VAS Scale For Pain Research Articles

Observational Study with a New Portable Cryosurgery Device, HYDROZID®, in Superficial Epidermal Lesions: An Indian Experience

Abstract Background: Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID®, a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India. Aims: This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions. Methods: The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit. Results: Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients. Conclusion: The data from this study support good clinical tolerability and safety of the Hydrozid® portable cryo device.

Effectiveness of Mindfulness Based Cognitive Therapy Verses Conventional Physiotherapy on Kinesiophobia in Patients with Frozen Shoulder: A Comparative Study

Background: Frozen Shoulder is defined as a clinical syndrome characterized by painful restriction of both active and passive shoulder movements (1) . there is high degree of kinesiophobia among patients having shoulder pain(2). Mindfulness based cognitive therapy (MBCT) may be an effective intervention for the treatment of active depression in a population with chronic pain (3) . The treatment goal of MBCT program, is to find ways of managing the pain and the adverse consequences on mental health and quality of life (4). considering that in patients with frozen shoulder treatment of pain alone was not enough to reduce fear of movement , Hence this study aimed to find the effect of MBCT on pain and kinesiophobia in patients with frozen shoulder. Objective: To find the effect of mindfulness based cognitive therapy on pain and kinesiophobia in patients with frozen shoulder. Methodology: After designing the study Institutional Ethical Approval was taken. Consent was obtained from all the participants. 30 samples were screened based on eligibility criteria, 2 were excluded and 28 were further divided into Group A (experimental group) received MBCT and conventional therapy and Group B (control group) received conventional therapy. Pre-assessment was by Tampa scale for kinesiophobia and VAS scale for pain done at Week 0. The experimental group received the MBCT and regular exercise program for 8 sessions 2 hours per day for 8 weeks. The control group received regular exercise program. Post-assessment was done at week 8. Result: The (INSTAT) was used for comparison of mean of group A and group B. One participant from the experimental group and one from the control group did not complete the study. The comparison of mean post intervention scores for group A and B of TSK Scores was found to be Extremely significant which was calculated using un-paired t test with t value t= 3.922, p value p= <0.0006. Comparison of mean post intervention scores for group A and B of VAS Scores was found to be Not significant which was calculated using un-paired t test with t value t= 0.4583, p value p= 0.6505. Conclusion: The study concludes that MBCT along with conventional physiotherapy is effective in reducing kinesiophobia in patients with frozen shoulder.

A novel synergistic device for joint inflammation – efficacy on ankle sprain cases

Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic – semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with – in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t-test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain (p = 0.006), edema (p = 0.011), dorsi-flexion (p = 0.015), and plantar flexion (p =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.

Pharmacologic treatment of GERD in adolescents: Is esophageal mucosal protection an option?

Background:Gastroesophageal reflux disease (GERD) is still a challenging and difficult to treat condition in children. Although acid suppression represents the mainstay of treatment in adolescents, it is not devoid of adverse events, especially in the long-term.Objectives:In this investigation we explored a new therapeutic avenue in GERD, that is esophageal mucosal protection.Design:To this end, we performed an investigator-initiated, retrospective study to evaluate the efficacy and safety of a short-term treatment with Esoxx™ medical device in 25 adolescents with GERD-related symptoms. This mucoadhesive formulation contains two natural mucopolysaccharides (sodium hyaluronate and chondroitin sulphate) and adheres to the esophageal mucosa, exerting a protective effect against refluxed gastric contents and allowing mucosal healing.Methods:Heartburn, epigastric burning and post-prandial regurgitation were scored with a pain VAS scale and re-evaluated after 3-week treatment with Esoxx (one stick post-prandially, three times daily).Results:All patients completed the treatment without adverse effects and with good tolerability and compliance. All the three major symptoms significantly (p<0.001) improved after treatment. No patient required additional investigation (i.e. upper Gastrointestinal endoscopy) or medication (i.e. antisecretory drugs).Conclusion:The results of this pilot study suggest that esophageal mucosal protection is a promising therapeutic avenue for GERD also in children. Provided, these data be confirmed by a large, randomized clinical trial, this medical device can enter our therapeutic armamentarium against this challenging disease.

Outcome of patients undergoing posterior spine fixation and decompression for posttraumatic thoracolumbar spine fractures and the factors predicting it

Background: Posterior spine fixation and decompression for thoracic and lumbar spine fractures have the advantage of stabilization of the fracture, decompression of neural canal, early mobilization and rehabilitation of the patient. The study aimed to find out the postoperative outcome and complications following posterior spine surgery and the factors affecting the outcome.&#x0D; Methods: A retrospective study was carried out among 44 patients who underwent posterior spine decompression and fusion for thoracic and lumbar spine fracture. The data regarding patient presenting symptoms, comorbidity, associated injuries and imaging finding in CT and MRI were collected. The postoperative outcome of patients after surgery was assessed using ASIA impairment scale, KPS, VAS scale for pain are noted at the preoperative and postoperative period. Other factors like improvement of bowel and bladder symptoms, back stiffness and return to the job after surgery were also found out.&#x0D; Results: There was a significant improvement in ASIA impairment scale (mean =0.74 grade), KPS score (mean = 40) and VAS pain scale (mean = 6.7) at 6 months follow up after surgery. Improvement in ASIA impairment scale was more in the patient with severe canal compromise (mean = 1.62 grade), patients with translational/ distraction injuries (mean= 1.01grade) and patients with paraparesis (mean=1.06). Only one-third of patients with bowel and bladder involvement improved after surgery. Around 56.8% of patients were able to return to jobs at 6 months follow up. Patients who were paraplegic at the initial presentation were mostly not able to return to jobs. The most common reported complication in the study was intraoperative pedicle breakage.&#x0D; Conclusion: Decompression of the spinal cord plus posterior spine fixation is a safe, reliable and effective method in the management of thoracic and lumbar fractures with significant improvement in outcome in terms of motor power, pain and quality of life.

Systematic literature review and network Meta-analysis of sulodexide and other drugs in chronic venous disease.

To assess the clinical efficacy of sulodexide, including a comparison with venoactive drugs (VAD) (micronized purified flavonoid fraction, MPFF; hydroxy-ethyl-rutosides, HR; calcium dobesilate;Ruscus extract combined with hesperidin methyl chalcone and vitamin C, Ruscus+HMC+VitC; horse chestnut seed extract, HCSE) and pentoxifylline in patients with chronic venous disease. We performed a literature search in MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) and observational studies. Proportion of patients with complete venous ulcer healing was the primary outcome and lower leg volume, foot volume, ankle circumference and symptoms were the secondary outcomes. Bayesian network meta-analysis (NMA) was perfomed with random effects models using only RCTs. A meta-analysis of observational studies was performed for sulodexide because no RCT could be included in NMA for symptoms or signs. Forty-five RCTs and eighteen observational studies were identified. Sulodexide was included only in a single NMA for the proportion of patients with complete ulcer healing and it showed to have the highest probability of being the best treatment (48%) compared with pentoxifylline (37%) and MPFF (16%). MPFF was the most effective treatment in reducing lower leg volume, CIVIQ-20 score and pain VAS scale while calcium dobesilate and Ruscus+HMC+VitC were the most effective in reducing foot volume and ankle circumference respectively.Meta-analyses of observational studies for sulodexide showed that it improves significantly the scoring of pain, feeling of swelling, heaviness and parasthesiae measured by Likert scales. Sulodexide is at least as effective as pentoxifylline and more effective than MPFF in improving the rate of ulcer healing in patients with CVD. VADs are effective in improving venous symptoms and signs, as was also shown by sulodexide in the meta-analysis of observational studies. The relative effectiveness of sulodexide and VADs needs to be evaluated by an RCT in order to better inform clinical practice.

Comparison of Functional Outcome Between Trans– 2nd Metacarpal Fixation and Trans-Trapezius Fixation with K-Wire for Bennett Fracture

Introduction: An articular fracture of the base of the thumb metacarpal consisting of a single, variable-sized, volar-ulnar fracture fragment is termed Bennett fracture. In the studies conducted so far there has been paucity in the knowledge about the methods of k wire fixation for the Bennett fracture and hence the purpose of this study is to compare functional outcome between the trans – 2nd metacarpal fixation and trans – trapezius fixation with K wire for Bennett fracture. Methods: Patients were 18 years and above with no previous injury on the 1st metacarpal . Final assessment was performed from six months to nine months after the treatment with the DASH Score, VAS scale for pain, Hand Grip strength by Dynamometer. Radiographic images were taken at 6 months post-op in two separate views to evaluate post-traumatic arthritis of the first CMC joint. Results: Statistical analysis showed a correlation between Pain and DASH score to be 0.946 in TTZ group and 0.966 in T2MC group and hence signifies that patients in T2MC group had a better functional outcome with lower DASH score and lower pain score. Significant correlation was seen between Pain and Grip strength, with -0.587 in TTZ group and -0.482 in T2MC group. Higher pain score correlated with higher DASH score and lower Grip strength and hence we can conclude that T2MC had a better functional outcome post-surgery than TTZ technique of fixation. Post op radiographs showed that T2MC group of patients had a better outcome with less arthritic complications and less pain and better grip strength. Conclusion: This study gives us the overview about the two fixation methods of Bennett fracture , and that when trans 2nd metacarpal fixation is done , there are less chances of arthritis of the CMC joint as well as better functional outcomes post operatively as compared to trans trapezial fixation and hence guides a surgeon to make a decision about the technique of fixation to be employed during fixing such fracture. Keywords: Bennett fracture, Trans-trapezial, Trans- 2nd metacarpal, Functional outcome

Autologous conditioned serum: clinical and functional results using a novel disease modifying agent for the management of knee osteoarthritis

Objective The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4 weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results Our results show an improvement of all the evaluation scales at 6 months follow-up. Particularly, VAS scales among all patients decreased by 35.8% (p = .00148), KSS functional scores improved by 38.2% (p = .00148), KSS clinical scores improved by 28.9% (p = .00236) and WOMAC scores were reduced by 19.8% (p = .00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intra-articular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects.

The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception.

Purpose There is still conflicting evidence to support postoperative rehabilitation protocols using immobilization following rotator cuff repair over early motion. The objective of the study was to evaluate the evolution of pain, shoulder function, and patients' perception of their health status up to 1 year after cuff rotator repair and a standard postoperative rehabilitation protocol consisting of 4 weeks of immobilization followed by a 2-week assisted controlled rehabilitation. Methods Descriptive, longitudinal, uncontrolled case-series study was performed on 49 patients who underwent arthroscopic rotator cuff repair following traumatic or degenerative lesions. VAS scale for pain, Constant–Murley score for function, and SF-12 score for quality of life were used as outcome measures and were administered before the rehabilitation treatment, at the end of the 2-week rehabilitation, 3 months, and 1 year after surgery. Results VAS pain score decreased significantly along the follow-up reaching almost a nil value after 1 year (0.2). Function as measured by Constant–Murley score had a significant improvement during follow-up, reaching a mean value of 84.6. The short form (SF)-12 score increased over time reaching 46.3 for the physical and 43.8 for the psychological dimension, respectively, at 1 year. Conclusion The present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4-week immobilization followed by a 2-week rehabilitation protocol without evidence of tendon un-healing or re-tearing. Level of Evidence This is a level IV, therapeutic case series.

Double wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture

Category: Hindfoot Introduction/Purpose: The pathoanatomy characteristics of the rockbottom malunion after calcaneal fracture include severe loss of calcaneal height, which result in the horizontal of the talus in the ankle mortise and anterior ankle impingement. This study was carreid out to evaluate the clinical results of double wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture. Methods: From February 2014 to February 2015, 9 cases of calcaneal rockbottom malunion after calcaneal fracture were treated with wedged osteomy and subtalar arthrodesis. And 8 patients get final followup. Weight bearing X ray were taken before the surgery and at final followup. Talar declination, lateral talocalcaneal angle, lateral talo-first metatarsal angle and Bohler’s angle were used to evaluate the correction of the malunion. The American Orthopaecid Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analog scale (VSA) for pain were collected. SPSS 22.0 software was used for Statistical analysis. Results: The average time for bone union was 17.1 weeks (12weeks~22weeks). The talar declination was improved from 2.5 ° (- 6°~13°) preoperatively to 13.25° (5°~19°) postoperatively (P&lt;0.001); the lateral talocalcaneal angle was improved from -0.25° (-15°~10°) preoperatively to 0.25° (7°~25°) postoperatively (P&lt;0.001); the talo-first metatarsal angle was improved from 21.13° (10°~30°) preoperatively to 9.88° (5°~14°) postoperatively (P&lt;0.001); and the calcaneal Bohler’s angle was improved from -25.6 ° preoperatively to 22.4 °postoperatively(P&lt;0.001). The AOFAS scale was 26.63 (12~53) preoperatively, and 79.75 (72~89) at final followup (P&lt;0.001); the VAS scale for pain was 7.5 (6~9) preoperatively, and 2.6 (2~3) at final followup (P&lt;0.001). Conclusion: Wedge osteomy and sutalar arthrodesis can effectively correct the malunion, restore the calcaneal height and hindfoor alignment. Pain was relieved after correction, and the function of the ankle and hindfoot was restored.

A study on efficacy and safety of etanercept in patients with rheumatoid arthritis

Aim and objective: To assess the efficacy of Etanercept and also to evaluate the safety profile of Etanercept in patients with Rheumatoid arthritis. The main objectives of the study are to evaluate the drug safety and efficacy among the Rheumatoid arthritis patients. And to monitor the ADRs observed in Rheumatoid arthritis patients with Etanercept. Materials and Methods: Study was carried out in a 300 bedded tertiary care hospital. The department selected for the study was orthopaedics. This method involves prospective observational analysis of Efficacy and safety of Etanercept in patients with Rheumatoid arthritis. The study was carried out by the collection and documentation of general information of the patient including personal history, past medical history, past medication history, lab investigations and treatment pain will be analysed by using visual analog scale(vas). ADR’s were assessed by using Naranjo adverse drug reaction probability scale. The whole procedure was carried out in Rheumatoid arthritis patients who received Etanercept without any alteration in therapy. Result and Discussion: This study on sample size of 35 was carried out to assess the short term safety and efficacy of Etanercept. Moreland et al compared placebo, ETN 10 mg twice weekly (ETN20), and ETN 25 mg twice weekly (ETN50) in patients with long-standing RA and an inadequate response to DMARDs. Although both treatment arms were significantly better than placebo, as measured by American College of Rheumatology. The study conducted by Elizabeth Mary Curtis et al., shows that Etanercept is a safe and well-tolerated treatment for RA, And another study conducted by Boulos Haraoui et al, study shows that Etanercept is both safe and effective to use in RA. Etanercept has been shown not only to reduce disease activity but also to limit progression of joint damage in early and late disease which are similar to our study. Conclusion: This study concludes incidence of rate of patients in the age group of 50 – 59 years were mostly affected by Rheumatiod arthritis compared to other age groups. The male patients were found to be affected more with rheumatoid arthritis than female patients. The study made use of 25mg Eternacept for the above obtained results. This could also be carried out using 50mg Eternacept and evaluated on the same. There was a decrease in pain VAS scale confirming the efficacy and safety of Etanercept. In the future, this study could be further extended to a combination therapy over longer duration of time for better results.

Hip arthroscopy for femoroacetabular impingement in professional and non-professional footballers and time to return to play

Introduction Femoroacetabular impingement (FAI) with associated intra-articular hip pathologies is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes and time to return to play football between professional and non-professional athletes following hip arthroscopic surgery for femoroacetabular impingement (FAI). Methods Football players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre- and postoperatively after an average of 3.6 years. For statistical analysis, a Cox proportional hazards model was used to examine whether professional or non-professional footballers were more likely to return faster to soccer at the same level. Results We included 50 soccer players (60 hips); 29 were professional players (36 hips) with a mean age at the time of operation 22.3 (16–35, SD 5.18) and 21 were non-professional (24 hips) with a mean age 31.6 (17–47, SD 7.78). The mean follow-up was 43.1 months (SD 14.09). Two non-professional athletes (2 hips) did not return to play because of ageing and one professional (2 hips) because of spinal surgery. For professional footballers, the mean patient satisfaction was 9.2 and for non-professional footballers was 8.75. The mean VAS scale for pain decreased considerably from 7.3 preop to 0.38 postoperatively for professional and from 6.5 preop to 1.29 postoperatively for non-professional athletes. The mean mHHS, sports score were improved for both groups. Professional footballers returned to their pre-injury level to play at a mean of 13.26 weeks (8–22, SD 2.95) and non-professional at a mean 23.3 weeks (8–54, SD 12.7). Statistical analysis showed that the hazard ratio was 1.99 (P value 0.016) suggesting that the professional players were about twice as likely to return to play football faster, at the same level than non-professional athletes. Conclusion This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in football players provides a significant clinical improvement and allows athletes to return to play at the same level. Professional football players are significantly more likely to return to play football faster compared to non-professional athletes.

Balneotherapy in treatment of spastic upper limb after stroke.

Introduction:After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke.Materials and methods:A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. Inclusion criteria: ischaemic stroke, developed spasticity of upper limb, post-stroke interval <6 months. Exclusion criteria: contraindications for balneotherapy and inability to follow commands. Experimental group (Ex) (n=35) was treated with sulphurous baths (31°-33°C) and controlled group (Co) with taped water baths, during 21 days. All patients were additionally treated with kinesitherapy and cryotherapy. The outcome was evaluated using Modified Ashworth scale for spasticity and VAS scale for pain. The significance value was sat at p<0.05.Goal:To find out the effects of balneotherapy with sulphurous bath on spasticity and pain in affected upper limb.Results:Reduction in tone of affected upper limb muscles was significant in Ex group (p<0.05). Pain decreased significantly in Ex-group (p<0.01).Conclusion:Our results show that balneotherapy with sulphurous water reduces spasticity and pain significantly and can help in treatment of post-stroke patients.

Comparison of Supervised Rehabilitation vs. Home Based Unsupervised Rehabilitation Programs after Total Knee Arthroplasty: A Pilot Study

Objective: The purpose of the current study was to compare two rehabilitation programs post primary total knee arthroplasty (1) Supervised rehabilitation delivered by qualified physiotherapist and (2) home-based unsupervised rehabilitation monitored by a physiotherapist via periodic telephone calls. Method: Twenty patients having primary total knee arthroplasty were assigned randomly to two rehabilitation program (1) supervised rehabilitation program group (2) home-based unsupervised rehabilitation program group. Outcome measures used to assess the outcome were (1) Knee Society Knee score for knee integrity (2) ILOA for level of assistance (3) Goniometry for ROM and (4) VAS Scale for pain. Results: The significant difference were observed in the score of all outcome scale used for assessment. The subjects in supervised rehabilitation program group performed better compared to home-based unsupervised rehabilitation program group. Conclusions: This pilot study shows that the supervised rehabilitation after total knee arthroplasty having better prognosis than home-based unsupervised rehabilitation program on range of motion and functional ability and pain.

Is There any Role for Pulsed Electromagnetic Fields in the Treatment of Early Osteoarthritis of the Knee?

Objective: Pulsed Electromagnetic Fields (PEMFs) were introduced in the clinical setting in the 1970s. Although it has been proven to be a successful method in non-union and delayed union of fractures, the effects on knee OA are equivocal. The use of PEMFs has received attention for the treatment of osteoarthritis and isolated cartilage lesions after in vitro and in vivo studies showed a pro-anabolic and anti-catabolic activity on cartilage metabolism. We hypothesized that the use of PEMFs in patients with symptomatic cartilage lesions of the knee would lead to improved clinical outcomes in an observational study to evaluate the results after 2-years. Study design: Prospective case series. Methods: 25 patients between 30 and 60 years who underwent treatment with PEMFs (4-hour treatment per day, duration 45 days) were included. All patients presented with symptomatic cartilage lesions of the knee (grade 2-3 as per ICRS classification) and OA changes of grade 0-1 (as per Kellgren-Lawrence classification) at the pre-treatment evaluation. Patients were evaluated pre-treatment, at 12 months and 24 months using VAS scale for pain, IKDC objective, Tegner and KOOS scores. Results: A significant improvement in all scores was observed at 1-year follow-up (p=0.003). At 2-year follow-up, results deteriorated but were still superior to pre-treatment levels (p=0.04). No adverse reactions were seen. Conclusions: PEMFs in patients with symptomatic isolated cartilage lesions of the knee can cause improvement in symptoms, knee function and activity in the short term. Repetition of treatment annually may improve the long term results.