Simple Pain Score Research Articles

Comparative efficacy of ultrasound-guided combined suprascapular and axillary nerve block with suprascapular nerve block alone in patients with frozen shoulder: A prospective, double-blinded randomized, single-centre trial

BackgroundFrozen shoulder is a troublesome disease of the shoulder joint. It leads to marked disability because of pain with restriction of active and passive movement of the joint. We aimed to determine and compare the efficacy of combined suprascapular and axillary nerve blocks with suprascapular nerve block alone for the treatment of frozen shoulder pain. MethodologyA total of 61 patients with frozen shoulder included in the study underwent ultrasound-guided combined suprascapular and axillary nerve block (n ​= ​31) and suprascapular nerve block (n ​= ​30). All the patients were assessed for visual analogue scale (VAS) pain (0-10), simple pain score (0-5), total pain score (0-9), range of motion (abduction, external rotation, and internal rotation) of the affected shoulder joint at baseline and post-procedure at 7 days, 1 month, 3 months, 6 months, and 12 months. ResultThere was a significant improvement in VAS pain score, simple pain scores, total pain scores and range of motion of the affected shoulder joint in both groups at all time points as compared to the baseline. However, in the combined nerve block group the VAS scores, simple and total pain scores, abduction, and internal rotation were significantly better at 6 months, 3 months, 6 months, and 12 months, respectively. ConclusionThe combined block provided faster and superior pain relief and improvement in function.

Use of Vascularized, Denervated Muscle Targets for Prevention and Treatment of Upper-Extremity Neuromas

Neuroma formation following upper-extremity peripheral nerve injury often results in persistent, debilitating neuropathic pain with a limited response to medical management. Vascularized, denervated muscle targets (VDMTs) offer a newly described surgical approach to address this challenging problem. Like targeted muscle reinnervation and regenerative peripheral nerve targets, VDMTs are used to redirect regenerating axons from an injured nerve into denervated muscle to prevent neuroma formation. By providing a vascularized muscle target that is reinnervated via direct neurotization, VDMTs offer some theoretical advantages in comparison with the other contemporary surgical options. In this study, we followed the short-term pain outcomes of patients who underwent VDMT surgery for neuroma prevention or treatment. We performed a retrospective chart review of 9 patients (2 pediatric and 7 adult) who underwent VDMTs either for symptomatic upper-extremity neuromas or as a prophylactic measure to prevent primary neuroma formation. In-person and/or telephone interviews were conducted to assess their postoperative clinical outcomes, including the visual analog pain scale simple pain score. Of the 9 patients included in this study, 7 underwent VDMT surgery as a prophylactic measure against neuroma formation, and 2 presented with symptomatic neuromas that were treated with VDMTs. The average follow-up was 5.6 ± 4.1 months (range, 0.5-13.2 months). The average postoperative pain score of the 7 adult patients was 1.1 (range, 0-8). This study demonstrated favorable short-term outcomes in a small cohort of patients treated with VDMTs in the upper extremity. Larger, prospective, and comparative studies with validated patient-reported and objective outcome measures and longer-term follow-ups are needed to further evaluate the benefits of VDMTs in upper-extremity neuroma management and prevention. Therapeutic III.

Frozen shoulder: evaluation of intraarticular corticosteroids injection versus suprascapular nerve block “A prospective clinical study”

Introduction: Adhesive capsulitis (frozen shoulder) has an incidence of 3-5% in the general population. This disorder is one of the most common musculoskeletal problem seen in orthopaedics. Aims and objectives 1. The study was designed to assess the effectiveness of suprascapular nerve block (SSNB) and intra articular steroid (IAS) to relieve pain and improve range of motion. 2. To assess which one had better results in terms of simple pain score and SPADI (shoulder pain and disability index) score along with range of movement at shoulder joint. 3. To record any adverse effects and complications. Materials and methods: The study was conducted in department of orthopaedics, S.M.S. Medical college and attached group of hospitals, Jaipur, with due permission from institutional ethical committee and review board after taking informed and written consent from the patient from 1.4.2015 to 1.4.2016 Study design: hospital based, prospective, randomized, comparative study. Sample size: Sample size was calculated to be 23 subjects in each of 2 groups. Inclusion criteria 1. Patients with history of chronic shoulder pain and decreased range of motion (active and passive) of shoulder. 2. Age group 40-70 years. 3. Either sex. 4. Patients with pain and stiffness for atleast 4 weeks. 5. Who have been on conservative management like pain killers, physiotherapy etc. 6. Patients who give consent to participate in study. 7. Diabetic patients whose HbA1c is less than 6.5% and fasting blood sugar levels are less than 126 mg/dl. Exclusion criteria 1. Patients with intrinsic pathologies of the shoulder such as a) rotator cuff tears b) biceps tendinitis c) Calcific tendinosis. d) History of fracture and dislocation. e) Arthritis of glenohumeral or acromioclavicular joint. f) Sympathetic dystrophy. 2. Patients with extrinsic problems such as a) Neuromuscular disorders (Parkinsonism). b) Referred pain from associated conditions- extrusion of a cervical disc with radiculopathy. c) History of previous surgery of affected shoulder. 3. Patients who refuse to participate in study Results: In early follow ups there was significant improvement in abduction in IAS group than SSNB group, but at final follow up almost normal range of motion was achieved in both the groups. The average improvement in abduction in SSNB group was 86.92º and 68.46º in IAS group. Both groups achieved almost normal range of ER movement at final follow up. The average improvement in ER was 25.19º (SSNB- 32.3º & IAS – 18.08º).All groups achieved significant improvement in pain and restriction of movement and achieved almost normal day to day activity at final follow up. Overall good to excellent results were seen in both the groups.

Response to Comments on "Correlation between Radiologic Sign of Lumbar Lordosis and Functional Status in Patients with Chronic Mechanical Low Back Pain".

Dear Editor, We appreciate the interest in our work and for the opportunity to focus on detailed aspects of chronic mechanical low back pain. The reader attempted to emphasize the importance of pelvic incidence as a predictive factor for chronic low back pain. We should mention that concordant with this valuable comment there are several studies considering sagittal imbalance as a potential contributing factor for developing low back pain [1,2,3]. Pelvic incidence, a pelvic anatomic parameter that is specific and constant for each person determines the size of lumbar lordosis. Changes in this parameter either through relation with back muscle degeneration or other spine conditions might play a role in chronic mechanical low back pain [2,3,4]. The main focus of our study was lumbar lordosis and its effect on functional status measured by Oswestry disability index (ODI) that is not a simple pain score. According to this index, no significant correlation between the degree of lumbar lordosis and the score of functional disability was found [5]. Also, in a recent study using ODI, osteoarthritis of the facet joints as specific locations of degenerative changes to the lumbar spine, was not definitely correlated with ODI scores [6]. On the other hand, 2 studies investigating the relationship between spinopelvic parameters and clinical symptoms of severe isthmic spondylolisthesis used ODI and found a significant correlation between degree of lumbar lordosis and the Oswestry score. However, there was no correlation between pelvic incidence and the Oswestry score [7,8]. Disability is the main consequence of low back pain that should be prevented or treated once occurred. Thus, for more clarification we suggest randomized trials to evaluate possible relationships between the various spinopelvic alignment parameters such as pelvic incidence and the level of functional disability in patients with chronic mechanical low back pain.

Suprascapular nerve block for the treatment of frozen shoulder

Aims:The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections.Settings and Design:Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block.Methods:Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients’ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block.Statistical Analysis:In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used.Results:Patient's simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block.Conclusion:Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.

Can chronic neuropathic pain following thoracic surgery be predicted during the postoperative period?

Chronic pain following thoracic surgery is common and associated with neuropathic symptoms, however, the proportion of patients with neuropathic pain in the immediate postoperative period is unknown. We aimed to determine the proportion of patients who have neuropathic symptoms and signs immediately after, and at three months following thoracic surgery. The study was designed as a prospective observational cohort study. We identified patients with pain of predominantly neuropathic origin using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score in the immediate postoperative period and the self-report LANSS (S-LANSS) version three months after surgery. One hundred patients undergoing video assisted thoracic surgery (VATS) or thoracotomy completed LANSS scores preoperatively and in the immediate postoperative period. Eighty-seven percent completed three months S-LANSS follow-up scores. Eight percent of patients had positive LANSS scores in the immediate postoperative period; 22% of patients had positive S-LANSS scores three months following surgery. There was a significant association between positive scores in the acute and chronic periods (relative risk (RR) 3.5, [95% confidence interval (CI) 1.7-7.2]). Identifying pain of predominantly neuropathic origin in the postoperative period with a simple pain score can help identify those at risk of developing chronic pain with these features following thoracic surgery.

Neuropathic pain and quality of life

The overarching reason that pain patients seek medical attention is because their pain interferes with some or all aspects of their quality of life (QOL). Interventions are considered successful by the patient if QOL is improved. Simple pain scores, although providing important information, do not capture the patient's total pain experience, which includes the effect on QOL. A focus on patient QOL should be adopted by all clinicians treating patients with neuropathic pain to work toward successful outcomes.

Patient satisfaction with postoperative analgesia in ICU: pain is not the unique determinant

Despite advances in its management, pain is a frequent problem in ICU. It is a major determinant of patient stress and it is also correlated with morbidity, probably due to sympathetic activation, respiratory restriction, immobility, etc. Several studies have tried to validate different tools for analgesia evaluation, but they fail to evaluate the impact of pain management strategies on patient satisfaction. Our objective was to evaluate whether different pain management strategies alter postoperative ICU patient satisfaction reports. A total of 110 postoperative patients without evident cognitive deficits were evaluated. We obtained data about type of surgery, type of analgesia used (continuous or intermittent, regularly administered or on a patient-demand basis), patient pain scores from an analogic-visual pain scale (AVPS: 0, no pain; 4, moderate pain; 10, most severe pain) and patient satisfaction scores at the moment they left the ICU. Sixty per cent of the patients were males, 40% were females, and mean age was 63 ± 17 years (mean ± SE). Of the patients investigated 82% gave high satisfaction scores with the analgesia strategy used, but 18% (20 patients) were not satisfied, referring they had unbearable pain during ICU stay; from those 20 patients, 10 (50%) never referred a pain score above3 during ICU, 13 (66%) were female and 16 (80%) did not receive analgesia on a regular basis. Our data suggest that evaluation of satisfaction with pain management in ICU should take into account pain scores, but also a specific satisfaction questionnaire. We could observe that female and patients with on-demand-basis analgesia are more prone to refer low levels of satisfaction with pain management. Further, simple pain scores like the classical analogic-visual pain scale may fail to detect pain in the ICU patient because of a putative high incidence of a communication disorder.

Clinical evaluation of transhiatal bilateral splanchnicotomy for patients with intractable supramesenteric pain.

Although a transhiatal bilateral splanchnicotomy (TBS) has many advantages, it has not been widely employed as an effective minimal invasive therapy for intractable supramesenteric pain. Furthermore, the effects of TBS have not yet been clearly evaluated. Between 1995 and 1997, TBS was performed on 11 patients with intractable epigastric and/or flank pain due to unresectable pancreatic cancer, chronic pancreatitis, or an unknown cause. The effect of TBS on the pain was evaluated using a novel simple pain score and pain reduction percentage scaled on the basis of the medication and the judgments by patients themselves, respectively. The detection and cutting of the bilateral great splanchnic nerves were easily performed in all of the patients using common flexible chondrocostal retractors. The evaluation of the TBS effect using the pain score clearly demonstrated the early and late mean postoperative pain score (1.1 +/- 0.9 and 1.4 +/- 1.2: mean +/- SD) to be significantly (P = 0.0002 and P = 0.002, respectively) lower than the preoperative pain score (3.5 +/- 0.7). Furthermore, the mean postoperative pain reduction percentage (85% +/- 13%) evaluated by those patients was also significantly different (P < 0.0001). The present study showed no significant complications for TBS, except for minor complications such as the transient fall of blood pressure and reparable pleural damage. Interestingly, a long-term follow-up revealed that no complications related to the splanchnicotomy were observed. These results indicate that TBS is a useful treatment for patients with intractable supramesenteric pain caused by cancer as well as benign diseases.