the Numerical Pain Rating Scale and the Stoma-Quality of Life (QoL) Questionnaire andpre-test and post-test values were recorded before and after theexercises. The data were tabulated and evaluated. The findings suggest that specific mobility exercises following four weeks of intervention have a significant effect (p< 0.001) in reducing pain except inyoung adult stoma patients as they were found to be anxious and depressed, which was reflected in the findings as not statistically significant for pain on the NPRS (t(1) = 7, p > 0.001). However, it has been demonstrated that these specific mobility exercises have a significant effect (p< 0.001) in improving the quality of life among all stoma patients. The study evidenced that four weeks of specific mobility exercises in line with general medical treatment showed a significantreduction in pain and an improvement in quality of life among stoma patients. However, it should be noted that in the study, the majority of stoma patients were male and there were only a few patients with inflammatory bowel disease, which can limit the study findings. Future studies have to focus on equally distributing gender and conditions by emphasizing the importance of randomizing patients into the experimental and control groups and involving a combination of other exercises in rehabilitation for patients following stoma surgery.

Assessment of the Admission and Follow-up Characteristics of Children Diagnosed with Secondary Osteoporosis.

Secondary osteoporosis is a condition when the underlying disease or its treatment causes the bone mass to decrease and the bone structure to deteriorate, increasing the risk of fracture. The importance of diagnosis and treatment during childhood and adolescence is due to its long-term negative effects. In this study, our objectives were to determine the diagnostic findings, treatment efficacy, and follow-up characteristics of childhood with secondary osteoporosis. 61 patients diagnosed with secondary osteoporosis between January 2000 and January 2021 were included in the study. The research is a cross-sectional and descriptive study. Study participants had to be under 18 years of age when the primary underlying disease was diagnosed and received treatment for secondary osteoporosis. Patient data were collected from patient files. Patient data were obtained from patient files in hospitals and were interpreted through the IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA). 61 patients (28 women/33 men) were evaluated. The most common underlying primary diseases in patients with secondary osteoporosis were inflammatory diseases (57.7%), neuromuscular diseases (26.2%), immunodeficiency (13.1%), acute lymphoblastic leukemia (8.2%), metabolic diseases (8.2%), and solid organ transplantation. (8.2%), bone marrow transplantation (6.6%) and epilepsy (6.6%). The average chronological age when secondary osteoporosis was diagnosed was 11.89±4.88 years. They were evaluated for osteoporosis 6.39±5.13 years after the onset of the underlying primary chronic diseases. 78.7% of the patients had one or more chronic drug use. Systemic steroid use was 59%, chemotherapeutics 23%, immunomodulatory drugs 19.7%, antiepileptic drugs 8.2%, inhaled steroids 4.9%, IVIG 1.6%, and antituberculosis drugs 1.6%. Additionally, 1.6% of the patients were using testosterone as replacement, 3.3% L-Thyroxine, 1.6% estrogen, and 1.6% growth hormone. Bone pain was detected in 49.2% of the patients. All patients had vertebral fractures before treatment. Bisphosphonate treatment was given to 45 patients with secondary osteoporosis. There was a statistically significant increase in mean bone mineral density (BMD) and bone mineral content values six months after treatment, (p<0.001). There was a significant increase in BMD Z-score values for chronological and height age (p<0.001). The patients' BMD values increased on average by 31.15% with treatment. Following bisphosphonate treatment, there was a significant reduction in both fracture number and bone pain in patients (p<0.01). When patients who received and did not receive steroid treatment were compared, both groups received similar benefits from bisphosphonate treatment. Secondary osteoporosis is a condition that is influenced by many factors, such as the primary disease causing osteoporosis, chronic medication use, especially steroids. If left untreated, osteoporosis leads to important diseases such as bone pain, bone fractures, immobilization, and reduced linear growth of bone. When used to treat childhood secondary osteoporosis, Bisphosphonates significantly improve BMD and reduce fracture risk.

Effects of yoga and add on Ayurvedic Kati Basti therapy for patients with chronic low back pain: A randomized controlled trial

BackgroundChronic low back pain (CLBP) signficantly affects quality of life and productivity, leading to limitations in mobility, activity, and potential work absenteesim. Yoga and Ayurveda have shown promising evidence in reducing pain, improve function, and enhancing well-being for individuals with CLBP, as demonstrated by numerous studies. ObjectivesThe aim of this study is to assess the effect of a 1-week residential integrative approach to yoga therapy. (IAYT) alone versus when combined with Ayurveda therapy (Kati Basti) in patients with CLBP. MethodsForty patients were recruited from E-section of a holistic health center in South India for randomization and split into a Yoga and Ayurveda (n=20) and a Yoga-only (n=20) group. Yoga and Ayurveda group received a 1-week residential program combining Yoga and Ayurveda (therapy including Kati Basti with Ksheerbala Taila), while the Yoga-only group received only yoga therapy. Assessments at baseline, 1-week, and three months were measure pain intensity, disability, and depression. ResultsBoth Yoga and Ayurveda group, and Yoga-only group showed significant reductions in pain and improvements in disability and depression at 1-week and three months. Quality of life also improved, specifically in physical, social, environmental, and psychological health. No significant differences were found between the groups in terms of pain, disability, and depression. ConclusionBoth interventions demonstrated comparable results in pain reduction and disability improvement, as well as alleviating depression symptoms. Only Yoga and Ayurveda group exhibited improvement in physical health. Further research should explore long-term effects and compare different yoga interventions.

Application of Nerve Blocks in Upper and Lower Extremity Trauma Patients Presenting to the Emergency Department of a Tertiary Care Hospital: A Prospective Observational Study.

Background Pain related to trauma is often severe and undergoes undertreated in many patients. Peripheral nerve blocks provide analgesia, which is site-specific and devoid of any systemic adverse effects. Regional anesthesia may also confer several other advantages including decreased length of stay in the emergency departmentand improved comfort and safety for emergency procedures compared to conventional analgesia. This study aims to evaluate the feasibility of the application of nerve blocks in upper and lower extremity trauma patients presenting to the Emergency Department of a tertiary care hospital. Methodology We conducted a prospective observational study in the Department of Emergency Medicine (EM) at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune between 2023 and 2024. As a part of this research proposal, we intended to study the application of nerve blocks in upper and lower extremity trauma among patients presenting with upper and lower extremity trauma to the ED during the study period. After institutional Ethics Committee approval and informed written consent, 95 patients aged above 18 years presenting with upper and lower extremity trauma within 12 hours were selected. Patients under 18 years old, those with a history of coagulopathies, patients with open fractures, and pregnant patients were excluded from the study. Results The study comprised 95 participants, with diverse age groups represented. Among them, 26% were under 25 years old, 54% fell between the ages of 26 and 30, and 20% were over 30 years old. Gender distribution showed 64.2% male and 35.8% female participants. In terms of injury nature, the majority experienced injuries from motor vehicle crashes (31.5%) and domestic incidents (22.1%), followed by workplace injuries (15.8%), sports injuries (14.7%), falls from heights (7.4%), and assault (7.4%). The time required for interventions varied, with 41.1% of cases completed in five minutes or less, while in 58.9% of instances, more than five minutes were necessary. Similarly, the time taken for pain relief post-intervention was reported, with 66.3% experiencing relief within five minutes and 33.7% requiring more than five minutes. On initial presentation, the mean VAS score was 8.8 with an SD of 1.1, indicating high levels of pain. Following the block, there was a significant reduction in pain, with the mean VAS score dropping to 1.9 and an SD of 1.2. This change was statistically significant with a p-value of less than 0.001, indicating a substantial improvement in pain levels post-block administration. Regarding the duration of pain relief, a similar pattern emerged, with 77.8% reporting relief lasting three hours or less, and 22.2% experiencing relief for more than three hours. Conclusion In emergency situations, our research showed that peripheral nerve blocks are a very useful tool for treating pain from trauma to the upper and lower extremities. These blocks significantly reduce pain and have a long-lasting effect. Further research with larger, multi-center trials is needed to validate these findings and explore long-term outcomes.

Oral transmucosal fentanyl citrate as breakthrough pain relieving medication: A pilot study

ABSTRACT Background: Breakthrough pain in cancer patients is a common and distressing symptom that significantly impacts their quality of life. Traditional pain management strategies often fail to provide adequate relief. Oral transmucosal fentanyl citrate (OTFC) has emerged as a rapid-onset opioid analgesic, offering a potential solution for managing this challenging condition in home care settings. Aims: This study aims to evaluate the efficacy of OTFC in managing breakthrough pain and its effects on the quality of life in cancer patients treated at home. Materials and Methods: A pilot study was conducted with 40 cancer patients experiencing more than one episode of breakthrough pain daily. These patients were administered OTFC 400 μg for pain management. Degree of pain (NRS) and modified ‘Quality of Well-being’ (QWB) scores were analysed using data filled in by patients. Data were collected and analysed using paired t-tests to compare pre- and post-treatment scores. Results: The administration of OTFC resulted in a significant reduction in pain, as indicated by the decrease in NRS scores from 9.9 ± 0.304 to 0.5 ± 0.906 within 30 minutes (P &lt; 0.0001). Additionally, there was a marked improvement in QWB scores, which increased from 26.18 ± 2.8 to 36.3 ± 3.16 over the same period (P &lt; 0.001). Mild side effects, such as nausea, headache, and somnolence, were reported, but no serious adverse events were observed. Conclusions: We conclude that OTFC 400 μg is an effective and well-tolerated option for managing breakthrough pain in cancer patients and in improving the quality of life in home care settings.

Effectiveness of TENS and Acetaminophen for Pain Control During Orthodontic Treatment: A Comparative Study.

Orthodontic treatment often induces pain, especially post appliance placement. This study compares transcutaneous electrical nerve stimulation (TENS) and acetaminophen for orthodontic pain management. A randomized trial included 120 fixed orthodontic patients divided into three groups (n = 40): Group A received TENS, group B received acetaminophen, and group C was the control. Data were expressed as mean ± SD. Repeated ANOVA analysis compared mean values, followed by post-hoc Tukey analysis. Pain levels were assessed using a visual analog scale before any intervention and at 30 minutes, 6 hours, and 24 hours post activation. TENS and acetaminophen significantly reduced pain compared to the control. Group A (TENS) showed significant pain reduction post activation. Group B (acetaminophen) exhibited comparable pain relief, with no significant difference between groups. Both TENS and acetaminophen effectively manage orthodontic appliance activation pain.

Effect of Relaxation, Lumbopelvic Stabilization, and Strengthening on Pain, Quality of Life, and Lumbopelvic Impairments in Women With Endometriosis

Background: Endometriosis, a chronic gynecological disorder characterized by the presence of endometrial-like tissue outside the uterus, significantly impacts the quality of life and physical functioning of affected women. Conventional treatments involve pharmacological interventions and surgery, which may not always provide long-term relief and are often associated with side effects. Objective: This study aimed to evaluate the effects of relaxation, lumbopelvic stabilization, and strengthening exercises on pain, quality of life, and lumbopelvic impairments in women with endometriosis in Faisalabad, Pakistan. Methods: A quasi-experimental design was employed, involving 40 women diagnosed with endometriosis, recruited from local hospitals and fitness centers. Participants underwent a structured intervention consisting of relaxation techniques, lumbopelvic stabilization, and strengthening exercises, conducted three times per week for seven weeks. Data were collected using the Visual Analogue Scale (VAS) for pain, the Endometriosis Health Profile-30 (EHP-30) for quality of life, and specific physical performance tests for lumbopelvic impairments. Statistical analysis was performed using SPSS version 25, employing repeated measures ANOVA to assess changes from baseline to post-intervention. Results: The intervention resulted in significant reductions in pain (VAS scores decreased, p&lt;0.001), improvements in quality of life (EHP-30 scores improved in all domains, p&lt;0.001 for most domains), and enhanced lumbopelvic function (endurance test scores increased, p&lt;0.001). Conclusion: The study findings suggest that structured physical therapy interventions can significantly improve pain, quality of life, and physical functioning in women with endometriosis. These results support the inclusion of physical therapy as a viable component of comprehensive endometriosis management. Keywords: Endometriosis, Physical Therapy, Quality of Life, Pelvic Pain, Lumbopelvic Stabilization, Strengthening Exercises, Non-Pharmacological Treatment.

The Effect of Lumbopelvic Manipulation for Pain Reduction in Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Patellofemoral pain syndrome (PFPS) is one of the most common etiologies of knee pain and might be relieved with lumbopelvic manipulation (LPM). This meta-analysis aimed to investigate the effects of LPM on pain reduction in patients with PFPS. Electronic databases were searched from inception to December 2023 for randomized controlled trials (RCTs) investigating the effects of LPM on PFPS. The primary outcome was the change in visual analog or numeric rating scale scores assessing pain. Ten studies comprising 346 participants were included. Significant pain reduction was noted in the LPM group (Hedges' g = -0.706, 95% confidence interval [CI] = -1.197 to -0.214, p = 0.005, I2 = 79.624%) compared with the control group. Moreover, pain relief was more pronounced when LPM was combined with other physical therapies (Hedges' g = -0.701, 95% CI = -1.386 to -0.017, p = 0.045, I2 = 73.537%). No adverse events were reported during the LPM. The LPM appears to be a safe and effective adjuvant therapy for pain reduction in patients with PFPS. Clinicians should consider adding LPM to other physical therapies (e.g., quadriceps muscle strengthening) during the management of these patients.

The effectiveness of core stabilization and schroth exercise on pain reduction in adolescents with scoliosis

Background: Disorders of the spine, such as scoliosis, kyposis, and lordosis, are often complained about by many people. Currently, disorders of the spine are not only limited to adults and the elderly. They can also affect children and adolescents, where the prevalence of adolescent idiopathic scoliosis in the world ranges from 0.47% to 5.2%. The spine has a crucial role in human movement activities, playing a role as a support and enforcer of the body. In this regard, appropriate intervention for people with scoliosis is very important to be carried out. Objective: To find out how effective core stabilization and schroth exercise are at reducing pain in scoliosis in adolescents aged 13-15 years. Research Method: The type of research used is quasi-experimental research with a pre-test and post test two-group design. Results: After 4 weeks of intervention with a frequency of two times a week, there was a significant reduction in scoliosis pain in adolescents. Both models of exercise core stabilization and schroth exercise – are equally effective. Suggestion: The researcher is expected to expand this research by increasing the number of samples and extending the duration of the study.

Fucoidan as a Promising Drug for Pain Treatment: Systematic Review and Meta-Analysis.

Fucoidan is a polymer of L-fucose and L-fucose-4-sulphate naturally found in marine sources that inhibits p-selectin, preventing neutrophil recruitment to the site of injury. Fucoidan is employed in many studies as a tool to investigate the contribution of neutrophils to pain, showing analgesic effects. We performed a systematic review and meta-analysis to quantify the analgesic effects of pretreatment with fucoidan reported in the available preclinical studies. In addition, we summarized the articles which have studied the therapeutic effects of fucoidan in pathological pain at preclinical and clinical levels. The results of this systematic review reveal that pretreatment with fucoidan is a powerful tool which reduces neutrophil infiltration by 70-90% at early time points. This meta-analysis showed that preventative treatment with fucoidan produced a significant pain reduction. In addition, several preclinical studies have observed that fucoidan treatment reduces the pain that is associated with various pathologies. Finally, fucoidan has also been tested in several clinical trials, with some degree of analgesic efficacy, but they were mostly small pilot studies. Considering all the above information, it can be concluded that fucoidan is not only a preclinical tool for studying the role of neutrophils in pain but also a promising therapeutic strategy for pain treatment.

Robotic-assisted versus conventional laparoscopic management of deep endometriosis involving the sacral plexus and sciatic nerve: A comparative before and after study.

To compare robotic-assisted laparoscopy (RAL) and laparoscopy (LPS) for intraoperative and postoperative outcomes, and functional results after a 6-month follow-up period among patients having undergone excision of deep endometriosis (DE) involving the sacral plexus (SP) and sciatic nerve (SN). A retrospective analysis of 100 patients included in our prospective database, who underwent surgical eradication of DE involving the SP and SN at our tertiary referral centre between September 2018 and June 2023. Patients were managed by LPS (n = 71) until 2021, and subsequently by RAL (n = 29). Baseline symptoms and distribution of DE lesions were comparable in the two groups. Nerve dissection, nerve shaving, and intra-nerve dissection were performed in 55 (77.5%), 14 (19.7%), and 2 (5.6%) patients in the LPS group, respectively. Nerve dissection and nerve shaving were performed and in 24 (82.8%) and 5 (17.2%) patients in the RAL group, while no cases of intra-nerve dissection were observed (P = 0.434). Mean operative times were 183.71 ± 85.32 min and 177.41 ± 77.19 min, respectively (P = 0.734). There were no reported cases of conversion to open surgery. Intraoperative and early postoperative complications were comparable between the two groups. At 6 months follow up, we observed a significant reduction in sciatic pain in both the LPS group (39.1% vs 15.6%, P < 0.001) and RAL group (37.5% vs 25%, P = 0.001), with no differences in terms of outcomes (P = 0.1). Both LPS and RAL result in significant long-term relief of symptoms associated with SP and SN endometriosis. Although surgeons found that RAL improved the quality of excision of these specific DE localizations, our study did not reveal significant advantages in terms of its outcomes.

MAMSAGATA VATA W.R.T MYALGIA/IDIOPATHIC MUSCULOSKELETAL PAIN IN CHILDREN: A CASE STUDY

Introduction: A 13-year-old male patient reported to the Outpatient Department (OPD) of Kaumarabhrithya at Shree Swaminarayan Ayurvedic College and Hospital with complaints of diffused (un-localized) severe muscle pain, slurred speech and sleeplessness from the past one year. Another associated complaint was the inability to pronounce the word ‘r’. The main complaint, though, was the muscular pain throughout the body. Though the patient was previously diagnosed and treated for pain as per the conventional science/medical hospitals, the pa-tient and his parents did not have the records. They were unable to recall the names of the medicines prescribed. At Swaminarayan Ayurvedic Hospital, he was diagnosed with Mamsagata Vata and treated with a combination of internal medications and Panchakarma procedures. Methods- The patient was treated with internal medica-tions Brahmi vati Swarnauyukta (250 mg/BD), Brahmi Gritha (5 ml/BD) and Dashamularishta (10 ml with 20 ml water/BD); Panchakarma therapies of Sarvanga Abhyanga (full body therapeutic massage therapy), Sarvanga Swedana (full body fomentation therapy) and Matra Basti (therapeutic enema with medicated oil with low quan-tity) for seven days. The primary objective was to treat Mamsagata Vata and associated symptoms with Snehana, Vatagna dravyas and Medhya rasayana. Results- The patient was treated with internal medications and Panchakarma therapies for seven days. There was a significant reduction in muscular pain and an improve-ment in sleep. No adverse effects were reported. This case study elucidates Snehana's (Matra Basti) efficacy in managing Mamsagata Vata. Discussion- The clinical data from this study suggests that Ayurvedic treatment in managing Mamsagata Vata w.r.t Myalgia/Idiopathic musculoskeletal pain in Children can provide effective re-sults.

Multimodality Treatment of Trigeminal Neuralgia: An Institutional Experience.

Object Trigeminal neuralgia (TN) consists of excruciating paroxysmal pain, which lasts for seconds to minutes, in the distribution of fifth cranial nerve. TN is not life-threatening, but life became miserable because of high intensity of pain. This study aimed to assess the overall success rates of different treatments, considering pain relief, recurrence rates, and potential side effects. Material and Methods A total of 203 patients of TN treated in the period of last 10 years, that is, 2013 to 2022, were included. Medial management was in 103, radiofrequency ablation in 17, neurectomy in 9, tumor excision in 6, and microvascular decompression (MVD) was done in 68 patients. Magnetic resonance imaging brain with fast imaging employing steady-state acquisition was the basic investigation to decide the etiology of disease. Results Preliminary findings from our institutional experience indicate that a multidisciplinary approach, combining medical, surgical, and noninvasive treatments, yielded the most favorable results in managing TN. The majority of patients achieved significant pain reduction and improved quality of life with these selected therapies. However, certain subgroups of patients exhibited a higher propensity for treatment resistance, necessitating further investigation into personalized treatment strategies. Conclusion Our study concludes that there is no definitive treatment modality (either medical or surgical) available for patients with TN. As the etiology of TN is varied, management of TN also varied, that is, multidisciplinary approach. Every type of treatment has pros and cons but when the cause of TN is vascular compression and patient's general condition permits for surgery, in such cases MVD should be preferred over the ablative procedures.

Coccygectomy for refractory coccydynia, old-fashioned but effective procedure: A retrospective analysis.

Coccydynia, characterized by persistent pain in the coccygeal region, significantly impacts patients' quality of life. While various treatment modalities exist, including conservative measures and surgical interventions like coccygectomy, optimal management remains unclear. This retrospective cohort study aimed to compare the clinical outcomes, functional improvements, and quality of life in patients with chronic coccydynia undergoing either infiltrative treatment or coccygectomy. Data from patients treated at our institution from January 2018 to December 2022 were analyzed. Participants meeting inclusion criteria were divided into two groups: Group A underwent coccygectomy, while Group B received conservative therapy. Clinical assessments, radiographic evaluations, and patient-reported outcomes were collected preoperatively and at follow-up intervals. Of the 223 initially examined patients, 55 met inclusion criteria. Group A (n = 21) underwent coccygectomy, while Group B (n = 34) received conservative therapy. Both groups showed significant pain reduction post-intervention, with sustained improvement in Group A. Functional outcomes favoured Group A, with significant improvements in disability and quality of life measures. Complications were minimal, with only one case of superficial wound infection in Group A. Our findings suggest that coccygectomy provides superior and lasting pain relief, functional improvement, and quality of life improvement compared to conservative therapy. While complications were minimal, further research with larger cohorts is warranted to validate these results and explore long-term outcomes. Despite its historical association with complications, advancements in surgical techniques and perioperative care have led to improved outcomes and reduced complication rates. Thus, coccygectomy should be considered in the treatment algorithm for patients with debilitating coccydynia.

Donor site wound healing following free gingival graft surgery using platelet rich fibrin: A randomized controlled trial.

The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated. Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group. NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4weeks) between groups. CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.