VAS Points Research Articles

Coronally Advanced Flap with Xenogeneic Collagen Matrix for the Treatment of Gingival Recessions at Sites Presenting with Cervical Restorations or Noncarious Cervical Lesions: A Clinical and Ultrasonographic Study.

The aim of this prospective study was to evaluate the efficacy of a cross-linked xenogeneic volume-stable collagen matrix (CCM) in treating gingival recessions (GRs) at teeth presenting with cervical restorations or noncarious cervical lesions (NCCLs). Fifteen patients with esthetic concerns for multiple sites with GRs and cervical restorations were consecutively enrolled. The sites were treated with a coronally advanced flap (CAF) design in combination with a CCM. When present, the previous restoration was removed, and the cementoenamel junction was reconstructed with a composite material. The CCM was stabilized on the root surface(s) previously occupied by the restoration. The CAF was sutured to completely cover the graft. Clinical measurements and intraoral digital and ultrasonographic scans were collected at baseline and at 3 and 6 months postsurgery. Limited postoperative discomfort was reported by patients during the healing. The mean root coverage at 6 months was 74.81%. Average increases in gingival thickness of 0.43 mm and 0.52 mm were observed when measured with ultrasonography 1.5 mm and 3 mm apical to the gingival margin, respectively (P < .05). Relatively high patient-reported satisfaction and esthetics were associated with the treatment outcomes. The treatment resulted in a significant reduction in dental hypersensitivity (mean: 33 VAS points). The present study demonstrated that CAF + CCM is an effective approach for treating GRs at sites with cervical restorations or NCCLs. Int J Periodontics Restorative Dent 2023;43:147-154. doi: 10.11607/prd.6448.

Pain And Coping Methods Of Hemodialysis Patients During The Covid-19 Pandemic Process

Objectives: This research was conducted to determine determine the pain and coping methods of hemodialysis patients during the covid-19 pandemic process . Methods: The research was conducted between April 2022 and August 2022. Data were collected from four dialysis centers in a city center. A total of 503 people receive hemodialysis treatment in the centers where the study was conducted. The sample consisted of 170 patients who volunteered to participate in the study and met the study criteria. The data of the study were collected using patient information form, and VAS Pain (Pain Level Measurement and Pain Coping Scale (PCS). Results: Accordingly, the VAS pain score experienced by the patients during the Covid 19 pandemic process is 7.64±0.97. The mean scores of the PCQ sub-dimensions; 27.1±8.96 in the self-coping sub-dimension; 19.86±4.83 in the helplessness sub-dimension; 9.77±5.24 in the sub-dimension of conscious cognitive interventions; It was found to be 18.84±4.22 in the sub-dimension of seeking medical help. In the case of VAS and PCQ total points averages, according to the pain characteristics of individuals, the severity of the pain, the pain type, the pain type the difference between the time and the scale point averages according to the methods of dealing with pain was statistically significant (p&lt;0.05). It has been found that the average of VAS and PCQ total points for individuals who suffer unbearable, have chest pain, define sudden and sharp pain, and experience pain all day long. In individuals who are waiting for the pain to be rested and spontaneous, VAS points averages and those who practice breathing exercises have been found to have significantly higher PCQ total score average. Conclusions: Most of the patients who participated in our study described the pain they experienced during the pandemic process suddenly and sharply, and the mean scores of VAS pain and PCQ were found to be significantly higher in this patient group. It has been determined that pain is experienced mostly at night and analgesics are mostly used to cope with it.

Is intravenous magnesium sulphate a suitable adjuvant in postoperative pain management?- A critical and systematic review of methodology in randomized controlled trials.

A growing worldwide focus on opioid-free anaesthesia entails multimodal analgesic strategies involving non-opioids such as magnesium sulphate (MgSO4). Several systematic reviews have concluded there is beneficial analgesic effect of MgSO4 administration but do not take considerable heterogeneity among the studies into consideration. Medical literature published until June 2021 was searched in PubMed/Medline, Embase, Central and Web of Science: The final search yielded a total of 5,672 articles. We included only randomised controlled trials assessing the effect of intravenous MgSO4 on opioid consumption and acute postoperative pain when compared to either placebo or standardized analgesic treatment. The primary aim was to compare the homogeneity of essential variables and confounders. A post-hoc meta-analysis demonstrated a reduction in both postoperative morphine consumption (-6.12mg) and pain score (-12.32 VAS points) in favour of the MgSO4-groups. Data for meta-analysis was missing from 19 studies (45%) on morphine consumption and 29 studies (69%) for pain score, the majority of which reports no effect for either morphine consumption or pain score. The calculated heterogeneity among the included studies was considerable for both outcomes; I 2=91% for morphine consumption and I 2=96% for pain score. Although we found a per se reduction in opioid consumption and pain score, methodological heterogeneity and clinical shortcomings of pre-, intra-, and post anaesthetic data precludes conclusions on clinical importance of intraoperative intravenous MgSO4. In addition, the reduction is likely less than what can be gained from using standardized analgesic treatment.

Ускоренное выздоровление при простой лапароскопической нефрэктомии.

Introduction. Simple nephrectomy is used for non-cancer diseases. That is, when the preservation of the kidney is unreasonable or dangerous. Since simple nephrectomy is a typical organ-delivering surgery, it is possible to optimize the perioperative period to reduce hospitalization and disability. The aim of the study was to compare the outcomes of simple laparoscopic nephrectomy using the enchanted recovery protocol and the standard approach. Materials and methods. A prospective randomized multicenter study included 27 patients with an established diagnosis of a non-functioning kidney, who were treated in the period 2018–2021 in urological hospitals in the city of Irkutsk. All patients were divided into two comparison groups: STANDART group (group I, n=14) and ENCHANCED RECOVERY group (group II, n=13). Results. Primary efficacy was comparable (p=0.892). It was found that the level of complications of class III according to Clavien-Dindo was statistically comparable in both groups (p&gt;0.05), and the level of complications of class II was significantly higher in group I (p&lt;0.05). When comparing the duration of hospitalization, there is a significantly (p &lt;0.001) longer stay of patients in group I (9.5±2.2 days) compared to group II (1.0±0.0 days). Subjective satisfaction with the treatment performed (upon requesting a critical analysis of all possible complaints) was comparable and amounted to 57.1% for group I and 100% for group II (p=0.342). When conducting a logistic regression analysis for postoperative febrile condition, according to multivariate regression, the volume of intraoperative infusion was found to be a significant predictor (for each +1 ml; OR 0.003; 95% CI 0.0001; 0.005; p = 0.042); for postoperative pain syndrome &gt;5 VAS points – increase in the size of the surgical approach per 1 mm (OR 0.14; 95% CI -0.01; 0.307; p = 0.077); for satisfaction with treatment, a negative effect of the duration of the postoperative stay was found (for each +1 day; OR -1.08; 95% CI -2.32; 0.15; p = 0.086). Conclusion. Simple laparoscopic nephrectomy under the enchanted recovery protocol allows achieving similar treatment results without increasing the risk of readmission or reoperation, but with the achievement of a better subjective and objective postoperative status of the patient.

Comparison of Treatments for Frozen Shoulder

There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional. To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines. Medline, EMBASE, Scopus, and CINHAL were searched in February 2020. Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included. Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used. Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up. From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, -1.0 visual analog scale [VAS] point; 95% CI, -1.5 to -0.5 VAS points; P < .001; vs physiotherapy: MD, -1.1 VAS points; 95% CI, -1.7 to -0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, -1.4 VAS points; 95% CI, -1.8 to -1.1 VAS points; P < .001). The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.

Comparative Characteristics of Hemostasis During Vaginal Hysterectomy

Aim. To compare the results of surgical treatment using bipolar hemostasis and traditional ligation of ligaments and blood vessels in vaginal hysterectomy.Material and methods. Fifty patients with benign uterine disease underwent vaginal hysterectomy using electrosurgery (n = 29) or conventional suture ligation (n = 21 controls).Results. Postoperative pain (especially on the fi rst day) was decreased in the electrosurgery group (5.50 ± 1.43 VAS points) as compared to the control group (7.64 ± 0.58 points), p &lt; 0.001. Intraoperative blood loss was signifi cantly lower in electrosurgery group (82.86 ± 22.58 ml) than in the control group (226.36 ± 129.12 ml), p &lt; 0.001. Operating time was signifi cantly shorter in the main group than in the controls (65.36 ± 20.9 min vs. 86.59 ± 40.19 min, p &lt; 0.05). On average, 2.75 ± 1.11 suture packages were used with bipolar coagulation, 6.00 ± 1.93 in the controls (p &lt; 0.001). Hospital stay was similar for both groups. Adverse event rates did not differ signifi cantly.Conclusions. Bipolar coagulation with the TissueSeal Plus proved to be more effi cient or identical to traditional suture ligation. Intraoperative blood loss, postoperative pain and the duration of the operation were less, while the complications were identical for both groups. In addition, bipolar coagulation was easier to use and cost effective. These fi ndings prove the feasibility and effectiveness of the use of electrosurgical techniques to perform hysterectomy and its further study

Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis.

Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% confidence interval 0.46 to 3.67 minutes, p = 0.01, I2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference -2.40, 95% confidence interval -3.41 to -1.38, p < 0.00001; I2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled risk ratio 0.98, 95% confidence interval 0.93 to 1.03, p = 0.36, I2 0%, p = 0.64) and complication rates (random effects, pooled risk ratio 0.40, 95% confidence interval 0.07 to 2.18, p = 0.29, I2 60% p = 0.08) between WALANT versus conventional methods. Conclusions: The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.

A Prospective Six-Month Study of Chronic Pain Sufferers: A Novel OTC Neuromodulation Therapy.

Objective To assess the durability of treatment over various chronic pain conditions of an emerging, nonprescription electromagnetic neuromodulation device that uses pulsed shortwave therapy. Methods A 6-month prospective study, involving 240 chronic pain sufferers, 94% of whom reported using pain pills and 98% reported using pain therapies prior to entering the study. Their average baseline pain was 8.2 VAS points before treatment; they had a pain duration of 6.5 years, and they were positive responders to pulsed shortwave therapy in an initial 7-day trial. Prospective assessments were obtained at intervals of 3, 4, and 6 months following a retrospective 7-day assessment. Longitudinal analyses were conducted to determine pain relief trends after the initial 7-day device use. Results Seven days after initial treatment, the average pain was reduced to 2.9, a 65% pain reduction for the study subjects. At the 6-month measurement, the average pain was 3.3, a 60% pain reduction from baseline. Only 17% of the subjects saw their pain level increase although this new level was still lower than baseline pain. Pain relief translated into improved quality of life and reduced medication use for the majority of the subjects. There were no significant adverse side effects reported over the 6 months of use. Conclusion Ninety-seven percent of the recruited subjects, all of whom had previously reported clinically significant pain relief using the 7-day PSWT device, sustained this relief for 6 months by using the device on an as-needed basis.

Effect of continuous nursing care on quality of life in patients with rheumatoid arthritis

Objective To study the effect of continuous nursing care on quality of life in patients with rheumatoid arthritis after discharge. Methods Patients with rheumatoid arthritis who were admitted to hospital from August 2016 to August 2017 were selected as the study subjects. According to the random number table method, they were divided into the control group and the research group, and the lost cases were eliminated. There were 99 cases in the control group and 94 cases in the research group. The control group was given routine care, and the research group conducted continuous nursing care measures on the basis of the control group. The morning stiffness time, pain score, disease activity, patient health status and nursing satisfaction of the two groups were observed before and 6 weeks after discharge. Results Six weeks after discharge, the morning stiffness time (23.76±12.76) min of the research group was significantly higher than that of the control group (38.22±14.53) min, the difference was statistically significant (t=3.865, P<0.05). Six weeks after discharge, the VAS (2.01±0.68) and HAQ (0.42±0.34) points of the research group were lower than those of the control group (4.17±1.30), (0.92±0.63) points, the difference was statistically significant (t=4.073, 3.916, P<0.05). The nursing satisfaction of the research group was 94.68%(89/94), and that of the control group was 78.79%(78/99), and the difference was statistically significant (χ2=9.416, P < 0.05). Conclusions The implementation of continuous care mode after discharge from patients with rheumatoid arthritis is beneficial to alleviate clinical symptoms such as morning stiffness and pain. Moreover, it can also improve patient health and quality of life, increase risk of disease progression, and care satisfaction is high which can help to protect the harmony between nurses and patients. Key words: Rheumatoid arthritis; Continuing nursing care

Prevalence and factors associated with a higher risk of neck and back pain among permanent wheelchair users: a cross-sectional study.

Cross-sectional study. To determine the prevalence of, and factors associated with, spinal pain among wheelchair users. Four Spanish hospitals specialized in providing care for wheelchair users. Persons who had used a wheelchair for a median (IRQ) of 10 (5;19) years, 27% of them due to reasons other than spinal cord injury, were recruited consecutively (n = 750). Data on 43 demographic, psychosocial, ergonomic, and clinical variables were collected, and analyzed. Main outcome measures were: point prevalence of neck (NP), thoracic (TP), low back pain (LBP), and pain at any spinal level (PASL); and factors associated with them. Point prevalence was 56% for NP, 54% for TP, 45% for LBP, and 76% for PSAL. PASL was associated with a lower quality of life (OR (95% CI) 0.91 (0.86; 0.97)). Multivariable regression models showed that the main factors associated with significant pain (≥1.5 VAS points) were: (a) For NP: cervical spinal injury and wheelchair seat cushion thickness, (b) For TP: thoracic spinal injury and sagittal index, (c) For LBP: thoracic or lumbar spinal injury, with some sensitivity remaining, (d) For PASL: being female, living alone, and using a non-power wheelchair. Discrimination (AUC) of these models ranged between 0.638 and 0.818. p-values in the Hosmer-Lemeshow test ranged between 0.420 and 0.701. Prevalence of spinal pain among wheelchair users is high. It is associated with a lower quality of life. Future studies should assess whether using a power wheelchair affects PASL, and if the thickness of seat cushion affects NP. Spanish Back Pain Research Network.

Assessing Offset Analgesia through electrical stimulations in healthy volunteers

Abstract Background and aims Offset Analgesia (OA) is a disproportionally large decrease of pain perception evoked by a slight decrease of a painful cutaneous heat stimulus, resulting in a lower pain perception compared to a simple constant stimulus at the same temperature. This study aimed to investigate the possibility of evoking the same disproportional analgesic effect by applying electrical stimuli. Methods 24 subjects underwent two control-trials of 30 s constant intensity by applying either heat stimulation at 48 °C or an electrical stimulation at 150% of the individual electrical Pain Detection (ePD) on the volar forearm. OA-trials consisted of a 30 s stimulation, divided into three periods: T1 (5 s), T2 (5 s), and T3 (20 s), with stimuli intensities of 48 °C, 49°C and 48°C or 150% of ePD, 180% of ePD, and 150% of ePD. Subjects were asked to rate the pain intensity on an electronic Visual Analog Scale (VAS; 0: no pain; 10: worst imaginable pain), and were categorized as responders if they showed more than 30% lower VAS at heat OA-trials compared to heat control-trial. Repeated measures Analysis of Variance was applied to investigate the difference in pain intensity to the electrical OA-trials, compared with the electrical control-trials. Results Responders to the heat OA-trial also responded to the electrical OA-trial compared to the electrical control-trial, with an analgesic effect of 3.3±0.5 VAS points (P &lt; 0.001). However, when analyzing all subjects, no difference was found comparing the electrical OA-trial (VAS 3.8±0.5) to the electrical control-trial (VAS 6.2±0.4; P &gt; 0.5). Conclusions This study suggests that responders to the heat OA-paradigm also respond to the electrical OA-paradigm.

Effect of Structured Pre-anesthetic Communication on Preoperative Patient Anxiety

Background: The preanesthetic visit influences patient satisfaction and medical outcome. Providing relevant information may reduce anxiety. This study aimed to evaluate whether training for a structured interview technique improves communication skills, resulting in increased patient satisfaction and reduced patient’s anxiety and fear of anesthesia. Methods: Randomized controlled observational study, comparing patients (n=47) interviewed by anesthesiologists having obtained training to optimize structured communication (TA) or by anesthesiologists without such training (CA). Patient anxiety and fear was recorded before and after the preoperative interview. Interview duration and satisfaction with the anesthesiologist were also recorded. Data were analysed to test for superiority of the structured interview approach. Results: Mean preoperative anxiety was 1.2 VAS points lower in TA vs. CA group (95% CI-2.39; -0.03, P=0.082). Structured interviews significantly reduced preoperative anxiety in younger (<47 years) but not in older patients (≥ 47 years; interaction P=0.045). Patients’ fear of anesthesia was strongly reduced after the interview (median VAS: 8.0); reduction was stronger in the group with structured interview technique versus control group (difference in VAS: 1.86 [0.59; 3.12], P=0.006). Duration of the interview was statistically not significantly shorter using structured interview technique (P=0.142). Conclusion and recommendation: Compared to standard interview techniques, a structured interview approach reduces anxiety and fear of anesthesia, particularly in younger patients. Our data suggest that a structured interview technique may decrease the duration of the preoperative interview. Anesthesia departments should train communication skills geared toward a structured preoperative interview.

엘리트 남녀역도선수들의 등속성 허리 근기능 및 유연성과 요통과의 관계

Purpose. This study of purpose was to compare and analyze the relationship among the isokinetic trunk muscular functions, flexibility and low back pain of elite weight lifter with regard of sex. Methods. we measured the level of low back pain, isokinetic muscular functions according to gender, then analyzed the relationship between isokinetic functions and the level of low back pain, between flexibility and the level of pain, between Athletic Career and the level. Results. In this study, the gender, the VAS point was and the VRS point was in males. The other side, in females the VAS points was and the VRS was . There was significant negative correlation(r

Five-year results of lumbar disc prostheses in the SWISSspine registry.

The Swiss Federal Office of Public Health demanded a nationwide HTA registry for lumbar total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISS spine registry is to generate evidence about the safety and efficiency of lumbar TDA. Two hundred forty-eight cases treated between 3-2005 and 6-2006, who were eligible for the 5-year follow-up were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 85.9, 77.0, 44.0 and 51.2 %, respectively. Outcome measures were back and leg pain, medication consumption, quality of life, intraoperative and postoperative complication and revision rates. Additionally, segmental mobility, ossification, adjacent and distant segment degeneration were analysed at the 5-year follow-up. There was a significant, clinically relevant and lasting reduction of back (preop/postop 73/29 VAS points) and leg pain (preop/postop VAS 55/22) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.30/0.76 EQ-5D score points) until 5 years after surgery. The rates for intraoperative and early postoperative complications were 4.4 and 3.2 %, respectively. The overall complication rate during five postoperative years was 23.4 %, and the adjacent segment degeneration rate was 10.7 %. In 4.4 % of patients, a revision surgery was performed. Cumulative survivorship probability for a revision/re-intervention-free 5-year postoperative course was 90.4 %. At the 5-year follow-up, the average range of motion of the mobile segments (86.8 %) was 9.7°. In 43.9 % of patients, osteophytes at least potentially affecting the range of motion were seen. Lumbar TDA appeared as efficient in long-term pain alleviation, consequent reduction of pain medication consumption and improvement of quality of life. The procedure also appeared sufficiently safe, but surgeons have to be aware of a list of potential adverse events. The outcome is stable over the 5-year postoperative period. The vast majority of treated segments remained mobile after 5 years, although almost half of patients showed osteophytes.

Subtalare Distraktionsarthrodese mit allogenem Knochenspan

Isolated subtalar disorders often require subtalar arthrodesis in combination with bone transplantation for the hindfoot reconstruction. Arthrodesis using an iliac crest bone graft is the standard procedure. We present results after subtalar arthrodesis using an allogenic bone graft. Clinical and radiological examinations were performed on 19 feet preoperatively, 6, 12 weeks and 12 months postoperatively. The AOFAS score of 35 (31-42) points preoperatively improved to 86 (78-90) points 12 months postoperatively. The VAS points of 6 (4-8) preoperatively decreased to 2 (1-2) points 12 months postoperatively. Osseous fusion could be acchieved in all cases. Using allogenic bone graft for subtalar arthrodesis leads to secure integration and avoids iliac crest bone graft morbidity.

The Painfulness of Active, but not Sham, Transcranial Magnetic Stimulation Decreases Rapidly Over Time: Results From the Double-Blind Phase of the OPT-TMS Trial

BackgroundDaily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks is an FDA approved treatment for major depression. Although rTMS is generally safe when administered using the FDA guidelines, there are a number of side effects that can make it difficult for patients to complete a course of rTMS. Many patients report that rTMS is painful, although patients appear to accommodate to the initial painfulness. The reduction in pain is hypothesized to be due to prefrontal stimulation and is not solely explained by accommodation to the stimulation. MethodsIn a recent 4 site randomized controlled trial (using an active electrical sham stimulation system) investigating the antidepressant effects of daily left dorsolateral prefrontal rTMS (Optimization of TMS, or OPT-TMS), the procedural painfulness of TMS was assessed before and after each treatment session. Computerized visual analog scale ratings were gathered before and after each TMS session in the OPT-TMS trial. Stimulation was delivered with an iron core figure-8 coil (Neuronetics) with the following parameters: 10 Hz, 120% MT (EMG-defined), 4 s pulse train, 26 s inter-train interval, 3000 pulses per session, one 37.5 min session per day. After each session, procedural pain (pain at the beginning of the TMS session, pain toward the middle, and pain toward then end of the session) ratings were collected at all 4 sites. From the 199 patients randomized, we had usable data from 142 subjects for the initial 15 TMS sessions (double-blind phase) delivered over 3 weeks (142 × 2 × 15 = 4260 rating sessions). ResultsThe painfulness of real TMS was initially higher than that of the active sham condition. Over the 15 treatment sessions, subjective reports of the painfulness of rTMS (during the beginning, middle and end of the session) decreased significantly 37% from baseline in those receiving active TMS, with no change in painfulness in those receiving sham. This reduction, although greatest in the first few days, continued steadily over the 3 weeks. Overall, there was a decay rate of 1.56 VAS points per session in subjective painfulness of the procedure in those receiving active TMS. DiscussionThe procedural pain of left, prefrontal rTMS decreases over time, independently of other emotional changes, and only in those receiving active TMS. These data suggest that actual TMS stimulation of prefrontal cortex maybe related to the reduction in pain, and that it is not a non-specific accommodation to pain. This painfulness reduction softly corresponds with later clinical outcome. Further work is needed to better understand this phenomenon and whether acute within-session or over time painfulness changes might be used as short-term biomarkers of antidepressant response.

Five-year results of cervical disc prostheses in the SWISSspine registry

The Swiss Federal Office of Public Health demanded a nationwide HTA-registry for cervical total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISSspine registry is to generate evidence about the safety and efficiency of cervical TDA. Three hundred thirty-two cases treated between 3.2005 and 6.2006 who were eligible for 5 years follow-ups were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 84.6, 74.4, 50.6 and 64.8 %, respectively. Outcome measures were neck and arm pain, medication, quality of life, intraoperative and postoperative complication and revision rates. In addition, segmental mobility, ossification, adjacent and distant segment degeneration were analyzed at the 5-year follow-up. There was significant, clinically relevant and lasting reduction of neck (preop/postop 60/21 VAS points) and arm pain (preop/postop VAS 67/17) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.39/0.82 EQ-5D points) until the 5-year follow-up. The rates for intraoperative and early postoperative complications were 0.6 and 7.2 %, respectively. In 0.6 % an early and in 3.9 % a late revision surgery was performed. At the 5-year follow-up, the average range of motion of the mobile segments (88.2 %) was 10.2°. In 40.7 % of the patients osteophytes at least potentially affecting range of motion were seen. Cervical TDA appeared as safe and efficient in long-term pain alleviation, consequent reduction of pain killer consumption and in improvement of quality of life. The improvement is stable over the 5 years postoperative period. The vast majority of treated segments remained mobile after 5 years, although 40.7 % of patients showed osteophytes.

Comparative effectiveness research across two spine registries

Comparative effectiveness research in spine surgery is still a rarity. In this study, pain alleviation and quality of life (QoL) improvement after lumbar total disc arthroplasty (TDA) and anterior lumbar interbody fusion (ALIF) were anonymously compared by surgeon and implant. A total of 534 monosegmental TDAs from the SWISSspine registry were analyzed. Mean age was 42 years (19-65 years), 59% were females. Fifty cases with ALIF were documented in the international Spine Tango registry and used as concurrent comparator group for the pain analysis. Mean age was 46 years (21-69 years), 78% were females. The average follow-up time in both samples was 1 year. Comparison of back/leg pain alleviation and QoL improvement was performed. Unadjusted and adjusted probabilities for achievement of minimum clinically relevant improvements of 18 VAS points or 0.25 EQ-5D points were calculated for each surgeon. Mean preoperative back pain decreased from 69 to 30 points at 1 year (ØΔ 39pts) after TDA, and from 66 to 27 points after ALIF (ØΔ 39pts). Mean preoperative QoL improved from 0.34 to 0.74 points at 1 year (ØΔ 0.40pts). There were surgeons with better patient selection, indicated by lower adjusted probabilities reflecting worsening of outcomes if they had treated an average patient sample. ALIF had similar pain alleviation than TDA. Pain alleviation after TDA and ALIF was similar. Differences in surgeon's patient selection based on pain and QoL were revealed. Some surgeons seem to miss the full therapeutic potential of TDA by selecting patients with lower symptom severity.

Toxina botulínica tipo A en la migraña crónica refractaria: experiencia en uso compasivo preautorización

Chronic migraine is very disabling, with medication overuse commonly associated. The recent approval of botulinum toxin-A -OnabotulinumtoxinA (OnabotA)- means a hallmark.To describe our experience in compassionate use before approval.35 cases with chronic migraine assessed between July 2009-December 2011 in a specialized headache consultation. 100 U of OnabotA were injected in 21 points over the facial and pericranial muscles, according to a modified PREEMPT protocol. We determined before and after treatment: number of episodes and migraine days; pain intensity and days of disability extracted from MIDAS score, and data regarding drug intake. After follow-up, new injections were given at intervals dictated by individualized response timing. Therapeutic response was considered when: intensity of pain was reduced to a half o ≥ 4 VAS points, or the number of monthly days of pain descended ≥ 7/month, or the case converted to non-drug overuser.In 27 cases (80%) it was proved clinical improvement. This effect was confirmed by: a reduction in headache severity, reflected as much in pain intensity (VAS scale < 0.001) as in the number of days with disability (3.2 vs 0.4, p < 0.001); an improvement in the number of monthly days of pain (19.8 vs 13.8, p < 0.05; a significant decrease in the number of cases of medication overuse (69% vs 13%, p < 0.01). Mean duration of effect was 15 weeks and mean follow-up 9.8 months.OnabotA disclosed efficacy as prophylactic treatment of chronic migraine. It is mainly expressed as a reduction of pain intensity. Medication overuse also descended. Adverse events were sparse.

Balloon Kyphoplasty Improves Back Pain but does not Result in a Permanent Realignment of the Thoracolumbar Spine

Balloon kyphoplasty (BKP) has been established as a standard procedure for treatment of osteoporotic compression fractures of the spine in elderly patients, as it results in pain relief for most of the patients. Moreover, BKP may result in a partial realignment of the sagittal shape of the vertebra and the spine. However, it is unclear whether BKP may result in long-term improvement of the sagittal alignment of the spine. The aim of the current study was to investigate if there is a significant loss of correction of the sagittal alignment of the thoracolumbar spine following BKP. A prospective, noncontrolled, nonrandomized study, consisting of 71 patients treated for single level osteoporotic compression fracture by BKP at 1 institution and by 1 surgeon, was done. We checked the following radiographic outcome parameters: Beck's ratio, the kyphosis angle of the treated vertebra, the angle of kyphosis including the treated vertebra and the adjacent disc (monosegmental angle), the angle of kyphosis, including the treated segment, the adjacent disc as well as the adjacent vertebra (bisegmental angle). BKP resulted in significant pain relief with a score decreasing from 7.11 to 1.73 on a visual analogue scale immediately after the procedure. The effekt persisted after 1 year with a score of 1.58 VAS points. BKP also led to an improvement of each radiographic outcome parameter immediately after surgery. Beck's ratio was improved from 0.71 to 0.83. The Cobb's angle of the relevant vertebral bodies decreased from 11.4° to 6.8°. Monosegmental and bisegmental kyphosis angles decreased from 8.12° to 4.9° and from 6.9° to 4.5° respectively. Within 1 year, however, there was a significant loss of correction in each radiographic parameter analyzed. Beck's ratio decreased to 0.72, Cobb's angle increased to 10.8°, and the mono- and bisegmental kyphosis angles to 8.8° and 8.3°, respectively.BKP does not result in a permanent realignment of the thoracolumbar spine following treatment of single level osteoporotic compression fractures.