Signs Pain Scale Research Articles

PASHTO TRANSLATION, VALIDITY AND RELIABILITY OF LEEDS ASSESSMENT OF NEUROPATHIC SYMPTOMS AND SIGNS (LANSS) IN SPINAL CORD INJURY PATIENTS

Objective: The aim pf this study was to translate to translate English version of Leeds assessment of Neuropathic symptoms and signs (LANSS) pain scale into Pashto language and to determine the validity and reliability of Pashto version of LANSS pain scale in spinal cord injury patients. Material & Methods: LANSS was translated from original language into Pashto and then back translated to English. It was reviewed by ten physical therapy experts for face and content validity. The scores of the Pashto version of the LANSS were studied in a sample of 113 spinal cord injury patients having pain from Pashto speaking region, Khyber Pakhtunkhwa, Pakistan. Comparison between Pashto LANSS and DN4 Questionnaire score was done to check for concurrent validity. Intra-class correlation coefficient, Cohen’s kappa agreement and internal consistency were estimated to check the reliability of Pashto version of LANSS. Results: For a p-value of <0.01, the overall mean score of Pashto-LANSS was higher in patients suffering from neuropathic pain. The ICC score for Pashto-LANSS was 0.76, kappa value 0.76 and Cronbach’s alpha 0.83 indicating significant scores. The results of Pearson’s correlation showed significant correlation between Pashto-LANSS and DN4. Conclusion: Pashto LANSS is a reliable and valid tool to identify neuropathic pain in SCI patients. Pashto version of LANSS can be used in differentiating neuropathic pain from nociceptive pain in people with spinal cord injury (SCI). Key terms: LANSS, Neuropathic pain, DN4 Questionnaire, Spinal cord injury, Pashto version of LANSS (Pashto-LANSS).

Effect of 5% lidocaine-medicated plaster in preventing chronic postsurgical pain after knee replacement: protocol for a randomized double-blind placebo-controlled trial.

With an aging population, knee arthroplasty is increasingly common; however, chronic postsurgical pain (CPSP) affects up to 30% of patients. This study aims to evaluate the efficacy of 5% lidocaine-medicated plaster (LP5) in preventing CPSP among patients undergoing knee arthroplasty. This is a dual-center, randomized, double-blind, placebo-controlled trial involving 128 adult patients scheduled for knee arthroplasty. Participants will be randomly assigned, stratified by center, to either the LP5 group or the placebo group (n = 64 per group). The LP5 or placebo group will apply the patch 1day before surgery and on postoperative days 1-3, with multimodal analgesia administered postoperatively. Multimodal analgesia will include intraoperative flurbiprofen axetil and postoperative patient-controlled sufentanil. The primary outcome is the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3 months postoperatively. Secondary outcomes will include WOMAC stiffness, function, and total scales; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale; 36-Item Short Form Health Survey (SF-36); postoperative pain scores; Visual Analog Scale (VAS) sleep scores; postoperative sufentanil consumption; need for rescue analgesia; length of Post-Anesthesia Care Unit (PACU) stay; length of hospital stay; and 90-day mortality. Safety outcomes will include assessments of hypotension, hypertension, bradycardia, tachycardia, arrhythmia, interventions for haemodynamic events, headache, dizziness, nausea, vomiting, local skin allergy, wound infection, and toxic reaction. Data will be analyzed following a modified intention-to-treat approach. This study aims to provide high-quality evidence for the efficacy and safety of LP5 in preventing CPSP in patients undergoing knee arthroplasty.

An analysis of neuropathic pain, vasomotor manifestations, and sympathetic skin reactions in post-COVID-19 patients relative to healthy individuals.

This study aims to assess the incidence of neuropathic pain, vasomotor symptoms, and sympathetic skin responses (SSR) in patients who have recovered from COVID-19 infection and contrast these findings with healthy controls. The study encompassed 56 post-COVID-19 patients and 40 healthy controls (group 1: post-COVID-19 patients, and group 2: healthy controls). The presence of autonomic dysfunction symptoms (ADS) and orthostatic hypotension following COVID-19 infection was documented in group 1. Concurrently, fatigue and forgetfulness levels were appraised using the numerical rating scale, and the leeds assessment of neuropathic symptoms and signs pain scale was deployed to probe for the incidence of neuropathic pain among participants. SSR of all participants was conducted bilaterally from median and tibial nerves using an electroneuromyographic device. Among post-COVID-19 patients, neuropathic pain was observed in 17.9% of cases. There were no notable variations in the initiation and magnitude of bilateral median and tibial nerve SSR across the 2 groups. Significant discrepancies were observed in ADS scores between groups 1 and 2 (P = .001). Furthermore, a positive correlation was established between the latencies of the left median nerve SSR and ADS scores (R = 0.339, P = .014). The SSR patterns were congruous between healthy individuals and post-COVID-19 patients. However, a higher prevalence of autonomic dysfunction symptoms and correlations among SSR, autonomic dysfunction scores, fatigue, and forgetfulness levels were identified among post-COVID-19 patients.

Phase III, international, multicentre, double-blind, dose increment, parallel-arm, randomised controlled trial of duloxetine versus pregabalin for opioid-unresponsive neuropathic cancer pain.

TPS12146 Background: Management of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy has already been confirmed in two randomised controlled trials (RCTs) compared with placebo. Duloxetine offers the potential of analgesia in opioid refractory NCP. However, there are no RCT of duloxetine for the management of opioid-refractory NCP as a first line treatment. Both classes of drugs have the potential to reduce NCP, but there has been no head-to-head comparison for the efficacy and safety, especially given differing side effect profiles. Methods: An international, multicentre, double-blind, dose increment, parallel-arm, RCT. Eligibility criteria include: adult cancer patients experiencing NCP refractory to opioids; Brief Pain Inventory (BPI)-item 3 (worst pain) ≥4; Neuropathic Pain on the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale ≥12 despite of an adequate trial of regular opioid medication (≥60mg/day oral morphine equivalent dose). The study will recruit inpatients and outpatients in Japan and Australia. Participants will be randomised (1:1 allocation ratio) to duloxetine or pregabalin. Dose escalation is to day 14 and from day 14 to 21 is a dose de-escalation period to avoid withdrawal effects. Dose escalation schedule in each-arm is shown in Table 1. The primary endpoint is the mean difference in BPI item 3 over the previous 24 hours on day 14 between groups. Null hypothesis is there is no difference in BPI item 3 in the previous 24 hours on day 14 between both groups for patients with opioid refractory NCP. Comparison of the BPI item 3 on day 14 between duloxetine groups and pregabalin groups will be conducted using a two-sided Student’s t-test at a significance level of 5% according to the intention-to-treat principle. Point estimates and 95% CIs for the difference between two groups will be calculated. A sample size of 160 participants is required with 67 subjects enrolled to date. The DSMC last reviewed the trial in December 2022 and case accumulation expected to be completed by the end of 2024. Table 1：Dose escalation schedule in each-arm. Duloxetine Arm Stage 1 (Day 1-3): Duloxetine (30 mg) 1 capsule (morning) and Placebo 1 capsule (bedtime) Stage 2 (Day 4-7): Same as Stage 1 Stage 3 (Day 8-14): Duloxetine (30 mg) 1 capsule twice a day (morning and bedtime). Pregabalin Arm Stage 1 (Day 1-3): Pregabalin (25 mg) 1 capsule twice a day (morning and bedtime). Stage 2 (Day 4-7): Pregabalin (75 mg) 1 capsule twice a day (morning and bedtime). Stage 3 (Day 8-14): Pregabalin (75 mg) 2 capsules (150 mg) twice a day (morning and bedtime). Clinical trial information: ACTRN12620000656932 , jRCTs051190087.

Can chronic spontaneous urticaria produce symptoms of neuropathic pain?

BackgroundChronic spontaneous urticaria (CSU) is a condition that is associated with recurrent pruritic hives and/or angioedema lasting for more than 6 weeks and is known to affect 1% of the population. Neuropathic pain can be defined as abnormal pain in the peripheral or central nervous system following injury and results from dysfunctions in the peripheral or central nervous system without peripheral nociceptor stimulation. Histamine appears in the pathogenesis of both the CSU and diseases of the neuropathic pain spectrum. ObjectiveTo evaluate the symptoms of neuropathic pain in patients with CSU using scales. MethodFifty-one patients with CSU and 47 sex- and age-matched healthy controls were included in the study. ResultsThe results of the short-form McGill Pain Questionnaire revealed the scores in the sensory and affective domains, Visual Analogue Scale (VAS) scores and pain indices to be significantly higher in the patient group (p < 0.05 for all cases), while the overall pain assessment and sensory assessment based on the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale were also significantly higher in the patient group. Based on the assumption that scores of > 12 indicated neuropathy, 27 (53%) of the patients in the patient group and 8 (17%) in the control group were found to have neuropathy (p < 0.05). Study limitationsCross-sectional study, small patient sample and use of self-reported scales. ConclusionIn addition to itching, patients with CSU should be aware of the potential for the association of neuropathic pain. In this chronic disease that is known to affect the quality of life, using an integrated approach with the patients and identifying accompanying problems are as important as treating the dermatological disorder.

Is Cerebrolysin effective in reducing symptoms of Diabetic Peripheral Neuropathy?

Aim This is an investigator initiated observational comparative medical program, to test the efficacy of Cerebrolysin® intake for 1 month versus 2 months, in patients clinically diagnosed with type 2 diabetes mellitus (T2DM) and suffering from peripheral neuropathy. Methods Patients aged ≥ 18 years old, clinically diagnosed with mild or moderate painful diabetic polyneuropathy, received Cerebrolysin® for 1 or 2 months according to investigators’ decision. Demographic data, detailed medical history, and laboratory results were collected at baseline. All enrolled patients were evaluated for Toronto Clinical Scoring System (TCSS), Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline and end of the program (1 month/2 month). Results VAS, TCSS, and LANSS were significantly improved for all 136 enrolled patients at the end of their treatment with Cerebrolysin® for 1 or 2 months, regarding gender, duration since diagnosis of T2DM (more than or less than 10 years) and HbA1c ≤ 9% or ˃ 9%, with a very highly statistically significant difference (p-value ˂ 0.001). They were slightly improved more in patients received Cerebrolysin® for 1 month more than for 2 months. There was no statistically significant difference for gender, duration of diagnosis with diabetes mellitus less or more than 10 years, and HbA1c ≤ 9% &amp; ˃ 9% regarding the change of VAS, TCSS, and LANSS as dependent variables, using Linear stepwise regression. While there was noticed improvement in VAS, TCSS, and LANSS with use of Cerebrolysin® for 1 month more than 2 months, Regression Coefficient (B (95% of Confidence interval)) B=0.794 (0.29-1.29), B=1.472 (0.87-2.074), B=2.143 (0.45-3.83) and p-value = 0.002, p-value ˂ 0.001, p-value = 0.13 respectively. There was no adverse event (AE) or serious adverse event (SAE) reported during the program. Conclusion: Cerebrolysin® is considered effective in the management of peripheral neuropathy in patients with T2DM Abbreviations: Adverse Event (AE), Advanced Glycation End products (AGE), Contract Research Organization (CRO), Diabetic Peripheral Neuropathy (DPN), Diacylglycerol (DAG), estimated Glomerular Filtration (eGFR), Fasting Blood Sugar (FBS), Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS), Peripheral Vascular Disease (PVD), Pin- Prick Threshold (PPT), Protein Kinase C (PKC), Statistical Analysis Plan (SAP), Serious Adverse Event (SAE), Standard Deviation (SD), Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), Toronto Clinical Scoring System (TCSS), Traumatic Brain Injury (TBI), Visual Analogue Scale (VAS).

The assessment of neuropathic pain in patients with prediabetes

AimsNeuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes. MethodsOne hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity. ResultsTwenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001). ConclusionsNeuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.

Characterization of neuropathic component of back pain in patients with osteoporotic vertebral fractures.

BACKGROUND:Osteoporotic vertebral fractures (OVFs) are often followed by chronic back pain which may have a nociceptive, neuropathic, or mixed component. However, literature on this topic is lacking.OBJECTIVE:The objective of this cross-sectional study is to characterize the neuropathic component of chronic back pain in patients with OVFs.METHODS:Spine fractures were detected by morphometric examination. Pain severity and its impact on activities of daily living (ADL) were evaluated through the Brief Pain Inventory (BPI). Neuropathic pain was investigated through the Italian versions of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS) and the painDETECT questionnaire (PD-Q).RESULTS:We included 72 patients, mainly women (88.8%), with mean age of 69.2 years. The 70.8% of patients had multiple OVFs, of which 47% located at the thoracic spine, 43.1% at the thoracic and at lumbar spine, and 9.8% at the lumbar spine. The BPI showed moderate back pain in 23.6% of cases and severe in 8.3% of cases, with high interference with ADL in 38.9% of patients. The PD-Q revealed the presence of neuropathic pain in 5.5% of cases, while the LANSS in 23.6% of cases.CONCLUSIONS:In our study, the prevalence of neuropathic component of chronic back pain ranged from 5.5% to 23.6%, according to PD-Q and LANSS respectively, in patients with OVFs. Further studies should investigate if the characterization of chronic back pain might contribute to appropriateness of interventions for this population.

Neuropathic pain prevalence and risk factors in head and neck cancer survivors.

Neuropathic pain (NP) is a debilitating symptom among head and neck cancer (HNC) survivors although few large studies report its prevalence and associated risk factors. A cross-sectional survey assessing demographic, behavioral, and clinical risk factors for NP. NP was assessed using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). Forty-five percent (227/505) reported having pain including 13.7% (69/505) who were positive for S-LANSS. Reported pain sites were in the regions of the head and oral cavity (46.2%) and neck and throat (41.5%). Despite a higher self-reported use of analgesic medication (NP+=41.2%; NP-=27.4%; p=0.020) and alternative pain therapies (NP+=19.1%; NP-=8.4%; p=0.009), severe pain was more prevalent among those with NP (N+=23.2%; NP-=13.3%; p=0.004). Adjusted for opioid medications, ethnicity/race, age, surgery, depression, and comorbidities were risk factors for NP. NP remains prevalent in HNC survivors highlighting the importance of routine pain surveillance.

Effects of Thoracic Paravertebral Block on Postoperative Anxiety and Depression for Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery.

This study is aimed at investigating the effect of thoracic paravertebral block (TPVB) on the occurrence of chronic postoperative pain, postoperative anxiety, and depression in patients undergoing thoracoscopic radical lung cancer surgery. A total of 120 patients who underwent thoracoscopic radical lung cancer surgery in our hospital from June 2019 to March 2021 were included. There were 62 males and 58 females, with an age of 18-75 years old and a body mass index of 20-28 kg/m2. Patients were divided into two groups using the random number table method, TPVB group (n = 60) and normal saline group (control group, n = 60). Two-point nerve block was performed at T5-6 and T6-7 levels. Patients in the TPVB group received nerve block with 15 mL of 0.375% ropivacaine hydrochloride, while those in the control group received 5 mL of 0.9% normal saline. The numeric rating scale (NRS) scores at rest and during movement at 24 and 48 hours after surgery and the number of times the button on the patient-controlled analgesia pressed at 24 h after surgery in two groups were recorded. All patients were followed up by outpatient visits or phone visits at 1 year after surgery and assessed using Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and Hospital Anxiety and Depression Scale (HADS). According to the inclusion, exclusion, and drop-out criteria, 108 patients were finally included, with 52 patients in the TPVB group and 56 patients in the control group. There was no statistically significant difference between the two groups in terms of age, sex, height, body weight, body mass index, ASA classification, and operation time (P > 0.05). NRS pain scores at 24 h (P = 0.0108) and 48 h (P = 0.0000) after surgery, the number of times pressing patient-controlled analgesia at 24 h after surgery (P = 0.0000), the LANSS scores (P = 0.0000), HADS anxiety score (P = 0.0000), and depression scores (P = 0.0000) at 1 year after surgery in the TPVB group were both significantly lower than those in the control group. To sum up, ultrasound-guided TPVB can effectively relieve pain at 48 hours after thoracoscopic lung cancer radical surgery and chronic postoperative pain at 6 months after V thoracoscopic lung cancer radical surgery.

Evaluation of pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in fibromyalgia patients.

BackgroundPsychological stressors may cause mental disorders such as anxiety, depression, and post-traumatic stress disorders and fibromyalgia (FM) patients could be affected by these stressors.AimTo evaluate pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in patients with FM.MethodsAccording to the 2016 American College of Rheumatology (ACR) criteria, fifty-seven patients with FM alone and 77 patients with FM and recovering from COVID-19 infection were recruited to the study (group 1: patients with FM alone and group 2: patients with FM and recovering from COVID-19). Demographic and clinical characteristics were recorded. The pain level was determined by the Numerical Rating Scale (NRS), the pain regions by the Widespread Pain Index (WPI) of the 2016 ACR criteria, the severity of the symptoms by the Symptom Severity Scale (SSS) of the 2016 ACR criteria, the disease activity by the Fibromyalgia Impact Questionnaire (FIQ), the anxiety and depression levels by the Hospital Anxiety and Depression Scale (HADS), and the neuropathic pain level by Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS).ResultsAge, height, weight, Body Mass Index (BMI), and the duration of FM diagnosis were similar in both groups (p > 0.05). NRS, FIQ, HADS depression scale, and SSS and LANSS scores were similar between group 1 and group 2 (p > 0.05). HADS anxiety score and WPI were significantly increased in group 2 (p = 0.026 and p = 0.024 respectively).ConclusionsAnxiety and widespread pain levels were higher in patients with FM and recovering from COVID-19 infection.

Evaluation of central neuropathic pain and its relationship with quality of life in patients with stroke: a cross-sectional study

Objectives: In addition to other complications in stroke patients, central post-stroke pain (CPSP) is sometimes overlooked. Considering the morbidities it causes in patients, it turns out to be a very important problem. The aim of this study is to investigate the frequency of CPSP, the factors causing CPSP, and the relationship between the CPSP and the quality of life and ambulation of individuals. Methods: A cross-sectional study was conducted on a group of patients with stroke. One hundred forty stroke patients were included in the study. Pain (The Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale), health-related quality of life (Short Form 36 Questionnaire) and ambulation (Functional Ambulation Classification) were evaluated. In addition, a special evaluation form was created for this study. With this form, demographic characteristics of the patients, stroke type, cerebral location and hemisphere affected in stroke were recorded. These data were collected for the period between May 2016 and January 2018. Patients were divided into two groups. Group 1 included patients with CPSP and Group 2 patients without neuropathic symptoms. Results: CPSP was detected in 23 of 140 patients. In terms of demographic data, only gender differences were found between group 1 and group 2. CPSP was statistically significantly higher in female patients. There was no significant difference between the two groups in terms of the affected cerebral region and stroke type, but CPSP was significantly more common in patients with left hemispheric involvement. Emotional role restriction, body pain, social funtion, general health and mental health subcategories of the SF-36 were found to be significantly lower in group 1 compared to group 2. Also ambulation was worse in patients with CPSP. Conclusions: It was concluded that CPSP is a common problem and negatively affects the quality of life of the patients. Therefore, CPSP should be recognized in the early period after stroke and treatments should be arranged accordingly.

Comparison of Clinical Symptoms and Neurophysiological Findings in Patients With Chemotherapy Induced Peripheral Neuropathy.

IntroductionTaxanes are associated with a distal sensory neuropathy, significantly affecting cancer survivor quality of life. However, chemotherapy-induced peripheral neuropathy (CIPN) assessments are primarily based on clinical symptoms rather than objective neurophysiologic findings. Therefore, we investigated neurophysiologic changes in symptomatic subjects, comparing them with symptom severity.Materials and MethodsMedical charts of 111 subjects who were referred for CIPN diagnosis after chemotherapy for breast or ovarian cancer between May 1, 2016, and December 31, 2019, were retrospectively reviewed. Demographics, anthropometric parameters, and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale data were collected. The nerve conduction study (NCS) results, including sensory nerve action potentials recorded from sural nerves, were analyzed relative to clinical symptoms. To optimize follow-up (FU) NCS diagnostic sensitivity, relative references of FU sural amplitude reductions to >30% and an absolute reference <10 μV were used.ResultsEighty-eight female patients met the criteria, and 20 underwent FU NCS. Baseline and FU sural amplitudes showed significant positive correlation with respective LANSS scores (p < 0.01). FU sural amplitude was significantly lower than the initial result (p < 0.05). The FU LANSS score was not different from the initial score. Initial NCS sensitivity and specificity for clinically suspected CIPN diagnoses with LANSS were 69.7 and 47.3%, respectively. All 20 subjects with FU evaluation were clinically compatible with CIPN (LANSS >12) at initial and FU assessments. Among them, only six (30.0%) had abnormal sural amplitudes (<10μV for ≤50 s, <3 μV for 60 s, <1 μV for 70 s) in the initial NCS. In the FU NCS, sural amplitude became abnormal in five additional subjects. Between the initial and FU NCS, sural amplitude was reduced by > 30% in eight subjects (40.0%). NCS sensitivity increased to 65.0% when including either abnormal sural amplitudes or a > 30% reduction in sural amplitude in FU studies.ConclusionsAlthough clinical symptoms and NCS results were positively correlated, a single NCS point had limited value for suspected CIPN electrophysiological diagnoses. Serial NCS during chemotherapy might help assess the degree of chemotherapy-induced nerve damage, attain evidence of CIPN prior to symptom aggravation, and monitor the progression of CIPN. Further study is needed to find specific relative references for variable patient factors to increase the sensitivity of electrophysiological studies of clinically suspected CIPN.

Laparoscopic versus robotic inguinal hernia repair: 1- and 2-year outcomes from the RIVAL trial.

Robotic inguinal hernia repair is growing in popularity among general surgeons despite little high-quality evidence supporting short- or long-term advantages over traditional laparoscopic inguinal hernia repair. The original RIVAL trial showed increased operative time, cost, and surgeon frustration for the robotic approach without advantages over laparoscopy. Here we report the 1- and 2-year outcomes of the trial. This is a multi-center, patient-blinded, randomized clinical study conducted at six sites from 2016 to 2019, comparing laparoscopic versus robotic transabdominal preperitoneal (TAPP) inguinal hernia repair with follow-up at 1 and 2years. Outcomes include pain (visual analog scale), neuropathic pain (Leeds assessment of neuropathic symptoms and signs pain scale), wound morbidity, composite hernia recurrence (patient-reported and clinical exam), health-related quality of life (36-item short-form health survey), and physical activity (physical activity assessment tool). Early trial participation included 102 patients; 83 (81%) completed 1-year follow-up (45 laparoscopic vs. 38 robotic) and 77 (75%) completed 2-year follow-up (43 laparoscopic vs. 34 robotic). At 1 and 2years, pain was similar for both groups. No patients in either treatment arm experienced neuropathic pain. Health-related quality of life and physical activity were similar for both groups at 1 and 2years. No long-term wound morbidity was seen for either repair type. At 2years, there was no difference in hernia recurrence (1 laparoscopic vs. 1 robotic; P = 1.0). Laparoscopic and robotic inguinal hernia repairs have similar long-term outcomes when performed by surgeons with experience in minimally invasive inguinal hernia repairs.

Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study.

Objectives This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS). Patients and methods Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3±11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups and evaluated. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing. Results The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001). Conclusion This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.

The association of Type D personality with functional outcomes, quality of life and neuropathic pain in persons with spinal cord injury.

Cross-sectional study. This study aimed to investigate the association of Type D personality (TDP) with functional outcomes, health-related quality of life (HRQoL) and neuropathic pain in persons with spinal cord injury (SCI), using dichotomous and continuous analysis methods. Tertiary rehabilitation center. This study included 105 persons with SCI. Independence level was determined using the Functional Independence Measure (FIM)-motor subscale. The Short Form-36 questionnaire (SF-36) was used to assess HRQoL. TDP (combined existence of negative affectivity and social inhibition) was assessed using Type D Scale-14 (DS-14). Presence of chronic pain was questioned and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale was used to distinguish neuropathic pain from others. In dichotomous method, the FIM-motor score was significantly lower in persons with TDP (41 persons, 39%) (p = 0.025). Persons with TDP had significantly lower scores in vitality, emotional role and mental health. There was no significant difference between the groups, regarding neuropathic pain and LANSS scores (p > 0.05 for all). Negative affectivity and total DS-14 scores had negative correlation with mental health and vitality. In continuous interaction method, TDP predicted mainly the mental health components of SF-36 (particularly, vitality and mental health). Negative affectivity was the driving factor. TDP was not associated with FIM-motor, VAS pain or LANSS scores. Mental component of HRQoL is associated with Type D in persons with SCI in both analyses. Assessment of potential differences related with TDP may be beneficial to develop and apply person-specific goals in SCI rehabilitation.

The Effect of Supportive Educational Intervention on Perceived Stress and Severity of Chemotherapy-Related Neuropathy in Breast Cancer Patients

Background: The nature of breast cancer (BC) and its treatment is such that it leads to physical and psychological complications. Objectives: The present study aimed to determine the effect of supportive educational intervention on the perceived stress and severity of chemotherapy-related neuropathy in BC patients. Methods: This quasi-experimental study was carried out on 60 women suffering from BC in Zahedan, Iran, in 2020. The patients were selected using the convenience sampling method and randomly assigned into two groups of intervention and control. The patients in the intervention group received four 45-minute sessions about the common problems of BC on a weekly and individual basis. The control group received only routine ward care. Data collection tools were the Perceived Stress Scale (PSS) developed by Cohen and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. Data were collected before the intervention and six weeks after the intervention. Data analysis was performed using SPSS 22 software. Results: The results of independent t-test showed that the mean and standard deviation of perceived stress score in the intervention group decreased from 56.8 ± 5.92 to 50.36 ± 3.89 (P &lt; 0.001), and in the control group decreased from 55.6 ± 3.65 to 54.8 ± 3.53 (P = 0.258). The mean and standard deviation of neuropathy severity score in the intervention group decreased from 12.90 ± 1.66 to 8.43 ± 2.16 (P &lt; 0.001), and in the control group increased from 12.56 ± 2.28 to 13.03 ± 1.93 (P = 0.276). The independent t-test showed that after implementing the supportive educational intervention, there was a significant difference between the two groups in terms of mean and standard deviation of neuropathy severity score (P &lt; 0.001). Conclusions: According to our results, supportive educational intervention reduced the perceived stress and severity of neuropathy. Thus, it is necessary to include these supportive interventions in educational and care programs to improve patients’ psychological status and reduce stress and neuropathy.

Phase III, international, multicentre, double-blind, dose increment, parallel-arm, randomised controlled trial of duloxetine versus pregabalin for opioid-unresponsive neuropathic cancer pain: a JORTC-PAL16 trial protocol

IntroductionManagement of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy (CIPN) has already been confirmed in...

Evaluation of Knowledge and Attitudes About The Traditional and Complementary Medicine Practices of the Patients with Neuropatic Pain Who Applied to the Physıcal Medicine and Rehabilitation Clinic

Objective: To evaluate the frequency of traditional and complementary medicine (TCM) use, the variety of applications, the sociodemographic and clinical characteristics of patients with neuropathic pain, and their knowledge and attitudes about TCM practices.Material and Methods: A total of 250 patients with neuropathic pain were included in this, cross-sectional study. The patients were divided into two groups: medication only (group 1, n=119) and medication with TCM practices (group 2, n=131). Questionnaires were completed by the patients in face-to-face interviews by a blinded physician.Results: The mean age of the patients in group 2 (50.68±16.39) was found to be higher than in group 1 (p=0.043). In terms of chronic diseases, hypertension, cardiovascular diseases, and other diseases were found to be more common in group 2 than in group 1 (p&amp;lt;0.05). The number of patients with duration of neuropathic pain more than 5 years, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and the Neuropathic Pain 4 (DN4) scale scores were found to be higher in group 2 than in group 1 (p&amp;lt;0.05). At least one TCM is known by %78.6 of group 2 and 61.3% of group 1 (p=0.003). The three most commonly used TCM practice in group 2 were wet cupping/cupping therapy (24%), leeches (22.8%), and acupuncture (11.6%).Conclusion: It was determined that the mean age of patients who used medication with TCM practices together for the treatment of neuropathic pain was higher, neuropathic pain severity was higher, and neuropathic pain duration was longer than patients who used medication only for the treatment of neuropathic pain.

Efficacy of moxibustion in diabetes peripheral neuropathy.

Background:Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. The main clinical manifestations of DPN include pain, numbness, paraesthesia, and weakness of the lower limbs which often leads to diabetic foot ulceration, eventually resulting in amputation. Based on Traditional Chinese Medicine theory, moxibustion has a great effect on treating and preventing DPN. However, randomized clinical trials done to evaluate the efficacy of this treatment are still lacking. Hence, this study is carried out to evaluate the effectiveness and safety of moxibustion therapy on diabetic peripheral neuropathy.Methods:This study will be a pilot, interventional, randomized, 2-armed, parallel, singled-masked, controlled trial. A total of 40 diabetes mellitus patients with peripheral neuropathy will be recruited and assigned randomly into 2 groups (moxibustion group and waiting group) at a 1:1 ratio. This trial consists of an 8-week intervention period and a 4-week follow-up period. During the intervention period, the moxibustion group will take 3 moxibustion sessions per week, whereas no intervention will be done on the waiting group to act as the control group. The outcome will be assessed by an outcome assessor who is unaware of the group assignment. The primary outcome will be pain assessment measured with algometry, Leeds Assessment of Neuropathic Symptoms and Signs pain scale, visual analogue scale, and neuropathy pain scale. The secondary outcome will be an evaluation of functional performance capacity with 6 minutes walking test, evaluation of the Foot and Ankle Ability Measure, and serum HbA1c and albumin levels.Discussion:We hope that this trial will provide valuable insights on the efficacy of moxibustion in the management of diabetic peripheral neuropathy.Trial registration:ClinicalTrials.gov Registry No.: NCT04894461 (URL: https://clinicaltrials.gov/ct2/show/NCT04894461?term=NCT04894461&draw=2&rank=1) Registered on May 20, 2021.