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Purpose: To evaluate and compare responsiveness characteristics for the Foot Function Index revised short form (FFI-RS), RAND-12 Health Status Inventory (RAND-12), and Numeric Rating Scale (NRS), in patients with plantar fasciopathy receiving non-surgical treatment. Materials and methods: This study was conducted on a sub-group of patients from an ongoing randomised controlled trial. One-hundred fifteen patients were included. The patient-reported outcome measures (PROMs) were applied at baseline and after 6 months. Responsiveness was calculated using standardised response mean and area under the receiver operating characteristic (ROC) curve. ROC curves were used to compute the minimal important change (MIC) for the outcome measures. Results: The region specific FFI-RS had best responsiveness and the NRS at rest had lowest responsiveness. Conclusion: FFI-RS were marginally more responsive than the other PROMs. Responsiveness and MIC estimates should be regarded as indicative rather than fixed estimates. IMPLICATIONS FOR REHABILITATION: The region-specific Foot Function Index Revised Short Form could, based on responsiveness perspectives, be recommended as an outcome measurement for patients with plantar fasciopathy. Responsiveness and minimal important change estimates are indicative and should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Abstract Background To explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC). Methods One-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance. Results The accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p

Chemonucleolysis utilizing condoliase is a minimally invasive treatment for lumbar disc herniation (LDH) aimed at reducing intervertebral disc pressure and enhancing symptoms. In this study, lower limb pain was measured using the numeric rating scale (NRS) the day after treatment and 1 and 3 months after treatment. Prognostic factors were assessed, categorizing participants into an improvement group (I-group) for NRS lower limb pain scores of 3.5 and a non-improvement group (N-group) for scores of

Summary The objective of the current study was to evaluate the clinical utility of bruxism episode index in predicting the level of masticatory muscle pain intensity. The study involved adults (n = 220) recruited from the Outpatient Clinic of Temporomandibular Disorders at the Department of Experimental Dentistry, Wroclaw Medical University, during the period 2017–2022. Participants underwent medical interview and dental examination, focusing on signs and symptoms of sleep bruxism. The intensity of masticatory muscle pain was gauged using the Numeric Rating Scale. Patients identified with probable sleep bruxism underwent further evaluation through video‐polysomnography. Statistical analyses included the Shapiro–Wilk test, Spearman's rank correlation test, association rules, receiver operating characteristic curves, linear regression, multivariate regression and prediction accuracy analyses. The analysis of correlation and one‐factor linear regression revealed no statistically significant relationships between bruxism episode index and Numeric Rating Scale (p > 0.05 for all analyses). Examination of receiver operating characteristic curves and prediction accuracy indicated a lack of predictive utility for bruxism episode index in relation to masticatory muscle pain intensity. Multivariate regression analysis demonstrated no discernible relationship between bruxism episode index and Numeric Rating Scale across all examined masticatory muscles. In conclusion, bruxism episode index and masticatory muscle pain intensity exhibit no correlation, and bruxism episode index lacks predictive value for masticatory muscle pain. Clinicians are advised to refrain from employing the frequency of masticatory muscle activity as a method for assessing the association between masticatory muscle pain and sleep bruxism. [ABSTRACT FROM AUTHOR]

Background: To explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC). Methods: One-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance. Results: The accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p < 0.001). Significant pain relief was observed in novel group as opposed to control group after one injection. Procedure time in novel group (8.4 ± 1.6 min) was shorter than control group (15.8 ± 3.5 min) (p < 0.001) with less radiation dosage (3047 ± 5670 vs. 8808 ± 1039 μGy/m2, p < 0.001). Significantly, lower incidence of L5 paresthesia occurred in novel group. Statistical differences of NRS scores between the novel and control group were reached at 1 week after procedure (1 (IQR: − 1–3) vs. 3 (IQR: − 1–7), p = 0.006), while not reached at both 1- (1 (IQR: 0–2) vs. 1 (IQR: − 1–3), p = 0.086) or 3-month follow-up (0 (IQR: − 1–1) vs. 1 (IQR: 0–2), p = 0.094). Both groups showed similar functional improvement (F = 0.103, p = 0.749) during follow-up. Conclusions: The novel sonographic technique provided superior accuracy needle placement and better pain-relieving effect through one injection as compared to the routine transverse approach. Consequently, in situations where the HIC imposed limitations for TFEIs performance on L5, the novel technique should be recommended to consider increasing accurate puncture, minimizing radiation exposure, consuming procedure time, and reducing the risk of neuraxial injury. [ABSTRACT FROM AUTHOR]

Ultrasound (US)-guided cervical selective nerve root block (CSNRB) procedures are increasingly being performed as an alternative to conventional fluoroscopy (FL)-guided epidural injections for the treatment of cervical radicular pain. The aim of this study was to compare the effectiveness of US-guided CSNRB versus FL-guided interlaminar cervical epidural steroid injection (IL-CESI) for cervical radicular pain. A total of 60 patients with cervical radicular pain due to a single-level disc herniation were randomized into either the FL or US group. The numeric rating scale, Short Form-36, and neck disability index were evaluated before treatment at months 1, 3, and 6 after treatment. Procedure time, complications, pain medication consumption, and patient satisfaction were also recorded. Patients experienced significant improvement in pain, disability, and quality of life scores up to 6 months after the procedure (p < 0.001). Treatment success rate was achieved in 56.6% of the IL-CESI group and 50% of the CSNRB group without any significant difference between the study arms (p = 0.617). US-guided CSNRB was shown to be as effective as the FL-guided IL-CESI in the treatment of cervical radicular pain, in addition to the absence of radiation exposure and requiring less procedure time. [ABSTRACT FROM AUTHOR]

Purpose: Adult spinal deformity (ASD) is associated with a combination of back and leg pain of various intensities. The objective of the present study was to investigate the diverse reaction of pain profiles following ASD surgery as well as post-operative patient satisfaction. Methods: Multicenter surveillance collected data for patients ≥ 19 years old who underwent primary thoracolumbar fusion surgery at > 5 spinal levels for ASD. Two-step cluster analysis was performed utilizing pre-operative numeric rating scale (NRS) for back and leg pain. Radiologic parameters and patient-reported outcome (PRO) scores were also obtained. One-year post-operative outcomes and satisfaction rates were compared among clusters, and influencing factors were analyzed. Results: Based on cluster analysis, 191 ASD patients were categorized into three groups: ClusterNP, mild pain only (n = 55); ClusterBP, back pain only (n = 68); and ClusterBLP, significant back and leg pain (n = 68). ClusterBLP (mean NRSback 7.6, mean NRSleg 6.9) was the oldest 73.4 years (p < 0.001) and underwent interbody fusion (88%, p < 0.001) and sacral/pelvic fixation (69%, p = 0.001) more commonly than the other groups, for the worst pelvis incidence—lumbar lordosis mismatch (mean 43.7°, p = 0.03) and the greatest sagittal vertical axis (mean 123 mm, p = 0.002). While NRSback, NRSleg and PRO scores were all improved postoperatively in ClustersBP and BLP, ClusterBLP showed the lowest satisfaction rate (80% vs. 80% vs. 63%, p = 0.11), which correlated with post-operative NRSback (rho = −0.357). Conclusions: Cluster analysis revealed three clusters of ASD patients, and the cluster with the worst pain back and leg pain had the most advanced disease and showed the lowest satisfaction rate, affected by postoperative back pain. [ABSTRACT FROM AUTHOR]

Study Design: Prospective randomized controlled trial. Objectives: No prospective studies have directly compared clinical and radiographic outcomes of unilateral vs bilateral instrumented lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease (LDD). We compared the short-term radiographic, clinical outcomes, and some complications of the unilateral percutaneous pedicle screw (PPS) (UPS) vs bilateral PPS (BPS) fixation in short-level spinal fusion with LLIF for LDD. Methods: This was a prospective randomized controlled study of 33 patients who underwent UPS or BPS fixation after LLIF for LDD; 18 patients were assigned to the UPS group and 15 patients to the BPS group. Clinical outcomes, complication rates, and fusion rates were assessed. Results: The two groups were similar in age, sex, preoperative diagnosis, and level of surgery. Blood loss, length of hospital stay, and numeric rating scale score one year after surgery did not differ between groups. The operative time was longer in the BPS than UPS group (120.2 vs 88.8 min, respectively; P =.029). Both groups showed improvement in disc height and dural sac in the immediate postoperative computed tomography and magnetic resonance imaging, which did not differ significantly between groups. The subsidence grade and fusion rate did not differ, but cage subsidence was more severe in the UPS than BPS group. Conclusion: Unilateral and bilateral PPS fixation after LLIF yielded similar short-term clinical and radiological outcomes. However, severe cage subsidence was more common in the UPS group, which suggests that BPS fixation after LLIF may be a better choice over the long term. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar spine surgeries need multimodal analgesia to control postoperative pain and early recovery. The study is about comparing the efficacy of bilateral single-shot ultrasound-guided (USG) erector spinae plane block (ESPB) versus local anesthetic infiltration before incision in patients scheduled for spine surgeries under general anesthesia (GA). Aim: This study aimed to compare USG-guided ESPB versus local anesthetic infiltration in spine surgeries for intraoperative and postoperative analgesia. Materials and Methods: Forty patients, the American Society of Anesthesiologists I, II, and III aged 18–80 years, undergoing spine surgeries under GA were enrolled in this prospective, randomized study. Patients were randomized to two groups of 20 each. Group L received GA and local anesthetic infiltration at the incision site by the surgeon and Group E received GA and preoperative bilateral ESPB with 20 mL 0.375% bupivacaine at each site. The primary outcome was the assessment by Numeric Rating Score (NRS) and total postoperative analgesic consumption in the first 24 h. The secondary objectives were intraoperative hemodynamic stability and dexmedetomidine requirement. Results: NRS at 4-h, 6-h, and 12-h postincision was significantly higher in Group L compared to Group E (P = 0.006, P = 00.001, and P = 00.006). The requirement of intraoperative dexmedetomidine and total doses of postoperative analgesic were significantly lower in Group E compared to Group L (P = 0.001). Patients who received ESPB showed better hemodynamic stability compared to those who received local anesthetic infiltration at the incision site. Conclusion: Preoperative bilateral single-shot USG-guided ESPB provides safe and effective intraoperative as well as postoperative analgesia for spine surgeries with reduced analgesic requirement.

Perceived pain is a multi-factorial subjective variable, commonly measured by numeric rating scales, verbal descriptive scales (VDS), or by a position on an analogue line (VAS). A major question is whether an individual’s VAS and VDS pain assessments, on the same occasion, could be comparable. The aim was to compare continuous and discretized VAS pain data with verbal descriptive pain datasets from the Oswestry Disability Index (ODI) and the European Quality of Life Scale (EQ-5D) in paired pain datasets.

Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. The objective of the present study was to explore the use of numeric pain assessment in individuals with hEDS, from a patient-centered perspective. Our analysis is based on in-depth qualitative interviews. The interviews were conducted over the phone. Our participants were patients living with hEDS (N = 35). Interviews were recorded, transcribed, and analyzed to identify factors related to their use of these pain assessment instruments. Three primary themes emerged from these data, namely, (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. These results demonstrate the need for caution in relying exclusively on numeric pain assessment instruments. We conclude with a brief proposal for a clinical communication strategy that may help to address the limitations of numeric pain assessment that were identified in our interviews. Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. Clinicians should be aware that patients have difficulties with the Numeric Rating Scale (NRS) for at least three reasons: (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. Clinicians should use caution in relying exclusively on NRS instruments. Clinicians may benefit from using clinical communication strategies outlined in our paper, which may help to address the limitations of the NRS that were identified in our interviews. [ABSTRACT FROM AUTHOR]

Purpose: This study intended to evaluate the effects of Low-Level Laser Therapy (LLLT) on Failed Back Surgery Syndrome (FBSS). FBSS refers to symptoms and disabilities which remain or occur after lumbar spinal surgery. Prevalent treatments for FBSS are based mostly on conservative management while LLLT has gained significant interest in the treatment of a wide variety of musculoskeletal disorders. Methods: In the present study, the authors included 50 individuals with FBSS. Target points were determined by an ultrasonic study including bilateral L2-L3 through L5-S1 facet joints, sacroiliac joints, and the region immediately above bilateral supra crestal iliac bones representing cluneal nerves. LLLT was performed three times a week for 3 weeks. A near-infrared laser (wavelength 808 nm, power 500 mw) was used in continuous mode for laser therapy sessions. The Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were registered before treatment and after last treatment session, 1 month and 6 months later, respectively. Results: NRS and ODI were significantly improved after treatment, as well as therapeutic effects, after 1 month and 6 months were also evident and comparison of the NRS and ODI showed significant difference. Conclusion: LLLT has a positive impact on pain and disability in patients with FBSS. [ABSTRACT FROM AUTHOR]

To assess postoperative pain intensity in adults, the numeric rating scale (NRS) is used. This scale has shown acceptable psychometric features, although its scale properties need further examination. We aimed to evaluate scale properties of the NRS using an item response theory (IRT) approach. Data from an international postoperative pain registry (QUIPS) was analyzed retrospectively. Overall, 346,892 adult patients (age groups: 18-20 years: 1.6%, 21-30 years: 6.7%, 31-40 years: 8.3%, 41-50 years: 13.2%, 51-60 years: 17.1%, 61-70 years: 17.3%, 71-80 years: 16.4%, 81-90 years: 3.9%, >90: 0.2%) were included. Among the patients, 55.7% are female and 38% had preoperative pain. Three pain items (movement pain, worst pain, least pain) were analyzed using 4 different IRT models: partial credit model (PCM), generalized partial credit model (GPCM), rating scale model (RSM), and graded response model (GRM). Fit indices were compared to decide the best fitting model (lower fit indices indicate a better model fit). Subgroup analyses were done for sex and age groups. After collapsing the highest and the second highest response category, the GRM outperformed other models (lowest Bayesian information criterion) in all subgroups. Overlapping categories were found in category boundary curves for worst and minimum pain and particularly for higher pain ratings. Response category widths differed depending on pain intensity. For female, male, and age groups, similar results were obtained. Response categories on the NRS are ordered but have different widths. The interval scale properties of the NRS should be questioned. In dealing with missing linearity in pain intensity ratings using the NRS, IRT methods may be helpful. [ABSTRACT FROM AUTHOR]

Objectives: This study is based on data collected at the Acupuncture clinic of the Local Health Authority (ASL) in Turin from 2008 to 2022 and aims at evaluating the effectiveness of acupuncture in the treatment of musculoskeletal pain using the Numeric Rating Scale (NRS) which analyzes changes in pain perceived by patients in different body regions. Methods: The database consists of data provided by patients during the initial visit and the last session. Only patients who provided data at the beginning and end of treatment were included. The data were processed using JASP 0.17.2.1 software. The sample consisted of 932 patients with musculoskeletal conditions, excluding 254 subjects with internal medical conditions, who were treated during the same period. The selected population includes individuals aged 23-94, comprising 242 men and 690 women. Patients followed a therapeutic protocol based on the initial diagnosis and underwent an initial cycle of six weekly sessions, with the possibility of four additional sessions if needed. Acupuncture was performed by experienced medical personnel following Traditional Chinese Medicine guideline. Results: The average NRS values were 7.49 at the beginning and 4.27 at the end, with a 43% reduction in pain. The data were analyzed using the Wilcoxon test, confirming statistical significance (p < 0.001). They were then divided by body region, showing a reduction in pain ranging from 40% to 55%. Statistical analysis among different conditions was performed using the Kruskal--Wallis test, with further comparisons using the Dunn test. Discussion: The study demonstrates that acupuncture is effective in reducing musculoskeletal suffering, with a significant decrease in pain perceived by patients. The results suggest that acupuncture can be a valid treatment for a wide range of conditions, with pain reduction ranging from 40% to 55% and greater effectiveness for elbow-related conditions. However, it is important to note that sample size may influence the results, and further research is needed to confirm and expand these findings, especially for less-represented conditions by the sample. [ABSTRACT FROM AUTHOR]

Despite the possibility of postoperative pain occurrence, in some patients, vitreoretinal surgeries (VRSs) require performance of general anesthesia (GA). The administration of intraoperative intravenous rescue opioid analgesics (IROA) during GA constitutes a risk of perioperative adverse events. The Adequacy of Anesthesia (AoA) concept consists of an entropy electroencephalogram to guide the depth of GA and surgical pleth index (SPI) to optimize the titration of IROA. Preemptive analgesia (PA) using cyclooxygenase-3 (COX-3) inhibitors is added to GA to minimize the demand for IROA and reduce postoperative pain. The current analysis evaluated the advantage of PA using COX-3 inhibitors added to GA with AoA-guided administration of IROA on the rate of postoperative pain and hemodynamic stability in patients undergoing VRS. A total of 165 patients undergoing VRS were randomly allocated to receive either GA with AoA-guided IROA administration with intravenous paracetamol/metamizole or with preemptive paracetamol or metamizole. Preemptive paracetamol resulted in a reduction in the IROA requirement; both preemptive metamizole/paracetamol resulted in a reduced rate of postoperative pain as compared to metamizole alone. We recommend using intraoperative AOA-guided IROA administration during VRS to ensure hemodynamic stability alongside PA using both paracetamol/metamizole to reduce postoperative pain. [ABSTRACT FROM AUTHOR]

Objective Our study aimed to investigate the analgesic efficacy of nebulized ketamine in managing acute moderate-to-severe musculoskeletal pain in older emergency department (ED) patients compared with intravenous (IV) morphine. Methods This was a non-inferiority, double-blind, randomized controlled trial conducted at a single medical centre. The patients aged 65 and older, who presented at the ED musculoskeletal pain within 7 days and had a pain score of 5 or more on an 11-point numeric rating scale (NRS), were included in the study. The outcomes were a comparison of the NRS reduction between nebulized ketamine and IV morphine 30 minutes after treatment, incidence of adverse events and rate of rescue therapy. Results The final study included 92 individuals, divided equally into two groups. At 30 minutes, the difference in mean NRS between the nebulized ketamine and IV morphine groups was insignificant (5.2 versus 5.7). The comparative mean difference in the NRS change from baseline between nebulized ketamine and IV morphine [−1.96 (95% confidence interval—CI: −2.45 to −1.46) and −2.15 (95% CI: −2.64 to −1.66) = 0.2 (95% CI: −0.49 to 0.89)] did not exceed the non-inferiority margin of 1.3. The rate of rescue therapy did not differ between the groups. The morphine group had considerably higher incidence of nausea than the control group (zero patients in the ketamine group versus eight patients (17.4%) in the morphine group; P  = 0.006). Conclusions Nebulized ketamine has non-inferior analgesic efficacy compared with IV morphine for acute musculoskeletal pain in older persons, with fewer adverse effects. [ABSTRACT FROM AUTHOR]

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To investigate the outcome of total laparoscopic hysterectomy (TLH) and postoperative pain characteristics and compare the pain severity after TLH for adenomyosis or uterine fibroids. This prospective observational study collected 101 patients received TLH for adenomyosis (AD group) including 41 patients were injected goserelin (3.6 mg) 28 days before TLH, while other adenomyosis patients received TLH without preoperative treatment, and 113 patients received TLH for uterine fibroids (UF group). Pain scores were evaluated at different time sites from operation day to postoperative 72 h using the numeric rating scale. Clinical data were collected from clinical record. Operative time and anaesthetic time were longer in the AD group than those in the UF group (66.88 ± 8.65 vs. 64.46 ± 7.21, p = 0.04; 83.95 ± 10.05 vs. 79.77 ± 6.88, p < 0.01), severe endometriosis was quite more common in AD group (23.76% vs. 2.65%, p < 0.01). Postoperative usage of Flurbiprofen in AD group were more than that of UF group (15.48 ± 38.00 vs. 4.79 ± 18.16, p = 0.02). Total pains and abdominal visceral pains of AD group were more severe compared with UF group in motion and rest pattern at several time sites, while incision pain and shoulder pain were similar. The total postoperative pains after goserelin preoperative treatment in AD group were less than that without goserelin preoperative treatment (p < 0.05). The levels of serum NPY, PGE2 and NGF after laparoscopic hysterectomy of adenomyosis reduced with GnRH agonist pretreatment. Acute postoperative pain for adenomyosis and uterine fibroids showed considerably different severity, postoperative total pain and abdominal visceral pains of TLH for adenomyosis were more severe compared with uterine fibroids. While patients received goserelin before laparoscopic hysterectomy of adenomyosis suffered from less severity of postoperative total pain than that without goserelin preoperative treatment. Acute postoperative pain for adenomyosis and uterine fibroids showed considerably different severity, postoperative total pain and abdominal visceral pains of TLH for adenomyosis were more severe compared with uterine fibroids. Patients received goserelin before laparoscopic hysterectomy of adenomyosis suffered from less severity of postoperative total pain than that without goserelin preoperative treatment. [ABSTRACT FROM AUTHOR]

Purpose: Bowel urgency (BU) is an important symptom of Crohn's disease (CD), however there is no patient-reported outcome (PRO) scale validated in this population to assess BU severity. Here we evaluated the content validity and psychometric properties of the Urgency Numeric Rating Scale (NRS). Method: Qualitative interviews were conducted with moderate-to-severe CD participants to confirm importance and relevance of BU in this population, cognitively debrief the Urgency NRS, and explore score interpretation and CD remission. A quantitative web survey study was conducted to explore the measurement properties of the urgency NRS. Results: Qualitative Interview: 34 of 35 participants reported BU. It was most bothersome for 44%, 47% reported it daily, 18% with every bowel movement. BU had a severe impact on daily activities, causing many participants to stay home more than preferred. Patients confirmed the relevance, appropriateness, comprehensibility of the item, recall period, response options, and instructions of the Urgency NRS. Small reductions on the Urgency NRS score reflected meaningful improvements. Quantitative survey: The study sample comprised 76 participants (65.8% female). Mean Urgency NRS score was 4.7 (SD 2.26; N = 76) at Week 1, with no floor/ceiling effect. Test–retest reliability was acceptable. Construct and known-groups validity against selected PROs were overall strong and within ranges hypothesized a priori. Conclusion: The Urgency NRS is a valid and reliable instrument to assess BU severity in CD. [ABSTRACT FROM AUTHOR]

IntroductionUnbearable post-hemorrhoidectomy pain is a well-documented challenge, significantly impacting patient well-being and satisfaction after surgery, often influencing patients to decline in undergoing this procedure. It is widely recognized that methylene blue has an effect of reducing inflammation and pain by reduces the production of nitric oxide and inhibiting the action potentials production in nerves. This study aims to explore the potential benefits of postoperative regional administration of methylene blue in providing extended relief from post-hemorrhoidectomy pain.MethodsThis study included 97 patients aged 18–75 undergoing hemorrhoidectomy for stage III or IV hemorrhoids. A double-blind, randomized controlled trial compared postoperative intradermal injections of 1% methylene blue to 0.5% Marcaine as the control group. Two-week follow-up assessed pain. Statistical analysis, adherence to ethical standards, and registration were conducted.ResultNo significant differences were found in baseline demographics, surgical parameters, or complications between the Methylene Blue and control groups. Intervention group remained lower in mean pain score until the 12th day. Methylene blue group reported significantly lower postoperative pain scores from days 1 to 7, with no significant differences afterward.ConclusionThis ongoing randomized controlled trial reveals the potential analgesic benefits of intradermal injection 1% methylene blue. It demonstrates comparable efficacy in reducing post-hemorrhoidectomy pain, with negligible side effects and complications.

Abstract Background A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is “pain as bad as you can imagine”. We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either “extremely severe pain”, or the original BPI, with the anchor “pain as bad as you can imagine”. Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for “extreme” vs. “imaginable” anchor text (p = 0.005). Conclusion Pain rating scales should utilize the modified anchor text “extremely severe pain” instead of “pain as bad as you can imagine”. Further research should explore the effects of anchors for other symptoms.

BackgroundThe Itch Numeric Rating Scale (NRS), Skin Pain NRS, and Atopic Dermatitis Sleep Scale (ADSS) are self-administered patient-reported outcome (PRO) instruments developed to assess symptoms in patients with atopic dermatitis (AD). The objective of this study was to evaluate the psychometric properties (reliability, validity, and responsiveness) and interpretability thresholds of these PROs using data from three pivotal Phase 3 studies in adults.MethodsBREEZE-AD1, BREEZE-AD2, and BREEZE-AD5 evaluated the safety and efficacy of baricitinib in adults with moderate-to-severe AD. Clinician-reported outcomes and other PROs commonly assessed in patients with AD were used to estimate meaningful changes and evaluate test-retest reliability, convergent and divergent validity, known-groups validity, responsiveness, and meaningful change thresholds (MCTs) of the Itch NRS, Skin Pain NRS, and ADSS.ResultsThe test-retest reliability of the Itch NRS, Skin Pain NRS, and ADSS was evidenced by generally large intraclass correlation coefficients (> 0.7) in stable groups of patients between baseline and Week 1 and Weeks 4 and 8. Moderate-to-large correlations (r > 0.4) at baseline and Week 16 were generally observed between each measure and other PROs measuring the same concept, supporting convergent validity. Small-to-moderate correlations with clinician-reported outcomes demonstrated divergent validity. Each instrument was able to distinguish between known groups of disease severity as assessed using other indicators of AD severity. The responsiveness of the Itch NRS, Skin Pain NRS, and ADSS scales was demonstrated through significant differences in their change scores from baseline to Week 16 between categories of change in another PRO also from baseline to Week 16. Thresholds for interpreting meaningful change were estimated as - 4.0 for the 0-10 Itch and Skin Pain NRS items; - 1.25 for the 0-4 ADSS Items 1 and 3 and; - 1.50 for the 0-29 ADSS Item 2, these equivalent to moderate degrees of change.ConclusionsResults of this study demonstrate that the psychometric properties of the Itch NRS, Skin Pain NRS, and ADSS are good to excellent. These findings support the use of these instruments in daily assessment of AD symptoms in adults with moderate-to-severe AD. Trial registration ClinicalTrials.gov numbers: NCT03334396, NCT03334422, and NCT03435081.

ObjectivesThis study is based on data collected at the Acupuncture clinic of the Local Health Authority (ASL) in Turin from 2008 to 2022 and aims at evaluating the effectiveness of acupuncture in the treatment of musculoskeletal pain using the Numeric Rating Scale (NRS) which analyzes changes in pain perceived by patients in different body regions.MethodsThe database consists of data provided by patients during the initial visit and the last session. Only patients who provided data at the beginning and end of treatment were included. The data were processed using JASP 0.17.2.1 software. The sample consisted of 932 patients with musculoskeletal conditions, excluding 254 subjects with internal medical conditions, who were treated during the same period. The selected population includes individuals aged 23–94, comprising 242 men and 690 women. Patients followed a therapeutic protocol based on the initial diagnosis and underwent an initial cycle of six weekly sessions, with the possibility of four additional sessions if needed. Acupuncture was performed by experienced medical personnel following Traditional Chinese Medicine guideline.ResultsThe average NRS values were 7.49 at the beginning and 4.27 at the end, with a 43% reduction in pain. The data were analyzed using the Wilcoxon test, confirming statistical significance (p

AbstractObjective To investigate the outcome of total laparoscopic hysterectomy (TLH) and postoperative pain characteristics and compare the pain severity after TLH for adenomyosis or uterine fibroids.Methods This prospective observational study collected 101 patients received TLH for adenomyosis (AD group) including 41 patients were injected goserelin (3.6 mg) 28 days before TLH, while other adenomyosis patients received TLH without preoperative treatment, and 113 patients received TLH for uterine fibroids (UF group). Pain scores were evaluated at different time sites from operation day to postoperative 72 h using the numeric rating scale. Clinical data were collected from clinical record.Results Operative time and anaesthetic time were longer in the AD group than those in the UF group (66.88 ± 8.65 vs. 64.46 ± 7.21, p = 0.04; 83.95 ± 10.05 vs. 79.77 ± 6.88, p

Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is "no pain" and 10 is "pain as bad as you can imagine". We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either "extremely severe pain", or the original BPI, with the anchor "pain as bad as you can imagine". Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results: Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for "extreme" vs. "imaginable" anchor text (p = 0.005). Conclusion: Pain rating scales should utilize the modified anchor text "extremely severe pain" instead of "pain as bad as you can imagine". Further research should explore the effects of anchors for other symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Laparoscopic surgeries, despite being minimally invasive, is not popular as a day care surgery because of the post operative pain and requirement of intravenous analgesic drugs. The aim of this study is to compare the efficacy of intraperitoneal instillation of levobupivacaine alone versus levobupivacaine with different doses of dexmedetomidine for post operative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: Prospective observational study. In the study, 100 patients, scheduled for elective laparoscopic cholecystectomy after getting informed and written consent were taken up and were randomised into 4 groups to receive either 50 ml of 0.25% levobupivacaine + 5ml normal saline [GROUP A], 50ml of 0.25% levobupivacaine + dexmedetomidine 0.5mcg/kg diluted in 5ml normal saline [GROUP B], 50ml of 0.25% levobupivacaine + dexmedetomidine 1mcg/kg diluted in 5ml normal saline [GROUP C], 50ml of 0.25% levobupivacaine + dexmedetomidine 1.5mcg/kg diluted in 5ml normal saline [GROUP D]. Study drug was instilled before the removal of the trocar at the end of the surgery. All the patients also received infiltration of 0.25% bupivacaine at the port sites. Post operative pain using NRS, time to first rescue analgesia and total analgesic requirement of the patients amongst all the four groups was observed and compared. RESULTS: The mean NRS was found to be significantly lesser in Groups C & D as compared to Groups A & B. Inj. Fentanyl [1-2mcg/kg] was used as rescue analgesia for patients with NRS>4. Patients belonging to Group A received rescue analgesia earlier and higher as compared with Group B. Patients belonging to Group C & D did not require any rescue analgesia. CONCLUSION: The addition of dexmedetomidine to levobupivacaine for intraperitoneal instillation was found to be more efficacious for post operative analgesia and 1mcg/kg of dexmedetomidine can be used as optimal adjuvant dose with levobupivacaine in patients undergoing laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: As a subjective sensation, pain is difficult to evaluate objectively. The assessment of pain degree is largely dependent on subjective methods such as the numeric rating scale (NRS). The PainVisionTM system has recently been introduced as an objective pain degree measurement tool. The purpose of this study was to analyze correlations between the NRS and the current perception threshold (CPT), pain equivalent current (PEC), and quantified pain degree (QPD). Methods: Medical records of 398 subjects who visited the pain clinic in a university hospital from March 2017 to February 2019 were retrospectively reviewed. To evaluate the pain degree, NRS, CPT, PEC, and QPD were measured. Subjects were categorized into two groups: the Pain group (n = 355) and the No-pain group (n = 43). Results: The NRS showed a negative correlation with CPT (R = −0.10, p = 0.054) and a positive correlation with QPD (R = 0.13, p = 0.008). Among various diseases, only spinal disease patients showed a negative correlation between CPT and NRS (R = −0.22, p = 0.003). Additionally, there were significant differences in CPT and QPD between the Pain and No-pain groups (p = 0.005 and p = 0.002, respectively). Conclusions: CPT and QPD measured using the PainVisionTM system could be used to estimate pain intensity and the presence of pain. These parameters would be considered useful for predicting pain itself and its intensity. [ABSTRACT FROM AUTHOR]

Jung Hwan Lee,1 Jun Ho Lee,2 Min Cheol Chang3 1Namdarun Rehabilitation Clinic, Yongin-City, Gyeonggi-Do, South Korea; 2Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, 02447, South Korea; 3Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, 705-717, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email wheel633@gmail.comPurpose: This study aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) in patients with lumbosacral disc herniation by comparing its effect between those diagnosed by clinical evaluation and plain radiography only (X-ray group) and those by additional magnetic resonance imaging (MRI) (MRI group). Additionally, we investigated the accuracy of the preliminary clinical assumption in the X-ray group using confirmative post-injection MRI.Patients and Methods: We retrospectively recruited 367 patients with back and radicular pain due to lumbosacral disc herniation from a single pain clinic. Among them, 201 and 166 patients were categorized into the X-ray and MRI groups, respectively. In the X-ray group, the pathological level assumed initially by clinical evaluation and plain radiography concurred with that confirmed later on post-injection MRI in 139 patients (corresponding group); the remaining 62 patients lacked this concurrence (non-corresponding group). The NRS scores and Macnab criteria results were compared between the X-ray and MRI groups as well as the corresponding and non-corresponding groups.Results: Both the X-ray and MRI groups showed significant reductions in the NRS scores at 2 and 10 weeks post-injection when compared with the pretreatment scores. However, no significant difference was noted between the groups in terms of the magnitude of clinical improvement assessed by successful reduction in the NRS or Macnab scores. Furthermore, similar results were obtained in the comparison between the corresponding and non-corresponding groups of the X-ray group.Conclusion: TFESI guarantees favorable clinical outcomes even in the absence of confirmative MRI in patients with back and radicular pain. The preemptive application of this procedure could be prioritized and justified in patients suspected of lumbosacral disc herniation based on clinical evaluation and plain radiography only without the preceding MRI verification.Keywords: lumbosacral disc herniation, epidural injection, transforaminal, numeric rating scale, plain radiography

Objective:Non-steroidal anti-inflammatory drugs (NSAIDs) are used routinely and as first choice in the analgesic treatment of abdominal pain caused by primary dysmenorrhea (PD). In our study, we aimed to compare the analgesic efficacy of 400 mg and 800 mg ibuprofen doses administered intravenously (iv) in the treatment of patients presenting with abdominal pain due to PD.Methods:The study was conducted in emergency department over a period of 4 months in a prospective, randomized, controlled and single-blind design. Females aged between 18-50 years were included in the study. The patients were randomly divided into two groups as those who received ibuprofen 400 mg and those who received 800 mg. In these two groups, the pain scores of the patients at 0, 30 and 60 min were determined and analyzed using the 10-unit Numeric Rating Scale (NRS).Results:A total of 54 patients, 27 in each group were included in the study. Age, weight and body mass index parameters of the groups were statistically similar. There was no statistically significant difference between the two groups in terms of the degree of pain at admission and at the 30th-60th min of follow-up. In the 400 mg and 800 mg treatment groups, the NRS score differences between 0 and30 min periods [median [interquartile range (IQR): 4 (3-5) and 4 (3-4); p=0.224] and between 0 and 60 min periods [median (IQR): 4 (3-5) and 4 (3-4); p=0.224] were statistically similar. There was no difference between the two groups in terms of need for rescue medication and side effects.Conclusion:Similar efficacy is observed in reducing pain intensity between 400 mg and 800 mg doses of iv ibuprofen. According to these findings, it can be concluded that 400 mg of ibuprofen IV preparation can be preferred over 800 mg in the treatment of abdominal pain in patients with PD.

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Objective: To translate the English version of the Oxford Knee Score into Urdu and then to see the internal consistency and validation with the Visual analogue scale and Numerical rating scale in patients suffering from primary knee osteoarthritis. Study Design: Cross sectional study. Place and Duration of study: Tertiary Care Hospital, Peshawar Pakistan, from Apr 2019 to Feb 2020. Methodology: In the first stage, Oxford Knee Score English was translated into Urdu, and it was administered to Osteoarthritis knee patients. In the second stage, the validation of the Oxford knee score Urdu version was carried out with two pain scales. Results: In this study, 92 patients with Osteoarthritis knee were included. These include 59(64%) males and 33(36%) females. Based on the grading of the Urdu Oxford knee score, 34(36.95%) patients had severe OA knee, 36(39.13%) patients had moderate, and the remaining 22(23.91%) patients had mild knee osteoarthritis. The reliability of the Urdu version of the Oxford knee score was checked, which showed Cronbach's Alpha with a value of 0.813. The Pearson correlation coefficient value of Oxford knee score Urdu with Visual analogue scale and Numerical rating scale was 0.951 and 0.961, respectively. Conclusion: This study shows that the Urdu version of the Oxford knee score is a valid and reliable method for osteoarthritis knee patients of our cultural background.

The painDETECT questionnaire (PDQ) is one of the available screening tools for neuropathic pain (NeP), with a cut-off score of 13. This study aimed to investigate changes in PDQ scores in patients undergoing posterior cervical decompression surgery for degenerative cervical myelopathy (DCM). Patients with DCM undergoing cervical laminoplasty or laminectomy with posterior fusion were recruited. They were asked to complete a booklet questionnaire including PDQ and Numerical Rating Scales (NRS) for pain at baseline and one year after surgery. Patients with a preoperative PDQ score ≥13 were further investigated. A total of 131 patients (mean age = 70.1 years; 77 male and 54 female) were analyzed. After posterior cervical decompression surgery for DCM, mean PDQ scores decreased from 8.93 to 7.28 (P = 0.008) in all patients. Of the 35 patients (27%) with preoperative PDQ scores ≥13, mean PDQ changed from 18.83 to 12.09 (P < 0.001). Comparing the NeP improved group (17 patients with postoperative PDQ scores ≤12) with the NeP residual group (18 patients with postoperative PDQ scores ≥13), the NeP improved group showed less preoperative neck pain (2.8 vs. 4.4, P = 0.043) compared to the NeP residual group. There was no difference in the postoperative satisfaction rate between the two groups. Approximately 30% of patients exhibited preoperative PDQ scores ≥13, and about half of these patients demonstrated improvements to below to the cut-off value for NeP after posterior cervical decompression surgery. The PDQ score change was relatively associated with preoperative neck pain. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided erector spinae plane block (ESPB) is an interfascial plane block used for analgesia of the chest and abdominal wall. This study aimed to evaluate the perioperative analgesic efficacy of bilateral single-shot ESPB at T5 vertebral level in breast reduction surgery. Materials and Methods: Sixty adult female patients scheduled for breast reduction surgery were included and randomly allocated to two groups to receive either preoperative ESPB with a local anesthetic mixture of 10 mL 0.5% bupivacaine, 5 mL 2% lidocaine, and 5 mL saline, or sham block. Patients in both groups received intraoperative remifentanil infusion and, postoperatively, morphine via the patient-controlled analgesia (PCA) device. The primary outcome was 24-h total morphine consumption, and secondary outcomes included intraoperative opioid consumption, postoperative pain intensity, time to first PCA request, supplement analgesic requirements, functional recovery, patient satisfaction, length of hospital stay, and side effects and complications. Results: The 24-h total morphine consumption was significantly lower in the ESPB group vs. the sham group (mean ± SD, 6.7 ± 3.9, and 13.9 ± 5.7 mg, respectively, p < 0.001). Compared with sham block, ESPB reduced pain scores, intraoperative opioid consumption, supplement analgesic requirements, delayed time to first PCA request, and improved functional recovery and patient satisfaction. Conclusion: In breast reduction surgery, preoperative single-shot ESPB reduces perioperative opioid consumption and provides adequate pain relief within 24 h postoperatively compared to systemic analgesics alone. Trial Registration Number: NCT03621345 Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

A retrospective observational study. The type of sagittal profile defined by Roussouly has affected spinal degeneration and surgical outcome. This study aimed to investigate the effect of preoperative Roussouly classification on pain intensity and radiological data of patients with lumbar degenerative disease who underwent indirect decompression with lateral lumbar interbody fusion (LLIF). We retrospectively investigated 102 patients who underwent LLIF without direct decompression. Patients were subdivided into 4 groups according to the Roussouly classification determined from preoperative full-length and lateral spine X-rays, and classified according to Roussouly types I, II, and IV in the nonstandard group and Roussouly type III in the standard group. The nonstandard group showed improved sagittal vertical axis and lumbar lordosis after LLIF surgery, but the midsagittal canal diameter and axial central canal area of the thecal sac using T2-weighted sagittal and axial magnetic resonance imaging were smaller than those in the standard group. On the other hand, each numeric rating scale score 1 year after surgery improved in all patients. Changes in numeric rating scale scores in low back pain, leg pain, and numbness were not statistically significant between Roussouly classification types. These results suggest that the nonstandard group may have less indirect decompression effect from LLIF than the standard group. In the short term, we show for the first time after LLIF surgery that preoperative sagittal spinal alignment and the pelvic position may not significantly impact pain improvement. [ABSTRACT FROM AUTHOR]

Objective: Electrophysiological techniques are emerging as an aid in identifying prognostic or therapeutic biomarkers in patients with spinal muscular atrophy (SMA), but electrophysiological assessments may be burdensome for patients. We, therefore, assessed feasibility and tolerability of multimodal peripheral non-invasive electrophysiological techniques in a cohort of patients with SMA. Methods: We conducted a single center, longitudinal cohort study investigating the feasibility and tolerability of applying multimodal electrophysiological techniques to the median nerve unilaterally. Techniques consisted of the compound muscle action potential scan, motor nerve excitability tests, repetitive nerve stimulation and sensory nerve action potential. We assessed tolerability using the numeric rating scale (NRS), ranging from 0 (no pain) to 10 (worst possible pain), and defined the protocol to be tolerable if the NRS score ≤ 3. The protocol was considered feasible if it could be performed according to test and quality standards. Results: We included 71 patients with SMA types 1–4 (median 39 years; range 13–67) and 63 patients at follow-up. The protocol was feasible in 98% of patients and was well-tolerated in up to 90% of patients. Median NRS score was 2 (range 0–6 at baseline and range 0–4 at follow-up (p

Abstract Background Recent neuroimaging studies have demonstrated pathological mechanisms related to cerebral neuroplasticity in chronic low back pain (CLBP). Few studies have compared cerebral changes between patients with and without pain in the absence of an experimentally induced stimulus. We investigated the neurobiological substrates associated with chronic low back pain using [99mTc]Tc-ECD brain SPECT and correlated rCBF findings with the numeric rating scale (NRS) of pain and douleur neuropathique en 4 questions (DN4). Ten healthy control volunteers and fourteen patients with neuropathic CLBP due to lumbar disc herniation underwent cerebral SPECT scans. A quantitative comparison of rCBF findings between patients and controls was made using the Statistical Parametric Mapping (SPM), revealing clusters of voxels with a significant increase or decrease in rCBF. The intensity of CLBP was assessed by NRS and by DN4. RESULTS: The results demonstrated an rCBF increase in clusters A (occipital and posterior cingulate cortex) and B (right frontal) and a decrease in cluster C (superior parietal lobe and middle cingulate cortex). NRS scores were inversely and moderately correlated with the intensity of rCBF increase in cluster B, but not to rCBF changes in clusters A and C. DN4 scores did not correlate with rCBF changes in all three clusters. CONCLUSIONS: This study will be important for future therapeutic studies that aim to validate the association of rCBF findings with the pharmacokinetic and pharmacodynamic profiles of therapeutic challenges in pain.

Objective: To assess the association of Depression with Chronic Low back pain. Methodology: In this cross-sectional investigation, 169 participants with a mean age of 54.1 years were studied at the PN Shifa medical outpatient department in Karachi, Pakistan. The research was conducted over a threemonth period, from June to August 2020, using a non-probability convenience sampling approach. The severity of low back pain (LBP) was measured using the Numeric Rating Scale (NRS) and the Wong Baker Faces Pain Rating Scale. To evaluate levels of depression, the Patient Health Questionnaire (PHQ-9) scale was employed. The Chisquare test and one-way ANOVA test were used to establish statistical significance. Results: Patients with moderate to severe chronic low back pain (CLBP) demonstrated higher pain levels on both the Wong Baker Faces Pain Rating Scale and NRS, with a p-value of 0.000. Based on the PHQ-9 scores, severe depression correlated with more intense pain, with a p-value of 0.000, and greater pain severity in the current and previous week (as assessed by the NRS and Wong Baker Faces Pain Rating Scale). A higher percentage of males (34%) experienced mild CLBP compared to females (22%). However, 26% of females were found to suffer from severe CLBP, as opposed to 12% of males, with a p-value of 0.014. Conclusion: Patients with chronic low back pain often experience depression and report high levels of pain. [ABSTRACT FROM AUTHOR]

Post-surgery acute pain, especially after orthognathic surgery, is a debilitating experience for patients as it significantly affects their mastication function. Evaluating facial pain is crucial to provide adequate pain treatment for post-orthognathic patients. This systematic review aims to assess acute facial pain in post-orthognathic surgery patients. We screened research articles published in the last decade that evaluated pain experienced by post-orthognathic surgery patients using three search engines. After initial screening, we conducted duplication, title and abstract checking and applied inclusion and exclusion criteria to select relevant articles. We then extracted and analysed data from the final included articles. The review included seven articles that evaluated pain in post-orthognathic surgery patients. Data analysis revealed that the visual analogue scale was the most frequently used pain scale to assess facial pain after surgery (four articles), followed by the numeric rating scale (two articles), and one article used both pain scales. The pain intensity ranged from 1 to 7.8 on a 10-point scale. Factors affecting facial pain intensity included the type and duration of surgery and pre-and postoperative analgesic medication. The study concludes that post-orthognathic surgery patients experience varying degrees of facial pain, ranging from mild to severe, and this intensity is likely affected by several surgeryrelated variables. [ABSTRACT FROM AUTHOR]

Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are used routinely and as first choice in the analgesic treatment of abdominal pain caused by primary dysmenorrhea (PD). In our study, we aimed to compare the analgesic efficacy of 400 mg and 800 mg ibuprofen doses administered intravenously (iv) in the treatment of patients presenting with abdominal pain due to PD. Methods: The study was conducted in emergency department over a period of 4 months in a prospective, randomized, controlled and single-blind design. Females aged between 18-50 years were included in the study. The patients were randomly divided into two groups as those who received ibuprofen 400 mg and those who received 800 mg. In these two groups, the pain scores of the patients at 0, 30 and 60 min were determined and analyzed using the 10-unit Numeric Rating Scale (NRS). Results: A total of 54 patients, 27 in each group were included in the study. Age, weight and body mass index parameters of the groups were statistically similar. There was no statistically significant difference between the two groups in terms of the degree of pain at admission and at the 30th-60th min of follow-up. In the 400 mg and 800 mg treatment groups, the NRS score differences between 0 and30 min periods [median [interquartile range (IQR): 4 (3-5) and 4 (3-4); p=0.224] and between 0 and 60 min periods [median (IQR): 4 (3-5) and 4 (3-4); p=0.224] were statistically similar. There was no difference between the two groups in terms of need for rescue medication and side effects. Conclusion: Similar efficacy is observed in reducing pain intensity between 400 mg and 800 mg doses of iv ibuprofen. According to these findings, it can be concluded that 400 mg of ibuprofen IV preparation can be preferred over 800 mg in the treatment of abdominal pain in patients with PD. [ABSTRACT FROM AUTHOR]

Homeopathic treatment is claimed to be beneficial for primary dysmenorrhoea (PD); still, systematic research evidences remain compromised. This study was undertaken to examine the efficacy of individualized homeopathic medicines (IH) against placebo in the treatment of PD. A double-blind, randomized, placebo-controlled trial was conducted at the gynecology outpatient department of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, West Bengal, India. Patients were randomized to receive either IH (n=64) or identical-looking placebo (n=64). Primary and secondary outcome measures were 0–10 numeric rating scales (NRS) measuring intensity of pain of dysmenorrhea and verbal multidimensional scoring system (VMSS) respectively; all measured at baseline, and every month, up to 3 months. Group differences and effect sizes (Cohen's d) were calculated on intention-to-treat (ITT) sample. Groups were comparable at baseline (all p>0.05). Attrition rate was 10.9% (IH: 7, placebo: 7). Differences between groups in both pain NRS and VMSS favoured IH over placebo at all time points (all p<0.001, unpaired t-tests and two-ways repeated measures analysis of variance) with medium to large effect sizes. Natrum muriaticum and Pulsatilla nigricans (n=20 each; 15.6%) were the most frequently prescribed medicines. No harms, serious adverse events and intercurrent illnesses were recorded in either of the groups. Homeopathic medicines acted significantly better than placebo in the treatment of PD. Independent replication is warranted. Trial registration: CTRI/2018/10/016013. [ABSTRACT FROM AUTHOR]

Background: Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. Methods: A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. Results: The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. Conclusions: The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA. [ABSTRACT FROM AUTHOR]

The risks and benefits of epidural analgesia have been studied extensively, but information regarding many other aspects of epidural catheter insertion is limited. The authors aimed to add information regarding procedural pain, procedure duration, failure rates, and the effect of experience to the ongoing discussion on this procedure. A prospective observational study. A Danish tertiary hospital. Patients scheduled to undergo video-assisted thoracic surgery. Epidural catheter insertion in 173 patients undergoing video-assisted thoracic surgery for lung cancer. The authors recorded the time required for the epidural insertion procedure, the attempts used, insertion level, access use, patient position, placement technique used, and the designation of the physician placing the catheter. Furthermore, the authors asked the patients to evaluate the expected procedural pain, and after the procedure the authors asked them to evaluate the actual level of pain experienced. Six and 24 months after discharge, the authors examined persistent sequelae by using questionnaire assessments. The median procedure duration was 13 minutes, with 75% of the catheters placed within 22 minutes. Actual procedure-related pain (mean score [M] = 3.5, SD = 2.0) was significantly (p < 0.0001) less than that expected before the procedure (M = 4.9, SD = 2.0). The patients' expected pain, attempts required for successful catheter placement, and approach used to access the epidural space significantly affected the actual procedure-related pain (p = 0.001, p ≤ 0.003, and p = 0.023, respectively). Persistent pain and sensory disturbances were observed in 11% and 4% of the patients, respectively, after 6 months and in 6% and 4% of the patients, respectively, after 2 years. In this study, the authors examined several lesser-known aspects of epidural procedures. The use of epidural analgesia as part of the pain management plan after surgery requires a more complex evaluation instead of merely discussing the possibility of procedural infections, hematomas, or neurologic injuries. The procedure time, patients' expected and experienced pain related to the procedure, and the potential long-term side effects should be a part of the decision-making process. [ABSTRACT FROM AUTHOR]

Abstract Background Despite some advances, treatment of trigeminal neuralgia remains a significant challenge. This study determines the efficacy and safety of autologous conditioned serum (Orthokine) injection into the foramen oval to treat refractory trigeminal neuralgia. Case presentation This is a consecutive case series from the Pain and Palliative Care Department of Imam Reza University Hospital, Tabriz, Iran. Eleven Iranian patients, eligible according to the inclusion and exclusion criteria, aged 45.64 ± 11.58 years (Four male and seven female, all Iranian) with established classical trigeminal neuralgia were injected with Orthokine (2 mL per injection) once a week for three consecutive weeks (total of four injections). Numeric rating scale scores for facial pain intensity and also carbamazepine daily dose were confirmed at pretreatment (T0) and at week 1 (T1), week 2 (T2), week 3 (T3), week 4 (T4), and month 2 (T5) posttreatment. Pain intensity was significantly reduced in the first 3 weeks of follow-up in comparison with baseline (T0 to T3) (8.18 ± 1.99 to 2.82 ± 2.13, p

Plain English summary Itching is a distressing medical condition common in patients with chronic kidney disease, especially those undergoing hemodialysis. The itch often leads to skin damage due to a continuous and uncontrollable urge to scratch. It affects about 60% of hemodialysis patients and can be severe enough to seriously affect quality of life. At present, there are no approved therapies. To evaluate whether new treatments for itch are effective, clinicians need to assess if the intensity of itch decreases over time. However, because itch intensity can only be measured accurately by the person experiencing it, a measure is required that can be easily understood and used by patients. This study evaluated a scale in which patients mark a number between ‘0’ (corresponding to no itch) and ‘10’ (the worst itching imaginable), to describe the worst itch intensity they experienced over the last 24 hours. Using data from three clinical trials of a novel treatment for itch in patients undergoing hemodialysis with moderate-to-severe pruritus, we found that the scale was reliable in repeat-testing experiments, and mirrored other methods of measuring changes in itch. In interviews, patients said they found the scale straightforward and easy to complete. Our analysis and patients’ opinions showed a 3-point reduction in itch intensity on the scale represented a meaningful improvement. These findings support the use of this scale to assess the efficacy of new treatments and in clinical evaluation and management of pruritus in patients with chronic kidney disease.

The article discusses the study based on qualitative interviews with patients diagnosed with Hypermobile Ehlers-Danlos Syndrome to elicit and characterize the thought processes behind their use of an 11-point numeric rating scale (NRS). The study indicates that participants felt changing attitudes toward pain and its quantification over their lifetimes which emphasizes the need for clinicians to practice caution when using the NRS to assess pain.

Background: Recent neuroimaging studies have demonstrated pathological mechanisms related to cerebral neuroplasticity in chronic low back pain (CLBP). Few studies have compared cerebral changes between patients with and without pain in the absence of an experimentally induced stimulus. We investigated the neurobiological substrates associated with chronic low back pain using [99mTc]Tc-ECD brain SPECT and correlated rCBF findings with the numeric rating scale (NRS) of pain and douleur neuropathique en 4 questions (DN4). Ten healthy control volunteers and fourteen patients with neuropathic CLBP due to lumbar disc herniation underwent cerebral SPECT scans. A quantitative comparison of rCBF findings between patients and controls was made using the Statistical Parametric Mapping (SPM), revealing clusters of voxels with a significant increase or decrease in rCBF. The intensity of CLBP was assessed by NRS and by DN4. RESULTS: The results demonstrated an rCBF increase in clusters A (occipital and posterior cingulate cortex) and B (right frontal) and a decrease in cluster C (superior parietal lobe and middle cingulate cortex). NRS scores were inversely and moderately correlated with the intensity of rCBF increase in cluster B, but not to rCBF changes in clusters A and C. DN4 scores did not correlate with rCBF changes in all three clusters. CONCLUSIONS: This study will be important for future therapeutic studies that aim to validate the association of rCBF findings with the pharmacokinetic and pharmacodynamic profiles of therapeutic challenges in pain. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare clinical and radiological results of lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease in patients under the age of 80 years with those over the age of 80 years. One hundred two patients who underwent LLIF without direct decompression were enrolled, including 92 patients who were less than 80 years (group A) and 10 over 80 years (group B). All patients were evaluated using numerical evaluation scale scores for low back pain, leg pain, and leg numbness, as well as demographic data, surgical data, and imaging data before and after LLIF surgery. Patients over the age of 80 years were found to have longer hospital stays (P = 0.006) and more postoperative muscle weakness (P = 0.011) and endplate injuries (P = 0.038). In addition, each numerical evaluation scale score improved significantly from preoperative to postoperative (P < 0.001). However, the changes in scores between preoperative and postoperative for each numerical evaluation scale were not significantly different between the 2 groups. Statistically significant increases in lumbar lordosis preoperatively compared with postoperatively were observed in patients under 80 years but did not change in those over 80 years. These data suggest a need for awareness of intraoperative endplate injury and postoperative motor weakness. Critically, indirect decompression with LLIF in lumbar degenerative disease in patients over age 80 as well as those under age 80 has shown satisfactory clinical and radiological results. This study shows that age alone should not prevent older people from undergoing LLIF. [ABSTRACT FROM AUTHOR]

Objective Pain-related function is not routinely assessed in the hospital. This prospective cohort study examined whether patients' daily pain-related function during hospitalization, based on the validated Youth Acute Pain Functional Ability Questionnaire (YAPFAQ), is associated with pain and quality of life. Design The YAPFAQ is a 12-item measure assessing functional parameters of recovery related to pain and has been validated in children and adolescents with sickle cell disease and after surgery. Adolescents undergoing major musculoskeletal surgery (n = 93) completed the YAPFAQ daily for up to 3 days after surgery. Adolescents self-reported health-related quality of life on the Pediatric Quality of Life Inventory and pain intensity on a numeric rating scale at home 2 weeks after surgery. Results Higher YAPFAQ scores, representing poorer function, were associated with higher pain intensity (β = 0.2, P  = 0.04) and poorer health-related quality of life (β   =   –0.3, P  = 0.01) at home 2 weeks after surgery. This functional measure could be clinically relevant to providers to identify adolescents at risk of difficulty with pain and recovery at home after surgery who might need further intervention to minimize functional impairment and delayed recovery. Perspective This article provides conceptual validation of a functional score for pediatric pain, the YAPFAQ, to assess pain intensity and health-related quality of life in the subacute period. [ABSTRACT FROM AUTHOR]