Subjective Pain Assessment Research Articles

Relationship Between Patient-reported Outcome Measures and Accelerometer-measured Physical Activity and Sleep in Patients With Postherpetic Neuralgia.

Available treatment for chronic neuropathic pain is still limited, and the positive effects are modest. Thus, clinicians aim to improve activity and quality of life despite pain. The objective monitoring of activity is attracting attention in chronic pain assessments. Therefore, we objectively evaluated daytime activity and sleep in patients with postherpetic neuralgia (PHN), using actigraphy to determine risk factors for decreased activity. Participants with PHN wore an actigraph (a wristwatch-like accelerometer) on the nondominant hand. The actigraph measured day-time activity and sleep, which were compared with participant-reported subjective pain and sleep assessments. Fifty-four individuals with PHN who visited our outpatient clinic completed questionnaires and a week of actigraph monitoring. Subjective scores of pain intensity, neuropathic pain, disability in daily life, pain-catastrophizing thoughts, and insomnia were all well correlated. However, the actigraph-monitored activity levels, using 2 equations, and sleep quality were not associated with any pain or sleep-related subjective scores. The discrepancy between the subjective and objective scores in this study may be due to (1) features of PHN, an archetype of peripheral neuropathic pain affecting no motor nerves, (2) actigraph measurement limitations regarding the sedentary life of the elderly, or (3) activity misperception, a new proposition explaining the discrepancy between subjective and objective measures of activity, similar to the sleep state misperception. In patients with PHN, high pain intensity may be reported in those with highly maintained activity, in which treatment must be selected cautiously to prevent interruption of their physical abilities.

Jasminum grandiflorum oral gel as an add-on to standard of care in radiation induced grade 2 oral mucositis - an open label pilot clinical trial

BackgroundRadiation-induced oral mucositis is one of the most critical dose-limiting toxicities associated with radiation therapy for oral cancer which can result in treatment interruption and compromise the quality of the life of cancer patients. Jati (Jasminum grandiflorum) is used in Ayurveda to treat oral conditions like stomatitis and mouth ulcers. ObjectiveTo test the feasibility of Jati oral gel as an add on therapy in grade 2 radiation-induced oral mucositis. Materials and methodsA prospective, open-label, non-randomised pilot trial was conducted on 20 patients with grade 2 radiation-induced oral mucositis at a tertiary cancer hospital. The control group received sodium bicarbonate mouthwash 4–5 times daily as the standard of care, while the intervention arm also received Jati oral gel twice daily. We used the ImageJ software for objective assessment and the Visual Analogue Scale for subjective pain assessment. The study was continued for 15 days or until the mucositis progressed to grade 3 or resolved to grade 1. ResultThere was a significant reduction in the mean pain score and mean area of mucositis in the intervention group compared to the control group. ConclusionJati oral gel is a suitable medicament as an add-on therapy in managing grade 2 radiation-induced oral mucositis.

A Spatiotemporal Deep Learning Framework for Scalp EEG-Based Automated Pain Assessment in Children.

Common pain assessment approaches such as self-evaluation and observation scales are inappropriate for children as they require patients to have reasonable communication ability. Subjective, inconsistent, and discontinuous pain assessment in children may reduce therapeutic effectiveness and thus affect their later life. To address the need for suitable assessment measures, this paper proposes a spatiotemporal deep learning framework for scalp electroencephalogram (EEG)-based automated pain assessment in children. The dataset comprises scalp EEG data recorded from 33 pediatric patients with an arterial puncture as a pain stimulus. Two electrode reduction plans in line with clinical findings are proposed. Combining three-dimensional hand-crafted features and preprocessed raw signals, the proposed transformer-based pain assessment network (STPA-Net) integrates both spatial and temporal information. STPA-Net achieves superior performance with a subject-independent accuracy of 87.83% for pain recognition, and outperforms other state-of-the-art approaches. The effectiveness of electrode combinations is explored to analyze pain-related cortical activities and correspondingly reduce cost. The two proposed electrode reduction plans both demonstrate competitive pain assessment performance qualitatively and quantitatively. This study is the first to develop a scalp EEG-based automated pain assessment for children adopting a method that is objective, standardized, and consistent. The findings provide a potential reference for future clinical research.

Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial.

This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. 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 .

The Efficiency of Kinesiotherapy versus Physical Modalities on Pain and Other Common Complaints in Fibromyalgia

Due to its variety of signs and symptoms, there have been numerous attempts to treat fibromyalgia (FM), but a cure has yet to be established. The aim of this study was to evaluate the effects of a complex kinetic therapy program and a combined physical modality program on pain and other common symptoms of FM. Patients and methods: A total of 78 female patients were included in this study; 39 subjects underwent a kinesiotherapy (KT) intervention (combining aerobic and Pilates exercises), and 39 participated in a physical modality (PM) program (including electrotherapy (TENS and low-laser therapy) and thermotherapy). Results: Regarding the parameter of pain assessment, kinesiotherapy demonstrated its superiority both during the treatment period and in the evaluation 3 months after therapy cessation. Both in terms of patient-reported pain (inter-group comparisons: p = 0.000 at T3) and the examination of tender points (inter-group comparisons: p = 0.000 at T3), as well as the algometric assessment, pain was alleviated by the two forms of applied kinetic therapy. The observed functional impairment was statistically significantly influenced (p = 0.001) at the end of the kinetic program application, while for the perceived functional impairment, neither therapy proved superiority over the other at any point of evaluation (inter-group comparisons: p = 0.715 at T3). Regarding the influence of the emotional consequences implied by fibromyalgia, neither the forms of kinesiotherapy nor the chosen physical modalities proved superiority at any point of evaluation (HAQ anxiety inter-group comparisons: p = 0.000 at T3). In conclusion, even though kinesiotherapy had superior influences on fibromyalgia pain in the studied group, the current research lends credence to the significance of non-pharmacological therapy in managing fibromyalgia. Participants demonstrated positive advancements in subjective and objective pain assessments, as well as improvements in functional and emotional well-being.

Pain Assessment in Cattle by Use of Numerical Rating and Visual Analogue Scales-A Systematic Review and Meta-Analysis.

Subjective pain assessment in cattle is contingent upon the observer's experience and attitude. Studies of pain assessment in cattle by veterinarians and farmers using different pain scales have been published. This systematic review and meta-analysis aimed to describe and compare the pain scores given by veterinarians and producers for different procedures and conditions using either a NRS or VAS. The literature search was conducted with PubMed (MEDLINE) and Agricola, using defined search terms (e.g., peer-reviewed). A total of 842 articles were identified. After screening of duplicates, abstracts, and full texts, a total of 16 articles were included in this systematic review. Different pain scales were used for the included studies (NRS 0-10 for eight studies, NRS 1-10 for six studies, NRS 1-10 and VAS 0-10 for one study, and VAS 0-1 for one study). Most studies (n = 11) originated from the European Union. Mean values for pain scores differed significantly between studies included in the meta-analysis for both NRS 0-10 and 1-10. The findings of this study indicated that comparison of pain scoring used in different studies is difficult due to use of different pain scales and varying nomenclature, and that many variables (such as age and gender) influence pain scoring.

Adipose Tissue Stem Cells for Knee Arthritis and Cartilage Lesions: A Three-Year Follow Up.

The purpose of this research article is to evaluate the efficacy and the safety of injections of stromal vascular fraction (SVF), obtained with mini-lipoaspiration of fat tissue for knee osteoarthritis and cartilage lesions. Between January 2018 and February 2021, a total of 76 patients (45 females and 31 males, mean age 64 years; range 53-75 years, body mass index [BMI] no more than 30%, with symptomatic primary osteoarthritis of the knee, without previous arthroscopic intervention) underwent a local tumescent lipoaspiration procedure of 60-80cc of fat tissue from the abdomen. SVF was obtained after centrifugation according to the AdiPrep® Adipose Transfer System (Harvest-Terumo, Plymouth, Massachusetts) technique. The final product was checked with flow cytometry for absolute numbers, vitality, and the cluster of differentiation (CD) population. It was injected intraarticularly into the patients knees. Patients were divided in two groups: Group 1 had patients with knee osteoarthritis Kellgren-Lawrence grade early 4 and Group 2 with osteoarthritis K-L grade 2-3. The International Knee Documentation Committee (IKCD) and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires were used to evaluate clinical effects and measure patient's subjective assessment of pain, joint mobility, and physical disability before the injections. They were repeated at six months, one year, two years, and three years post injections. Knee cartilage lesions patients were divided in two subgroups: Group A (11 patients with OA K-L grade 2-3 and Outerbridge cartilage lesions grade 2-3) and Group B (7 patients with OA K-L grade early 4 and cartilage lesions Outerbridge grade late 3 to early 4) were estimated with quantitive analysis of magnetic resonance imaging (MRI) at one, two, and three years post injections. The average IKDC score in Group 1 was 45.9, 63.2, 62.4, 60, and 52. The KOOS score of the same group was 53, 79, 72, 69, and 62 at the end of the third year. At baseline, the average total IKDC score in Group 2 was 48.3, at 6 months 78.2, at one year 77, at two years 70.4, and at three years 61. The KOOS score of this group was 57, 84, 86, 79, and 69 at three years, respectively. For the patients with cartilage lesions, Group A presented lesser volume mean numbers of the lesion: 74% at the end of the first year post injection, 61% at the second, and 52% at the end of the third year with two out of seven patients in the group. The rest had no significant difference. Lesser volume mean number of the lesions in Group B was 85-88%, 70%, and 61% at the end of the third year in 5 out of 11 patients in the group. The rest had no significant difference. Adipose-derivedSVF, injected intraarticularly in arthritic knees, seems to provide good to excellent clinical results for three years and radiological results for cartilage lesions for two years post injections. All patients were satisfied with this treatment with reduction in pain and better joint mobility, especially after two to three months and up to three years. No serious side effects or complications were reported.

Exploring pain status and flexibility in fibromyalgia patients: Effect of 20 sessions of yoga therapy

Objectives: Fibromyalgia (FM) is a common neurological chronic health problem that causes widespread pain and tenderness (sensitivity to touch) throughout the body. Most often, people with this chronic illness complain of fatigue and sleep deprivation. Besides psychosomatic illness, neurological problems such as depression, anxiety, and memory loss are also reported by patients. Materials and Methods: Pain, flexibility, and range of motion in 18 FM patients were assessed before and after 20 sessions of yoga therapy. Subjective assessment of pain was done using a visual analogue scale (VAS) and pain catastrophising scale scores. Tender points were also localised. Objective assessment of pain was done using quantitative sensory testing of the left and right shoulder regions. Flexibility and range of motion were assessed using Schober’s and Sit and Reach tests, respectively, before and after yogic intervention. Results: Mean VAS score, age, and body mass index of patients at baseline were 7.05 ± 0.8, age 35.1 ± 8.9 Kg/m2, and 27.8 ± 2.9 kg/m2, respectively. VAS score (3.3 ± 1.3, P &lt; 0.05) was significantly reduced after the intervention; pain catastrophisation was also reduced in the patients after the therapy. Flexibility (Schober’s test scores) and range of motion (Sit and Reach test scores) significantly increased after 20 sessions of regular yoga therapy. Pressure pain threshold at the left shoulder and pressure pain tolerance at the right shoulder were significantly increased after the intervention (P &lt; 0.05). Conclusion: Twenty sessions of yoga therapy can relieve pain and improve the flexibility and range of motion of FM patients.

Activity of Corrugator Muscle with Pressure Pain Stimulation in Healthy People

Corrugator muscle activity with pressure pain stimulation has not yet been studied. We recorded corrugator muscle activity at rest and before, during and after pressure pain stimulation to the shoulder three times each in 14 healthy adults (20.0 ± 2.1 years of age (mean ± SD)) without pain using surface electromyography. Corrugator muscle activity with pressure pain and the relationships between corrugator muscle activity and pressure pain or unpleasantness intensity on a visual analogue scale measured three times were examined. The corrugator muscle activity during pressure pain stimulation was significantly higher than that before (p &lt; 0.001) and after (p = 0.019) stimulation. There were significant differences among the three measurements examining reproducibility in pain (p = 0.037) and unpleasantness (p = 0.014) but not among corrugator muscle activities before (p = 0.526), during (p = 0.145) and after (p = 0.109) stimulation. Significant correlations were revealed for corrugator muscle activity vs. pain (ρ = 0.465, p = 0.002) and corrugator muscle activity vs. unpleasantness (ρ = 0.558, p &lt; 0.001). Pressure pain increased corrugator muscle activity with reproducibility and correlated with subjective pain assessments, which indicates the utility of corrugator muscle activity as an objective indication of pain assessment.

Results of tocilizumab treatment in patients with rheumatoid arthritis

The aim of the work was to study the results of tocilizumab (TCZ) treatment in patients with high and moderate activity of rheumatoid arthritis (RA) in addition to basic therapy. The objectives of the work are to assess the degree of RA activity before and after intravenous administration of TCZ using the DAS–28 scale, as well as to compare the effectiveness of TCZ in groups of patients with initially different degrees of activity and the radiological stage of RA. Materials and methods. The study included 58 people with an established diagnosis of RA receiving basic therapy in combination with the biological drug TCZ (India) over the period from 04.2022 to 09.2022. After the consultation decision and the patient informed consent had been obtained, intravenous infusion with a solution of TCZ at the rate of 8 mg/kg was performed once a month for up to 5 courses. Evaluation of the effectiveness of therapy was carried out by analyzing the activity of the disease with the use of DAS-28 scale (including a subjective assessment of pain on a visual analog scale, the number of painful and swollen joints and laboratory indicators of ESR, CRP) before and after each subsequent administration of the drug. Results. The radiological stage of RA correlated with the disease duration (R=0.8). In patients with initial radiological changes, the activity was lower (DAS-28 according to ESR) of RA (p=0.03). High clinical efficacy and safety of TCZ therapy in patients with an initially high and moderate degree of disease activity has been established. In all patients, there was a significant decrease in RA activity according to the DAS-28 scale (according to CRP and ESR) after TCZ injections (p&lt;0.05). Clinical and laboratory remission occurred in 12% of subjects after the second injection, in 44% of patients – after the fourth (significantly more often than after the second injection, p=0.0274), in 37.5% – after the fifth injection of TCZ.

Arthroscopic capsular release for frozen shoulder: when etiology matters.

No therapeutic intervention is universally accepted for frozen shoulder, and the most effective management to restore motion and diminish pain has yet to be defined. The aim of this study was to investigate functional and psychological outcomes in patients who underwent arthroscopic capsular release for a frozen shoulder. A retrospective study with prospective data collection was conducted with 78 patients suffering from frozen shoulder resistance to conservative treatment. Considering the etiology, there were 36 (46.2%) idiopathic, 31 (39.7%) postoperative, and 11 (14.1%) posttraumatic cases. Preoperatively, each patient was evaluated with the range of motion (ROM) assessment and the Constant-Murley score (CMS). At follow-up, the 4-point subjective satisfaction scale (SSS), the ROM assessment, the SF-12 questionnaire, the numerical rating scale (NRS) for the subjective assessment of pain, the CMS and the Hospital Anxiety and Depression Scale (HADS) were assessed. After a mean follow-up of 54.2 ± 22.3months, ROM and CMS showed a statistically significant improvement between pre- and postoperative values (all p < 0.001). Before surgery, the mean CMS was 36.9% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 99.9% that of sex- and age-matched healthy individuals, and 49 (62.8%) patients showed a CMS equal to or higher than the normative data. The mean increase in the CMS was 56.1 ± 8.3 points. The mean SSS, HADS-A, HADS-D, and NRS were 3.7 ± 0.5, 2.5 ± 1.6, 2.2 ± 1.3, and 2.2 ± 1.0, respectively. All patients returned to their previous level of work and sports activity after 2 and 2.5months, respectively. The multivariate analysis showed the association between a higher postoperative CMS and the idiopathic etiology of a frozen shoulder (p = 0.004, β = 3.971). No intraoperative complications occurred. Postoperatively, four patients (5.1%) were treated with intra-articular steroid injections to manage residual symptoms. One patient (1.3%) with a postoperative frozen shoulder showed persistent symptoms and underwent a new successful arthroscopic capsular release. High patient satisfaction and statistically significant ROM and CMS recovery can be achieved after arthroscopic capsular release to manage frozen shoulder. Better functional outcomes are expected when the etiology is idiopathic. Results can help surgeons identify the patients who will most benefit from surgery and should be discussed with the patient. III.

Massage Therapy May be Safe and Reduce Pain in Critically Ill Patients with Acute Neurological Injury: a Case Control Study.

Massage therapy is an important adjunctive treatment for physiologic and psychologic symptoms and has been shown to benefit patients among a wide variety of patient populations. Few studies have investigated the utility of massage therapy in the general ICU setting, and even fewer have done so in the neurological ICU (NeuroICU). If massage therapy was determined to improve objective outcomes-or even subjective outcomes in the absence of harm-massage may be more readily employed as a complementary therapy, particularly in the ICU setting or in patients with acute neurological injury. This pilot study aimed to assess the safety of massage in the neurocritical care unit and its impact on patient vital signs, subjective pain assessment, and other clinical outcomes. Twenty-one patients who received massage therapy during admission to the neurocritical care service were compared to matched controls in a retrospective case control study design. We found a statistically significant reduction in pain scores among patients with acute neurological injury who received massage therapy. There was no statistical difference in hospital length of stay, discharge destination, in-hospital mortality, adverse events, or incidence/duration of delirium between patients who received massage therapy and those who did not. No adverse events were ascribed to the massage therapy when evaluated by blinded neurocritical care specialists. This study found that massage therapy may be safe for many patients in the NeuroICU and may offer additional subjective benefits.

Advantages of Dynamic Navigation in Prosthetic Implant Treatment in Terms of the Clinical Evaluation and Salivary Pro-Inflammatory Biomarkers: A Clinical Study

Successful implantation in augmented areas relies on adequate bone density and quality, along with thorough planning. The minimisation of the risks involved in the surgery and recovery phases is also of tremendous relevance. The aims of the present research were to clinically and biochemically evaluate the healing process after implant surgery (dental implants) using dynamic surgical navigation following prior bone augmentation. Thirty healthy patients who had implant treatment were analysed. The study participants (30 patients) were randomised between two groups. The 15 patients in the study group were treated with Navident dynamic navigation by using a flapless technique. The control group included 15 subjects in whom the implantation procedure was performed classically using the elevation flap full-thickness method. In all cases, the patient’s clinical condition, the patient’s subjective visual assessment of post-operative pain using the Visual Analogue Scale (VAS), and the levels of the salivary biomarkers interleukin 6 (IL 6) and C-reactive protein (CRP) immediately before surgery on the first post-operative day and on the seventh post-operative day were assessed. The healing process was shown to be faster in patients in the study group due to the low invasiveness of the treatment, which was confirmed by lower levels of pro-inflammatory cytokines in the study group versus the control group. The statistical analysis used Student’s t-test and Mann–Whitney test. The implementation of dynamic navigation and the application of the flapless technique reduced post-operative trauma, leading to a reduced risk of infection, reduced patient discomfort, and faster recovery.

Auricular Vagus Nerve Stimulation Improves Chronic Pain and Pain-Related Cytokine Levels: A Clinical Study

Periauricular Vagus Nerve Stimulation (pVNS) has been proven safe and effective in reducing chronic pain and related comorbidities in numerous clinical studies. This multicenter, interventional study used a non-randomized, interrupted time-series analysis to test the efficacy of an 8-week treatment protocol using the Stivax neurostimulator device. Subjects (n=33, 15 F, 18 M, age 40-77) were recruited at 3 clinic sites in California and Colorado. All subjects had long-term chronic pain and had failed other treatments. Subjects were treated with the Stivax device 3 times (2 weeks on, 1 week off). Subjective assessments of pain (Visual Analog Scale), disability (Oswestry Disability Index), depression (PHQ-9), and activity (IPAQ-E) were collected at baseline and weekly. Objective blood levels of pain-related cytokines collected at the end of weeks 2 and 8. Most subjects reported reduced pain, disability, and depression, with increased activity levels. At the end of week 8, subjects reported an average reduction in pain by 38.5% (3 subjects reported no pain), depression by 43.6% (2 subjects reported no depression), disability by 38.6% (2 subjects reported no disability), and an average 26.1% increase in activity level (5 subjects doubled their activity level). Levels of the pain-related cytokines IL-1ꞵ, IL-2, IL-3, IL-7, IL-10, IL-15, IL-17α, IL-21, TNF-α, IFN-γ, and FLT3-ligand showed improvement at week 8. pVNS is believed to “reset” central sensitization underlying chronic pain and other central sensitization syndromes, engaging the body’s pain modulation systems. Our results indicate that pVNS can clinically significantly improve chronic pain and associated morbidities without adverse effects.

Effect of Motor Imagery on Corticomotor Excitability and Pain Status in Rheumatoid Arthritis Patients.

Rheumatoid arthritis (RA) has been defined by the American College of Rheumatology in 1987 as a chronic inflammatory disease characterised by joint swelling, joint tenderness, and destruction of synovial joints leading to severe disability and premature mortality. There is a paucity of literature assessing corticomotor excitability in RA patients. This study aimed to assess the effect of motor imagery on corticomotor excitability and pain status in RA patients. The specific objectives were to study the effect of motor imagery on corticomotor excitability and pain status in RA patients. We also wanted to compare thecorticomotor excitability between RA patients with healthy controls. The correlation between the measures of corticomotor excitability and pain status in RA patients has also been done. The study was designed as a pilot clinical trial with a case-control design. Forty participants were recruited for the study. Twenty RA patients were recruited from the Department of Rheumatology and Department of Physical Medicine and Rehabilitation (PMR), AIIMS, New Delhi, and 20 healthy controls. Testing was performed at the Pain Research & rTMS Lab, Department of Physiology, AIIMS, New Delhi. The study was approved by the Institute Ethics Committee, AIIMS New Delhi, and registered in the Clinical Trials Registry-India (CTRI). For the subjective assessment of pain, the visual analogue scale (VAS), Short-Form McGill Pain Questionnaire, WHO-Quality of Life Brief questionnaire (WHO-QOL-BREF), and Rheumatoid Arthritis Pain Scale were used. For the objective assessment of pain, hot and cold pain thresholds were assessed using thermo-tactile quantitative sensory testing (QST) using the method of limits and corticomotor excitability using a transcranial magnetic stimulation device. All participants were also asked to perform motor imagery tasks which consisted of a metronome-paced thumb opposition paradigm. Results: The resting motor threshold (RMT) decreased significantly after motor imagery when compared to the mental calculation group. The amplitude of motor evoked potential (MEP) and QST parametervalue was comparable in both the groups before and after motor imagery and mental calculation. RMT was found to be significantly higher whereas MEP values were found to be significantly lower in RA compared to controls. We conclude that patients suffering from RA have decreased corticomotor excitability compared to controls. Motor imagery was effective in improving corticomotor excitability in these patients and can be used as rehabilitation in RA to relieve their pain.

A Comparison Study of the Western Ontario Rotator Cuff Index, and the Constant-Murley Score with Objective Assessment of External Rotator Muscle Strength and Pain in Patients after Arthroscopic Rotator Cuff Repair.

Although rotator cuff injures are often associated with a limited range of motion and muscle weakness, being able to conduct pain-free and efficient performances of the activities as part of daily living seems to be more important for patients. The aim of this study was to investigate the correlation between two questionnaires-the disease-specific, subjective questionnaire termed the Western Ontario Rotator Cuff Index (WORC), and the shoulder-specific, subjective-objective questionnaire Constant-Murley score (CMS), with the objective assessment of external rotator muscle strength, and the subjective assessment of pain according to the visual analog scale (VAS) in patients after arthroscopic rotator cuff repair. The study was carried out among 47 patients twice-6 and 12 months after surgery, respectively. All patients completed the WORC, the CMS, and the VAS. Isokinetic evaluation of the external rotators was performed using the Biodex 4 ProSystem. The correlations of all assessed muscle strength parameters with both the CMS and the WORC were found to be statistically significant, being mostly average during the 1st examination and mostly strong during the 2nd examination. There was a significant improvement in all assessed tools as a result of the undertaken rehabilitation. There were weak correlations present between changes in the WORC and changes in the external rotator muscle strength, with correlations between WORC-Sport and EXT900-AVERAGE-POWER and PEAK-TORQUE also being found statistically significant. Correlations of changes in the CMS scale with changes in the external rotator muscle strength were weak and statistically insignificant. It seems that the WORC questionnaire can be recommended more for the population after rotator cuff repair, which allows for a reliable assessment of patients' ability to function and its changes in various areas of life, and at the same time does not require a direct assessment by a clinician or researcher.

Первинний хронічний біль як соматизація дистресу

Relevance. The direct functional significance of pain is to signal the action of a stimulus, damage to the integrity of the organism or its individual structures. A number of scientists have approached the study of pain as a physiological defense mechanism, during which we understand the principles of its emergence, course, localization, and ways to overcome pain sensations through pharmacological, physical, and instrumental methods. However, the problem of pain arises when the physiological substrate is absent or does not correspond to the strength or duration of the manifestation. This is where we can talk about pain of a psychogenic nature, which despite a number of studies that are currently underway, still remains difficult to treat. Objective. To improve the effectiveness of medical-psychological assistance by studying the nature and patterns of pain syndrome in patients with primary chronic pain with subsequent psycho-correction and the use of psychotherapeutic interventions. Methods. The study design was a monocentric randomized controlled trial with parallel groups. The study involved 14 individuals with primary chronic pain syndrome, which corresponded to ethical and deontological norms according to the principles set out in the Helsinki Declaration. The tools used in the study included the SPAASMS subjective pain assessment scale, the somatic symptoms questionnaire (SSS-8), the Bass-Darky aggressiveness and hostility level questionnaire (BDHI), as well as the Chaban O.S. quality of life assessment scale (CQLS). Results. At the completion of the study, a statistically significant difference was observed for all clinical parameters between the experimental and control groups. Comparison of the values of the scale in the experimental group on days 1 and 42 demonstrated statistically significant changes in all four indicators. However, this study reveals a limited sample, which in turn allows for expanding the sample size and investigating the phenomenon of applied interventions in future pilot studies, as the primary results provide a qualitative and positive trend in reducing the effects and impact of primary chronic pain, as well as improving the quality of life indicator. Conclusions. The results of this study confirm the effectiveness of psychological interventions, as well as psychological interventions for reducing the subjective sensation of pain syndrome, symptoms of somatization, aggressive and hostile reactions, and improving the quality of life in individuals suffering from primary chronic pain.

PainVision-based evaluation of brain potentials: a novel approach for quantitative pain assessment.

Introduction: The complex and multidimensional nature of pain poses a major challenge in clinical pain assessments. In this study, we aimed to evaluate a novel approach combining quantitative sensory testing (QST) with event-related potential measurements for assessment of experimental pain in healthy individuals. Methods: QST was performed with a commercial device (PainVision, PS-2100), and numeric rating scale (NRS) scores after exposure to different sensory stimuli were reported by the participants. Resting-state electroencephalography (EEG) was simultaneously performed to capture the cortical responses to peripheral stimulation. Results: Pain scores increased with the intensity of stimuli, with mean NRS scores of 2.7 ± 1.0 after mild stimuli and 5.6 ± 1.0 after moderate stimuli. A reproducible, significant P2-N2 complex was evoked by both mild and moderately painful stimuli, but not by non-painful stimuli. The latency of pain-related potentials was not significantly different between stimuli. The amplitudes of both P2 and N2 components significantly increased when intense nociception was applied, and the increments mainly originated from theta oscillations. Conclusion: The combination of QST with EEG was feasible for subjective and objective pain assessment. Distinct patterns of brain potentials were associated with the phenotype of the peripheral stimuli (e.g., noxious versus. innoxious, high versus. low pain intensity).

Особливості управління болем у вагітних та породіль

Purpose - to evaluate the efficacy and adverse side effects (if any) of intravenous infusion of 1000 mg paracetamol as a method of pain relief in labour during the active phase of labour and in the postoperative period after caesarean section. Materials and methods. 43 pregnant women in the first stage of labor with active labor were studied. The selection criteria were healthy low-risk first-term mothers; aged 18-35 years; with spontaneous onset of labor at 37-40 weeks of pregnancy; the first period of labor with the opening of the cervix by 3-5 cm; one live fruit; main presentation Infulgan inf. solution was chosen as a paracetamol preparation 10 mg/ml per 100 ml. Multimodal anesthesia with a combination of the drugs Infulgan (paracetamol) and Keydex (dexketoprofen) was performed for postoperative analgesia. The pain intensity indicator was determined using the visual analog scale (VAS) - a method of subjective pain assessment. The patient marked a point on a non-graduated ruler 10 cm long, which corresponds to the degree of severity of pain. During the dynamic evaluation of changes in pain intensity, they were considered objective and significant if the true VAS value differed from the previous one by more than 1.3 cm. The comparison group consisted of 20 pregnant women in the 1st stage of labor who did not receive anesthesia at their own request. Also, a study of the effectiveness of complex multimodal anesthesia (Infulgan (paracetamol) and Keydex (dexketoprofen)) was conducted in 5 (11.6%) women in labor after delivery by caesarean section. Results. The use of intravenous paracetamol injection for analgesia during labor is an effective analgesia. There was an initial but significant decrease in the VAS score 30 minutes after Infulgan administration and a statistically significant decrease in pain after 2, 3 and 4 hours compared with the VAS score before treatment. In the group of women who did not undergo analgesia, the intensity of the pain syndrome steadily increased. In the postoperative period, after caesarean section, women underwent combined analgesia with the use of Infulgan (paracetamol) drugs as the basic component of multimodal analgesia and Keydex (dexketoprofen) as a necessary step of multimodal analgesia. The above-mentioned combination of drugs allows for Step-Up analgesia - step-by-step pain therapy. Infulgan was administered in 1 vial (1000 mg) every 6 hours by intravenous injection, and Keydex - in 1 ampoule every 8 hours by intramuscular injection. The addition of Keydex (dexketoprofen) to the analgesia provided an adequate analgesic effect and did not require the administration of opioid analgesics in the postoperative period. Conclusions. Intravenous paracetamol is an effective non-opioid drug for the relief of labor pain without any significant side effects for mother and fetus. The absence of any maternal side effects (sedation, respiratory depression, delayed gastric emptying, nausea and vomiting) or neonatal side effects (respiratory depression and decreased Apgar scores) associated with opioids allows us to recommend Infulgan for the relief of labor pain. The step-by-step Step-Up pain therapy in the postoperative period allows you to reduce the doses of each of the analgesics and reduce the frequency and side effects of the drugs. The use of Infulgan and Keydex as a method of pain management by means of Step-Up analgesia in the postoperative period in parturient women showed high efficiency, adequate tolerability and patient’s satisfaction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Subjective Versus Objective Pain Assessment in the Postpartum Period: Improving Pain Control After Vaginal Delivery [ID: 1378006

INTRODUCTION: The numerical pain rating scale (NPRS) is a validated measure to quantify acute pain; however, its utility after vaginal delivery is unclear. Poorly controlled postpartum pain can increase rates of complications; therefore, pain control is paramount. We investigated how subjective pain relates to objective pain in the postpartum period. METHODS: A prospective, observational study at a single academic hospital included patients with vaginal deliveries February to October 2021. Women with opioid use disorder, wound complication, hysterectomy, or readmission were excluded. Subjective pain assessment and NPRS were completed 2 weeks postdischarge. Subjective pain was recorded as “well controlled” versus “poorly controlled.” The numerical pain rating scale was scored 0–10. RESULTS: Two hundred thirty-eight patients were included, and 174 (73%) followed up. One hundred twenty (69%) reported “well-controlled” pain, and 54 (31%) reported “poorly controlled.” There was no significant difference in delivery mode, laceration, or nonopioid medication use (P&gt;.05). Patients who used oxycodone were significantly more likely to report “poorly controlled” pain (P=.02). “Poorly controlled” pain was associated with higher median NPRS score (5 [interquartile range (IQR) 4–6] versus 2 [IQR 0–3], P&lt;.001). Among patients with “poorly controlled” pain, 11 (20.4%) had NPRS scores of 0–3. Of those who reported “well-controlled” pain, 22 (18.3%) had NPRS scores of 4–10. CONCLUSION: While NPRS scores were higher for patients with “poorly controlled” pain, this was not universal. It is critical to accurately respond to postpartum pain for the nearly 20% of patients whose subjective experience did not correlate with their objective score. Titrating pain control to subjective and objective goals may improve patient experience and outcomes.