Visual Analog Scale Values Research Articles

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecological emergencies

ObjectiveTransvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive approach increasingly applied to perform many gynecological procedures. Despite a still limited level of evidence, compared to conventional laparoscopy, vNOTES seems to be associated with reduced blood loss, shorter operative time, less postoperative pain, shorter hospitalization time, better cosmetic results and decreased postoperative morbidity. Although growing evidence supports the effectiveness of vNOTES for elective adnexal surgeries, there is still limited knowledge regarding its feasibility and safety in emergency settings. In the present study, we report our experience performing vNOTES in gynecological emergency cases. Study designWe prospectively collected and analyzed data from patients who underwent vNOTES for gynecological emergencies between November 2021 and June 2023. Demographic and perioperative characteristics were collected and analyzed. ResultsSeventeen patients were included. Interventions were realized for suspicion of ectopic pregnancy in 7 cases (41.2%), for suspicion of adnexal torsion in 7 cases (41.2%), for post-hysterectomy hemoperitoneum in 2 cases (11.8%), and for uncontrollable uterine bleeding in 1 case (5.9%). Emergency procedures included unilateral salpingectomy (35.3%), ovarian cystectomy (23.5%), ovarian cystotomy (17.6%), adnexal detorsion (11.8%), hemoperitoneum drainage (11.8%), hysterectomy (5.9%), and appendectomy (5.9%). The overall median operative time was 38 [18–72] minutes. The median estimated intraoperative blood loss was 30 [5−150] mL, and no intraoperative complications occurred. Conversion to conventional laparoscopy or laparotomy was never needed. Patients stayed hospitalized for a median time of 30 [4−144] hours after the intervention. The median visual analog scale value for postoperative pain evaluation was 2 [0−5] at 12, 24, and 48 postoperative hours. No complications associated with the procedure occurred. ConclusionsThis study demonstrated the feasibility of performing vNOTES procedures for managing gynecological emergencies such as tubal ectopic pregnancy, adnexal torsion, painful ovarian lesions, post-hysterectomy hemoperitoneum, and uncontrollable uterine bleeding. Associated with data reported in the available literature, our results suggest potential benefits in treating gynecological emergencies by vNOTES over conventional laparoscopy. However, stronger evidence from larger studies is needed to confirm it.

Evaluation of the effects of somatotype profiles on pain, proprioception, isokinetic muscle strength and kinesiophobia in patients with meniscopathy.

Somatotype causes differentiation of physical, physiological and biochemical metabolisms in the body. To what extent meniscopathy (M) is affected by somatotype profiles has been an issue of concern. The aim of the study was to investigate whether somatotype profiles have an effect on kinesiophobia, pain, proprioception and isokinetic muscle strength in patients with an M diagnosis. 172 (85 female, 87 male) M patients between the ages of 18 and 65 were included in the study. The Heath-Carter method was used to determine somatotype components. Biodex Isokinetic system at 120∘/sec angular speed was used for muscle strength measurements, a digital inclinometer with goniometer was used for proprioception measurement, the Tampa Kinesiophobia Scale (TKS) was used for the assessment of kinesiophobia, the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale was used for the assessment of fatigue and pain, and the visual analogue scale (VAS) was used for pain assessment. Five somatotype profiles were found. When the right-left knee proprioception values were compared according to the somatotype profiles of patients, a significant difference was found in favor of balanced ectomorph at 15∘ and 30∘. No significant difference was found when TKS, FACIT, VAS values were compared in terms of somatotype profiles; while no significant difference was found in TKS, FACIT, VAS (REST-NIGHT) in terms of gender, a significant difference was found in VAS MOVE. Endomorph somatotype was dominant in the M patients. Individuals with M disease showed significant differences in terms of endomorph components. Obesity may also be one of the negative findings for M disease. Somatotype classification may represent a suitable tool for monitoring M.

Repetitive Transcranial Magnetic Stimulation of the Human Motor Cortex Modulates Processing of Heat Pain Sensation as Assessed by the Offset Analgesia Paradigm.

Offset analgesia (OA), which is defined as a disproportionately large reduction in pain perception following a small decrease in a heat stimulus, quantifies temporal aspects of endogenous pain modulation. In this study on healthy subjects, we aimed to (i) determine the Heat Pain Threshold (HPT) and the response to constant and dynamic heat stimuli assessing sensitization, adaptation and OA phenomena at the thenar eminence; (ii) evaluate the effects of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) of the primary motor cortex (M1) on these measures. Twenty-four healthy subjects underwent quantitative sensory testing before and after active or sham 10 Hz rTMS (1200 stimuli) of the left M1, during separate sessions. We did not observe any rTMS-related changes in the HPT or visual analogue scale (VAS) values recorded during the constant trial. Of note, at baseline, we did not find OA at the thenar eminence. Only after active rTMS did we detect significantly reduced VAS values during dynamic heat stimuli, indicating a delayed and attenuated OA phenomenon. rTMS of the left M1 may activate remote brain areas that belong to the descending pain modulatory and reward systems involved in the OA phenomenon. Our findings provide insights into the mechanisms by which rTMS of M1 could exert its analgesic effects.

Reverse Wafer Procedure

Abstract Purpose This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the “reverse wafer procedure,” and assess the mid-term clinical outcomes of patients treated with this technique. Methods A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results The mean follow-up period was 42.2 months (range: 24–68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery (p = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28–48 kg), which improved to 44 kg (range 30–52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values (p < 0.001, p = 0.001). The mean VAS score decreased from 6.1 (range 4–8) preoperatively to 0.9 (range 0–5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25–68.3) preoperatively to 10.13 (range 3.3–36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence IV Therapeutic.

A pilot study to evaluate the potential therapeutic effect of hydrogen-water bathing on atopic dermatitis in humans

BackgroundHydrogen molecules, which have excellent antioxidant and anti-inflammatory effects, are absorbed through the skin and spread hematogenously throughout the body. Hydrogen-water bathing (HWB) is expected to be effective against atopic dermatitis (AD); however, its usefulness remains controversial in humans. ObjectiveThis study aimed to determine whether HWB has the potential to have a therapeutic effect in a pilot study conducted on six patients with AD. MethodsAD severity was assessed based on the itching intensity per the visual analog scales (VAS) and the transepidermal water loss (TEWL) values of the lesions, in addition to macroscopic observations. ResultsHWB for eight weeks ameliorated the severity of rashes and increased TEWL levels in the trunk/limb areas that could be completely immersed in the bathwater, resulting in ameliorations in severe itching. The specificity of its therapeutic effect was further investigated in one patient who first underwent HWB for four weeks, discontinued it for two weeks, and resumed it for another four weeks. The rashes on the trunk/limb areas visibly improved after four weeks of HWB but worsened again after it was stopped for two weeks, only to improve again after the resumption of HWB for four weeks. The VAS and TEWL values also showed changes that reflected the skin condition. ConclusionThese results suggest that HWB may be useful in the treatment of AD. To conclude the effectiveness of HWB for AD, it needs to be supported by randomized controlled trials with larger sample sizes and longer study durations in the future.

Efficacy of Extracorporeal Shock Wave and Pulse Electromagnetic Field Therapies in Calcaneal Spurs.

Various treatment methods are available for calcaneal spur, which can cause disability. Objective: To evaluate the efficacy of pulsed electromagnetic field therapy (PEMFT) added to extracorporeal shock wave therapy (ESWT) on pain and functional capacity in treating calcaneal spurs. Patients with calcaneal spurs who were recommended ESWT or ESWT+PEMFT and whose Foot Function Index (FFI) and visual analogue scale (VAS) values were available in their records were retrospectively analyzed. The two groups were ESWT (n=35) and ESWT+PEMFT (n=40). FFI and VAS scores were obtained from their records before treatment, after treatment, and in the third month after treatment. The two groups were similar regarding their pre-treatment FFI and VAS scores. In intra-group evaluation, statistically significant decreases were found in terms of the FFI pain, disability, and activity limitation and VAS scores in both groups after treatment and in the third month after treatment compared to the pre-treatment period. In the comparison between the groups, the post-treatment and post-treatment third-month FFI pain, disability, and activity limitation and VAS scores were significantly lower in the PEMFT+ESWT group than the ESWT group (P<0.001). A calcaneal spur is a condition that can cause pain and functional limitation in patients. Various studies have demonstrated the efficacy of ESWT in the treatment of calcaneal spurs. In our study, we observed that PEMFT added to ESWT significantly improved the pain and functionality of the patients. Further studies are needed to evaluate the efficacy of PEMFT in calcaneal spurs.

The use of a combination of Diclofenac and Orphenadrine for analgesia in knee replacement

The objective was to assess the effectiveness and safety of the use of a fixed combination of Diclofenac and Orphenadrine (Neodolpasse) for analgesia in patients who underwent knee replacement.Materials and methods. 40 patients who underwent knee replacement in conditions of combined spinal-conduction analgesia (femoral nerve block) were included into the study. In the main group(n = 20), Neodolpasse (a combination of Diclofenac 75mg and of Orphenadrine 30 mg in 250 ml of solution) was administered intravenously 30 minutes before surgery, and then in the postoperative period 2 times a day for 2 days. In the comparison group (n = 20), Ketoprofen (intravenously,100 mg) was used instead of Neodolpasse 30 minutes before surgery, in the postoperative period, it was continued 2 times a day for 2 days (intravenously, 100 mg). The severity of the pain was assessed with a visual analog scale (VAS) 6, 12, 24 and 48 hours after surgery. The assessment of the restoration of the supporting function of the operated leg and the ability of the patient to perform active movements in the knee joint was carried out after 24 and 48 hours. The possible side effects was assessed throughout the entire period.Results. The median value of VAS after 24 hours in the main group was 2.5 (2;3) points, which was significantly lower in compassion to VAS of the control group 4(3;5) p = 0.006. A more pronounced analgesic effect while using Diclofenac and Orphenadrine persisted for 48 hours, the median value of VAS in the main group after surgery was 2 (2;3), in the control group – 3 (2.8;4) p = 0.021. There were no significant differences in the recovery time of restoration of the supporting ability of the operated leg and knee joint function, in the frequency of Tramadol use in the compared groups. Side effects and complications were not identified. Conclusion. The use of the fixed dose of Neodolpasse as part of multimodal perioperative analgesia in patients, who underwent knee replacement, contributed to a decrease in the severity of pain syndrome in the postoperative period.

Evaluation of the Effectiveness of Wet Cupping Therapy in Fibromyalgia Patients: A Randomized Controlled Trial

Introduction: The aim of this study was to investigate the efficacy of wet cupping therapy (WCT) in patients diagnosed with fibromyalgia syndrome (FMS) as a complementary method in fibromyalgia treatment. Materials and Methods: A total of 120 participants between 18 and 65 years who were diagnosed with FMS were included in the study. They were randomized into two groups: 60 patients as the intervention and 60 patients as the control group. Each participant in the intervention group received 3 sessions of WCT once a month in addition to their ongoing treatment whereas the control group received only routine medical treatment. The evaluation was conducted in both groups based on the fibromyalgia impact questionnaire (FIQ), visual analog scale (VAS), and quality of life scale (QoL) parameters initially (at 0th week) and 1 week after the WCT sessions (at the 10th week). For the comparison of quantitative variables showing a normal distribution between the two groups, the Student’s t test was used, while the Mann-Whitney U test was employed for variables not showing a normal distribution. The χ2 test and Continuity (Yates) Correction were used for the comparison of qualitative data. The significance level was set at p < 0.05. Results: The study included 107 female and 13 male participants, with a mean age of 45.79 ± 8.49 years. When comparing the pretreatment FIQ, VAS, and QoL scores with the scores obtained after three sessions of WCT, it was observed that in the WCT group, the FIQ and VAS values significantly decreased compared to the control group while the QoL significantly increased compared to the control group (p < 0.001 in all). Conclusion: The findings obtained from this study indicate that WCT can be an effective treatment option for patients with FMS.

Effect of Low-Level Laser on The Pain PerceptionFollowing Dental Extraction

The goal of this study was to determine the effectiveness of a single dose of low-level laser therapy (LLLT) on the pain of patients after tooth extraction. Thirty patients in total were divided into two treatment groups. Each group consists of fifteen patients. Group A received a single dose of LLLT 20 minutes after tooth extraction with (0.3 W, 30 sec, 9 J/cm2) diode laser. The irradiation was extra-orally 1 cm away from the site of interest. Group B is the control group. The patients' level of pain was assessed. Visual analog scale (VAS) was utilized to quantify pain intensity in the 2nd and 7th days after extraction. Results indicated that (Group A) had significantly decreased VAS values than (Group B) on postoperative day 7. The current study suggested that there is a significant effect of single dose (LLLT) on lowering pain following tooth extraction.

Effectiveness of CT-guided percutaneous cordotomy in intractable cancer pain: Experience in 14 patients.

Severe and treatment-resistant pain is a major issue for patients with cancer. Cordotomy is an effective approach for addressing severe cancer-related pain. It is based on blocking the transmission of pain by damaging the lateral spinothalamic tract. Computed tomography guided cordotomy was performed on 14 patients who did not respond to medical and interventional pain management methods. Fourteen patients with cancer pain underwent CT-guided percutaneous cordotomy. Pain relief was reported in 86% of the patients. The visual analog scale values before and after cordotomy were compared and a significant difference was found (p = 0.0001). The improvement in the Karnofsky Performance Scale score of the patients was found to be statistically significant (p = 0.0001). We believe that CT-guided cordotomy, performed by experienced hands in a team of experienced individuals and applied to the right patients, is an effective treatment. However, it is crucial to exercise extreme caution regarding potential side effects and serious complications during the cordotomy procedure.

Ultrasonography Guided Modified BRILMA (Blocking the Cutaneous Branches of Intercostal Nerves in the Middle Axillary Line) Block in Bariatric Surgery.

Background: Postoperative pain is one of the major problems after laparoscopic sleeve gastrectomy besides complications. Management of pain control is still unclear in the obese population. Modified BRILMA (blocking the cutaneous branches of intercostal nerves in the middle axillary line) is a new analgesia technique which is performed by ultrasonography guided through the way between eighth and ninth rib level. This study is to evaluate the efficiency of modified BRILMA in bariatric patients while comparing with trocar site infiltration. Materials and Methods: This is a prospective designed retrospective data analysis study. Patients undergoing laparoscopic sleeve gastrectomy between June 2019 and January 2020 were divided into two groups. One group underwent BRILMA block; the other group used traditional trocar site injection. Postoperative pain was followed by using visual analogue scale (VAS) (at 1, 3, 6, 12, 24, 36, 48 hours postoperatively). Results: Thirty patients were included in the study. Twenty-four (80%) of the patients were women, and 6 (20%) of the patients were men. Mean body mass index of patients were 39.83 ± 4.02 kg/m2. Mean operational time was calculated 86.16 ± 19.94 minutes. When the patients' VAS was compared, 12th hour VAS value was statistically less in the BRILMA group. There were no significant differences in other hours' VAS between two groups. When compared with the use of opioid amount, there were no statistically significant difference between the two groups (P = .66), but BRILMA group had less amount. Conclusion: Modified BRILMA is an alternative technique to the use of trocar site bupivacain injection in bariatric surgery. It is new technique that is tried in bariatric population, which is also cost-effective and has less opioid consumption.

A superiority study of the analgesic efficacy of ultrasound-guided erector spinae plain block compared to serratus anterior plain block using bupivacaine-dexamethasone for modified radical mastectomy

Background This trial compared the preemptive analgesic efficacy of erector spinae plain block (ESPB) and serratus anterior plain block (SAPB) for patients scheduled for modified radical mastectomy. Methods This randomized, controlled, double-blinded study embraced 40 patients aged 20 to 70 years undergoing modified radical mastectomy. Patients were randomly allocated into two equal groups: Group I (n=20): received SAPB, Group II (n=20): received ESPB. Both groups were injected with 30 ml of 0.25% bupivacaine and 8 mg dexamethasone. The time of the first analgesic request was the primary outcome measure while the secondary outcome measures were total fentanyl consumption (intraoperative and postoperative within 24 h), visual analogue scale (VAS) values within 24 h post-operatively at rest and ipsilateral arm movement and side effects related to the received blocks. Results This study illustrated that the median [interquartile range (IQR)] time of the first analgesic request was significantly longer in ESPB group [720(600–720) minute] than SAPB group [600(600–720) minute], P=0.04. The total median fentanyl consumption was significantly higher in SAPB group than ESPB group [0(40.000–80.000) vs. 0(0–0)], P=0.004 intraoperatively and [42.5(40–82.5) vs. 40(40–40)], P=0.005 post-operatively. VAS values at rest were significantly lower in ESPB group than SAPB group [immediate P=0.009, 2 h P=0.004, 6 h P=0.007, 12 h P=0.005, 24 h P=0.002] and values at ipsilateral arm abduction were significantly lower in ESPB group than SAPB [immediate P=0.004, 2 h P=0.02, 12 h P=0.009, 24 h P=0.023]. No side effects were detected in both groups. Conclusion ESPB provides superior analgesia to SAPB in patients undergoing modified radical mastectomy.

Trocar Site Location in Laparoscopic Appendectomy-A Prospective Randomized Study.

Laparoscopic appendectomy has been used in the treatment of appendicitis, which is among the most common emergency pathologies worldwide. There is no consensus on the best trocar entry sites. The purpose of the present study was to compare various trocar entry sites in the literature and to find the localization with the optimal usage area. Patients who underwent laparoscopic appendectomy between 2021 and 2022 were randomized into 4 groups and included in the study. The demographic data, perioperative, and postoperative findings of the patients were evaluated. A total of 200 patients participated in the study and 73% were male. No differences were detected between the groups in terms of demographic data, preoperative findings, length of stay, and complications of the patients. However, when the mean surgery times of the groups were examined (47.2±26.9, 58.4±23.1, 54.5±18.3, 55.8±18.6min), it was observed that this period was less in Group 1 (P=0.02). When the postoperative Visual Analogue Scale values were analyzed (4.8±2.2, 6.2±1.7, 5.5±2.0, and 5.8±1.9), Group 1 was found to be less painful (P=0.00001). When the surgical procedure is optimized and environmental factors are homogenized, Group 1 trocar entry sites seem advantageous for the procedure in terms of postoperative patient pain scale and operation times.

Immediate Effect of Ischemic Compression Therapy to Release Suboccipital Trigger Points in Tension-Type Headache among Adult Population of GCUF

Tension-type headache is a nervous illness and characterized by pain, causes stretch on both sides and stiffness which feels like a band or pressure leads to disruption in daily activities. Objective: To see the immediate effects of ischemic compression therapy to release sub-occipital trigger points in tension type headache. Methods: It was a quasi-experimental study. Study population was students and faculty members of GC University, Faisalabad from age between 25 to 35 years. Sample size of the study was 35. A convenient sampling technique was used to select individuals according to the defined inclusion criteria. Trigger points were evaluated by palpating the occipital region. Data collection tools including visual analogue scale (VAS) and HIT-6 was used to measure intensity of pain and tension-type headache. SPSS version 25.0 was used to analyze the data. Results: Post-treatment values of VAS showed the reduction in pain intensity (mean=0.57) as compared to the pre-intervention values (mean = 5.03). A notable reduction in HIT-6 impact from (mean = 65.13) to (mean = 40.40) was observed. Paired sample t-test showed a p-value below 0.05 for both VAS and HIT-6, highlighting the positive effects of ischemic compression therapy to release sub-occipital trigger points in tension type headache. Conclusions: There was a notable reduction of pain intensity immediately after the treatment session. Ischemic compression therapy was significantly effective to release sub-occipital trigger points in patients with tension type headache.

Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid- to Long-Term Follow-up.

The long-term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid- to long-term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non-surgically treated adjacent segments. We retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2-C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre- and postoperative values were compared using paired t-tests or Wilcoxon rank-sum tests. Independent Student t-tests or Mann-Whitney U tests analyzed continuous data between CDA and HS groups, while chi-square or Fisher exact tests assessed categorical data. Sixty-four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow-up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2-C7 ROM (p < 0.05), but at the last follow-up, the C2-C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow-up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%). CDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid-to-long-term follow-up. ASDeg is similar in non-surgical segments after 70 months of follow-up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration.

The effect of back massage with frankincense and myrrh oil before the cardiac electrophysiological procedure on back pain intensity and comfort: A single-blind randomized controlled trial

ContextBack pain is one of the most common problems experienced by patients after the cardiac electrophysiological study procedure. In addition, limitation of movement after the procedure negatively affects the comfort and satisfaction of patients. ObjectivesThe aim of this study was to determine the effect of back massage with frankincense and myrrh oil on back pain severity and comfort in patients who were to undergo cardiac electrophysiological study. MethodsThis is a randomized controlled study with a pretest–posttest design. This study was conducted from October 2020 to March 2021, at the angio unit of a heart hospital at a university in Turkey. The study was completed with 30 patients in each group, a total of 90 people. Data were collected using a patient information form, a Visual Analogue Scale (VAS) and the General Comfort Questionnaire (GCQ). The intervention group and the placebo group received back massage with frankincense and myrrh essential oil and with jojoba fixed oil respectively. No intervention was applied to the control group. ResultsThere was no statistically significant difference between the post-procedure VAS values according to the groups. Except for sociocultural comfort, there were significant differences between the groups in terms of GCQ total scores and subscales at the first and last follow-up. ConclusionsBack massage with frankincense and myrrh oil increased overall comfort, physical comfort, the psychospiritual comfort. Additional research with a rigorous design is needed to determine its effect on pain.

The Effect of Biogel Using Biomagnetic Energy in the Treatment of Acute Pain in the Upper Extremity and Spine: A Randomized Controlled Trial

Objective: Pain is a public health problem, which is caused by various etiological factors and leads to diminished quality of life and decreased workforce. The aim of this study was to determine whether Biogel has an effect in the treatment of pain. Methods: Patients due to acute pain in the upper extremity and/or trunk were divided into two groups as treatment and placebo by randomization method. For the patients in the treatment group,the non-interventional Biogel was applied for 10 minutes. For the control group, a non-interventional placebo was applied for 10 mins. A record was made of patient demographic data,the region of the pain, and mean arterial pressure (MAP) values before and after the application. All the patients in both groups were administered a Visual Analogue Scale (VAS) to evaluate pain severity,and the Nottingham Health Profile (NHP) before and after the applications. The data obtained were compared. Results: In the biogel group, a statistically significant decrease was determined in the NHP-P values after treatment compared to before treatment (P&lt;0.001). In the placebo group,no statistically significant difference was determined in the NHP-P values before and after treatment (P=0.104). In the Biogel group,a statistically significant decrease was determined in the VAS values after treatment compared to before treatment (P&lt;0.001). In the placebo group,no statistically significant difference was determined in the VAS values before and after treatment (P=0.157). Conclusion: These types of complementary medicine applications focussed on pain treatment can reduce the disease burden and can probably reduce costs.

The effects on joint functions of biplanar distal tubercle open-wedge high tibial osteotomy: A prospective study.

Distal tubercle biplanar open-wedge high tibial osteotomy (DT-BOWHTO) is a method frequently applied in the treatment of knee joint medial osteoarthritis. The aim of this study was to evaluate the radiological, clinical, and functional results of patients at 5 years after DT-BOWHTO surgery. The study included a total of 41 patients who underwent DT-BOWHTO, comprising 19 (46.3%) males and 22 (53.7%) females with a mean age of 55.54 ± 4.17 (45-63) years and mean follow-up of 66.76 ± 6.29 (60-81) months. Statistical comparisons were made of the preoperative and postoperative body mass index (BMI), modified Insall-Salvati index, Blackburn-Peel index, Kelgren-Lawrence classification (KLC), tibial slope angle, American Knee Society Functional Score (AKSFS), Clinical American Knee Society Score (CAKSS), visual analog scale (VAS) pain score, Tegner Functional Activity Score (TFAS), total corrected angular measurements (TCA), and the tibio-femoral varus angle. Compared to the preoperative values, no statistically significant difference was determined in the postoperative modified Insall-Salvati index, Blackburn-Peel index, and tibial slope angle values (P > .05), and a statistically significant difference was determined in the BMI, AKSFS, CAKSS, VAS, KLC, tibio-femoral varus angle, and TFAS values (P ≤ .001). When the preoperative and postoperative BMI values were compared in 3 groups of normal, overweight, and obese, there was found to be a statistically significant difference (P = .014). No significant correlation was determined between the BMI values and the VAS and KLC values (P > .05). No significant correlation was determined between the total corrected angular and the preoperative and postoperative pain, and clinical and functional knee scores (VAS, AKSFS, CAKSS, TFAS) (P > .05). DT-BOWHTO was seen to provide extremely good 5-year results in the knee clinical findings, pain severity, and functional results. As the patella height and tibial slope angle were not changed, this did not cause the development of osteoarthritis in the patellofemoral and tibiofemoral joints. Grafting and fixation of the tibial tubercle with additional screws in the application of DT-BOWHTO were not seen to make any additional contribution to the healing of the osteotomy line. There was no relationship between increased BMI, reduced pain, and increase in knee functions in patients who underwent DT-BOWHTO.

Effect of limb alignment correction on medial meniscus extrusion under loading condition in high tibial osteotomy

BackgroundThis study aimed to investigate the effect of high tibial osteotomy (HTO) on medial meniscus extrusion (MME) and the association between the changes in limb alignment and MME under weight-bearing (WB) conditions after HTO. MethodsWe included 17 patients with knee osteoarthritis (OA) who underwent HTO. MME was evaluated using ultrasonography in supine and unipedal standing positions. Knee alignment was evaluated radiographically using WB, whole-leg radiographs with the hip-knee-ankle angle (HKAA), percentage of the mechanical axis (%MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). All measurements were performed serially at four time points: preoperative and 3, 6, and 12 months postoperative. Clinical outcomes were assessed by knee injury and osteoarthrosis outcome score (KOOS) and visual analogue scale (VAS) value for pain. ResultsMean MME in the WB position was significantly greater than that in the supine position in the preoperative condition; however, MME in both supine and WB positions was significantly lowered postoperatively. The ΔMME, difference of MME between supine and WB positions, was significantly lowered postoperatively and maintained for up to 1 year. MME change in the WB position between preop and postoperative conditions was significantly correlated with change in HKAA and %MA at 1 year postoperative. KOOS and VAS score were significantly improved after HTO. ConclusionsHTO correcting varus alignment can decrease MME in WB position and minimise the change in MME between supine and WB positions. The changes in MME after HTO were correlated with changes in the mechanical alignments.

Surgical evolution in spinal dural arteriovenous fistula treatment-a 7 years monocentric experience.

Accounting for 70% of all spinal vascular malformations, spinal dural arteriovenous fistulas (SDAVF) are the most common type of malformation. Interruption of the fistulous arterialized vein point is the goal of surgical treatment. The aim of the study was to compare open surgery (laminectomy) versus minimal invasive surgery (MIS) in SDAVF treatment. Between March 2013 and March 2020, we retrospectively collected 21 consecutive adult patients with SDAVF. Since March 2017, MIS has been routinely used for surgical treatment. Pre- and post-operative clinical evaluations used Aminoff-Logue score (ALS). Complication rate was noted. Post-operative occlusion of the malformation was confirmed by digital subtraction angiography (DSA) in all patients. MIS was compared to open surgery in terms of efficacy and complications with statistical evaluation. Standard laminectomy was performed in 12 patients and MIS technique in 9 patients. No difference was noted on pre-operative parameters. ALS and MRI signs of myelopathy were improved in all cases except for 1 patient in each group. All SDAVFs were excluded based on post-operative DSA. Significant differences were noted between the 2 groups in terms of perioperative blood loss (p<0.001), post-operative pain visual analog scale values (p<0.001), and first time out of bed (p<0.001). Wrong level surgery occurred in one patient in each group; patients were re-operated using the same technique. No infection or cerebrospinal fluid (CSF) leak was noted. In our experience, MIS is a safe alternative to open laminectomy for SDAVF treatment. MIS contributes to patient comfort and minimizes blood loss without increasing complication rate.