Subjective Improvement In Pain Research Articles

Surgical and/ or conservative treatment improves quality of life (EHP-30) in patients with endometriosis.

To investigate the quality of life of women with endometriosis before treatment and 3 months after the start of surgical and/or conservative treatment. The sample comprised of 38 patients, of whom 26 underwent surgical treatment, 6 had pharmacological treatment, and 6 had both surgical and pharmacological treatment. The Endometriosis Health Profile (EHP-30) questionnaire in the Czech version and the Numeric Rating Scale (NRS) were used to assess quality of life. The questionnaires were completed before treatment and 3 months into the treatment. When comparing quality of life with the EHP-30 questionnaire, 3 months after the start of treatment, significantly better quality of life scores were found in all domains except the domain "Infertility." Statistically significant improvement was observed in the domains of "Control and powerlessness," "Emotional well-being," and "Pain" (P < 0.0001). Pain assessment using NRS showed subjective improvement in pain during menstruation, outside menstruation, during intercourse, micturition, and defecation. Statistically significant improvement was reported in pain during menstruation and outside menstruation (P < 0.0001). Treatment of endometriosis improves the quality of life and also leads to a subjective reduction of pain intensity as one of the main symptoms of the disease.

Computed tomography assessment of robotic versus fluoroscopic implant accuracy in sacroiliac joint fusion.

Computed tomography is considered the gold-standard imaging tool to evaluate spinal implant accuracy. However, there are no studies that evaluate the accuracy of robotic sacroiliac joint (SIJ) implant placement using CT to date. The aim of this study was to compare the accuracy of implant placement on CT between robotic and fluoroscopic navigation for SIJ fusion and the subsequent complications and clinical outcomes of suboptimally placed screws. A retrospective analysis of SIJ fusions utilizing either robotic or fluoroscopic guidance at a single institution was conducted from 2014 to 2023. Implant placement accuracy was evaluated on intra- or postoperative CT. Primary endpoints were SIJ screw placement accuracy and complications. Secondary endpoints were pain status at the first and second follow-ups and rates of 2-year revision surgery. Statistical analysis was performed using chi-square tests. Sixty-nine patients who underwent 78 SIJ fusions were included, of which 63 were robotic and 15 were fluoroscopic. The mean age of the cohort at the time of surgery was 55.9 ± 14.2 years, and 35 patients (50.7%) were female. There were 135 robotically placed and 34 fluoroscopically placed implants. A significant difference was found in implant placement accuracy between robotic and fluoroscopic fusion (97.8% vs 76.5%, p < 0.001). When comparing optimal versus suboptimal implant placement, no difference was found in the presence of 30-day complications (p = 0.98). No intraoperative complications were present in this cohort. No difference was found in subjective pain status at the first (p = 0.69) and second (p = 0.45) follow-ups between optimal and suboptimal implant placement. No patients underwent 2-year revision surgery. Use of robotic navigation was significantly more accurate than the use of fluoroscopic navigation for SIJ implant placement. Complications overall were low and not different between optimally and suboptimally placed implants. Suboptimally placed implants did not differ in degree of subjective pain improvement or rates of revision surgery postoperatively.

Cold Therapy for Pain Control in Pediatric Appendectomy Patients: A Randomized Controlled Trial

PurposeTopical ice has been shown to reduce pain scores and opioid use in adults with midline abdominal incisions. This study was designed to evaluate the efficacy of a cold therapy system in children following laparoscopic appendectomy. MethodsPatients 7 years and older who underwent laparoscopic appendectomy at our institution from December 2021–September 2022 were eligible. Patients were randomized to standard pain therapy (control) or standard plus cold therapy (treatment) utilizing a modified ice machine system with cool abdominal pad postoperatively. Pain scores on the first 3 postoperative days (PODs), postoperative narcotic consumption, and patient satisfaction were analyzed. ResultsFifty-eight patients were randomized, 29 to each group. Average survey response rate was 74% in control and 89% in treatment patients. There was no significant difference in median pain scores or narcotic use between groups. Cold therapy contributed to subjective pain improvement in 71%, 74%, and 50% of respondents on PODs 1, 2, and 3 respectively. ConclusionA majority of patients reported cold therapy to be a helpful adjunct in pain control after appendectomy, though it did not reduce postoperative pain scores or narcotic use in our cohort - likely due to this population's naturally expedient recovery and low baseline narcotic requirement. Type of StudyRandomized Controlled Trial. Level of EvidenceLevel I.

A75 PEDIATRIC ABDOMINAL PAIN PRESENTING TO A HOSPITAL-BASED GI CLINIC: EVOLUTION AND DISPOSITION

Abstract Background Abdominal pain accounts for 50% of pediatric gastroenterology consultations. While data exists on the possible etiologies of abdominal pain, there is a paucity of data on the natural evolution of abdominal pain while under the care of a Pediatric Gastroenterologist. Given limited access to Pediatric Gastroenterologists and long waiting times for initial consultation for abdominal pain, understanding what interventions ameliorate pain may help Gastroenterologists advise referring physicians while the patient awaits a consultation. Aims Primary outcome measure was the percentage of patients who reported at least a 75% subjective improvement of pain over baseline consultation. Methods A retrospective chart review between April 2014 and Dec 31, 2022 was taken in a hospital based GI clinic. Subjects referred for assessment of abdominal pain were identified, along with subjects referred for reflux and dysphagia as a comparator group. Subsequent visits were abstracted to identify diagnosis disposition and assess which interventions were tried and to what extent they succeeded. Patient loss to follow up were also measured. Results were summarized using descriptive statistics, and regression modeling will be attempted to identify predictors of response. Results 393 subjects were referred for abdominal pain and 286 for GERD and dysphagia. 439 (64.7%) reported at least 75% improvement in symptoms. 242 (35.6%) underwent endoscopy, 263 (38.7%) used Proton Pump Inhibitors, and 38 (8.54%) used Polyethylene Glycol-3350. Carbohydrate eliminations of various types were used in 13.5 - 27% of subjects with pain. 193 subjects (28.5%) were ultimately lost to follow up though some did report improvement in symptoms. Only 45 (6.6%) remained in active care by the end of the study while only 13 (1.93%) were transitioned to an Adult Gastroenterologist at 18 years old. Conclusions Pediatric Abdominal Pain is primarily a transitory population in the Pediatric GI clinic, with a large number responding to successive interventions. There is also a sizable minority who are lost to follow up. Future studies should attempt to identify the reasons for loss to follow up and ultimate disposition. Funding Agencies William Osler Health System Summer Student Research Program

Return to Sport Using Corticosteroid Injections for Knee Pain in Triathletes.

Introduction Despite the prevalence of corticosteroid injections in athletes, little is known about their efficacy in triathletes. We aim to assess attitudes, use, subjective effectiveness, and time to return to sport with corticosteroid injections compared to alternative methods in triathletes with knee pain. Methods This is an observational study during the COVID-19 pandemic.Triathletes answered a 13-question survey posted to three triathlon-specific websites. Results Sixty-one triathletes responded, 97% of whom experienced knee pain at some point in their triathlete career; 63% with knee pain received a corticosteroid injection as treatment (average age 51 years old). The most popular attitude (44.3%) regarding corticosteroid injections was "tried them, with good improvement".Most found the cortisone injection helpful for two to three months (28.6%), or more than one year (28.6%); of individuals who found the injections useful for more than oneyear, four-eight (50%) had received multiple injections during that same period. After injection, 80.6% returned to sport within one month. The average age of people using alternative treatment methods was 39 years old; most returned to sport within one month (73.7%). Compared to alternative methods, there was an ~80% higher odds of returning to sport within one month using corticosteroid injections; however, this relationship was not significant (OR=1.786, p=0.480, 95% CI:0.448-7.09). Conclusion This is the first study to examine corticosteroid use in triathletes. Corticosteroid use is more common in older triathletes and results in subjective pain improvement. A strong association does not exist for a quicker return to sport using corticosteroid injections compared to alternative methods. Triathletes should be counseled on the timing of injections, duration of side effects, and be aware of potential risks.

ID: 219132 Variables Associated With Non-Responders to 10kHz Spinal Cord Stimulation: A Retrospective Review of Preliminary Data

Non-response to 10kHz spinal cord stimulation (SCS) treatment has been documented in the literature as less than 50% subjective improvement in pain at 3-months post-implant1-5. Appropriateness in selection criteria is one of the most important factors associated with successful outcomes, but limited literature reports predictive factors in non-responders. Therefore, we aim to identify such variables and help distinguish the subset less likely to benefit from SCS.

Defining the minimal clinically important difference in smartphone-based mobility after spine surgery: correlation of survey questionnaire to mobility data.

Patient-reported outcome measures (PROMs) are the gold standard for assessing postoperative outcomes in spine surgery. However, PROMs are also limited by the inherent subjectivity of self-reported qualitative data. Recent literature has highlighted the utility of patient mobility data streamed from smartphone accelerometers as an objective measure of functional outcomes and complement to traditional PROMs. Still, for activity-based data to supplement existing PROMs, they must be validated against current metrics. In this study, the authors assessed the relationships and concordance between longitudinal smartphone-based mobility data and PROMs. Patients receiving laminectomy (n = 21) or fusion (n = 10) between 2017 and 2022 were retrospectively included. Activity data (steps-per-day count) recorded in the Apple Health mobile application over a 2-year perioperative window were extracted and subsequently normalized to allow for intersubject comparison. PROMS, including the visual analog scale (VAS), Patient Reported Outcome Measurement Information System Pain Interference (PROMIS-PI), Oswestry Disability Index (ODI), and EQ-5D, collected at the preoperative and 6-week postoperative visits were retrospectively extracted from the electronic medical record. Correlations between PROMs and patient mobility were assessed and compared between patients who did and those who did not achieve the established minimal clinically important difference (MCID) for each measure. A total of 31 patients receiving laminectomy (n = 21) or fusion (n = 10) were included. Change between preoperative and 6-week postoperative VAS and PROMIS-PI scores demonstrated moderate (r = -0.46) and strong (r = -0.74) inverse correlations, respectively, with changes in normalized steps-per-day count. In cohorts of patients who achieved PROMIS-PI MCID postoperatively, indicating subjective improvement in pain, there was a 0.784 standard deviation increase in normalized steps per day, representing a 56.5% improvement (p = 0.027). Patients who did achieve the MCID of improvement in either PROMIS-PI or VAS after surgery were more likely to experience an earlier sustained improvement in physical activity commensurate to or greater than their preoperative baseline (p = 2.98 × 10-18) than non-MCID patients. This study demonstrates a strong correlation between changes in mobility data extracted from patient smartphones and changes in PROMs following spine surgery. Further elucidating this relationship will allow for more robust supplementation of existing spine outcome measure tools with analyzed objective activity data.

Erector spinae plane versus paravertebral catheter techniques for rib fracture analgesia: A pilot matched cohort study

Background Numerous regional techniques are available to provide analgesia and reduce complications related to rib fractures. There is a paucity of evidence comparing the efficacy of these techniques. This pilot study aims to assess the efficacy of erector spinae plane block (ESPB) versus paravertebral block (PVB) catheters for rib fracture analgesia. Methods Patients who received either an ESPB or PVB catheter for rib fracture analgesia over the study period (April 2017 to September 2020) were eligible for inclusion. Patients were matched based on demographics and injury characteristics. Outcomes of interest included pre and post catheter-insertion numerical pain scores at rest and with movement, and time to rescue analgesia following catheter insertion. Results Thirty-four matched patients were included in this study. Pain scores at rest and with movement were significantly reduced in both groups. There were no statistically significant differences in post-block pain scores or time to rescue analgesia between the two groups. Fifteen (88.2%) of those in both groups had a documented subjective improvement in pain, inspiratory effort or cough strength. Conclusion This pilot study is the first to show that the recently described ESPB technique provides non-inferior analgesia compared to PVB for the management of rib fractures. Both techniques were effective in reducing pain scores and had similar times to rescue analgesia. This study supports claim that the ESPB is an effective alternative to traditional regional techniques in the management of rib fractures.

Long-term efficacy and patient satisfaction of pulsed radiofrequency therapy in temporomandibular disorders: A randomized controlled trial.

Background:Pulse radiofrequency (PRF) therapy is one of effective physical therapy modalities for treat temporomandibular disorders (TMD). This prospective randomized controlled trial aimed to evaluate the long-term treatment efficacy and patient satisfaction with PRF therapy in TMD.Methods:Eighty-six female patients with TMD were randomly assigned to either pulsed radiofrequency or placebo therapy in combination with other conventional treatments once a week for 12 weeks. A final analysis was performed 12 weeks after the completion of treatment. Clinical parameters and patient satisfaction were analyzed at baseline, 4, 8, and 12 weeks of intervention and at 24 weeks from baseline.Results:Pain intensity, comfortable and maximum mouth opening, and pain on capsule and masticatory muscle palpation were significantly improved after treatment in both groups. Notably, the pulsed radiofrequency group showed a significantly lower pain intensity at the final evaluation performed 3 months after the completion of treatment. Significantly more patients reported subjective pain improvement and satisfaction with treatment following intervention at baseline in the PRF group. Most patients did not report any discomfort following treatment in either group. However, significantly more patients in the PRF group reported a burning sensation with intervention.Conclusion:Long-term regular pulsed radiofrequency therapy was effective in significantly reducing TMD pain, and the effect was long-lasting following treatment completion. Pulsed radiofrequency therapy should be considered as a supportive physical therapy modality for TMD.

The Impact of Expectation for Pain Relief on Orofacial Pain Treatment Outcomes.

Aims: To examine the effects of expectations for pain relief on the objective and subjective outcome of chronic orofacial pain (OFP) treatment.Materials and Methods: Sixty individuals referred to the Orofacial Pain Clinic at the Hebrew University-Hadassah School of Dental Medicine between 2015 and 2017 with OFP reported their expectation for pain relief upon initial consultation. They were also interviewed by telephone after treatment and asked to recall their expectations, referred to as “recalled expectations” (RE). Correlations between RE and treatment success were calculated from pain diaries, and from subjective pain improvement rates (PIR) reported by the patients.Results: 21 males (35.0%) and 39 females (65%), mean age of 46.90 ± 15.77 years and mean pain duration of 49.07 ± 51.95 months participated in the study. All participants rated their expectations as “10” on a 0 to 10 scale during their first visit. RE did not correlate with diary ratings, (P = 0.773) but inversely correlated (−0.3) with PIR (P = 0.020) treatment outcomes.Conclusions: Expectations for pain relief, reported as 10 on a 0–10 scale during the first appointment, may reflect the patient's desire for complete relief of their pain rather than their expectations. Clinicians should therefore be aware of the need for clear communication and wording when examining for expectations. Inverse correlation between recalled expectations and subjective outcome may be due to the nature of recalled expectations when patients already knew their treatment outcomes, and may be explained by the concept of cognitive dissonance.

Evaluation of Extended-Release Oxycodone Administered through Enteral Tubes for the Management of Pain in Patients with Head and Neck Cancer: A Case Series

An abuse-deterrent, microsphere-in-capsule extended-release formulation of oxycodone myristate (Xtampza® ER, Collegium Pharmaceutical Inc, Canton, Massachusetts), was approved by the FDA in 2016 for the management of pain. The advantage of this formulation of oxycodone is that the microspheres can be administered via enteral tubes without compromising the long-acting formulation. This case series characterizes the experiences of five head and neck cancer patients initiated on oxycodone myristate through enteral tube administration for control of cancer-related pain. The primary outcome of patient reported subjective improvement in pain within one week occurred in all five patients. The median time to pain control was 4 days. The safety profile of oxycodone myristate was consistent with the package insert with no new findings reported. Oxycodone myristate can be an appropriate long-acting opioid analgesic option for patients requiring enteral tube administration of medications to achieve adequate cancer-related pain control.

Long-Term Efficacy of Pulsed Radiofrequency Therapy in Temporomandibular Disorders

This prospective randomized controlled trial aimed to evaluate long-term treatment efficacy and patient satisfaction of pulsed radiofrequency (PRF) therapy in temporomandibular disorders (TMD). Eighty-six female TMD patients diagnosed based on the Diagnostic Criteria for TMD (DC/TMD) were randomly assigned to either PRF or placebo therapy in combination with other conventional treatments. Therapy was delivered and symptoms were evaluated once a week for 12 weeks. Additional final analysis was done 12 weeks after treatment completion. Clinical outcomes including pain intensity, comfortable mouth opening range, maximum unassisted mouth opening range, response to palpation of the temporomandibular joint and masticatory muscle areas, and presence of joint noises and patient satisfaction were analyzed at baseline, 4, 8, and 12 weeks of intervention and at 24 weeks from baseline. Pain intensity, comfortable and maximum mouth opening range, and pain on capsule and masticatory muscle palpation were significantly improved after treatment in both groups. Notably, the PRF group showed a significantly lower pain intensity at the final evaluation done 3 months after completion of treatment. Significantly more patients in the PRF group reported subjective pain improvement and satisfaction with treatment following intervention at baseline. Long-term regular PRF therapy was effective in significantly reducing TMD pain and the effect was long-lasting following treatment completion. PRF therapy should be considered as a supportive physical therapy modality in TMD.

Mini-Anchors to Surgically Treat the Chronic Mandibular Dislocation

Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach. A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval. Patients subjectively rated their facial pain/headache, jaw function, disability, temporomandibular joint (TMJ) pain and diet. Objective functional changes were determined by measuring the interincisal opening and lateral excursions at T1 and T2. Significant subjective improvements in pain and dysfunction (89 to 94%) were observed (P < .01) from T1 to T2 in all parameters. The comfortable and guarded interincisal opening without mandibular dislocation increased by 41%, the maximum interincisal opening reduced 12 mm, and lateral excursions improved by 43%. Patients with recurrent mandibular dislocations with or without disc dislocation can be treated effectively by the mini-anchor translation control system.

Endovascular management of critical hand ischemia by 'palmar arch loop' technique.

Critical hand ischemia with advancing gangrene of digits requires urgent intervention to salvage as much tissue as possible. The purpose of this study was to evaluate the efficacy of "palmar arch loop" technique for endovascular management of critical hand ischemia by establishing inline flow to the palmar arch via both radial artery and ulnar artery, in patients with failed antegrade recanalization. To the best of our knowledge, this is the first case series evaluating the efficacy of "palmar arch loop" technique, with retrograde percutaneous transluminal angioplasty of the involved radial artery and/or ulnar artery. We retrospectively investigated 10 patients (60% female; mean age 42 ± 18 years; mean time of presentation post-acute event 24 ± 11 days) with critical hand ischemia undergoing endovascular intervention using "palmar arch loop" technique at a single center in northern India between April 2017 and March 2019. All patients were followed up at regular intervals (weekly for a month, fortnightly for 3 months, and then at 6 and 12 months) with clinical assessment and SpO2 measurement. Study end points were technical success rate, hand healing, and primary patency rate at one year. Causes for critical hand ischemia were iatrogenic injuries due to inadvertent intra-arterial injection in 50% (n = 5) and thromboembolic events in 50% patients (n = 5). Vessels involved were: both radial artery and ulnar artery along with the PA in 50%; radial artery and palmar arch in 30%; ulnar artery and palmar arch in 20%. All of them had total occlusion of the involved vessel (>2/3rd of total length) with occlusion/diffuse disease of palmar arch as well; 70% technical success rate was achieved ensuring inflow to palmar arch via both the arteries with improved flow distally to the common and proper digital arteries. Retrograde percutaneous transluminal angioplasty of radial artery in 50% (n = 5) and ulnar artery in 20% (n = 2) was done successfully by looping the guidewire across the palmar arch; 90% showed subjective improvement in pain with healing of the lesions and/or formation of clear line of demarcation with reversal of pregangrenous changes proximally. Out of the eight patients with gangrene of fingers, three underwent minor amputation of the gangrenous digits and five underwent auto-amputation of the gangrenous tissue with complete healing of the stump. Primary patency rate was 85.7% at one year. There was no access site-related complication or mortality in the follow-up period. Endovascular management of critical hand ischemia by "palmar arch loop" technique is an efficient technique to deal with occluded forearm vessels, particularly when antegrade recanalization fails. This technique, with good technical success and patency rates, is potentially a unique tool in the endovascular armamentarium for salvaging hand.

79 Efficacy of the Ultrasound Guided Bilateral Erector Spinae Plane Block in Treating Traumatic Thoracic Pain

Patients presenting to the emergency department (ED) with traumatic thoracic injuries are often in severe pain and are at high risk of developing respiratory complications secondary to decreased tidal volumes and opioid administration. The erector spinae plane block (ESPB) is a regional anesthesia technique previously described for perioperative and chronic pain. Our objective is to describe the novel use and efficacy of the bilateral ultrasound guided ESPB (and associated catheter placement) performed by emergency physicians for the treatment of acute traumatic thoracic pain. We performed a retrospective case series review of nine patients presenting to the ED in a five-month period between July and November 2019. All presented with bilateral thoracic trauma and had bilateral ESPBs placed by emergency physicians with simultaneous placement of catheters for continuous regional analgesia. We reviewed the medical record for each patient including data regarding opioid use, subjective pain scores and complications of the procedure. Opioid use was standardized by converting all opioids given to a patient (excluding those given for procedures such as catheterization) into the morphine milligram equivalent (MME). Mann-Whitney testing was used to compare the MME per day (MMED) used by patients with the ESPB catheter in place and days without the catheter. The average age of patients was 62.8 years of age including five males and four females. Six patients had trauma from falls or motor vehicle collisions and three had injuries from chest compressions. All patients had at least two rib fractures on each thoracic side with a mean total of 10.4 rib fractures per patient. All patients received an initial bolus of ropivacaine and a subsequent infusion ranging from 10 to 14 milliliters per hour. The average duration of the catheters was 6.9 days. The median MMED without the ESPB catheter was 47.0 mg/day (IQR 26.7-100) compared to 18.5 mg/day (IQR 5-41.1) with the catheter (p = 0.056). All patients had decreased opioid use with catheter placement except one patient who did not receive any opioids at all. All patients reported subjective improvement in pain with catheter placement. No complications such as infection, hemorrhage, pneumothorax, or local anesthetic toxicity were found. The bilateral ultrasound guided ESPB is an effective treatment for acute traumatic thoracic pain and can be performed safely by emergency physicians.

Evaluation Through Transcutaneous Tissue Oximetry (Near Infrared Spectroscopy) of Spinal Cord Stimulation in Patients With Complex Regional Pain Syndrome Type I

One of the physiopathological hypothesis behind complex regional pain syndrome (CRPS) type I involves the deep-tissue hypoxia of the affected areas. Spinal cord stimulation (SCS) appears to be effective in the treatment of these patients. We evaluated whether ESCS modifies tissue oxygen saturation (StO2 ) measured with near-infrared spectroscopy (NIRS) in the affected limbs in patients diagnosed with CRPS type I. Nonrandomized, cross-sectional study that evaluated 16 patients with CRPS type I who were receiving SCS applied to the posterior cords. NIRS was used to evaluate baseline StO2 (primary outcome) and variations in StO2 (secondary outcome) during an ischemia-reperfusion test performed using a vascular occlusion test, comparing the hands of limbs unilaterally affected by CRPS type I with the unaffected contralateral hands. We also determined whether the variations in StO2 were related to a modification in the percentage of subjective pain improvement and in the visual analog scale score. The baseline StO2 of the affected hands was significantly higher than that of the unaffected hands (mean 4.7%; 95% confidence interval: 1.41, 6.7; p = 0.005). Variations in StO2 during the ischemia-reperfusion test revealed no differences between affected and unaffected hands. No significant correlations were detected between baseline StO2 values or variations in StO2 during the vascular occlusion test and the pain measurements. Baseline StO2 evaluated by NIRS was greater in the affected hands of patients with CRPS type I treated with SCS than in the unaffected, contralateral hands.

Comparison of safety and analgesic efficacy of diclofenac sodium with etodolac after surgical extraction of third molars: a randomized, double-blind, double-dummy, parallel-group study.

BackgroundSurgical extraction of third molars is associated with postoperative pain and swelling at the extraction site. Pain is commonly managed using non-steroidal anti-inflammatory drugs (NSAIDs). Postoperative pain is usually moderate to severe in the first 12 h postoperatively and lasts for 3–5 days. However, with NSAIDs, these symptoms usually subside within 24 h. Diclofenac sodium and etodolac are NSAIDs, more selectively cyclooxygenase-2 inhibitors, with good analgesic efficacies.MethodsWe compared the safety and analgesic efficacy of diclofenac sodium with etodolac peroral after surgical extraction of third molars in a double-blind, double-dummy, parallel-group study. The subjective pain improvement and pain relief after 2, 6, 24, 48, and 72 h using the visual analogue scale were measured as the study outcome.ResultsEtodolac was equivalent to diclofenac sodium in pain alleviation at all postoperative time periods. No significant differences were found between diclofenac sodium and etodolac groups (P > 0.05). Both study medications were well tolerated and safe with mild adverse effects in only a few participants.ConclusionDiclofenac sodium and etodolac are comparable in terms of analgesic efficacy and safety after surgical removal of third molars.

Surgical rib fixation: Does increase case volume lead to improved outcomes?

Background: Surgical rib fixation in displaced rib fracture has been associated with positive patient outcomes in the literature. There is no data in the literature detailing the volume related outcomes in centres that offer surgical rib fixation in these patients.Methods: A retrospective review was conducted on surgical rib fixation cases performed from 2014 to 2018, with the early phase (EP) consisting of cases performed in the 2014-2017 period and the recent phase (RP) consisting of cases performed in 2018 to date. Variables for comparison included, indication for intervention, pain outcomes, and length of stay (LOS).Results: The five-year period yielded 37 cases. In the EP, 17 cases were performed, compared to 20 cases in the RP. The chest AIS scores were >3 for all cases with an average ISS of 21 in the EP compared to 19 in the RP. All patients underwent surgical rib fixation within 96 hours of admission. Pain was the predominant indication for intervention in the EP (65%, n = 11) compared to the RP where deformity and respiratory support (55%, n = 11) were the chief indicators. Subjective pain improvement was in favour of RP by 2.5 days. The average LOS was 546 hours days in the EP group, and 391 hours in the RP group. More anatomically difficult posterior and bilateral rib fixation cases were carried out in the RP group. Follow-up rate between the EP and RP were 75% vs 85% respectively with no hardware or pulmonary complications.Conclusion: Preliminary data analysis from the authors' institution suggests surgical rib fixation can be conducted with minimal complication. Increased case volume might improve outcomes related to subjective pain scores, length of stay, and complexity of surgical technique.

Patient-reported allergies predict postoperative outcomes and psychosomatic markers after spine surgery

Background ContextPrior studies have shown that patient-reported allergies can be prognostic of poorer postoperative outcomes. PurposeThe objective of this study was to investigate the correlation between self-reported allergies and outcomes after cervical or lumbar spine surgery. Study Design/SettingThis is a retrospective cohort study at a single tertiary care institution. Patient SampleThe patient sample included all patients undergoing cervical or lumbar spine surgery from 2009 to 2014. Outcome MeasuresThe primary outcome measure was change in the EuroQol-5 Dimensions (EQ-5D) after surgery. Secondary outcomes included changes in the Pain Disability Questionnaire (PDQ) and in the Patient Health Questionnaire-9 (PHQ-9), achievement of the minimal clinically important difference (MCID) in these measures, and cost of admission. MethodsBefore and after surgery, EQ-5D, PDQ, and PHQ-9 were recorded for patients with available data. Paired Student t tests were used to compare changes in these measures after surgery. Multivariable linear and logistic regressions were used to assess the relationship between the log transformation of the total number of allergies and outcomes. ResultsA total of 592 cervical patients and 4,465 lumbar patients were included. The median number of reported allergies was two. The EQ-5D index increased from 0.539 to 0.703 for cervical patients and from 0.530 to 0.676 for lumbar patients (p<.01 for both). Patients experienced significant pain improvement by the PDQ (80.1–58.2 for cervical patients and 79.4–58.1 for lumbar patients, p<.01). Using multivariable logistic regression, the log transformation of the number of allergies predicted significantly higher odds of achieving the PDQ MCID (odds ratio [OR]=2.09, 95% confidence interval [CI] 1.05–4.15, p=.02, for cervical patients; OR=1.30, 95% CI 1.03–1.68, p=.03, for lumbar patients). However, this relationship was not durable for patients with follow-up exceeding 1 year. The log transformation of the number of allergies for lumbar patients predicted a significantly increased cost of admission (β=$3,597, p<.01) and trended toward significance among cervical patients (β=$1,842, p=.10). ConclusionsPatient-reported allergies correlate with subjective improvement in pain and disability after spine surgery and may serve as a marker of postoperative outcomes. The relationship between allergies and PDQ improvement may be secondary to the short-term expectation-actuality discrepancy, as this relationship was not durable beyond 1 year.

Myofascial Release and Muscle Retraining for Dropped Head Syndrome Attributed to Radiation Fibrosis in Hodgkin Lymphoma: A Case Series

Background and Purpose: This article reviews the current knowledge base of dropped head syndrome and presents the case histories of 7 patients with a diagnosis of this condition at the Royal Hallamshire Hospital, Sheffield, through the Late Effects Clinic. All patients were referred for physiotherapy, and the assessment findings and subsequent treatment provided are discussed in detail. Case Description: Seven patients who were consecutively referred to physiotherapy and presented with signs and symptoms of suspected dropped head syndrome following previous treatment with mantle radiotherapy for Hodgkin lymphoma are discussed. Physiotherapy was delivered at various time intervals and duration on a one-to-one basis. Interventions were delivered to restore soft tissue length, rehabilitate proprioception, increase neck stabilizer strength, and retraining of muscles through range both locally and distally. Outcomes: All 7 patients reported subjective improvements in pain and function, with objective improvements in local and distal posture, tolerance to maintain head on neck position, and ability to grade through range neck movement locally. No formal outcome measures were used, as this is a retrospective report. Conclusion: Physiotherapy can offer short-term subjective and objective improvements in head on neck posture and control and effect more distal postural changes. Longer-term maintenance of improvements gained has yet to be determined. The most effective time point posttreatment for therapy intervention requires further research as does the type of physiotherapy intervention to be offered.