Pain Intensity Visual Analogue Scale Research Articles

Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Fremantle Neck Awareness Questionnaire (FreNAQ-GR) in Patients with Chronic Neck Pain

Background: Neck self-awareness, related to sensorimotor dysfunction, can be monitored with the Fremantle Neck Awareness Questionnaire (FreNAQ). The cross-cultural adaptation of the FreNAQ in Greek (FreNAQ-GR) and an assessment of its psychometric properties were conducted. Methods: This study included 104 participants (65 female) with non-specific chronic neck pain (NSCNP). Once the cross-cultural adaptation process of the FreNAQ-GR was complete, the testing of its construct validity was conducted via an exploratory factor analysis (EFA). The construct validity examination also included a correlational analysis with a Pain Intensity Visual Analogue Scale (PI-VAS), the Neck Disability Index (NDI), the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and demographics. The internal consistency of the FreNAQ-GR was also examined. A sub-sample of participants (n = 30) completed the FreNAQ-GR again after 5–7 days. Results: The dataset was appropriate for EFA (measure of sampling adequacy KMO = 0.763 and Bartlett’s test of sphericity p < 0.001). The FreNAQ-GR demonstrated a single-factor 6-item structure (items 7–9 removed), explaining 53.69% of the common variance. Statistically significant correlations (Spearman’s) were registered between the FreNAQ-GR (both versions) and the NDI (r = 0.33/0.29, p < 0.001), the TSK (r = 0.46/0.41, p < 0.001), and the PCS (r = 0.37/0.33, p < 0.001). For the 9-item and the 6-item FreNAQ-GR, the internal consistency (Chronbach’s a/McDonald’s ω) was 0.80/0.79 and 0.826/0.816, respectively. The test–retest reliability was excellent for both versions ICC2,1 (95% CI) = 0.98/0.98 (0.97–0.99/0.95–0.99), with low error values SEM = 0.90/0.74 and MDC95% = 2.49/2.05 points. Conclusions: The FreNAQ-GR is suitable for assessing neck self-awareness in Greek-speaking patients with NSCNP.

Comparison of Clinical Effects and Physical Examination of Transforaminal and Caudal Steroid Injection With Targeted Catheter in Lumbar Radiculopathy: A Single-Blind Randomized Clinical Trial.

Transforaminal and caudal epidural injections are two methods of steroid injection in lumbar radiculopathy. Using a targeted catheter with the possibility of accessing the involved spinal roots and steroid administration selectively next to them during the caudal procedure may achieve the benefits of both transforaminal and caudal procedures. The aim of this study was to investigate the clinical effects and physical examinations of transforaminal steroid injection compared to caudal through a targeted catheter in lumbar radiculopathy. Fifty patients with lumbar radiculopathy candidates for epidural steroid injection were divided into transforaminal (T) and caudal (C) groups. Steroid injection under fluoroscopic guidance was performed in group T with the transforaminal method and in group C with the caudal method using a targeted catheter for each involved spinal nerve root. Pain intensity visual analog scale (VAS), Oswestry Disability Index (ODI), daily analgesic consumption, and physical examinations on four follow-ups (before injection, second week, first and third month) were evaluated. Pain score (VAS) and functional disability index (ODI) were similar in both groups, and there was no significant difference between the two groups (p>0.05). The positive Lasègue test was significantly higher in the caudal group than in the transforaminal group only in the third month (p<0.05). Other physical examinations in both groups did not have significant differences in all the follow-ups. Moreover, there was no difference in the amount of analgesic consumption in the two groups. No complications were observed in both groups. This study showed that transforaminal and caudal steroid injection (with a targeted catheter) in patients with lumbar radiculopathy had similar effects in controlling pain and improving functional disability of patients in the short term. Cases of recurrence of positive Lasègue test in physical examinations in the long term (third month) in the caudal group may indicate the preference of the transforaminal approach. Iranian Registry of Clinical Trials (IRCT) number: IRCT20111102007984N31.

The Test-Retest Reliability of Pain Outcome Measures in People With Phantom Limb Pain.

To quantify the test-retest reliability of 3 patient-reported outcome measures of pain for people living with phantom limb pain (PLP) and assess the impact of test-retest errors on future research and clinical decisions. Thirty-nine participants (30 males), mean (SD) age: 55 (16), mean (SD) years postamputation: 6.8 (8.3), reported their PLP levels on a visual analogue scale (VAS) for pain intensity, the revised short-form McGill Pain Questionnaire (SF-MPQ-2), and a pain diary, on 2 occasions 7 to 14 days apart. Mean systematic change, within-subjects SD, limits of agreement (LOA), coefficient of variation, and the intraclass correlation coefficient (ICC) were quantified alongside their respective 95% confidence intervals (95% CIs). Systematic learning effects (mean changes) were not clinically relevant across the VAS, SF-MPQ-2, and pain diary. Within-subject SDs (95% CI) were 11.8 (9.6-15.3), 0.9 (0.7-1.2), and 8.6 (6.9-11.5), respectively. LOA (95% CI) were 32.6 (26.5-42.4), 2.5 (2-3.3), and 23.9 (19.2-31.8), respectively. ICCs (95% CI) were 0.8 (0.6-0.9), 0.8 (0.7-0.9), and 0.9 (0.8-0.9), respectively, but may have been inflated by sample heterogeneity. The test-retest errors allowed detection of clinically relevant effect sizes with feasible sample sizes in future studies, but individual errors were large. For people with PLP, a pain intensity VAS, the SF-MPQ-2, and a pain diary show an acceptable level of intersession reliability for use in future clinical trials with feasible sample sizes. Nevertheless, the random error observed for all 3 of the pain outcome measures suggests they should be interpreted with caution in case studies and when monitoring individuals' clinical status and progress.

A prospective, randomized, controlled, double-blind, multi-center study to evaluate the efficacy and safety of a blue light device for the treatment of chronic back pain.

Chronic back pain is one of the most prevalent conditions and has a large socio-economic impact. The lack of routine use of non-pharmacological options and issues associated with pharmacological treatments underscore high unmet needs in the treatment of back pain. Although blue light phototherapy has proven efficacy in dermatology, limited information is available about its use in back pain. In this proof-of-concept, randomized controlled trial, a pain relief patch (PRP) delivered blue light at the site of back pain for 30 min during five treatment sessions. The comparator device delivered green light for 5 s but was worn for 30 min. A follow-up visit took place after the last treatment. The primary objective was to demonstrate the superiority of treatment by PRP, compared to the control device, in reducing pain intensity at the end of the treatment period. The post-treatment visual analog scale (VAS) pain intensity score for each group was calculated across the five treatment sessions and compared to the baseline. Secondary objectives included the disability score (Roland-Morris Disability Questionnaire) and safety. The full analysis set included 171 patients. A statistically significant reduction in pain intensity occurred after the use of PRP (p < 0.02), but the study did not meet its primary objective of a superiority trial aimed at demonstrating a 0.6 cm difference in favor of PRP on the VAS scale. There was no significant change in the disability scores. Subgroup analyses were performed to identify the treatment response by patient characteristics such as pain intensity at baseline and skin type. As expected, safety data showed erythema and skin discoloration in the PRP group but not in the control group. This trial had multiple limitations that need to be addressed in future research. Although the primary objective was not achieved, this proof-of-concept study provides important efficacy and safety data in relation to the use of blue light in the treatment of chronic back pain and key insights that may support further research on similar devices. ClinicalTrials.gov, identifier NCT01528332.

Effects of mind-regulating acupuncture on pain, negative emotion and sleep quality in patients with postherpetic neuralgia： a randomized controlled pilot trial.

To observe the effect of mind-regulating acupuncture on pain intensity, sleep quality, negative emotion in patients with postherpetic neuralgia (PHN), and evaluate the clinical effect of mind-regulating acupuncture combined with surrounding needling and heavy moxibustion at Ashi points (Extra) in treatment of PHN. The patients with PHN were randomly divided into a control group (35 cases, 2 cases dropped out) and a comprehensive therapy group (35 cases). The patients in the control group were treated with surrounding needling and heavy moxibustion at Ashi points. In the comprehensive therapy group, the mind-regulating acupuncture therapy was delivered besides the treatment as the control group. The treatment was given once daily, one course of treatment was composed of 6 days and 2 courses were required in the 2 groups. Before and after treatment, the pain conditions were assessed using pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI), the negative emotions were assessed using Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), and the sleep quality with Pittsburgh sleep quality index (PSQI). One week before and one week after treatment, the average sleep time was recorded. The therapeutic effect of 2 groups was evaluated. The effective cases of 2 groups were followed up in 2 months after treatment completion and the recurrence of neuralgia was recorded. There were no statistical differences in the above indicators between the 2 groups before treatment. After 2 courses of treatment, the scores of PRI, VAS, PPI, HAMA, HAMD and PSQI were reduced when compared with those before treatment in the patients of the 2 groups (P<0.05), and the average sleep time was increased (P<0.05). The scores of PRI, VAS, PPI, HAMA, HAMD and PSQI in the comprehensive therapy group, as well as the average sleep time were all improved when compared with those of the control group (P<0.05). The total effective rate in the comprehensive therapy group (34/35, 97.14%) was higher than that of the control group (27/33, 81.82%, P<0.05) and the recurrence rate was lower (［2/34, 5.88%］vs［8/27, 29.63%］, P<0.05). The combination of mind-regulating acupuncture with surrounding needling and heavy moxibustion at Ashi acupoint can effectively relieve PHN. Compared with the traditional surrounding acupuncture in pain area combined with moxibustion at Ashi points, this comprehensive therapy is more effective for ameliorating pain intensity, improving sleep quality and reducing negative emotions. It is also effective for declining the recurrence.

124 Numerical Cut Points for Mild, Moderate and Severe Pain in Adult Burn Survivors

Abstract Introduction The optimal numerical cut points for mild, moderate, and severe burn pain have been established. Investigators at a single center determined that average burn pain can be categorized as mild (0-2), moderate (3-5), and severe (6-10). To address concerns about small sample size and limited diversity, we aimed to identify the most suitable average pain intensity rating scores for mild, moderate, and severe pain in a large, diverse cohort of adult burn survivors using a Patient Reported Outcome Measures Pain Interference (PROMIS-PI) short form. Methods Average 11-point pain intensity Visual Analog Scale (VAS) or Numerical Rating Scale (NRS) scores (0-10) and a customized PROMIS-PI 4-question short form were administered to adults with burn injury treated at 5 centers in the US at hospital discharge (baseline) and 6, 12, 24-months and 5-years post-injury. To identify pain intensity scores that best represent mild, moderate, and severe pain, F value statistics associated with multiple ANOVA comparisons for mean pain interference scores by various pain intensity cut points were computed. Based on previous research, 6 possible cut points (CP) were compared: CP 3,6; 3,7; 4,6; 4,7; 2,5; and 3,5. The optimal cut points were considered those with the highest ANOVA F statistic. Results Data from 1,190 participants (68% male, 80% white, 22% Hispanic, mean age 46 years) and 5 study centers with VAS/NRS pain intensity and PROMIS-PI scores at one or more study timepoints were analyzed. The optimal classification for mild, moderate, and severe pain was CP 2,5 at all timepoints (see table). Conclusions This study confirms that for a diverse cohort of burn-injured adults from multiple centers within the United States, burn intensity ratings of mild (0-2), moderate (3-5), and severe (6-10) is appropriate for up to 5 years post-injury. These findings support previous research findings and continue to advance our understanding of burn pain and pain intensity reporting while providing clinicians and researchers with an objective measure that can be used for screening, treatment, quality improvement, and research. Applicability of Research to Practice Use of this numerical classification for burn pain in the adult burn survivor can be used with greater confidence in diverse populations.

Outcomes of combined treatment of patients with acute lumbodynia

Introduction. Acute dorsalgia is a common reason to seek outpatient medical care in Russia. The clinical picture usually includes muscular-tonic and pain syndromes. The most common form of dorsalgia by localization is acute lumbar pain (lumbodynia).Aim. To evaluate the effectiveness of Spascuprel®, Traumeel S in the complex treatment of patients with acute lumbar pain in real-world clinical practice.Materials and methods. We conducted a non-interventional, prospective, observational study of 110 outpatients aged 26 to 65 years. Patients received a standard on-demand therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, Group 1 received Spascuprel® and Traumeel® C, and Group 2 received centrally acting muscle relaxants. The effectiveness of treatment was assessed using the visual analogue scale (VAS) of pain intensity and the limitations of various activities in daily living were measured using the Roland – Morris questionnaire. Consideration was given to the exacerbation duration, the need for additional intake of NSAIDs, and the number of cases of pain exacerbation within 60 days from the start of participation in the observational study.Results. Under treatment, pain intensity showed statistically significant decreases in VAS scores (from 61.0 to 35.5 scores out of 100 according to VAS by Day 7 and to 19.5 scores by Day 14 of treatment in Group 1, from 61.2 to 41.1 and to 25.8 scores in Group 2, respectively (p &lt; 0.05)). A more rapid decrease was observed in VAS pain intensity score from baseline in Group 1. Over 2-month observation period, group 1 had less exacerbations (p &lt; 0.05) and fewer cases of need for additional intake of NSAIDs (p &lt; 0.05). The frequency and severity of adverse events did not differ between two groups.Conclusion. A more rapid decrease in VAS pain intensity scores and reduction in the need for NSAIDs were noted in the group of patients with acute dorsalgia who used Traumeel® C and Spascuprel® in addition to standard NSAID therapy.

Influence of the volume of surgical intervention on the severity of pain in patients after orthognathic surgery

BACKGROUND: The treatment of patients with jaw abnormalities involves orthognathic surgery, a consequence of which is postoperative pain. Considerable research is allocated to the study of pain and its management because pain affects the comfort of patients during rehabilitation. Currently, the factors that are responsible for the severity of postoperative pain syndrome remains debatable. Additionally, before surgical treatment, patients are concerned about the intensity of postoperative pain and its relationship with the extent of surgery. Owing to existing disagreements, primarily regarding the relationship between the volume of surgical intervention and the intensity of pain, conducting this study is critical.&#x0D; AIM: To identify factors that directly influence postoperative pain experienced by patients.&#x0D; MATERIALS AND METHODS: Pain intensity in patients on day 2 following orthognathic surgery was measured using visual analog scale (VAS).&#x0D; RESULTS: During the study, patients after orthognathic surgery were divided into groups based on the extent of surgery, sex, age, and duration of surgery to compare their VAS pain intensity scores. No significant difference was found in the average VAS scores of patients’ pain intensity (p 0.05) between the groups.&#x0D; CONCLUSION: The volume and duration of orthognathic surgery, age, and sex of the patients did not affect the intensity of pain.

Efficacy of Marham-e-Dakhilyun Ointment and Alum Perineal Wash for Perineal Wound Healing and Pain Intensity in Postpartum Women: A Self-control Clinical Trial

Background and Objective:: Episiotomy, worldwide, is the most frequently performed obstetric surgical procedure. Delayed wound healing potentially amplifies the risk of wound infection, structural muscular alterations, and ultimately contributes to the loss of muscle tone. In addition, rapid and complete repair of the episiotomy or perineal tear is very important as the pain and discomfort of episiotomy wounds may affect the quality of life of postnatal mothers. Therefore, we aimed to determine the efficacy of Marham-e-Dakhilyun ointment and alum perineal wash on perineal wound healing and pain intensity in postnatal mothers. Materials and Methods:: A single-arm self-controlled study was conducted on postnatal mothers aged 18 to 40 years, who underwent full-term normal cephalic singleton vaginal delivery with episiotomy and/or 1st, 2nd, or 3rd-degree perineal tears. The recommended external care regimen for a period of 10 days involved perineal wash with a solution of alum powder (2 gm/500ml), followed by the application of Marham-e Dakhilyun ointment twice daily to the perineal wound. For the primary evaluation of wound healing, the REEDA (redness, edema, ecchymosis, discharge, and approximation) scale has been utilized, while the secondary assessment involved the use of the VAS (visual analog scale) pain intensity scale. The therapeutic outcome was determined based on the grading of REEDA scores on days 10-14 and VAS scores. Results:: We observed our trial medicine showed complete wound healing in 86.4% on days 10- 14. The mean pain reduction percentage (PR %) was 96.85% on days 10-14 from baseline. The REEDA score was 2.41±0.81 and 0.23±0.61 at one hour and day 10-14, respectively, with significant differences (p &lt; 0.001). The VAS score was 2.86±1.08 and 0.09±0.29 at one hour and day 10-14, respectively, with significant differences (p &lt; 0.001). Therefore, the trial ointment and alum have demonstrated beneficial effects in promoting perineal wound healing and alleviating pain in postnatal mothers. Conclusion:: The potential efficacy of Marham-e-Dakhilyun can be attributed to its composition of various phytoconstituents, such as oleuropein, phenolic acids, flavonols, flavones, linoleic acid isovitexin, vitexin vanillic acid, salicylic acid, beta-D-glucopyranoside, olanigroside Y1, solasonine, gallic acid, aucubin, scopoletin, and lantamajoside. These constituents have been proven in research studies to possess anti-inflammatory, wound healing, antimicrobial, analgesic, and antioxidant properties. The investigators have optimized the use of these Unani medicines to provide clinical evidence supporting their effectiveness in the wound-healing process and in reducing pain intensity.

Comparison of pain intensity measurements among patients with low-back pain

<p>Pain intensity is the most frequently assessed health domain in clinical studies among patients with low-back pain. Visual analogue scale (VAS) and Numeric rating scale (NRS) have been the mostly used measurement tools for pain intensity. We proposed to correlate these instruments to a generic health-related quality of life measurement tool in order to show the scale with superior clinical relevance.</p>. <p>We used cross-sectional, convenience sampling. 120 patients with chronic low-back pain administered the 29-item Patient Reported Outcomes Measurement Information System Profile with NRS included, and the VAS scale in the National Institute of Mental Health, Neurology and Neurosurgery. We determined the correlation between PROMIS domain T-scores and VAS and NRS scores.</p>. <p>We performed Spearman rank correlation test to calculate the correlation coefficient. We found VAS scales measuring pain had weak to moderate correlations with all PROMIS health domains (r = 0.24&ndash;0.55). Therefore, we compared correlation of PROMIS domain scores with PROMIS pain intensity numeric rating scale and VAS scales. PROMIS domains had moderate to strong correlations with pain intensity scale (r = 0.45&ndash;0.71). PROMIS physical function short form [r = &ndash;0.65, 95% CI (&ndash;0.75) &ndash; (&ndash;0.55)] and PROMIS pain interference short form (r = 0.71, 95% CI 0.63 &ndash; 0.79) had the strongest correlation with pain intensity item.</p>. <p>NRS has showed greater correlation with PROMIS domain T-scores than VAS scale. This may prove that NRS has greater connection to another health domains, thus it correlated more to health-related quality of life than visual scale. We recommend NRS to use in further clinical studies conducted among patients with low-back pain.</p>.

Skin blood flow as an objective measure for lateral elbow tendinopathy

PURPOSE: To investigate the test-retest reliability, side-to-side difference, responsiveness, and concurrent validity of skin blood flow (SkBF) measured by laser Doppler flowmetry (LDF) in individuals with acute or subacute lateral elbow tendinopathy (LET). METHODS: Eighteen individuals with acute or subacute LET were recruited for this study. SkBF was measured over the lateral epicondyle and common extensor origin on both ipsilateral and contralateral sides. The intraclass correlation coefficient (ICC3,1) was used to evaluate test-retest reliability. A paired t-test was used for comparing the side-to-side difference. Responsiveness was reported with a change score, paired t-test, effect size (ES), and standardized response mean (SRM). The concurrent validity of SkBF was investigated by correlating with a visual analog scale (VAS) pain intensity during resisted wrist extension isometric contraction using the Spearman correlation coefficient. RESULTS: Test-retest reliability was good at lateral epicondyle (ICC3,1 = 0.899), and at common extensor origin (ICC3,1 = 0.803). A side-to-side difference was found between the two sides (p &lt; 0.001). For responsiveness, the change score for SkBF at the lateral epicondyle was – 8.04, and the common extensor origin was – 3.54. The ES and SRM ranged from – 0.71 to – 0.78. Concurrent validity was reported with a strong correlation with pain intensity (r = – 0.637). DISCUSSION: SkBF is a reliable and responsive variable for investigating the elbows with acute or subacute LET providing clinical information according to its inflammatory responses. However, the concurrent validity can be found only for SkBF at common extensor origin, which correlates with pain during resisted wrist extension isometric contraction.

Safety and Efficacy of Oral Nalbuphine on Postoperative Pain in Hemorrhoidectomy Patients: A Randomized, Double-blind, Placebo-controlled, Pivotal Trial.

Severe postoperative pain requiring opioid treatment has been reported in 20-40% of hemorrhoidectomy patients. Compared to morphine, nalbuphine offers better hemodynamic stability, a lower risk of respiratory depression, and a lower potential for addiction. Nalbuphine was developed from intravenous form into an oral form (PHN131) to alleviate moderate-to-severe pain. A randomized, double-blind, placebo-controlled, multiple-dose, parallel-design trial was conducted to evaluate the safety and efficacy of PHN131 in patients undergoing hemorrhoidectomy. Eligible patients were randomly assigned to receive either PHN131 soft capsules containing nalbuphine hydrochloride 60mg or placebo capsules. Intramuscular diclofenac was the rescue analgesic. Pain was measured by the area under the curve of mean Visual Analog Scale (VAS) pain intensity scores. VAS results in patients receiving PHN131 were significantly lower than placebo group scores through 48 hours postoperatively (149.2±75.52 vs. 179.6±65.97; P=0.0301). According to Brief Pain Inventory Short Form scores, the impact of pain on quality of life was significantly smaller for the PHN131 group than for the placebo group. Time to the first use of diclofenac postoperatively was significantly longer in the PHN131 group than in the placebo group. The cumulative dosage of diclofenac in the PHN131 group was only around half of that in the placebo group (P<0.0001). Drug-related adverse events were mild-to-moderate and resolved by treatment end. No drug-related severe adverse events were observed. Our findings demonstrate that PHN131 is effective and well-tolerated in the treatment of moderate-to-severe pain and may provide another option for patients to control their pain.

Virtual reality hypnosis diminishes experimental cold pain and alters autonomic responses.

Immersive virtual reality (VR) is a promising tool to reduce pain in clinical setting. Digital scripts displayed by VR disposals can be enriched by several analgesic interventions, which are widely used to reduce pain. One of these techniques is hypnosis induced through the VR script (VRH) which is facilitated by immersive environment and particularly efficient even for low hypnotizable patients. The aim of this study is to assess the efficacy of a VRH script on experimentally induced cold pain perception (intensity and unpleasantness) and physiological expression. 41 healthy volunteers had been recruited in this within-subjects study. They received 9 stimulations of 20 s (3 non-nociceptive cold; 3 low nociceptive cold and 3 highly nociceptive cold) during a VRH session of 20 min (VRH condition) or without VRH (noVRH condition). Physiological monitoring during the cold pain stimulation protocol consisted of recording heart rate, heart rate variability and respiratory frequency. Maximum cold pain intensity perception, measured through the visual analog scale (VAS) on 10, was of 3.66 ± 1.84 (VAS score/10) in noVRH condition and 2.46 ± 1.54 in VRH (Wilcoxon, p < 0.0001). Considering pain unpleasantness perception, 3.68 ± 2.06 in noVRH and 2.21 ± 1.63 in VRH (Wilcoxon, p < 0.0001). Hypnotizability negatively correlated with the decrease in VAS intensity from noVRH to VRH (Spearman r = -0.45; p = 0.0038). In our sample, we found that 31/41 volunteers (75.6%) displayed a reduction of more than 10% of their VAS pain intensity and unpleasantness scores. Trait anxiety was the best predictor of the VRH responders, as well as heart rate variability. In addition, respiratory rate was diminished under VRH in every subgroup. VRH is an effective tool to reduced pain intensity and unpleasantness in a vast majority of healthy subjects. We further indicate in this study that heart rate variability parameter RMSSD (root mean square of successive differences) is a good predictor of this effect, as well as anxiety as a personality trait (but not state anxiety). Further studies are expected to determine more precisely to whom it will be the most useful to offer tailored, non-pharmacological pain management solutions to patients.

The Effect of Art Therapy on Pain, Emesis, Anxiety, and Quality of Life in Operated Breast Cancer Patients: Randomized Control Trials.

Background: Breast cancer symptoms related to the disease nature and treatments develop and the quality of life of patients is impacted. Art therapy improves the quality of life by increasing symptom control and treatment compliance. This study aimed to determine the effect of art therapy on pain, emesis, anxiety, and quality of life in operated breast cancer patients. Methods: This experimental research was carried out with a total of 60 patients, 30 in the intervention group (IG) and 30 in the control group (CG), who received treatment in the Oncology Center of Sivas Cumhuriyet University Practice and Research Hospital. A Personal Information Form, the Pain Intensity-Visual Analog Scale, the Rhodes Index of Nausea, Vomiting, and Retching, the Beck Anxiety Inventory, and the Functional Assessment of Cancer Therapy Scale-General (FACT-G) were used to collect research data. Within the scope of the research, IG received chemotherapy sessions for 10 weeks (five sessions) with 2-week intervals by an art specialist in marbling, accompanied by ney music. CG received no intervention. The obtained data were uploaded to the SPSS (22.0) program and statistical analysis was performed. Results: The decrease in the pain, nausea-vomiting, and anxiety levels of the patients in IG and the increase in their quality of life after the art therapy accompanied by ney music were statistically significant compared with the first follow-up (p < 0.05). There was no statistically significant change in the quality of life of the patients in the CG, whereas their pain, nausea-vomiting, and anxiety scores increased. According to the comparison between IG and CG, there was a significant difference in favor of IG in terms of pain severity, quality of life, emesis, and anxiety levels (p < 0.05). Conclusions: The art of marbling with ney was effective in operated breast cancer patients experiencing pain, emesis, and anxiety and improved their quality of life. Clinical Trial Registration: NCT05666583.

Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ-GR) in Patients with Chronic Shoulder Pain.

Shoulder pain is one of the most common musculoskeletal pathologies. The association of shoulder pain with impaired proprioception and bodily self-awareness called for the cross-cultural adaptation of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) in Greek. The FreSHAQ is a relatively new self-assessment 9-item scale for impaired somatic awareness in patients with shoulder pain. The study included 100 participants (54 women) between 20 and 80 years old, with chronic shoulder pain (>3 months duration), able to comprehend and speak Greek, and recruited from three private physical therapy practices. The cross-cultural adaptation process was followed to develop the Greek version of the questionnaire (FreSHAQ-GR). Further testing for construct validity via exploratory factor analysis and correlational analysis with the Shoulder Pain and Disability Index (SPADI), the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), the pain catastrophizing scale (PCS), a pain intensity visual analog scale (PI-VAS) in the last week, and the demographic characteristics followed. Test-retest reliability of the FreSHAQ-GR in a sub-sample of patients (n = 25) was tested upon repeated completion of the scale after a week and examined with the intraclass correlation coefficient (ICC2,1), the standard error of the measurement (SEM), and the minimum detectable change (MDC) indices. The internal consistency of the scale was also assessed. The factor analysis revealed that the scale comprised one factor relevant to shoulder awareness but with fewer items (first 6 items) than the original FreSHAQ. Additionally, the FreSHAQ-GR (both versions) demonstrated statistically significant correlations (Spearman's r) with participants' age (r = -0.31/-0.29, p < 0.002), the PI-VAS (r = 0.54/0.52, p < 0.001), the SPADI total score and both of its subscales (r = 0.39-0.45/0.34-0.39, p < 0.001), the QuickDASH (r = 0.37/0.34, p < 0.001), and the PCS (r = 0.50/0.40, p < 0.001). The questionnaire's internal consistency (Cronbach's α/McDonald's ω) was 0.833/0.827 for the 9-item and 0.871/0.867 for the 6-item FreSHAQ-GR. Test-retest reliability was excellent for both versions of the FreSHAQ-GR (ICC2,1(95% CI) = 0.97/0.98 (0.91-0.99/0.94-0.99), and with a low error margin (SEM = 1.31/0.94 and MDC95% = 3.63/2.61). Therefore, the FreSHAQ-GR (6-item version) possesses very good measurement properties and can be administered to Greek-speaking patients with chronic shoulder pain.

Precise management system for chronic intractable pain patients implanted with spinal cord stimulation based on a remote programming platform: study protocol for a randomized controlled trial (PreMaSy study)

BackgroundSpinal cord stimulation (SCS) is a surgical technique used in patients with chronic intractable pain, and its effectiveness and safety have been validated by multiple studies. However, to maintain an optimal and steady long-term effect is still challenging. Here, we report a new management paradigm integrating smartphone application and remote programming. Chronic pain patients with SCS implants can monitor their pain status on the phone and change stimulation parameters accordingly. The PreMaSy study is a randomized controlled trial to evaluate the clinical effectiveness and safety of this precise management system.MethodsPatients with chronic intractable pain will be screened for eligibility, and 82 participants are anticipated to be enrolled in this trial. After the electrode implantation, the stimulation effectiveness will be tested. Participants with a reduction of more than 50% in the visual analog scale (VAS) will receive implantation of an implantable pulse generator and randomized (1:1) into the experimental group or control group. All participants will be asked to take online follow-ups and complete assessments using a smartphone application. Daily pain characteristic assessments and monthly quality of life questionnaires are integrated into the App, and participants will be required to complete these assessments. The daily VAS for pain intensity will be monitored and a threshold will be set based on baseline VAS score. The interventional appointment will be scheduled once the threshold is reached. The primary outcome is the health condition and quality of life assessed by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). Utility values of EQ-5D-5L will be assessed at baseline and 1, 3, and 6 months post-operative.DiscussionThe PreMaSy study aims to evaluate the effectiveness and safety of a novel App-based, patient-centered, self-assessment management system for chronic intractable pain. A randomized controlled trial is designed to test the non-inferiority of this precise management system compared to the monthly online follow-ups. It is also expected to yield valuable experiences regarding precision medicine.Trial registrationClinicalTrials.gov NCT05761392. Registered on March 07, 2023.

Efficacy and safety of combined thermocoagulation radiofrequency and pulse radiofrequency in the treatment of trigeminal neuralgia

Aims: The aim of this study was to evaluate the efficacy and safety of radiofrequency thermocoagulation (RFT) combined with pulsed radiofrequency (PRF) of the Gasserian ganglion in patients with V2/V3 trigeminal neuralgia (TN).&#x0D; Methods: We evaluated 27 patients with V2/3 TN who had undergone combined RFT and PRF of the Gasserian ganglion. Patients were treated with PRF (42°C, 45 V, 20 ms, 120 s), RFT (65°C, 60 s), RFT (70°C, 60 s), and PRF (42°C, 45 V, 20 ms, 120 s), consecutively. Visual analogue scale (VAS) and Barrow Neurological Institute Pain Intensity Scale (BNI) scores were evaluated before and after (1st month, 6th month, and 12th month) the procedure. A BNI score of 1-3 was considered as an effective treatment, while a BNI score of 4 or 5 indicated unsuccessful treatment.&#x0D; Results: VAS scores were significantly lower than the baseline values in all post-treatment evaluation visits (1st month, 6th month, 12th month) during the 12-month follow-up period (p0.05).&#x0D; Conclusion: Combined RFT and PRF to the Gasserian ganglion is a safe and effective therapeutic approach in the treatment of TN. However, its efficacy partially decreases after one year.

RESULTS OF PAIN TREATMENT IN MILITARY MEDICAL CLINICAL CENTERS FOR COMBATANTS AFTER GUNSHOT WOUNDS

Resume. Unfortunately, the treatment of combatants with gunshot wounds does not end with wound healing. In 66.7 %-73.1 % of these patients, pain becomes chronic and affects quality of life. Therefore, studying the results of pain treatment in combatants after gunshot wounds in military medical clinical centers can help identify weaknesses on the way to improving the results of treatment of this category of patients.&#x0D; Objective. To study the results of treatment of combatants' pain after gunshot wounds in military medical clinical centres.&#x0D; Methods. The data on the results of treatment of 769 combatants with gunshot wounds after combat operations are presented. The intensity of pain during treatment was monitored using a visual analogue scale (VAS). Also, the time interval between analgesia was recorded. The groups were compared by the Mann-Whitney test and the chi-square test, taking into account the correction for continuity. To test the distribution of quantitative indicators for normality, the Shapiro-Wilk test was used, and to analyse the dynamics of indicators, the Friedman test for related samples was used, and a posteriori comparison was performed using the Bonferroni correction.&#x0D; Results. On admission, the VAS pain intensity in the 2 groups was practically the same and met the criteria of moderate and severe pain, here the number of points ranged from 4 to 7, which indicates the lack of quality pain control and low effectiveness of analgesia in the preliminary stages or during medical evacuation. on the 14th day after injury, the VAS pain intensity practically corresponded to 2 points – mild pain, which indicates stable pain control and sufficiently high-quality pain treatment. However, on the 9th day of observation (p=0.009, and then &lt;0.001), there was a difference, which is most likely due to the number of injured anatomical areas of the patient. The intervals between anesthetizations gradually increased. However, from the 10th day of observation there is a difference between the groups (p&lt;0.001).&#x0D; Conclusion: The data obtained indicate that at the stage of treatment in military mobile hospitals, from which combatants are evacuated to military medical clinical centres, as well as during evacuation, more attention should be paid to the issue of pain management, because the lack of quality pain control between treatment stages is one of the factors that affects the frequency of pain chronicity.

Tit comparative effects of mulligan traction straight leg raise versus muscle energy technique on pain intensity and hamstring tightness in patient with knee osteoarthritis

Objective: To determine the comparative effects of mulligan traction straight leg raise versus muscle energy technique on pain intensity and hamstring tightness in patient with knee osteoarthritis. Methodology: The design of this study was randomized clinical trial. Data was collected from Physiotherapy Clinics, the University of Faisalabad. The sample size was of 36 subjects. Informed consent was signed by all participants. Participants were included in study by considering inclusion and exclusion criteria. Subjects were divided randomly by lottery method into two groups, group A (mulligan traction straight legs raise technique) and group B (Muscle energy technique). Total treatment was of 4 weeks. Outcomes measures tool were, VAS (visual analogue scale) for pain intensity and Oxford knee score (OKS) for disability. Active Knee Extension test was used to assess hamstring flexibility. Results: Mean Age of the group A participants were 53.89±5.76 and group B age 56.39±5.78. MET group was more effective in improving knee function rather that mulligan group (42.6±4.3 vs 34.3±5.1 with p value .000) similarly. MET group was more effective in improving hamstring flexibility and in pain reduction her that mulligan group (17.1±3.6 vs 24.6±4.7 with p value .000; 1.4±.5 vs3.4±.8 with p value .000).

Use of μ1-opioid receptor agonist tafalgin in integrative therapy of chronic pain syndrome in progressive multiple myeloma. Clinical observation

Chronic pain syndrome developing in patients with oncological diseases significantly decreases their quality of life which makes effective integrative analgetic therapy a pressing issue. Currently, drugs of various pharmaceutical groups are used for pain management and administered subsequentially in accordance with the pain intensity visual analogue scale. For moderate and severe pain syndrome, opioid analgesics are used which have side effects limiting their use in some cases. Trials showed that new highly specific μ1-opioid receptor agonist tafalgin is characterized by high bioavailability, fast absorption, biotransformation, absence of accumulation which makes its safety profile favorable. Pronounced analgesic effect of tafalgin, as well as ease of administration and absence of significant adverse events, allow to significantly improve the quality of life of patients with chronic pain syndrome.