Pain Intensity Visual Analogue Scale Research Articles

Validity of the EQ-5D in patients with pemphigus vulgaris and pemphigus foliaceus.

No studies to date have employed the EuroQoL EQ-5D questionnaire to assess health-related quality of life (HRQoL) in patients with pemphigus. To evaluate the HRQoL of patients with pemphigus by the EQ-5D and to analyse the convergent and known-groups validity of the EQ-5D in this patient population. Between 2014 and 2017, a multicentre cross-sectional study was carried out. Outcome measures included the five-level EQ-5D (EQ-5D-5L), Dermatology Life Quality Index (DLQI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and an average pain intensity visual analogue scale (VAS) for the past 3 months. In total, 109 consecutive patients with pemphigus participated in the study (mean age 57 years; 64% women). Among the EQ-5D dimensions, the most problems were reported regarding pain/discomfort (50%), mobility (43%) and anxiety/depression (43%). No significant difference was found in mean EQ-5D index scores between patients with pemphigus vulgaris and those with pemphigus foliaceus (0·81 vs. 0·86, P = 0·14). The mean EQ-5D index scores of patients with limited, moderate, significant and extreme pemphigus were 0·88, 0·82, 0·72 and 0·67, respectively (P = 0·001). The number of comorbidities was associated with greater impairment in EQ-5D index scores (P < 0·001). DLQI (rs = -0·62, P < 0·001) and the average pain intensity VAS (rs = -0·59, P < 0·001) more strongly correlated with the EQ-5D index scores than did ABSIS (rs = -0·40, P < 0·001). This is the first study employing the EQ-5D questionnaire in pemphigus. The EQ-5D is a valid measure of HRQoL in patients with pemphigus that can be useful both in clinical practice and in economic evaluations to assess the health gains associated with new effective treatments.

A Randomized Single-Blinded Trial of Posttonsillectomy Liposomal Bupivacaine among Adult Patients.

To determine whether liposomal bupivacaine (Exparel) is safe and effective in the management of posttonsillectomy pain among adult patients. A prospective single-blind randomized controlled trial. An academic quaternary care center (Mayo Clinic, Rochester, Minnesota). From May 2015 to December 2016, 39 patients were randomized to receive oral pain medication and 8 mL of injected liposomal bupivacaine or oral pain medication alone for treatment of their posttonsillectomy pain. Visual analog scale pain intensity scores, oral pain medication usage, liquid oral intake, and complications were recorded for 2 weeks after the procedure. Thirty-nine patients were randomized, with 17 patients in the liposomal bupivacaine group and 22 in the control group. Fifteen patients in the liposomal bupivacaine group and 18 patients in the control group completed the study. Pain intensity score on postoperative day 1 ( P = .043) proved to be the only statistically significant result, with no difference noted in pain scores on postoperative days 2 to 14. There was no difference in pain medication usage, liquid oral intake, postoperative hemorrhage, or adverse events between groups. The injection of liposomal bupivacaine in the posttonsillectomy wound bed demonstrates improved pain intensity scores for the first 24 hours after surgery with no adverse complications noted in comparison with patients who did not receive the injection. Given the limited pain reduction and increased cost, use of liposomal bupivacaine in adult tonsillectomy patients appears to have minimal indication for use.

PATHOPHYSIOLOGICAL APPROACHES TO TREATMENT OF PATIENTS WITH CHRONIC PALVIC PAIN AND PELVIC INFLAMMATORY DISEASES

The article presents the pathophysiological features of the chronic pelvic pain (CPP) in women with pelvic inflammatory diseases. Multidisciplinary approaches to treatment, rehabilitation, drug therapy, physiotherapy and psychological rehabilitation are presented.Materials and methods. 90 women with pelvic inflammatory diseases were examined. The main group consisted of 50 women with CPP (I group) and 40 patients with painless course II group (comparison group). In assessing the pain syndrome, a visual analogue scale (VAS), a McGill pain questioner (MPQ), a Taylor scale, a Hamilton scale were used. The levels of luteotropic hormone (LH), follicle-stimulating hormone (FSH), estradiol, progesterone, prolactin, testosterone, DHEA- sulfate, and cytokines (IL-10, IL-6, TNF-α) were measured in serum.Results and discussion. The significantly increased level of proinflammatory cytokines IL-6, TNF-α in patients of the I group compared with II group (p &lt;0,001), correlated with the duration of CPP, pelvic pain intensity VAS with a severe degree of depressive disorders, and a violation of hormone-endocrine ratios. The established pathophysiological disturbances were the basis for determining the therapeutic tactics of CPP by pelvic inflammatory diseases.Conclusions. The proposed therapeutic tactics contributed to the regression of the pain syndrome at 1, 3 and 6 months according to VAS 34,61%; 62,84% and 100%. The psychoemotional status improved by 88,3% of women, decrease in reactive anxiety and depressive disorders by 84,7% of patients, which indicates a high clinical effectiveness of the developed method of treatment.

Robotic rectal resection: preliminary Russian experience

PurposeTo outline the preliminary experience of the da Vinci® robotic system used in a Moscow tertiary colorectal referral center for an unselected range of benign and malignant rectal conditions. MethodsProspective non-randomized single-center study which analyzed results of 26 robotic rectal resections performed between january 2014 and december 2016. ResultsThe cohort included 10 females and 16 males (mean total age 61.6 years). Three patients underwent surgery for benign rectal villous adenomas. The median overall ASA score was 4 (ranged from 2 to 5). Of the surgeries, there were 19 total mesorectal excisions with 6 patients undergoing a multivisceral resection. The mean operating time was 358 minutes with a mean blood loss of 203mL. All total mesorectal excision specimens were adjudged according Philip Quirke classification as mesorectal plane – Grade 3 with a mean of 18.5 lymph nodes identified (from 12 to 35). Of these there were 10 patients (38.5%) with lymph node metastases. After surgery the average pain score was 2.1 out of 10 on the “Visual-Analogue Pain Intensity Scale” and 1.5 score out of 10 on the “Brief Pain Inventory with Quality of Life”. Anal continency after rectal resection with total mesorectal excisions estimated according Wexner Scale: 10 days after surgery average score was −3.1 and a 6 month after surgery −1.6 score. The median length of hospital stay was 11 days (from 10 to 15). ConclusionOur initial experience with a totally robotic rectal resection has shown the technique to be safe and feasible, particularly in patients where conventional laparoscopic rectal resection would be anticipated to be challenging.

Upright versus recumbent position during first stage of labor among primipara women on labor outcomes

Objective: The aim of this study was to assess the effect of upright versus recumbent position during the active phase of first stage of labor among primipara women on labor outcomes in term of progress, duration of labor, method of delivery, neonatal outcome and maternal satisfaction with assumed position.Methods: Quasi experimental design was used. The study was conducted in the labor unit in obstetric department at Benha University Hospital. A purposive sample of 100 parturient women in 1st stage of labor were recruited in the study, they divided into two groups; upright group (50) and recumbent group (50). Data were collected through four main tools: Structured Interviewing questionnaire sheet, Structured Observational Checklist include (Partograph and Apgar score), Visual analogue pain intensity scale and maternal satisfaction with assumed position questionnaire.Results: It revealed that high statistical significant difference between the upright and recumbent groups in term of decreases interval and increases duration, frequency and intensity of uterine contraction, cervical dilatation and fetal head descent/fifth among the upright group. While the recumbent group showed less progress. Moreover, the recumbent group expressed more pain score, consume longer duration of 1st, 2nd, 3rd stage of labor than the upright group and statistical significant difference in Apgar score of the neonate during both first and fifth minute. In addition, the upright group had higher satisfaction scores compared to those assumed recumbent positions (p &lt; .001).Conclusions: Upright position had positive effect on progress of labor, decreased duration of the three stages of labor, better neonatal outcomes and improving parturient women's satisfaction with assumed position. The study recommended that all parturient women in low-risk labor should be informed about the benefits of assuming upright positions during first stage of labor, and be encouraged and supported to use them.

Balneotherapy is an alternative treatment for mastalgia; a randomized controlled trial

IntroductionMastalgia is the most common breast related complaint. Balneotherapy is widely used as a non-pharmacological treatment modality in many European countries. The objective of this study was to determine the efficacy of balneotherapy in patients with mastalgia. MethodsA randomized controlled clinical trial was conducted with forty women with mastalgia. Patients were randomly assigned to the control and balneotherapy groups. Conventional therapy was recommended for both groups for 6 weeks. The balneotherapy group was also given a total of ten sessions of balneotherapy during the last two weeks. Breast pain level, serum cytokine levels including interleukin-1β and tumor necrosis factor (TNF)-α and quality of life were evaluated in both groups before and 6-weeks after study. The Breast pain questionnaire was used for the assessment of mastalgia. This questionnaire includes sensorial and affective data, visual analog scale (VAS) and present pain intensity (PPI). Quality of life was measured by using Short Form (SF)-36. ResultsBaseline total breast pain scores (BPS) and cytokine levels were similar between the groups. Total BPS (p = 0.001), VAS (p = 0.039) and PPI (p = 0.004) in the balneotherapy group significantly improved after therapy. TNF-α level in the balneotherapy group also significantly decreased after therapy (p = 0.003). The results of SF-36 showed that five subscales were significantly improved in the balneotherapy group however only social functioning was significantly improved in the control group after treatment. ConclusionThe results of the study revealed that balneotherapy may be an effective method in the treatment of mastalgia and it can be recommended by clinicians.

EVALUATION OF THE EFFICACY AND SAFETY OF A GLYCOSAMINOGLYCAN-PEPTIDE COMPLEX IN THE TREATMENT OF KNEE OSTEOARTHRITIS IN PATIENTS WITH PREVIOUS INEFFICIENCY OF SLOW-RELEASE ORAL ANTI-INFLAMMATORY DRUGS (THE MULTICENTER OPEN-LABEL STUDY PRIMULA: USE OF RUMALON® WITH INITIALLY SMALL SUCCESS IN THE TREATMENT OF OSTEOARTHRITIS)

Glycosaminoglycan-peptide complex (GPC) (Rumalon®) is an injectable slow-release anti-inflammatory agent (SRIA) that has complex anti-inflammatory and metabolic effects. GPC has been successfully used in the treatment of osteoarthritis (OA) for several decades. The agent now returns again to Russian clinical practice. Objective: to evaluate the efficacy and tolerability of GPC in patients with knee OA, in whom other SRIAs have been previously ineffective. Subjects and methods . A study group consisted of 104 patients (92.3% women) (mean age, 63.2±8.5 years; body mass index (BMI), 28.5±5.4 kg/m2) with severe joint pain (≥40 mm on a 100-mm visual analogue scale (VAS)) and/or the need to regularly use nonsteroidal anti-inflammatory drugs (NSAIDs). All the patients received oral SRIAs in the last 6 months and had no improvement. At baseline, VAS pain intensity was 59.4±13.1 mm; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain was 227.3±90.8; WOMAC stiffness, 97.9±42.1; WOMAC function, 769.2±326.1; total WOMAC scores, 1095.1±426.6. GPC was used by the standard scheme: 25 intramuscular injections every other day per treatment cycle; the results of treatment were assessed at 8 and 12 weeks by VAS and WOMAC pain scores, needs for NSAIDs, satisfaction with treatment (measured on a 1- to 5-pont scale where 1 = no improvement or deterioration and 5 = the best result). Results and discussion. At 8 and 12 weeks, VAS pain scores decreased by 30.1±18.3% and 36.9±16.9%, respectively; the reductions in WOMAC pain scores were 29.8±16.3 and 38.2±23.4%; WOMAC stiffness scores, 29.2±15.4 and 31.6±17.4%; WOMAC function scores, 27.7±14.7 and 30.6±18.4%; and total WOMAC scores, 27.2±13.5 and 33.6±18.0%. The changes in pain intensity and WOMAC scores were statistically significant in both followup periods (p<0.001). The majority of patients rated their treatment result as good or excellent: 70.2% at 8 weeks and 75.9% at 12 weeks. 31.7% of the patients completely stopped taking NSAIDs at 12 weeks. Two patients were noted to have adverse reactions (pain at the injection site and allergic skin reaction) that did not require treatment discontinuation and completely resolved without consequences after completion of a GPC treatment cycle. Conclusion. GPC is an effective and safe agent for the treatment for OA, as well as in patients with severe OA and inefficiency of oral SRIAs.

Extended-release tramadol (tramadol ER) in the treatment of chronic low back pain

This study evaluated the safety and efficacy of tramadol ER 300 mg and 200 mg versus placebo once daily in the treatment of chronic low back pain, using an open-label run-in followed by, without washout, a randomized controlled study design. Adults with scores > or = 40 on a pain intensity visual analog scale (VAS; 0 = no pain; 100 = extreme pain) received open-label tramadol ER, initiated at 100 mg once daily and titrated to 300 mg once daily during a three-week open-label run-in. Patients completing run-in were randomized to receive tramadol ER 300 mg, 200 mg, or placebo once daily for 12 weeks. Of 619 patients enrolled, 233 (38 percent) withdrew from the run-in, primarily because of adverse event (n = 128) or lack of efficacy (n = 41). A total of 386 patients were then randomized to receive either 300 mg (n = 128), 200 mg (n = 129), or placebo (n = 129). Following randomization, mean scores for pain intensity VAS since the previous visit, averaged over the 12-week study period, increased more in the placebo group (12.2 mm) than in the tramadol ER 300-mg (5.2 mm, p = 0.009) and 200-mg (7.8 mm, p = 0.052) groups. Secondary efficacy scores for current pain intensity VAS, patient global assessment, Roland Disability Index, and overall sleep quality improved significantly (p < or = 0.029 each) in the tramadol ER groups compared with placebo. The most common adverse events during the double-blind period were nausea, constipation, headache, dizziness, insomnia, and diarrhea. In patients who tolerated and obtained pain relief from tramadol ER, continuation of tramadol ER treatment for 12 weeks maintained pain relief more effectively than placebo. Adverse events were similar to those previously reported for tramadol ER.

A multi-center, randomized controlled clinical trial, cost-effectiveness and qualitative research of electroacupuncture with usual care for patients with non-acute pain after back surgery: study protocol for a randomized controlled trial

BackgroundAlthough pain after back surgery is known to be difficult to control, various treatment options are available to patients and physicians. A protocol for a confirmatory randomized controlled trial (RCT) on pain and function after back surgery was designed based on the results of a pilot trial. The aim of this study is to compare the effectiveness and safety of electroacupuncture (EA) with usual care (UC) versus UC alone on pain control and functional improvement after back surgery.Methods/designThis study is a multi-center, randomized, assessor-blinded trial with an active control conducted in conjunction with a cost-effectiveness analysis and qualitative research. Participants with non-acute low back pain with or without leg pain after back surgery who have a Visual Analogue Scale (VAS) pain intensity score ≥ 50 mm will be randomly assigned to either the EA with UC group (n = 54) or the UC group (n = 54). Following randomization, participants in both groups will receive the same UC treatment twice a week for a four-week treatment period. Participants assigned to the EA with UC group will additionally receive EA twice a week for the same four-week period. The primary outcome measure will be assessed using a VAS pain intensity score for low back pain. The secondary outcomes will include the Oswestry Disability Index, EuroQol 5-Dimension score, and drug intake. The primary and secondary outcomes will be measured at one, four, and eight weeks post randomization.DiscussionThe results of this study will provide evidence of the effectiveness and cost-effectiveness of EA in managing postoperative pain following back surgery. In addition, the qualitative research results will help improve the quality of integrative medical interventions.Trial registrationClinical Research Information Service (CRIS), Republic of Korea, KCT0001939. Registered on 8 June 2016.

Appleby operation for carcinoma of the body and tail of the pancreas.

The aim of this study is to evaluate the therapeutic efficacy of Appleby operation for carcinoma of the body and tail of pancreas. From March 2010 to February 2015, Appleby operation was performed in 17 patients with carcinoma of the body and tail of pancreas. The values of fasting plasma blood, body weight (BW), visual analog pain intensity scale (VAS score), and the quality of life indices were evaluated before and 1 day, 1, 2, 6 weeks after surgery. Survival time, tumor recurrence time, hospitalization time, and treatment-related complications were analyzed. There was no hospital mortality. Pancreatic fistula and diarrhea were major and most frequent. The rate of morbidity in general was 47.1%. After operation, all of the patients were completely pain-free. The VAS score decreased more after surgery comparing with before (83.2 ± 8.5 vs. 1.9 ± 3.6, P < 0.05). After operation, patients gained more than their preoperative BW with a mean increment of (4.1 ± 1.3 kg) (68.1 ± 4.3 vs. 64.0 ± 6.7, P < 0.05). A significant rise of the overall quality of life index was observed after surgery (93.8 ± 9.7 vs. 68.6 ± 6.7, P < 0.05). The 1-, 2-, 3-, and 5-year recurrence rates were 22.9%, 58.9%, 72.6%, and 72.6%, respectively. The 1-, 2-, 3-, and 5-year survival rates after operation were 80.4%, 54.2%, 32.5%, and 16.3%, respectively. Appleby operation is both safe and effective with regard to pain relief and improvement of overall quality of life. Appleby operation can also achieve a high survival rate and a long overall survival time.

Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients.

Background.There is a great deal of tools for treatment of occipital neuralgia but currently we are lacking a complete consensus among practitioners regarding the optimal approach to this debilitating condition. Occipital nerve block (ONB) is known as one of the management options but there is lack of scientific literature exploring its effectiveness.Materials and methods.The prospective study was undertaken between March 2014 and February 2018 at the State Vilnius University Hospital. Forty-four patients aged from 28 to 84 years (age mean = 56.30 ± 14.71) of which 79.55% were female (n = 35) were diagnosed with occipital neuralgia (ON) and treated with a local anaesthetic and corticosteroids combination injection into the greater or greater plus lesser occipital nerve (n = 29 and n = 15, respectively) and followed up after 6 months. Analysis of the outcomes of those patients was done by comparing the Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Intensity Score (BNIPIS) prior to treatment, 24 hours after the block, and at a follow-up 6 months later. Analgesic medication consumption before and after 6 months was recorded. A comparison of procedure efficacy in lidocaine and bupivacaine groups was made. Evaluation of block potency for acute and chronic pain categories was conducted as well. The success criteria were defined as patient satisfaction with own condition for at least 6 months, not requiring another block in order to stay comfortable.Results.Of 44 patients, 42 (95.45%) who underwent the occipital nerve block procedure showed satisfactory results for at least 6 months. Mean headache VAS scores decreased from 7.23 ± 0.93 (pre-treatment) to 1.95 ± 1.59 (24 hours after, p < 0.0001) and increased to 2.21 ± 1.73 at the follow-up after 6 months, showing no statistically significant difference between post-interventional and six-month VAS scores (p = 0.07). In all patients the necessity of medication to control pain decreased to 16.67% (n = 7) during the the check-up after 6 months. There was no statistically significant difference in the effectiveness of ONB with regard to the local anaesthetic used or the pain group targeted. Similar results were obtained comparing patients who underwent more than one ONB.Conclusions.Occipital nerve block with a local anaesthetic and corticosteroids provides a safe, simple, and effective treatment method for the patient with medically-refractory occipital neuralgia.

Effect of orthodontic pain on quality of life of patients undergoing orthodontic treatment

Pain is an important aspect of oral health-related quality of life (OHRQOL). Understanding how patients' pain experiences during their treatment affect their quality of life (QOL) is important and the absence of pain/discomfort is important for achieving a high QOL. The objective of this study was to assess the relationship between pain and OHRQOL among patients wearing fixed orthodontic appliances and to evaluate whether patient motivation and counseling had an effect on the pain and discomfort. The McGill-Short-Form with visual analog scale and present pain intensity and Oral Health Impact Profile-14 indices were used to determine the intensity and severity of pain and to evaluate the QOL of 200 adolescents undergoing fixed orthodontic treatment during different phases of treatment. There was a significant correlation found between pain and the QOL of patients undergoing orthodontic treatment. Overall score of OHRQOL increased significantly (mean 43.5 ± 10.9) in the initial phase of treatment where the incidence of severe to moderate pain was reported in 80% patients. Ninety-five percent patients felt pain or discomfort. After 1 day of appliance placement, more than 85% of patients experienced severe to mild pain whereas 9% of patients suffered very severe pain. Pain reduced over a week, and at the end of a month, 10.5% patients had moderate pain whereas majority, i.e., 58% of patients complained of only mild pain (P < 0.05). Pain is important sequelae of orthodontic treatment and has a significant effect on the QOL of orthodontic patients, especially during the initial phases of treatment. Patient motivation and counseling by the orthodontist have a profounding effect in reducing the pain and discomfort, improving the QOL, and an overall improvement in the patient compliance affecting the successful outcome of the treatment.

Acupuncture at the superficial fascia for 48 cases of cervical type of cervical spondylosis

ObjectiveTo observe the clinical efficacy of acupuncture at the superficial fascia for cervical type of cervical spondylosis. MethodsAcupuncture at the superficial fascia was carried out for 48 patients with cervical type of cervical spondylosis by selecting the tender points on both sides of the cervical vertebral body and on the neck and shoulders. The treatment was conducted for once a day and treatment for 5 times was considered as 1 course of treatment. Two days were free from treatment between courses, and 3 courses were needed in total. The scores of McGill pain questionnaire [MPQ, including three indexes: Pain rating index (PRI), Visual analogue scale (VAS) and Present pain intensity (PPI)] of patients before and after treatment were compared, therapeutic effct of cervical type of cervical spondylosis was evaluated. ResultsAccording to the comparison before and after treatment, the scores of PRI (29.44±9.26 vs13.15±7.04), VAS (5.63±2.73 vs 1.23±1.15), and PPI (3.00±1.24 vs 0.38±0.49) of patients with cervical type of cervical spondylosis reduced significantly (all P<0.05), indicating that the differences were statistically significant. Among 48 cases, cured 40 cases (83.33%), markedly effective 4 cases (8.34%), effective 3 cases (6.25%), ineffective 1 case (2.08%). The total effective rate was 97.92% (47/48). ConclusionThe curative effect of acupuncture at the superficial fascia for cervical type of cervical spondylosis was satisfactory.

Study protocol for a randomised controlled trial of ultrasound-guided pulsed radiofrequency of the genicular nerves in the treatment of patients with osteoarthritis knee pain

IntroductionThe goals for the management of patients with osteoarthritis (OA) of the knee are to control pain and to minimise disability. Because the number of patients will increase as the...

Effect of ice pack application on pain intensity during active phase of the first stage of labor among primiparaous

Labor pain management is one of the main goals of maternity care. Ice application or cooling has been claimed to be as an effective, safe and non-invasive adjuvant mean for providing pain relief during the first stage of labor. Aim of the study: To evaluate effect of ice pack application on pain intensity during active phase of the first stage of labor among primiparaous. Research design: None-randomized-controlled clinical trial research design was utilized. Setting: The study was conducted at labor and delivery unit of El Shatby Maternity University Hospital affiliated to Alexandria University. Subjects: Convenience sample of 80 pregnant women attending the previously mentioned setting were recruited in the study. They were equally divided into ice application &amp; control groups. Tools: Three tools were used for data collection, namely: Tool (I): Pregnant women basic data structured interview schedule, Tool II: Visual Analogue pain intensity scale (VAS) &amp; Tool III: Present Behavioral Intensity Scale (PBIS) Tool IV: Satisfaction visual analogue scale (SVAS). A high statistically significant difference was observed between the study &amp; control groups in relation to their pain intensity using VAS before and after the intervention (P ≤ .000). In addition, another high statistically significant difference was detected between the study group &amp; control groups in relation to their behavior of labor pain (P = .000) before &amp; after 30 as well as 60 min of intervention. Based on the study findings, it could be concluded that the application of ice pack application during active phase of first stage of labor appeared to have a remarkable effect on labor pain intensity. In service training programs for nurses in labor units about the utilization of non-pharmacological approaches is recommended.

Clinical observation of fast acupuncture for cervical type of cervical spondylosis

To compare the effects between fast acupuncture and retaining acupuncture for the cervical type of cervical spondylosis. Sixty patients were randomized into a fast acupuncture group and a retaining needle group, 30 cases in each one. The acupoints in the two groups were Fengchi (GB 20), Jiaji (EX-B 2, C2, C4, C6) and Jianjing (GB 21), Jianjing 1 (Extra) and Jianjing 2 (Extra). The needles in the fast acupuncture group were out after qi arrival, while those in the retaining needle group were retained for 30 min, three times a week, once the other day. One week was seen as a course and the treatment was given for 2 courses. The indices were observed before and after treatment, including Northwick Park neck pain questionnaire (NPQ), short-form McGill pain questionnaire (SF-MPQ) [pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI)]. The effects were compared in the two groups. After treatment, the NPQ score was lower than that before treatment in the two groups (both P<0.01), and that in the fast acupuncture group was better (P<0.01). All the items of SF-MPQ decreased compared with those before treatment in the two groups (all P<0.01), with the better results of PRI sensation score and PRI total score in the fast acupuncture group (both P<0.05). The PRI feeling score, VAS score, and PPI score were not significantly different after treatment between the two groups (all P>0.05). The total effective rate in the fast acupuncture group was 83.3% (25/30), not significantly different from 76.7% (23/30) in the retaining needle group (P>0.05). Fast acupuncture and retaining needle are both effective for the cervical type of cervical spondylosis, which can apparently improve the clinical symptoms. Fast acupuncture is superior to retaining acupuncture.

Kinesiophobia, functional disability and physical deconditioning evaluation in chronic low back pain

Chronic low back pain, which represents only 5 to 10% of the cases, is the cause of high health and social costs. Non-specific chronic low back pain has negative effects for physical activities and patient psychology. The aim of this study was to evaluate kinesiophobia, functional abilities and physical deconditioning in a population with chronic low back pain. The Tampa Scale of Kinesiophobia (TSK) Arabic version was used to evaluate pain beliefs and fear of movement/(re) injury. To evaluate functional abilities, we used both Oswestry Disability index (ODI) and Visual Analog Scale (VAS) of functional discomfort. Pain intensity was measured in calculating VAS of pain intensity. In order to assess endurance-responses, the following tests were used: Sorensen and Shirado tests. In addition, we studied relations between Kinesiophobia, Pain Intensity, Functional Disabilities and Endurance tests. To verify the significance of the correlations between the different variables, we used the Spearman correlation coefficient. The significance level was set at 5% ( P < 0.05). A total of 50 patients with non-specific chronic low back pain were recruited from Department of Physical Medicine and Functional Rehabilitation, Habib Bourguiba University Hospital of Sfax, Tunisia. The average Kinesiophobia score was high in our patients (48.5 ± 10.2). The mean Oswestry index was 34.4 ± 12.5%, whereas the functional VAS was 5.86 ± 2.13. High positive correlation was founded between global score of TSK and ODI ( r = 0.6, P < 0.001). Moreover, TSK was significantly correlated with VAS of functional discomfort ( r = 0.7, P < 0.001) and VAS of pain intensity ( r = 0.46, P = 0.001). About endurance variables, TSK showed negative correlations according Shirado test ( r = −0.51, P < 0.001) and Sorensen test ( r = −0.39, P = 0.004) on a moderate to low level. Given these results, Kinesiophobia presents a real problem in chronic low back pain patients since it has been significantly correlated with functional abilities and physical deconditioning. We intend to propose multidisciplinary therapeutic management programs. These programs will rely on psychological education and cognitive-behavioral therapies that allow patients to change their erroneous beliefs and to promote functional recovery.

Local Infiltration Analgesia With Liposomal Bupivacaine Improves Pain Scores and Reduces Opioid Use After Total Knee Arthroplasty: Results of a Randomized Controlled Trial

BackgroundLocal infiltration analgesia (LIA) with liposomal bupivacaine (LB) in patients undergoing total knee arthroplasty (TKA) has yielded mixed results. The PILLAR study, which was designed to minimize limitations associated with previous studies, compared the effects of LIA with or without LB on pain scores, opioid consumption, including proportion of opioid-free patients, time to first opioid rescue, and safety after primary unilateral TKA. MethodsPatients (N = 140) were randomized to LIA with LB 266 mg/20 mL (admixed with bupivacaine HCl 0.5%, 20 mL) or LIA with bupivacaine HCl 0.5%, 20 mL. Standardized infiltration techniques and a standardized multimodal pain management protocol were used. The coprimary efficacy endpoints were area under the curve (AUC) of visual analog scale pain intensity scores 12-48 hours (AUC12-48) postsurgery and total opioid consumption 0-48 hours postsurgery. ResultsMean AUC12-48 of visual analog scale pain intensity score was 180.8 with LB and 209.3 without LB (least squares [LS] mean treatment difference −26.88, P = .0381). LS mean total opioid consumption 0-48 hours postsurgery was 18.7 mg with and 84.9 mg without LB (LS ratio 0.220, P = .0048). Significant differences in favor of LB were observed for the percentage of opioid-free patients (P < .01) and time to first opioid rescue (P = .0230). Treatments were similarly well tolerated. ConclusionThis study provides data on LIA with LB administered using optimal techniques specific to TKA. In this setting, LIA with LB significantly improved postsurgical pain, opioid consumption, and time to first opioid rescue, with more opioid-free patients and no unexpected safety concerns.

Sebacoyl Dinalbuphine Ester Extended-release Injection for Long-acting Analgesia: A Multicenter, Randomized, Double-Blind, And Placebo-controlled Study in Hemorrhoidectomy Patients.

This study was conducted to evaluate the safety and efficacy of single sebacoyl dinalbuphine ester (SDE) injection (150 mg/2 mL) when administered intramuscularly to patients who underwent hemorrhoidectomy for postoperative long-acting analgesia. A total of 221 patients scheduled for hemorrhoidectomy from 6 centers in Taiwan were randomly divided into SDE group and placebo group, and received the treatment, vehicle or SDE, 1 day before the surgery. Visual analogue scale (VAS) was recorded up to 7 to 10 days. Pain intensity using VAS AUC through 48 hours after surgery was calculated as the primary efficacy endpoint. Area under the curve of VAS pain intensity scores (VAS AUC) through 48 hours after hemorrhoidectomy was significantly less in SDE group than those in placebo group (209.93 vs. 253.53). VAS AUC from the end of surgical procedure to day 7 was also significantly different between SDE and placebo group (630.79 vs. 749.94). SDE group consumed significantly less amount of other analgesics, such as PCA ketorolac and oral ketorolac. Median time from the end of surgery to the first use of pain relief medication was also shortened in the placebo group than in the SDE group. Most adverse events were assessed as mild and tolerable in both groups. SDE injection demonstrated an extended analgesia effect, with a statistically significant reduction in pain intensity through 48 hours and 7 days after hemorrhoidectomy.

Pain in Patients with Dystrophic Epidermolysis Bullosa: Association with Anxiety and Depression.

ObjectiveWe investigate the presence and the quality of pain in patients with dystrophic epidermolysis bullosa (DEB), and its correlation with the level of anxiety and depression.MethodsWe collected data from 27 DEB patients and 26 healthy individuals. DEB patients and controls completed 1 scale for the quality of pain, and 1 scale for anxiety and depression. Pain was assessed with the short form of the McGill Pain Questionnaire, whereas anxiety and depression were assessed with the Hamilton rating scale for anxiety and depression.ResultsDEB patients and healthy control individuals were homogeneous for age and gender (p>0.05). A statistically significant difference in the two groups was seen for sensory pain rating scale (p<0.001), affective pain rating scale (p=0.029), total pain rating scale (p<0.001), visual analogue scale (p=0.012) and present pain intensity (p=0.001), but not for anxiety (p=0.169) and depression (p=0.530). The characteristics of pain that showed a significant difference between DEB patients and healthy controls were shooting, splitting, tender and throbbing (p<0.05). In DEB patients pain was not correlated with anxiety or depression (p>0.05), whereas a slight correlation between pain and anxiety was found in healthy controls (p<0.05). No difference was found between quality of pain and anxiety-depression in DEB patients (p>0.05), but was between the DEB dominant and the recessive form of DEB (p=0.025).ConclusionThe perception of pain in DEB patients appears greater than in healthy individuals, with splitting and tender characteristics being the most significant ones, but was not associated with anxious and/or depressive symptoms.