Subjective Pain Scale Research Articles

Biomarkers for intervertebral disc and associated back pain: From diagnosis to disease prognosis and personalized treatment.

Biomarkers are commonly recognized as objective indicators of a medical state or clinical outcome and have been widely used as clinical and diagnostic tools and surrogate endpoints in many pathological conditions. In the context of intervertebral disc (IVD) and associated back pain, also known as degenerative disc disease (DDD), the use of biomarkers has been poorly explored. DDD is currently diagnosed using imaging techniques and subjective pain scales, limiting an objective association between DDD and pain levels, as well as an evaluation of disease progression. There is a need for objective and reliable measurements for DDD, pain and pathology progression. DDD predictors could also help clinicians in deciding on the optimal treatment for distinct patient groups. This review addresses the current candidate biomarkers in DDD, including imaging, genetic, metabolite and protein-based parameters, both at the tissue and systemic levels, that may become a major advance in the diagnosis and prognosis of the disease, as well as in the management of therapeutic approaches to DDD.

The Relationship Between Colonoscopy Practice Style, Operator Ergonomics and Procedure Quality.

We aimed to compare three endoscopy operators who performed colonoscopy in three different styles in terms of procedure results, colonoscopy quality, and operator comfort during the procedure. A total of 246 patients, who underwent routine screening colonoscopy for precancerous lesions between May and December 2022 in Istanbul Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey, were prospectively analyzed. The results of three different styles (single operator sitting, single operator standing, and two operators standing) were compared with each other. The following criteria were examined: polyp/adenoma detection rate, number of polyps detected per patient, cecal intubation rate, total procedure time, number of endoscope corrective maneuvers, number of patient position corrections during the procedure, and the endoscopist's subjective pain scale after the procedure. The number of corrections and changes in scope position, rates of changing the patient's position during the procedure, and the postprocedural fatigue degree of the endoscopist were the highest for the single-operator standing style (p<0.001). The total processing time and post-procedure fatigue degree of the endoscopist were the lowest for the single-operator sitting style (p<0.001). The adenoma detection rate was the highest for single-operator standing style (37.8% vs 22.0% and 29.3%). The strongest predictive factors for the total procedure time were the colonoscopy style and patient age. The strongest predictive factors for the change in the total number of detected polyps were colonoscopy style, patient gender, and patient age. Independent of all other factors, the total detected number of polyps was statistically significantly higher for the single-operator standing style compared to other styles (B=-0.217, 95% confidence interval: -0.369 - -0.066 and p=0.005) (B=-0.172, 95% confidence interval: -0.326 - -0.017 and p=0.029). Two conclusions were drawn from this study. For routine screening colonoscopy, the single-operator sitting style seems to be superior to other styles in terms of the shortest procedure time and the least tiring. However, the widely used single-operator standing style should be preferred over other styles in terms of the highest adenoma detection rate although it is most tiring and time-consuming.

Association Between Race and Usage of Pain Medications in Children With Long Bone Fractures in US Emergency Departments, 2011-2019.

The purpose of this study was to determine the association between race and analgesic administration for children with long bone fracture (LBF) in US emergency departments. Previous studies have shown conflicting results regarding association between race and analgesic administration for pediatric LBFs. We conducted a retrospective analysis of pediatric emergency department visits for LBF using the 2011-2019 National Hospital Ambulatory Medical Care Survey-Emergency Department. We investigated the diagnostic workup and analgesic prescription rate among White, Black, and other pediatric emergency department visits for LBF. Of the estimated 292 million pediatric visits to US emergency departments from 2011 to 2019, 3.1% were LBFs. Black children were less likely to be seen for a LBF than White or other children (1.8% vs 3.6% and 3.1%, P < 0.001). There was no association between race and subjective pain scale ( P = 0.998), triage severity ( P = 0.980), imaging (x-ray, P = 0.612; computed tomography scan, P = 0.291), or analgesic administration (opioids, P = 0.068; nonsteroidal antiinflammatory drugs/acetaminophen, P = 0.750). Trend analysis showed a significant decrease in opioid administration for pediatric LBF from 2011 to 2019 ( P < 0.001), with 33.0% receiving opioids. There was no association between race and analgesic administration, including opioids, or diagnostic workup in pediatric LBF. In addition, there was a significant downtrend in opioid administration for pediatric LBF from 2011 to 2019.

스포츠마사지 전공수업이 VDT 증후군 주요 통증 부위 중 상부 근육의 주관적 통증 척도와 객관적 통증 척도와의 비교 분석

The purpose of this study was to compare and analyze the subjective pain scale and objective pain scale felt by individuals on the effect of sports massage major classes on muscle tension and muscle stiffness of upper muscles, which are major pain areas of VDT syndrome. To this end, 13 students who participated in the sports massage class majoring in sports rehabilitation at G University with no physical diseases and no musculoskeletal abnormalities were selected as subjects. In order to achieve the purpose of the study, the difference between the scales of muscle tension variables was identified through comparative analysis after measuring two subjective pain evaluation scales and objective pain evaluation scales in the 15th week. Based on the above research method and research model verification, the results derived in this study are as follows. First, there was a statistical significant difference in the muscle tension and muscle stiffness of the upper muscles that sports massage treatment had pain improvement effects on both the NRS and VAS pain scales. Second, in the case of the objective pain scale of sports massage treatment in the muscular tension and muscle stiffness of the upper muscle, there was a statistical significance difference in the left mitral muscle. The above results showed that sports massage treatment was sufficient through a subjective pain scale in muscle tension and muscle stiffness of the upper muscle through a 12-week sports massage major class, but there was no statistical significance difference in the objective pain scale except for the left mitral muscle, but there was no positive effect.

Human salivary concentrations of brain derived neurotrophic factor correlates with subjective pain intensity associated with initial orthodontic therapy

Current study aimed to evaluate presence & concentration of salivary molecular pain biomarkers Calcitonin Gene Related Peptide (CGRP) and Brain-Derived Neurotrophic Factor (BDNF) during initial stages of orthodontic treatment and correlation with subjective pain scales, Numerical Rating Scale (NRS), Visual Analogue Scale (VAS), Verbal Rating Scale (VRS) and McGill Pain Questionnaire (MPQ). Consented, healthy-pain free patients (n = 40) undergoing orthodontic therapy, having moderate crowding with pre-molar extraction were recruited. Unstimulated whole saliva was collected and stored at -80 °C in cryotubes. Levels of CGRP & BDNF in salivary samples was assessed by enzyme–linked immunosorbent assay. Samples were collected under stipulated 5 time periods using saliva collection tube by passive drooling method: immediately after bonding but before wire placement (T0-baseline), after 24 h (T1), 48 h (T2), 72 h (T3) & 168 h (T4) after wire placement. Consolidated subjective pain scales were administered concurrently. Regression value (R2 > 0.9) confirmed BDNF & CGRP in saliva. Significant change was observed from baseline to 168 h in all subjective parameters (p < 0.05). CGRP did not correlate with subjective pain scales statistically (p > 0.05). BDNF levels correlated with all the subjective pain scales, NRS (T3-p = 0.0092&T4-p = 0.0064), VRS (T3-p = 0.0112&T4-p = 0.0500), VAS (T3-p = 0.0092 &T4-p = 0.0064) &MPQ (T1-p = 0.0255). Mean BDNF & median subjective pain scale graphs were similar. BDNF correlated with all the subjective pain scales warranting further investigation.Trial registration; Clinical Trial Registry—India (CTRI) Reg No: CTRI/2018/12/016571; Registered 10th December, 2018 (10/12/2018) prospectively; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=29640&EncHid=&userName=Dr%20Sagar%20S%20Bhat.

Infrared thermographic changes after decompression surgery in patients with carpal tunnel syndrome

BackgroundDigital infrared thermal imaging (DITI), which detects infrared rays emitted from body surface to create a body heat map, has been utilized at various musculocutaneous conditions. Notably, DITI can demonstrate autonomic vasomotor activity in the nerve-innervated area, and thus may be of use in carpal tunnel syndrome (CTS). In this study, we compared DITI findings before and after carpal tunnel release (CTR) surgery in patients with unilateral CTS to investigate the corresponding neurophysiological changes.MethodsIn this retrospective cohort study, DITI parameters such as the temperature differences between the median and ulnar nerve territories and median nerve-innervated digital anisometry were measured. Subjective symptom duration, pain scale, and ultrasonographic findings were also compared before and after CTR. Patients were evaluated before and 6 weeks after CTR, respectively.ResultsA total of 27 patients aged 59.0 ± 11.2 years were finally included. After CTR, median nerve-innervated thermal anisometry was improved (2.55 ± 0.96 °C to 1.64 ± 1.34 °C; p = 0.003). The temperature differences between the median and ulnar nerve territories were not significantly changed. Subjective pain, the Simovic Weinberg Clinical Scale, and palmar bowing of the flexor retinaculum were also significantly improved (p < 0.001 for all comparisons).ConclusionsOur results demonstrated that DITI findings could reflect an improvement in autonomic function after CTR. Therefore, DITI can be an objective method to assess pre- and post-operative neurophysiologic changes in CTS.

Accuracy of Pain Scales in Predicting Critical Diagnoses in Non-Traumatic Abdominal Pain Cases; a Cross-sectional Study.

Accurate assessment and management of abdominal pain in the emergency department (ED) is crucial, as it can indicate potentially life-threatening conditions requiring timely treatment. This study aimed to evaluate the ability of pain scales to predict critical diagnoses in patients with non-traumatic abdominal pain. This cross-sectional study was conducted at a tertiary university hospital and involved individuals aged 15 years and above who presented to the ED with non-traumatic abdominal pain. Pain severity was evaluated using subjective pain scales, including the Numerical Rating Scale (NRS) and the Face Pain Scale (FPS), as well as objective pain scales, including the Critical Care Pain Observation Tool (CPOT) and the Non-verbal Pain Score (NVPS). The area under the receiver operating characteristic curve (AuROC) was employed to determine the discriminative ability of each pain scale to predict critical diagnosis. 264 cases with the mean age of 47.2±19.4 years were studied (53.0% male). The most common location of abdominal pain was epigastric pain (43.9%). Most patients presented with dull-aching pain, and those with critical diagnoses had more of this characteristic than those with non-critical diagnoses. (52.5% vs. 28.3%, p = 0.01). The overall median NRS, FPS, CPOT, and NVPS of included participants were 8 (interquartile range (IQR) 7-10), 8 (IQR 6-8), 3 (IQR 1-4), and 3 (IQR 2-4), respectively. Patients with critical diagnoses had a higher NVPS score than patients with non-critical diagnoses (median score of 4 vs. 3, p = 0.02). The AuROC of NRS, FPS, CPOT, and NVPS were 0.53 (95% CI: 0.45-0.62), 0.55 (95% CI: 0.46-0.63), 0.59 (95% CI: 0.50-0.68), and 0.62 (95% CI: 0.53-0.71), respectively. The correlation coefficients among these scales were considered moderately correlated or higher. In evaluating patients with non-traumatic abdominal pain, the NVPS demonstrated the highest accuracy in predicting critical diagnoses. However, all pain scales, whether subjective or objective, exhibited suboptimal performance in predicting critical diagnoses.

Efficacy of Pain Scales in the Athletic Population and Pairing With Algometric Measurements

The purpose of this study was to determine if subjective pain scales commonly used (a) are correlated to each other and with algometric measurements and (b) differ between collegiate athletes and noncollegiate athletes. There were consistent significant positive correlations between all pain scales, regardless of groupings (collegiate athletes: r = .234–.730, p ≤ .007; noncollegiate athletes: r = .518–.820, p ≤ .002; female: r = .437–.690, p ≤ .010; male: r = .492–.784, p ≤ .005). These findings suggest that the pain scales studied could be used with both athletic and nonathletic populations. Algometric assessments may be better suited for patients with altered pain processing compared with those without.

성인 여성의 전방머리자세의 연령에 따른 통증 척도와 근활성도 비교 분석

The The purpose of this study is a comparative analysis of pain scale and muscle activity by myself in the forward head posture of adult women. Subjects were classified into adult A group(n=7) in their 20s and adult B group(n=7) in their 40s with Forward Head Posture, and examined for body composition, algometry, visual analogue scale, and muscle activity. And compared. For data processing, the mean and standard deviation were calculated using the SPSS 25.0 program, an independent t-test between groups was performed, and the significance level was set to .05. Results First, algometry showed significant differences in the sternocleidomastoid muscles(p.001) and the upper trapezius muscles such as the stomach(p.001). Significant differences also appeared in the visual analogue scale(p.001). Second, muscle activity showed a statistically significant difference in the upper trapezius muscle(p.001). Therefore, in order to verify the effect of the exercise program on the Forward Head Posture through this study, both objective and subjective Pain Scale must be examined.

Preliminary results of alternative treatment for postmastectomy pain syndrome: stromal vascular fraction-enriched fat grafting

Postmastectomy pain syndrome (PMPS) is defined as chronic pain lasting more than 3 months after surgery. PMPS reduces the quality of life for patients and affects their daily life. Although the pathogenesis of PMPS has not been clearly elucidated, it is strongly suggestive of neuropathic pain caused by damage to the intercostobrachial nerve. While previous studies have used stromal vascular fraction (SVF)-enriched fat grafts in patients with neuralgia, few studies have used it for PMPS. Therefore, the present study evaluated the use of SVF-enriched fat, which includes adipose-derived stem cells with good differentiation capacity, in patients with PMPS to improve quality of life and reduce neuropathic pain. In three patients, the fat was mixed with concentrated SVF using a centrifuge and injected into the primary pain sites. After surgery, in all three cases, the subjective pain scale score decreased significantly over time.

Liquid Biopsy-Based Biomarkers of Inflammatory Nociception Identified in Male Rats.

Physicians are challenged in treating pain patients due to the lack of quantifiable, objective methods of measuring pain in the clinic; pain sensation is multifaceted and subjective to each individual. There is a critical need for point-of-care quantification of accessible biomarkers to provide objective analyses beyond the subjective pain scales currently employed in clinical care settings. In the present study, we employed an animal model to test the hypothesis that circulating regulators of the inflammatory response directly associate with an objective behavioral response to inflammatory pain. Upon induction of localized paw inflammation, we measured the systemic protein expression of cytokines, and activity levels of matrix metalloproteinases (MMPs) that are known to participate in the inflammatory response at the site of injury and investigated their relationship to the behavioral response across a 24 h period. Intraplantar injection with 1% λ-carrageenan induced a significant increase in paw thickness across this timespan with maximal effects observed at the 8 h timepoint when locomotor activity was also impaired. Expression of the chemokines C-X-C motif chemokine ligand 1 (CXCL1) and C-C motif chemokine ligand 2 (CCL2) positively correlated with paw inflammation and negatively correlated with locomotor activity at 8 h. The ratio of MMP9 to MMP2 activity negatively correlated with paw inflammation at the 8 h timepoint. We postulate that the CXCL1 and CCL2 as well as the ratio of MMP9 to MMP2 activity may serve as predictive biomarkers for the timecourse of inflammation-associated locomotor impairment. These data define opportunities for the future development of a point-of-care device to objectively quantify biomarkers for inflammatory pain states.

Cryotherapy in Anterior Cruciate Ligamentoplasty Pain: A Scoping Review.

Cryotherapy is used in individuals in the postoperative period (PO) of anterior cruciate ligament (ACL) repair, owing to its effects such as increased pain threshold, decreased cellular activity, and vasoconstriction. The aim of this study was to analyze the effect of cryotherapy on pain intensity in the immediate PO of ACL reconstruction. A scoping review was performed in the databases: Cochrane, Embase, Lilacs, LIVIVO, PEDro, PubMed, Scopus, and Web of Science; and gray literature: Google Scholar, CAPES Thesis Database, and Open Grey. PRISMA recommendation was followed. Two blinded reviewers performed the selection of studies: Phase 1-reading of titles and abstracts and Phase 2-Reading of the full texts and disagreements resolved in consensus. The references of 701 studies were identified, 603 from the main databases and 98 from the gray literature. After removal of duplicates, 387 studies were left for Phase 1-reading of titles and abstracts according to eligibility criteria and for Phase 2-28 studies for reading of full texts. Two studies were excluded: one randomized clinical trial and another sandwich study. Finally, 15 studies were included in this review. Cryotherapy is effective in reducing pain intensity because there were reductions in the scores of subjective pain scales in the immediate PO of ACL reconstruction. Cryocompression was shown to be superior to conventional cryotherapy.

Correlation between skin conductance measurements and subjective pain scales in children after otolaryngological procedures

Abstract Introduction Pain assessment in children is crucial in managing postoperative analgesia; it is therefore necessary to determine the most accurate tool for assessing pain in children. The aim of this study was to evaluate the correlation between skin conductance measurements and self-reporting pain scales in children after otolaryngology procedures. Materials and methods Thirty-three children (N=33) were assessed for eligibility for the research. Postoperative pain was assessed using the Visual Analogue Scale; the Wong-Baker Faces Pain Rating Scale; the Face, Legs, Activity, Cry, and Consolability scale; and a skin conductance algesimeter. The postoperative pain was measured 1 and 2 hours after the surgery. Results There was no statistically significant correlation between self-reported pain scores and the skin conductance fluctuations in the children studied, regardless of gender or age. A statistically significant correlation was found between the existing subjective pain scales in children. Conclusions The skin conductance measurements do not provide an additional reliable tool for assessing pain in patients after otolaryngological procedures. The existing self-reported pain scales are sufficient to assess postoperative pain in children.

Effect of Auriculotherapy on Musculoskeletal Pain: A Systematic Review and Meta-Analysis

The aim of this study was to evaluate the effect of auriculotherapy on musculoskeletal pain in adults. A total of 885 studies were retrieved from nine databases (PubMed, Scopus, CINAHL, Web of Science, Ovid Medline, Cochrane Library, RISS, KMbase, and KISS). Sixteen studies were selected for meta-analysis, which satisfied the inclusion criteria and the evaluation of risk of bias. Demographic data, auriculotherapy types, intervention characteristics, auricular points, and outcomes related to pain (subjective pain scale, and amount of analgesic) were extracted from all included studies. The effect size of auriculotherapy was analyzed through comprehensive meta analysis 3.0, and the presence of publication bias was analyzed through a funnel plot and Egger's regression. The results of the meta-analysis (n = 16) revealed that the auriculotherapy was significantly superior to the control group on present pain in adults (Hedges' g = -0.35, 95% Confidence Interval [CI] = -0.55~-0.15). According to the results of subgroup analysis, the effect size of auricular acupuncture therapy (Hedges' g = 0.45, 95% CI = -0.75~-0.15) was higher than the auricular acupuncture (Hedges' g = 0.27, 95% CI = -0.53~0.00): the longer the intervention period, the greater the effect size. In this study, auriculotherapy demonstrates a significant reduction in musculoskeletal pain in adults. Therefore, it is necessary to refine the curriculum to include auriculotherapy as a nursing intervention to relieve musculoskeletal pain in adults and encourage its use in clinical settings.

Multimodal cerebral imaging study on the effects of \u201cAdjust Zang Dredge Meridian\u201d electroacupuncture on cerebral central sensitization in PDPN patients: a study protocol for a sham-controlled, randomized trial

BackgroundPainful diabetic peripheral neuropathy (PDPN) has a great impact on an individual’s quality of life. The current researchers’ previous trial suggested that acupuncture was a promising adjunctive treatment for PDPN. However, the underlying mechanism of action of acupuncture treatment for PDPN is still unclear, especially its effects at the cerebral level. The aim of this trial will be to explore how acupuncture works in treating PDPN by using multimodal cerebral imaging.Method and designThis will be a randomized controlled trial. A total of 150 participants will be recruited and assigned to one of three groups: the healthy group, the DM without PDPN group and the DM with PDPN group. Participants in the DM without PDPN and the DM with PDPN groups will each be further divided between an electroacupuncture group and a sham electroacupuncture group. Participants will receive six treatment sessions per week for 4 weeks. Multimodal cerebral imaging includes resting-state functional magnetic resonance imaging (rs-fMRI), diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS); this neurophysiological testing will be the primary outcome measure. Subjective pain scales and blood analysis will be a secondary outcome measure and will be used to assess the clinical efficacy of the intervention. Multimodal cerebral imaging will be used to detect cerebral activity changes in each treatment group. The clinical data and fMRI data will be analysed for all the groups. Multiple correlation regression analyses will be used to assess the association between changes in cerebral functional activity and the improvement of clinical outcomes after acupuncture treatment.DiscussionThis study is based on the results of the researchers’ previous study, and using combined clinical and cerebral function changes, it will help evaluate the effects of acupuncture on PDPN. The investigation of acupuncture’s central mechanism of action will further expand the understanding of acupuncture treatment of PDPN.Trial registrationChinese Clinical Trial Registry ChiCTR1900024109. Registered on 26 June 2019.

Quantitative gait analysis of patients with severe sacroiliac joint dysfunction: a prospective clinical study.

Sacroiliac joint (SIJ) dysfunction is a chronic painful condition responsible for up to 30% of back pain. Treatment modalities include physiotherapy, intraarticular analgesic injections, ablation techniques or SIJ fusion. The severity of SIJ dysfunction is commonly assessed via subjective pain or disability scales. Quantitative gait analysis offers an objective means of evaluating patients with SIJ dysfunction prior to its surgical treatment. Ten patients diagnosed with severe SIJ dysfunction were matched with 10 healthy controls. All individuals underwent quantitative 3D gait analysis using the Qualisys program and statistical analysis was performed to identify significant differences in gait parameters between the two groups. Two groups of data were obtained; angular parameters described by the Gait Profile Score (GPS) and spatiotemporal parameters described in standard SI units. Statistically significant differences were found between the patient and control group for parameters: overall GPS (p = 0,049), hip abduction/adduction (p = 0,017) and ankle plantar/dorsal flexion (p = 0,003), stride length (p = 0,002), step length (p = 0,001), swing time (p = 0,03) and initial double limb support (p = 0,02). This paper is the first to perform complex quantitative gait analysis of patients with SIJ dysfunction and to compare it with healthy individuals. These results can provide clinicians with baseline gait values for these patients in order to objectively quantify the extent of their disease.

The Effects of Initial Rehabilitation Exercise on Range of Motion, Muscular Strength, and Muscle Pain after Surgery for Osteochondritis Dissecans of the Humeral Capitellum in Middle and High School Baseball Players.

Background:This study evaluated the effects of a 4-week initial rehabilitation program in middle and high school baseball players who underwent removal of a loose body from osteochondritis dissecans of the capitellum humerus.Methods:Middle and high school baseball players with osteochondritis dissecans of the capitellum humerus were enrolled in this study. Each had more than 3 yr of experience and had undergone arthroscopic removal of loose bodies from the same expert at Kim’s Orthop Special Clinic in Seoul. The initial exercise rehabilitation program was based on a two-stage program. Body composition, range of motion of flexion and extension in the elbow and wrist joints, grip strength, and subjective pain scale were measured before and after rehabilitation. To assess the differences between groups, we used a two-way analysis of variance.Results:The range of motion for flexion and extension of the elbow and wrist joints, grip strength, and score on the visual analog scale each were significantly improved following the 4-week program (P<0.001), had an interactive effect in time × group (P<0.001), and had significance between groups (P<0.05).Conclusion:The 4-week initial rehabilitation exercise program might improve the overall range of motion of the elbow joint and has a positive therapeutic effect on grip strength and visual analog scores. However, future well-designed studies with more subjects and multicentric research groups are necessary for verification.

TNF-\u03b1 - mediated peripheral and central inflammation are associated with increased incidence of PND in acute postoperative pain

BackgroundAcute postoperative pain plays an important role in the perioperative neurocognitive disorders (PND). The pathogenesis of PND is still unknown, but it is generally believed that peripheral and central nervous system inflammation play an important role, and acute postoperative pain is also thought to aggravate postoperative inflammatory response. The aim of the present study is to explore the effect of acute postoperative pain on peripheral and central nervous system inflammation and related cognitive impairment behaviour in elderly rats after surgery.MethodsRats were assigned into four groups: control, surgery for internal fixation for tibial fracture, surgery with analgesia using intraperitoneal morphine, and morphine without surgery. Pain was assessed by the Subjective Pain Scale. The spatial memory of rats was assessed by the Morris water maze (delayed matching task) from the second day to the seventh day after surgery (POD2-POD7). In part of the rats, the pro-inflammatory cytokines TNF-α in plasma, the medial prefrontal cortex (mPFC), and the hippocampus were determined by ELISA on the POD2. The activation of microglia and the expression of c-Fos in the hippocampal CA1 regions and mPFC were detected by the immunohistochemical method on the POD2.ResultsAcute postoperative pain and spatial memory impairment occurred after operation, and postoperative analgesia could significantly improve the both parameters. Additionally, on the POD2, the levels of TNF-α in plasma, hippocampus and mPFC were significantly increased, while the activation of microglia cells and the expression c-Fos in the hippocampal CA1 regions and mPFC were significantly increased. And postoperative analgesia with morphine significantly inhibited the above reactions.ConclusionOur data suggest that acute postoperative pain increases the incidence of perioperative neurocognitive disorders. Peripheral and central nervous system inflammation may be involved in this cognitive impairment. And reducing the intensity of acute postoperative pain may be one of the main preventive strategies for PND.

Effect of Two Different Nursing Techniques on Labor pain, Duration, and Anxiety Level among Primiparous Women

Background: Labor pain is considered as one of the most intense forms of pain. Psychological challenge such as anxiety can contribute towards women’s perception of pain and may affect their labor and birth experience. Aromatherapy is one of modern many non-invasive methods and is the most popular complementary therapy to relieve pain during childbirth. The aim of this study was to evaluate the effect of two different nursing techniques on labor pain, duration, and anxiety level among primiparous women. A Quasi-experimental design was utilized to achieve the aim of the study, conducted at labor and delivery unit at Shaqra Governate general hospital, KSA. Sample: A total of 150 laboring women were recruited (75 for each group). Tools: four tools were used; 1) A structured interviewing questionnaire schedule, 2) Subjective labor pain scale (visual-analogue scale [VAS]), 3)- Partograph and 4)- Spielberger state-trait anxiety questionnaire. Results: There were statistically significant differences between the two groups in labor pain scores at active phase after the intervention at (p < 0.001), and in transitional phase after the intervention at (p = 0.06). There was significant difference toward total labor duration among studied sample. Nearly half (49.3%) of the lavender group were satisfied and referenced it for future pregnancies. Conclusion: Two different nursing techniques were effective methods for reducing pain intensity, duration of labor and anxiety level. It can be clinically recommended as an alternative, safe and affordable method of pain relief during labor. However, lavender aromatherapy is more effective in decreasing pain during labor, and anxiety than breathing technique. Recommendations Educational program facilities and methods about non-pharmacological methods as; lectures, handout, and videos should be developed and become accessible to all pregnant women in the outpatient clinics.

Ultrasound cyclo plasty for the management of refractory glaucoma in chinese patients: a before-after study.

Cyclocryotherapy and transscleral cyclophotocoagulation are commonly used procedures for the treatment of refractory glaucoma, but still with many complications. Ultrasound cyclo plasty (UCP) is a novel technique that determines a selective and more precise coagulation necrosis of the ciliary body to reduce intraocular pressure (IOP), but its efficacy and safety have been less investigated in Chinese population. This study aimed to evaluate the clinical efficacy and safety of UCP in Chinese patients with refractory glaucoma. We designed a prospective, before-after study involving 36 eyes of 36 patients with refractory glaucoma that underwent uneventful UCP. Mean IOP, mean IOP reduction and subjective pain scale scores before and after UCP were compared to evaluate the efficacy of UCP in these patients. Procedural success defined as no abnormality of the treatment sites, and complications were recorded, along with confirmation of the safety of UCP. The 36 UCP patients had a mean IOP of 53.61 ± 12.4mmHg and a mean VAS score of 5.69 ± 3.02 preoperatively. Successful operation was achieved in 28 patients, with a success rate of 77.8%. In the follow-up observation at day 1, day 7, and month 1, 2, 3 and 6 postoperatively, both mean IOP and mean VAS score were significantly lower than those before operation (both P < 0.0001). The median baseline IOP reduction ranged from 22 to 36%. The mean reduction was 42.5% in 36 patients when taking IOP at the last follow-up visit as the last. No significant changes in visual acuity were achieved in 4 patients after UCP, and no adverse outcomes were present in other patients after timely treatment of complications such as conjunctival hyperemia, subconjunctival hemorrhage, or hyphema. UCP is a novel yet reliable option for Chinese patients with refractory glaucoma since its high efficacy and safety.