What constitutes a clinically important pain reduction in patients after third molar surgery?

BACKGROUND: For patients with surgical third molar removal, it is unknown what constitutes a clinically important change in patients' visual analogue scale (VAS) reports of pain intensity. OBJECTIVES: To determine what constitutes a clinically important change in pain intensity on a VAS following surgical removal of the third molar. METHODS: The study population consisted of patients participating in three randomized trials. Patients were asked to rate their pain three times per day over a period of seven days on a 100 mm VAS after surgical removal of the third molar. Global Perceived Effect was measured on day 1 and day 7 and was used as the external criterion for assessing clinically important pain reduction. Global Perceived Effect scores of 6 ('much improved') or higher were classified as clinically 'successful', and scores of 5 ('slightly improved') or below were classified as clinically 'unsuccessful'. For each trial, the mean absolute and relative changes in VAS scores were calculated for both 'successful' and 'unsuccessful' treatments. Sensitivity and specificity analyses were performed. RESULTS: The patients who reported 'successful' pain reduction showed a relative pain reduction of ≥69% and an absolute pain reduction >2.5 cm on the VAS, whereas patients who classified their pain reduction as 'unsuccessful' had a relative pain reduction of ≤18.5% and an absolute pain reduction <0.5 cm on the VAS. Furthermore, sensitivity and specificity analyses showed that a cut-off point of ≥50% relative pain reduction exhibited the best balance of sensitivity and specificity. CONCLUSION: Relative pain reduction of ≥50% and an absolute pain reduction of ≥2.5 cm on the VAS were most accurate in predicting a successful pain reduction after a given treatment.

Can a single pain rating replace a multiple pain rating in third molar surgery studies? Analysis of 220 patients.

This study describes the comparison of multiple and single pain ratings in patients after surgical removal of the third molar. Correlation and agreement analysis were performed between the average pain intensity measured three times a day over a period of 7 days and one single pain rating (designated the 'recalled average' pain, as assessed by the patient) after surgical removal of the lower third molar. The study population consisted of patients participating in three randomized trials. The results show that both measurement correlated good to excellent, but there was a large variation in agreement between the ratings. In conclusion, in patients with surgical third molar removal a single pain rating is not an accurate predictor of the average pain measured by a multiple pain-rating test. A single pain rating cannot replace a multiple pain assessment.

Is thromboembolism prophylaxis necessary for low and moderate risk patients in maxillofacial trauma? A retrospective analysis.

This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial trauma between January 2000 and January 2009 in the Department of Oral and Maxillofacial Surgery of the VU University Medical Center, Amsterdam. Patients' records were reviewed for complaints and information related to deep venous thrombosis (DVT) and pulmonary embolism (PE). The patients were classified according to a risk classification, and the incidence of reported DVT and PE was calculated. None of the patients received any form of thromboembolism prophylaxis. Of the 479 patients included in this study, one presented with VTE (0.2%). This male patient was treated for a panfacial trauma and was classified as high risk. From all analysed parameters only surgery time classification proved to have a significant relationship with VTE.

Cytokine gene polymorphisms in the Dutch population.

Numerous studies have shown that variations in the production and activity of cytokines influence the susceptibility and/or resistance to various infectious agents, autoimmune diseases, and cancer, as well as the predisposition to allograft rejection. Differences in the production of cytokines between individuals are often caused by single nucleotide polymorphisms (SNP) in the promoter or coding regions of cytokine genes. The cytokine polymorphisms of 107 unrelated Caucasian individuals originating from various parts of the Netherlands were studied and compared with the results of two European (Czech and Italian) populations. Twenty-two SNPs of 13 different cytokine genes were analysed. To test the Hardy-Weinberg equilibrium, allele frequencies were estimated by direct gene counting. Evaluation of the allele frequencies of the Dutch, Italian and Czech populations showed that five SNPs were significantly different between the Dutch and the Italians, while these SNPs did not vary between the Dutch and the Czechs. This analysis, in combination with other types of immune profiling, may be helpful for prediction of the clinical outcome of various infectious and immune-related disorders, as well as for estimation of the risk for rejection and graft vs. host disease after organ or stem cell transplantation.