Wong-Baker Faces Pain Rating Scale Research Articles

Ozone Therapy for Early Childhood Caries (ECC) Treatment: An In Vivo Prospective Study

The present study aimed to evaluate the effectiveness of ozone therapy in (1) increasing the compactness of decayed dentin (main aim), (2) reducing dentin hypersensitivity, (3) decreasing the salivary bacterial count, and (4) improving the quality of life in ECC-affected children during a 3-month follow-up. A total of 20 subjects uncooperative with conventional restorative treatment were treated with a 60 s ozone application/week (OzoneDTA®) for 4 weeks. Patients were evaluated at T0 = baseline; T1 = after ozone cycle and T2, T3, T4 = 1, 2, 3-month follow-up, respectively. Dentin compactness was evaluated according to the Affected Dentine Scale (ADS) proposed by the authors; dentin hypersensitivity was recorded with the Wong–Baker Faces Pain Rating Scale (WBFPRS); salivary bacteria were measured with the Saliva Check Mutans Test and quality of life with the Early Childhood Oral Health Impact Scale (ECOHIS). ADS values and salivary bacteria count results were analyzed using non-parametric tests. Statistically significant differences were detected for both parameters between T0 and T1 (p < 0.01). At T1, dentin hypersensitivity was resolved and quality of life improved. Ozone therapy is a simple and painless approach, which might be useful for controlling caries’ progression in uncooperative children until appropriate cooperation is achieved.

The effect of parental presence and dental anxiety on children's fear during dental procedures: A randomized trial.

Objective: To evaluate the effect of anxiety of parent accompanying child on child's anxiety during treatment. Methods: The study included two groups: one group with 80 children whose parents were anxious, and the other group with 80 children with non-anxious parents, totaling 160 children. Each group was further randomized into subgroups, with and without parents accompanying their children. The children's heart rates were measured using a portable pulse oximeter during the treatment. The child's perception was measured using the Wong-Baker Faces Rating Scale, and another pediatric dentist rated child's behavior using the Frankl scale based on the treatment video that was limited to the child's appearance. Results: The highest pulse rates were observed in children accompanied by an anxious parent (p < .001). Values on the Wong-Baker scale did not differ according to parental anxiety and parental presence (p > .05). According to the dentist, the presence of parents negatively affected the anxiety of the child (p = .025), while the effect of parents' anxiety was not statistically significant (p = .514). Conclusions: The anxiety of parent accompanying the child affects child's anxiety. Parents with high anxiety appeared to negatively affect their children's behavior.

Correlation between skin conductance measurements and subjective pain scales in children after otolaryngological procedures

Abstract Introduction Pain assessment in children is crucial in managing postoperative analgesia; it is therefore necessary to determine the most accurate tool for assessing pain in children. The aim of this study was to evaluate the correlation between skin conductance measurements and self-reporting pain scales in children after otolaryngology procedures. Materials and methods Thirty-three children (N=33) were assessed for eligibility for the research. Postoperative pain was assessed using the Visual Analogue Scale; the Wong-Baker Faces Pain Rating Scale; the Face, Legs, Activity, Cry, and Consolability scale; and a skin conductance algesimeter. The postoperative pain was measured 1 and 2 hours after the surgery. Results There was no statistically significant correlation between self-reported pain scores and the skin conductance fluctuations in the children studied, regardless of gender or age. A statistically significant correlation was found between the existing subjective pain scales in children. Conclusions The skin conductance measurements do not provide an additional reliable tool for assessing pain in patients after otolaryngological procedures. The existing self-reported pain scales are sufficient to assess postoperative pain in children.

Evaluating anxiety levels and pain perception while administering local anesthesia using conventional, insulin, and deception syringes in 6-12-year-olds.

BackgroundInjections are one of the most fear-provoking stimuli in dentistry. Painless administration of an injection is a vital step in alleviating anxiety, which in turn leads to good behavior in children. The aim is to evaluate and compare anxiety levels and pain perception using conventional, insulin, and deception syringes during the administration of local anesthesia in children.MethodsForty-five children aged 6–12 were selected using a standard sample size formula and equally divided into three groups. Local anesthesia was administered using a conventional syringe to Group A participants and an insulin syringe for Group B participants. Group C participants were administered local anesthesia using a deception syringe by showing the patient disposable obturation tips, and eventually a conventional syringe was used for administration of local anesthesia after hiding them from the patient. Anxiety levels were assessed using Venham’s Picture Scale and pulse rate at baseline and after administration of local anesthesia. The Wong-Baker Faces Pain Rating Scale was used to assess pain perception after the administration of local anesthesia.ResultsInsulin and deception syringes showed better reduction in anxiety levels and pain perception than conventional syringes, demonstrating a high statistically significant difference.ConclusionThe use of insulin and deception syringes for administration of anesthesia was demonstrated to be effective in alleviating anxiety in children and is therefore recommended as an alternative to conventional syringes.

Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients.

Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. This clinical trial included 50 patients aged 3-18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.

Buffered articaine infiltration for primary maxillary molar extractions: a randomized controlled study.

BackgroundDental pain management is an important aspect of patient management in pediatric dentistry. Articaine is considered the most successful anesthetic agent for infiltration anesthesia. Buffered articaine has been observed to have faster onset and longer duration of action with less pain on injection. The aim of this study was to evaluate and compare pain on injection, onset of action, and pain during extraction using buffered (using Sodium bicarbonate (NaHCO3)) and non-buffered 4% articaine (with 1:100000 adrenaline) infiltrations for primary maxillary molar extractions in 4–10-year-old children.MethodsSeventy children who required extraction of maxillary primary molars were enrolled in this triple-blind randomized study. Children undergoing extraction were randomly divided into two groups, with 35 in each group. The study group was the buffered articaine group; the control group was the non-buffered articaine group. Buccal and palatal infiltrations were administered with either buffered or non-buffered articaine. Subjective evaluation was done for pain on injection, pain during extraction using Wong–Baker Faces Pain Rating Scale (WBFPR) and onset of anesthesia in seconds. Pain on injection, pain during extraction were objectively evaluated using Sound Eye Motor (SEM) scale and onset of anesthesia was also evaluated objectively by pricking with sharp dental probe.ResultsThe outcome was, significantly less pain on injection and significantly faster onset of anesthesia with significantly less pain during extraction for both subjective and objective evaluations in the buffered articaine group. Subgroup analysis was also performed and it showed variable results, with only significant difference for WBFPR scores in age subgroup 4–7 years for palatal infiltration.ConclusionLess pain on injection, faster onset of anesthesia, and less pain during extraction were observed when buffered articaine was used for maxillary primary molar extraction.

Clinical Evaluation of Fractional Radiofrequency for the Treatment and Reduction of Wrinkles: A Prospective Study.

Fractional radiofrequency (FRF) technology has been shown in clinical studies to improve skin laxity, and to treat various skin conditions related to aging and alternate collagen structures such as rhytids. The objective of this clinical study was to evaluate the safety and performance of FRF (up to 124 mJ per pin) for the treatment of facial rhytids, emphasizing the upper lip and perioral areas. Enrolled subjects received a series of 3 FRF treatments to the full face, 3 to 5 weeks apart. Immediately after treatment, the subjects were given a scale to assess pain and tolerability of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Before and after photographs were graded for change by three blinded evaluators using the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and the Global Aesthetic Improvement Scale (GAIS). Image sets of 10 enrolled subjects (average age 62.7 years) were assessed by blinded evaluators. The overall face FWES score improved from 5.97 (SE 0.20) at baseline to 5.78 (SE 0.22) at 12-week follow-up. The GAIS improved by 0.4 points and was significant compared to baseline (P = 0.0004). Subject satisfaction was high with subjects giving an average satisfaction score of 3.2 (&ldquo;satisfied&rdquo;) out of 4. Pain was rated &ldquo;mild to moderate&rdquo; with an average of 3.9 on a 11-point Wong Baker FACES Scale. Ninety percent (90%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Eighty percent (80%) of subjects reported that they would recommend the treatment to a friend. There were no reports of adverse events or unanticipated side effects during the duration of the study. A statistically significant reduction in rhytids of the upper lip and the perioral area, was found, as evaluated by independent blinded evaluators. There were no adverse events. Treatment pain was low and tolerable, and subjects had high levels of satisfaction with the results at last follow-up. J Drugs Dermatol. 2022;21(1):43-48. doi:10.36849/JDD.6492.

Children’s self-reported discomfort of restorative treatments for deep caries lesions in primary teeth: Results from a randomized clinical trial

The aim of this study was to evaluate the impact of different restorative techniques to treat deep caries lesions of primary molars on children’s self-reported discomfort. A randomized clinical trial with two parallel arms (1:1) was conducted in São Paulo, Brazil. 4-8 years-old children with at least one occlusal or occlusoproximal deep caries lesion in primary molars were selected. Molars were randomly allocated into two groups: (1) restoration performed with calcium hydroxide cement followed by high-viscosity Glass Ionomer Cement (CHC+HVGIC), and (2) HVGIC restoration. Immediately after the intervention, children reported the experienced discomfort during restoration to an external examiner using a Wong-Baker face-scale. Children’s self-reported discomfort was analyzed using Poisson regression comparing both groups and assessing other variables’ influence (α=5%). One hundred and eight children fulfilled the eligibility criteria and were randomized in the two groups (n=54). Most of the children who received CHC+HVGIC restorations reported none or minimal discomfort (83.3%). Similar scores (92.6%) were reported for those treated with HVGIC (p=0.758). The mean reported discomfort in children with CHC+HVGIC restorations was 0.37(1.01), and 0.41(1.01) for those with HVGIC restorations. Children’s self-reported discomfort was associated with age, sex, children’s cooperation, and intervention duration. We can conclude that CHC+HVGIC or HVGIC restorations result in none or minimal discomfort in the management of deep caries lesions, being considered a reliable option.

Effects of intralesional pulsed radiofrequency treatment on pain in patients with calcaneal spur: results of 460 patients

BackgroundThis study aimed to investigate the efficacy of intralesional pulsed radiofrequency (RF) in the treatment of calcaneal spur and the results of patients who underwent single and double sessions of RF treatment.MethodsThe population of this retrospective study consisted of 460 patients who were diagnosed with calcaneal spur with clinical examination and direct radiography. The Wong-Baker Faces Pain Rating Scale and The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were used to determine the pain status and functional capacities of the patients. Posttreatment evaluation was carried out on average in the 6th week.ResultsThe study involved 460 patients, 76.9% of whom were female, with the average age of 50.8 ± 10.9 years in total. Of the patients 43% was given RF therapy in a single session, and 57% of them in double sessions. After the RF procedure, the number of patients whose pain decreased according to both AOFAS and Wong-Baker pain scoring systems increased statistically significantly (p < 0.001). There was a statistically significant increase in the AOFAS-pain scores and the total AOFAS scores and a significant decrease in the Wong Baker-pain scale after treatment. However, there was no significant change in treatment success with respect to the number of RF sessions. Although not statistically significant, the differences in the AOFAS-pain scores and in the total AOFAS scores were found to be higher in patients who underwent single session RF, while the difference in the Wong Baker-pain ranking was higher in patients who received double sessions RF.ConclusionIntralesional pulsed RF procedure can be preferred as a relatively less invasive method that does not have any serious complications in patients with persistent calcaneal spurs who do not respond to the use of oral anti-inflammatory drugs and shoe insoles, nor corticosteroid injection to the lesion area.

Comparison between the analgesic effectiveness and patients\u2019 preference for virtual reality vs. topical anesthesia gel during the administration of local anesthesia in adult dental patients: a randomized clinical study

This study aimed to compare the analgesic effectiveness of virtual reality vs. topical anesthesia gel during the administration of local anesthesia (injections to numb the gums) in adult dental patients; as well as to determine which approach is preferred by the patients. Twenty-one adult patients received dental anesthetic injections bilaterally for their maxillary premolars area. We predicted that VR would be more effective than a topical anesthetic gel at reducing pain during injections into the gums. Using a within subject design, each patient received two injections during a single dental visit. Pain was measured after each injection. One side was of the mouth was injected under the influence of the topical anesthesia (TA) 20% benzocaine. The other side of the mouth was injected when the patient was in virtual reality (VR) watching an animated movie using an Oculus Quest® helmet to distract them during the other injection, treatment order randomized. Immediately after each injection, the patients were directed to rate their pain experience using the Wong-Baker Faces Pain-rating Scale (W-BFPS), and to choose which delivery system they preferred. Heart rates were recorded prior to and after the injections using a finger pulse oximeter. Participants reported the predicted pattern of a lower W-PFPS score (less pain intensity) during needle injection while in VR than the injection with topical anesthesia gel, however, the difference was not statistically significant. A statistically significant majority of the participants (p = 0.021) preferred VR to TA. No statistically significant difference heart rate during VR vs. TA was found. Although dental patients reported less pain during VR distraction vs. topical gel anesthetic, the difference was not significant. A statistically significant majority of patients preferred virtual reality over topical anesthesia during their future injections. However, no significant difference in heart rate was found.

New Daily Persistent Headache in Children

Source: Strong E, Pierce EL, Langdon R, et al. New daily persistent headache in a pediatric population. J Child Neurol. 2021; 36(10):888–893; doi:10.1177/08830738211004514Investigators from Children’s National Hospital, Washington, DC, conducted a retrospective study to describe the characteristics of new daily persistent headache (NDPH) in pediatric patients. Study participants were patients seen at the Children’s National Hospital Headache Clinic between 2016 and 2018 who were included in a clinic patient registry and were identified as having NDPH using ICD-10 codes. All enrolled youths were evaluated by headache specialists; a standardized history intake form was used to record clinical characteristics. Data abstracted from the medical record of study participants included demographics, site of headache and quality of pain, presence of migrainous features (photophobia, phonophobia, reduced activity), medications and non-pharmacologic treatments, head imaging results, comorbidities, and family history of headaches. Patients additionally were diagnosed with medication overuse headaches based on International Classification of Headache Disorders, 3rd Edition criteria.Among a total of 3,620 visits to the headache clinic during the 2-year study period, 245 patients were diagnosed with NDPH. The average age of the NDPH patients was 14.7 years, with a range of 12.7 to 16.8 years. Among these youths with NDPH, 79% were female, and 73% were white. The most common site of headache was frontal in 66% of patients, followed by occipital (26%), and temporal (22%). The quality of the pain was described as pulsatile and throbbing in 38% of study participants, and the median pain level on the Wong-Baker FACES scale was 6 out of 10. Migrainous features were common, with 85% of patients reporting photophobia, 85% phonophobia, and 88% reduced activity level. Comorbidities in the NDPH patients included anxiety (reported in 19%) and depression (10%); there was a history of head trauma in 23%. Overall, 54% of participants had undergone neuroimaging, including MRI in 43% and CT in 11%. No findings to explain headaches were seen. There was a family history of headache in 70% of patients. Abortive medications had been tried in nearly 80% of study participants, with ibuprofen (51%) and acetaminophen (29%) most commonly used. A diagnosis of medication overuse headache was made in 36% of patients. Preventive medications were used by 35%. Non-pharmacologic treatment had been tried in 16%, including pain-focused cognitive behavioral therapy, acupuncture, and physical therapy desensitization.The authors conclude that NDPH is a common cause of chronic headache in pediatric patients.Dr Alissa has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Headache in children is a concerning complaint for both parents and physicians. Although generally benign, the fear of a tumor or a serious underlying condition is real.1 In 2019, the American Academy of Pediatrics’ Healthy Children publication released instructions to parents about when to call their pediatrician if their child suffers a headache. The instructions stated that although most headaches are harmless, recurrent headaches can cause school problems, behavioral problems, and/or depression.2 The same instructions warned parents to be careful using over-the-counter medication because more than 3 doses per week can cause medication overuse headache.2 In a recent study, Neiswand et al were not able to find any reliable effects of preventive medications to treat children with headache when compared to adults.3NDPH may have features of both migraine and tension-type headache. The same preventive medications indicated for chronic migraine or chronic tension-type headache, including tricyclic antidepressants amitriptyline and topiramate, commonly are used in NDPH despite the lack of standardized guidelines.4 Integrating conventional medicine with mind-body-spirit methods such as acupuncture, stimulation, and physical therapy has been useful in managing headache in adolescents.5The current investigators diagnosed 14% of their total headache population with NDPH. Migrainous features were noted in nearly 90% of their adolescent patients compared to 50% of adults,6 which suggests that pediatric NDPH is more likely to present with characteristics consistent with migraine than adults. Abortive medications had been used in 79% of participants, most commonly ibuprofen and acetaminophen, and more than half had failed at least 1 medication. On the other hand, 35% of participants were treated with preventive medication, most commonly amitriptyline and topiramate, with the same failure proportion.This study’s limitations included lack of reporting the morbidity of headaches, such as missing school for the patients and/or work for their parents. The authors failed to provide guidance regarding appropriate interventions or preventive measures to consider when facing patients with NDPH.NDPH is a relatively common diagnosis in children with chronic headache. It is debilitating and highly refractory to treatment.For the uninitiated, NDPH is a relatively newly described subtype of chronic headache.7 It is severe, unremitting, and persists for at least 3 months. Perhaps the authors failed to report effective preventive and abortive pharmacotherapies as they have yet to be identified.

Comparison of The Analgesic Outcomes of Local Wound Infiltration using Bupivacaine with Tramadol in Pediatric Inguinal Hernia Repair

Objective: To compare the time for first analgesic requirement after local wound infiltration with tramadol and bupivacaine in pediatric inguinal herniotomy. Materials and Methods: A total of 130 children aged 4 to 12 years who underwent inguinal herniotomy were included in this randomized comparative study. The study was conducted in anesthesiology unit of a tertiary care center in Qatar from Nov-2020 to July-2021. Patients in Group T received wound infiltration by Inj. Tramadol 2 mg/kg diluted in 10cc distilled water while patients in Group B received Inj. Bupivacaine 1mg/kg diluted in 10 cc distilled water. Postoperatively Pain score using Wong Baker Faces Scale was noted from ½ hour to 6 hours after surgery. Time of first rescue analgesia was noted. Results: The mean age was 7.98±2.40 years in group B versus 7.49±2.58 years in group T (p-value 0.26). There were 42 (64.6%) in group B versus 45 (69.2%) in group T (p-value 0.93). Mean surgery duration was 46.66±4.73 minutes in group T and 45.50±4.37 minutes in group B. The Wong-Baker pain score at different time intervals was significantly lower in group T in comparison to group B. Time of first analgesia requirement was 6.87±0.76 hours in group P versus 5.67±0.97 hours in group P, this duration was significantly prolonged in group T with p-value &lt;0.001. Conclusion: Local wound infiltration with tramadol provides a longer time for first analgesic requirement as compared to the bupivacaine in children undergoing inguinal hernia repair. Keywords: Inguinal hernia, wound infiltration, tramadol, bupivacaine, post-operative pain.

PSXV-20 Pilot Study: How does horse and rider vital signs respond to participation in an equine assisted psychotherapy and learning outpatient collegiate substance use recovery program?

Abstract While research supporting the psychological benefits of equine assisted psychotherapy and learning (EAPL) is expanding, little is known about the physiological impact this therapy has on the human and horse. The physical activity for younger adults may hold promise where other therapies have failed, but can this form of exercise therapy be physically demanding on the participant? Therefore, the objective of this study was to measure physiological responses of horse and human for those participating in an EAPL outpatient collegiate recovery program for substance use disorder (SUD). This pilot study assessed humans (n = 4) and horses (n = 5) participating in a collegiate recovery community EAPL SUD program. The six-week program included riding and ground activities for 1 hr/wk. Vital signs (heart and respiratory rates and pain rating) were recorded weekly at the beginning and end of each session. Human pain rating used the Wong-Baker Faces Pain Rating Scale and equines used the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP). T-tests were performed comparing measurements at the beginning and end of each session (P = 0.05). Pearson Correlations were used to determine relationships between human and horse vital signs. While no changes were seen in human heart rate, a significant decrease in respiratory rates and pain scores was found by the end of the session (Table 1). Horse heart and respiratory rates and EQUUS-FAP scores increased. A moderate correlation was determined for human and horse respiration rates (r=0.65, P = 0.00). Correlations became weaker when evaluating the other vital signs (Heart Rates: r=0.54, P = 0.00; Pain Rating Scores: r=0.27, P = 0.17). While relationships between horse and human vital signs were limited, it is important to note the differences in how the two physiologically respond to EAPL suggesting further research beyond this pilot study may be needed to investigate the physical demand of EAPL on the horse.

Efficacy of Preemptive Analgesia on Postoperative Pain Control in Children Who Underwent Full-Mouth Dental Rehabilitation Under General Anesthesia: A Randomized Controlled Clinical Trial.

To evaluate the efficacy of intravenous preemptive analgesia on postoperative pain in children undergoing dental rehabilitation under general anesthesia. In this prospective randomized clinical trial, 70 children aged 3 to 7 years were scheduled for dental treatment and randomized into two groups: the control group or the preemptive group. Patients received 15 mg/kg of intravenous paracetamol either before the start of treatment (preemptive group, n = 35) or at the end of treatment (control group, n = 35). Postoperative pain scores were recorded at 1, 2, 4, 6, 8, 12, and 24 hours using the Wong-Baker FACES Pain Rating Scale (WBFS). Additionally, the need for rescue analgesic and the total opioid consumption of the patients were recorded during the first 24 hours postoperative. The pain scores in the preemptive group were significantly lower than those in the control group at the postanesthesia care unit and at 2, 4, and 8 hours postoperative (P < .05). However, there were no statistically significant differences in pain scores between groups at 12 and 24 hours postoperative. Need for rescue analgesics and total intravenous fentanyl consumption were significantly higher in the control group than in the preemptive group (P < .05). The percentage of children who received medication for pain relief at home was higher in the control group than in the preemptive group, but the difference was not statistically significant (P > .05). Preemptive use of intravenous paracetamol reduces postoperative pain scores and postoperative opioid consumption. However, there is a need to evaluate pain levels in children who receive comprehensive dental treatment under general anesthesia after hospital discharge for effective postoperative pain control.

An in vivo, randomized, controlled comparative evaluation of efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years.

To compare and evaluate the efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years. 100 participants were randomly distributed to receive either 4% articaine using infiltration anesthesia or 2% lidocaine using inferior alveolar nerve block on each side of the mandibular arch, in two different appointments, after a 1-week interval. The pain perception was evaluated using visual analog scale (VAS) and Wong-Baker Faces pain rating scale (WBFPRS). In both the appointments, the efficacy and onset of anesthesia were evaluated using an electric pulp tester. Hemodynamic parameters, which included pulse rate and oxygen saturation levels, were evaluated using a pulse oximeter. Postoperative complications were evaluated at 24-hour follow-up. Pain score recorded with block was more painful compared to infiltration (P < .05). Anesthetic success was observed with both the local anesthetic agents, with no significant differences (P > .05). Shorter onset of action was observed with articaine (P < .05). Statistically significant differences between groups were noted with regard to heart rate (P < .05). Oxygen saturation levels did not show significant differences (P > .05). When postoperative complications were evaluated with either 4% articaine or 2% lidocaine, very few adverse effects were recorded (P > .05). Buccal infiltration using 4% articaine has the potential to replace 2% lidocaine using inferior alveolar nerve block in children.(Quintessence Int 2021;52:780-786; doi: 10.3290/j.qi.b1492247).

Validity and Reliability of WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) Type 12 Questions Indonesian Version on Back Pain

The study was to prove the validity and reliability of the WHODAS 2.0 Indonesian version questionnaire in patients with back pain. This study was an observational cross-sectional study conducted in 2018. The study included the filling of WHODAS 2.0 Indonesian version, Indonesian version of Oswestry Disability Index (ODI) questionnaire, Wong-Baker Scale, conducted at Department of Rehabilitative Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, against 82 respondents with back pain. Each respondent was given informed consent. The validity of the WHODAS 2.0 Indonesian version questionnaire was measured using Pearson's test on the correlation of WHODAS 2.0 Indonesian version questionnaire and Oswestry Disability Index questionnaire with r &gt;0.3 (0.862). WHODAS 2.0 Indonesian version questionnaire and Wong-Baker Scale had r &gt;0.3 (0.449–0.785). The reliability of the WHODAS 2.0 Indonesian version questionnaire was measured using Pearson's correlation test with r &gt;0.3 (0.764–0.866). WHODAS 2.0 Indonesian version's internal reliability was tested using Cronbach-Alfa Test with alpha &gt;0.6 (0.634–, 853). In conclusion, the WHODAS 2.0 - Indonesian version is a valid and reliable questionnaire for patients with back pain.

Pediatrik İnguinal Herni Onarımı Sonrası Postoperatif Analjezi: Transvers Abdominis Plan Bloğu veya Caudal Epidural Blok

PURPOSE: Transversus abdominis plane (TAP) block under ultrasonography and caudal epidural block are techniques used to provide postoperative analgesia in children. The aim of this study was to compare the effect of these two analgesic techniques in pediatric inguinal hernia operations. &#x0D; MATERIAL AND METHOD: The study included 64 patients aged 4-12 years who underwent surgery for unilateral inguinal hernia. Caudal epidural block was applied to 33 patients (Group C) and TAP block to 31 (Group T). Routine follow-up of postoperative pain for pediatric patients was made with the Wong-Baker faces pain rating scale. A record was made for each patient of the time of requirement for additional analgesia, complications during the intervention and side-effects. &#x0D; RESULTS: In the evaluation of the faces pain rating scale, the scores of Group C were found to be significantly lower than those of Group T at 6, 8, and 12 hours postoperatively (p=0.04, p=0.03, p=0.03). The duration of postoperative analgesia was found to be mean 220 mins (min-max; 118.65 – 355.3 mins) for Group T, and 351.2 mins (min-max; 167.8-617.65 mins) for Group C. The time of first requirement for additional analgesia was mean 13±4.8 hours in Group C, and 8±3.5 hours in Group T (p=0.02). &#x0D; CONCLUSION: The application of caudal block provided more effective postoperative analgesia than TAP block applied under ultrasonography guidance in pediatric inguinal hernia repair.

Application of virtual reality on non-drug behavioral management of short-term dental procedure in children

BackgroundDue to the inherent characteristics of immersion, imagination, and interactivity in virtual reality (VR), it might be suitable for non-drug behavior management of children in dental clinics. The purpose of this trial was to measure the role of VR distraction on behavior management in short-term dental procedures in children.MethodsA randomized clinical trial design was carried out on 120 children aged between 4 and 8 years to identify the comparative efficacy of VR and tell-show-do (TSD) to improve behavioral management during dental procedures. The primary outcomes were evaluated anxiety, pain, and compliance scores in perioperative children. The levels of operative anxiety and pain were assessed using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Wong Baker FACES Pain Rating Scale (WBFS), respectively. The Frankl Behavior Rating Scale (FBRS) was tested before and during dental procedures. The length of the dental procedure was compared between both groups after treatment.ResultsThe average anxiety and behavioral scores of the VR group significantly reduced compared with the control. The decreased anxiety score for the VR group and control group were 8 (7, 11) and 5 (5, 7), p < 0.05. The compliance scores of the control group during treatment were 3 (2, 3), and the same in the VR intervention were 3 (3, 4), p = 0.02. A significant reduction in pain was observed when using VR distraction (p < 0.05). Comparing the length of the dental procedure, the VR group (19.0 2 ± 5.32 min) had a shorter treatment time than the control group (27.80 ± 10.40 min).ConclusionThe use of VR significantly reduced the anxiety and pain of children and the length of the dental procedure and improved the compliance of children that underwent short-term dental procedures without an adverse reaction.Trial registrationChinese Clinical Trial Registry, ChiCTR2000029802. Registered on February 14, 2020

Osteopathic interventions via telehealth in a pediatric population: a retrospective case series.

Healthcare delivery was dramatically affected during the coronavirus disease 2019 (COVID-19) pandemic. Many outpatient visits were cancelled or forgone for fear of exposure to the virus, allowing telemedicine to take on a much larger role in healthcare. The delivery of manual therapies, such as osteopathic manipulative treatment (OMT), via telehealth posed a unique challenge as these are typically provided in-person by a trained osteopathic physician. This study provides a description of one osteopathic pediatrician's experience in delivering osteopathic interventions to pediatric patients via telehealth. To our knowledge, these techniques have not previously been described in the literature. To detail the experience of one osteopathic pediatrician's experience in delivering osteopathic interventions via telehealth. Patients were offered the option of converting their existing OMT appointment to a telehealth visit. Prior to the appointment, instructions were emailed to the patient's parent or guardian along with a voluntary survey to provide feedback. Thirty-minute telehealth visits were conducted during which the provider gave verbal and visual instructions to a parent or guardian over a video platform to guide them in providing treatment to the patient based on osteopathic principles. Patients aged 3 and older rated their pain before and after the appointment using the Wong-Baker FACES scale. Deidentified patient demographics, chief complaints, treatments, anatomic locations, and pain scores were recorded in a REDcap database. Descriptive statistics were analyzed and paired samples t-tests were used with a p-value of <0.05 used to determine significance. Eighteen patients ranging from 6months to 19 years of age were treated utilizing osteopathic interventions via telehealth during 54 distinct visits. The most common chief complaints treated were back (n=31; 26.3%) and neck (n=28; 23.7%) pain. The most common osteopathic techniques upon which instruction was based were inhibition (n=131; 29.7%) soft tissue (n=127; 28.8%) and counterstrain (n=78; 17.7%). The average post-treatment pain score (2.57) was significantly lower than the average pre-treatment pain score (6.77) p<0.01. No serious complications were observed. In our small retrospective case series, osteopathic interventions via telehealth resulted in decreased average pain scores following treatment while minimizing risk of viral exposure and transmission. Further study is needed to determine if such treatment methods could be effective on a larger scale when distance or illness preclude an in-person OMT visit.

Virtual Reality Interventions for Needle-Related Procedural Pain, Fear and Anxiety-A Systematic Review and Meta-Analysis.

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. A meta-analysis was performed, taking into account online databases. Two authors independently conducted literature searches in December 2020. The last search was conducted in March 2021 from a total of 106 records, 7 met our inclusion criteria. One study was excluded from the meta-analysis due to insufficient data. VR was applied as a distractor during venous access. Statistically significant benefits of using VR were shown in children’s pain scores, where VR significantly decreased symptoms (n = 3204 patients, MD = −2.85; 95% CI −3.57, −2.14, for the Wong–Baker Faces Pain Rating Scale and n = 2240 patients, MD = −0.19; 95% CI −0.58, 0.20, for the Faces Pain Scale—Revised). The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field.