Evaluating the impact of platelet-rich plasma injection in spinal endoscopic nucleotomy on MRI pfirrmann grading and clinical outcomes in lumbar disc herniation.

BACKGROUND: This study investigates the clinical efficacy and safety of percutaneous endoscopic nucleotomy combined with platelet-rich plasma (PRP) injection in treating lumbar disc herniation (LDH) in young and middle-aged adults. METHODS: From April 2022 to September 2023, 60 patients diagnosed with LDH were randomly divided into two groups (n = 30/group). The observation group underwent percutaneous endoscopic nucleotomy combined with autologous PRP gel injection into the disc, while the control group underwent percutaneous endoscopic nucleotomy alone. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores were recorded preoperatively and at three time points postoperatively: three days, three months, and six months. The modified Macnab criteria were employed to evaluate efficacy at the final follow-up. Additionally, MRI Pfirrmann grading of the operated disc segment and potential complications were assessed both preoperatively and at the final follow-up. RESULTS: All patients were followed for a minimum of six months. VAS and ODI scores at all postoperative time points (three days, three months, and six months) exhibited significant differences compared to preoperative scores in both groups (P < 0.05). Notably, a significant difference was observed in VAS and ODI scores between the two groups at three days postoperatively (P < 0.05). Preoperative MRI Pfirrmann grading indicated no significant difference between groups (P = 0.669). However, at the final follow-up, the observation group demonstrated superior recovery compared to the control group (P = 0.013). The modified Macnab criteria revealed no significant difference in the rates of excellent and good outcomes between the observation group (96.67%) and the control group (93.33%) (P > 0.05). Furthermore, no patients experienced complications such as dural tears, nerve root injury, infection, or hematoma. CONCLUSION: The combination of percutaneous endoscopic nucleotomy and PRP injection could be a safe and effective treatment for LDH in young and middle-aged adults to promote disc repair following endoscopic procedures.

Hip and waist circumference correlations with demographic factors and pain intensity in patients with chronic pain.

Aim: This study aimed to investigate how demographic factors such as race, age, sex and ethnicity can impact hip circumference (HC) and waist circumference (WC) in patients with chronic pain.Materials & methods: We queried the NIH-sponsored All of Us database for patients with documented HC, WC and waist/hip ratio (WHR) data. This cross-sectional study categorized participants into four groups: total cohort, no chronic pain, mild/moderate chronic pain (numeric rating scale < 7) and severe chronic pain (numeric rating scale > 7). Further subgroup analyses were performed based on race, age, sex and ethnicity. We examined the correlation between chronic pain and WC, HC and WHR. ANCOVA analysis was used to determine to investigate demographics.Results: This study included 204,013 participants, with 25.22% having a chronic pain diagnoses. In most subgroups, females had significantly greater HC, while males had greater WC and WHR. WC (p < 0.001 in females, p < 0.01 in males), HC (p < 0.001 in females) and WHR (p < 0.001 in females, p < 0.05 in males) were significantly greater in the severe pain group compared with the mild/moderate pain group.Conclusion: These findings suggest that when assessing HC and WC, demographic variables need to be considered to develop more personalized and comprehensive treatment plans for chronic pain patients.

Our study looked at how factors like race, age, sex and ethnicity relate to hip and waist sizes in people with chronic pain. We wanted to see whether waist and hip measurements that lead to chronic pain is associated with race, age, sex and ethnicity. We used information from a database of patients with chronic pain formed in the USA. We grouped people based on how much pain they had (none, mild/moderate, severe) and then looked for differences between races, ages, sexes and ethnicities. Among men of all races, those with mild to moderate pain tended to have larger waists compared with those without pain. For women, those who experienced severe pain had larger waists and hips.We addressed how race, age, sex and ethnicity are associated with these results. Our main finding is that doctors should consider not just hip and waist sizes but also a patient's demographic background. This can help them create better treatment plans to determine risks of developing pain and individualizing treatment.

Comparing the effectiveness of pregabalin and gabapentin in patients with lumbar radiculopathy: A systematic review and meta-analysis.

BACKGROUND: Gabapentinoids are commonly prescribed to control neuropathic pain of lumbar radiculopathy. Few trials have compared the efficacy of gabapentin (GBP) and pregabalin (PGB). Therefore, the authors conducted a meta-analysis to compare the difference in effect between GBP and PGB in lumbar radiculopathy patients. METHODS: Articles which were published between January 1, 1960 and May 31, 2023 were investigated via Cochrane Central Register of Controlled Trials, Embase, Google Scholar, and MEDLINE. This meta-analysis was conducted on patients with lumbar radiculopathy. Gabapentin was used as an intervention, and pregabalin as a comparison. As outcomes, pain rating scales including visual analog scale (VAS) and numeric pain rating scale (NRS), and number of adverse events (dizziness and sedation) were obtained. RESULTS: PGB showed statistically significant improvement in pain scale (VAS and NRS) in short-term follow-up (6 weeks or less) compared to GBP. (Total mean difference of -0.31) However, in the long-term follow-up (6 weeks to 12 weeks), there was no difference in pain reduction effect between two groups. The incidence of AEs showed no difference between two groups. CONCLUSION: Based on this article, the existing evidence suggests that PGB was more effective in reducing pain of lumbar radiculopathy compared to GBP at the short-term follow-up, but there was no difference in the long-term follow-up. Physicians should consider this finding in prescribing medications for patients with lumbar radiculopathy.

Validation of a holistic composite outcome measure for the evaluation of chronic pain interventions.

Introduction: Chronic pain is a personal experience influenced by multiple biopsychosocial factors. Using a pain intensity measure alone to assess the effectiveness of a chronic pain intervention fails to fully evaluate its impact on the multifaceted chronic pain experience. The holistic minimal clinically important difference (MCID) is a composite outcome developed to provide a comprehensive assessment of chronic pain in response to intervention, across 5 outcome domains: pain intensity, health-related quality of life, sleep quality, physical, and emotional function. To focus on domains where the individual need is greatest, the holistic MCID reflects the cumulative MCID averaged over only the domains where subjects were impaired preintervention. Objectives: To assess the internal and construct validity of the Holistic MCID score to inform its future use as an evidence-based tool. Methods: This validation study was undertaken using data from the EVOKE trial with 111 patients up to 24-month follow-up. Internal consistency of the holistic MCID was assessed using Cronbach alpha statistic and dimensional exploration using principal component analysis. Results: The holistic MCID measure demonstrated strong internal consistency with Cronbach alpha >0.7 at all follow-ups. Principal component analysis showed one overarching holistic dimension to be present in the composite. Construct validity was demonstrated by an increase in the holistic MCID score being associated with both increased Patients' Global Impression of Change, EuroQol visual analogue scale score, and each of the outcome domains in a "leave-one-out" analysis (all P < 0.001). Conclusion: The holistic MCID provides a valid measure for the comprehensive, personalized assessment of response after a chronic pain intervention. The validity of the holistic MCID requires further confirmation in other chronic pain populations and with different interventions.

Evaluation of the single and combined therapeutic effects of individually manufactured earplug therapy in patients with myogenous temporomandibular disorders: A randomized controlled clinical trial.

OBJECTIVE: To evaluate the effect of individually manufactured earplug therapy on pain intensity (PI), symptom severity (SS), and maximum mouth opening (MMO), in patients with myogenous temporomandibular disorders (TMD). METHODS: One-hundred-twenty patients were randomly allocated to six groups: Groups EP (earplug), OS (occlusal splint), EX (exercise), EPO (earplug with occlusal splint), EPE (earplug with exercise), and C (control). Outcomes were PI (assessed with a visual analog scale (VAS)), SS (assessed with the modified Symptom Severity Index Questionnaire (mSSI)), and MMO (evaluated with a digital caliper). Measurements were performed at T0 (before the therapy), T1 (1-month follow-up), and T2 (3-month follow-up). Data were analyzed using one-way analysis of variance (ANOVA), Tukey's HSD, and chi-square tests (alpha = 0.05). RESULTS: At T1 and T2, the greatest VAS and mSSI reduction was detected for the groups EPE (VAS = 5.3 ± 1.05, 3.3 ± 0.7; mSSI = 38.2 ± 2.27, 43.6 ± 3.94) and EPO (VAS = 5.2 ± 0.91, 3.2 ± 0.78; mSSI = 36.3 ± 3.97, 42.2 ± 3.19), respectively (p < 0.05). At T1, occlusal splint groups (groups OS (34.8 ± 2.97 mm) and EPO (33.8 ± 3.49 mm)) gave the highest MMO values, while T2 values did not constitute a significant difference with T1 (p > 0.05). CONCLUSIONS: The short-term use of combined earplug therapy resulted in a decrease in both PI and SS. Improvement in MMO in participants using occlusal splints was observed in the 1st month and was maintained through the 3rd month. CLINICAL RELEVANCE: Earplug therapy can be applied as a complementary therapy to occlusal splint and exercise treatments to decrease PI and SS in patients with myogenous TMD. To achieve functional recovery such as MMO, its combined use with splints should be taken into consideration by clinicians.

Validation of the Japanese version of Algoplus® for the assessment of acute postoperative pain in older patients with cancer.

AIM: This study aimed to validate a Japanese version of the Algoplus® tool by assessing postoperative pain in older Japanese patients with cancer and examining the scale's psychometric properties. METHODS: After translating Algoplus® into Japanese, we conducted a cross-sectional study of patients aged 65 years or older who underwent surgery to remove malignant tumors. Two registered nurse-certified investigators used the Numerical Rating Scale, the Japanese version of Algoplus®, and the Japanese version of the Abbey Pain Scale before and after analgesic use on postoperative days 3 and 5 to evaluate response to pharmacologic therapy. Validity was tested by a correlation analysis between the Japanese version of Algoplus®, two pain scales, and nine hypotheses related to demographic variables and surgical invasions. The Kuder-Richardson-20 test and Cohen's Kappa coefficient were used for internal consistency and inter-rater reliability, respectively. RESULTS: The total score of the Japanese version of Algoplus® showed strong to moderate correlations with the two pain scales. Demographic characteristics were not associated with the total score of the Japanese version, but significant correlations with operative time and postoperative analgesia administration existed. The scale demonstrated good internal consistency (Kuder-Richardson-20 α: .70) and inter-rater reliability (Kappa coefficient .72). The total score of the Japanese version decreased significantly after analgesic use in both postoperative assessments. CONCLUSIONS: The Japanese version of Algoplus® is a reliable and valid instrument for nurses to easily assess acute postoperative pain in older Japanese patients with cancer and shows good responsiveness for detecting the change in pain status.

Limitations of Self-Report Tools in Pain Evaluation of Patients With Vertebral Fractures.

Few studies have evaluated the usefulness and limitations of pain assessment using verbal communication tools for acute orthopedic diseases in older patients. The purpose of this study was to assess the rate of usage of the numerical rating scale (NRS), a verbal communication tool, and to identify the characteristics of patients in whom continuous assessment was impossible. We retrospectively examined electronic medical records of patients with acute vertebral fractures who had been admitted to our hospital between April 2018 and March 2020. Continuous pain assessment using the NRS was possible in 43.2% of hospitalized patients with the fractures. The factors preventing continuous pain assessment using the NRS were an advanced age and low Mini-Mental State Examination (MMSE) scores. Based on the receiver-operating characteristic curves, the cutoff age and MMSE score were >85.3 years and <22, respectively. Continuous NRS-based pain assessment is difficult in older adult patients or those with cognitive decline with acute vertebral fractures. In future, a simple observational assessment tool for patients with dementia should be introduced in acute medical care settings.

Effects of Auricular Acupressure on Pain and Stress in Nursing College Students With Cervical Pain: A Single-Blind Placebo-Controlled Trial.

PURPOSE: This study aimed to examine the effects of auricular acupressure (AA) on neck pain and stress in nursing students with neck pain. METHODS: This single-blind, randomized, and placebo-controlled comparative pretest-posttest study involved administering AA for four weeks. The subjects included nursing students experiencing neck pain. The experimental group comprised 17 subjects, and the control group comprised 14 subjects. In the experimental group, AA was applied to the Shenmen, cervical vertebrae, shoulder, and liver areas to improve neck pain and reduce stress. In the control group, AA was applied to the anus, rectum, urethra, and external genitalia areas, which are not associated with neck pain and stress. To assess the intervention effects, NRS (Numeric Rating Scale), NDI (Neck Disability Index), and PSS (Perceived Stress Scale) scores were measured. RESULTS: The NRS scores in the experimental group with AA significantly decreased over time (F = 7.463, p < .001). The between group and group-by-time interaction results were F = 8.564, p = .007 and F = 3.252, p = .025, respectively. The NDI scores in the experimental group showed a statistically significant difference between the groups (F = 13.762, p = .001); however, there were no significant differences over time or in the group-by-time interaction (F = 1.086, p = .347) (F = .301, p = .757). The PSS scores in the experimental group decreased significantly over time (F = 5.557, p = .013), but there were no significant differences between the groups (F = .636, p = .432) or in the group-by-time interaction (F = .063, p = .891). CONCLUSION: AA applied for four weeks was found to be safe, noninvasive, and effective in reducing neck pain in nursing students with cervical pain.

Effect of Flaxseed on Pain Relief and Quality of Life in Patients With Mastalgia: A Single Arm Interventional Study.

Objective: Mastalgia, a common complaint among women, denotes breast discomfort that can manifest as cyclical or non-cyclical. Reassurance, mechanical support and various non-pharmacological treatments, like flaxseeds, have been seen to have a good effect in treating mastalgia. Thus, the aim of this study was to investigates the efficacy of flaxseed in alleviating pain associated with mastalgia and its impact on the overall health-related quality of life among female patients. Materials and Methods: Conducted at a tertiary care center in Northern India over 18 months, it employed a single-arm interventional design. The participants included females aged 18 years and older presenting with breast pain at the Department of General Surgery. The intervention involved daily consumption of 30 g of milled flaxseed for each participant, administered over a period of six months. Pain severity was assessed using the visual analogue scale (VAS) before supplementation and at follow-up intervals up to six months. Concurrently, the Short Form-12 (SF-12) items Health Survey measured health-related quality of life, encompassing both physical and mental health domains. Statistical analysis employed parametric (paired t-test) and non-parametric tests (chi-square, McNemar) where appropriate, with statistical significance set at p<0.05. Results: Two hundred women with mastalgia were included with a significant reduction in mean VAS scores from 6.03±0.83 at baseline to 2.19±0.66 at six months post-intervention (p = 0.0001). This reduction in pain intensity demonstrated a positive correlation with duration of flaxseed supplementation, notably declining after the initial three months. The mean difference in physical and mental SF-12 score at first visit and at 6 months after intervention was significant (p = 0.0001). Conclusion: This study underscores the potential of flaxseed as a therapeutic option for managing mastalgia and enhancing health-related quality of life among affected individuals.

A myriad of methods to determine temporal summation of pain in people with musculoskeletal pain and healthy participants: a scoping review.

Temporal summation of pain (TSP) is a human proxy for wind-up of dorsal horn neurons as assessed in animals. The common paradigm for eliciting TSP is evoked by repetitive nociceptive stimuli of equal intensity. Various stimulation and assessment protocols have been used. This scoping review aims to provide insight into key elements of TSP stimulation and assessment: modality, instruments, test location, familiarization, train characteristics, and calculations. PubMed, Embase, and Ebsco/CINAHL were searched for studies that measured TSP in adults with musculoskeletal conditions and healthy people. Four hundred six studies were included. Mechanical stimuli were the most commonly used modality (250 studies), followed by thermal stimuli (125 studies). Forty-six different instruments were used. Disregarding studies on widespread musculoskeletal pain and healthy participants, 40 studies evaluated TSP at painful sites, 77 in remote areas, and 66 in both locations. Of the 13 tested locations in patients, the hand (74 studies), lower leg (64 studies), and forearm (59 studies) were most commonly tested. A single practice round was the most common familiarization method (46 studies). Repeated stimuli were applied using 31 different frequencies (0.03-200 Hz) and sustained stimulations ranging from 5 to 1080 seconds were used. Twenty-two different train lengths, 63 different calculations (37 absolute, 19 relative, and 7 alternatives using data directly), and 14 different outcome measures (eg, self-reported pain rating scales and reflex thresholds) were used. Temporal summation of pain protocols vary excessively, hindering the comparison and pooling of results. None of the studies provided substantiation for their protocol choice.

Gel instillation sonohysterography (GIS) using Endosgel versus ExEmgel, comparison of pain and image quality and cost benefit analysis: A double blind randomised controlled trial. GISPAIN trial.

INTRODUCTION: Pain experience, physical reaction, image quality and adverse events during Gel Instillation Sonohysterography (GIS) can differ using gels with different compositions. As a result, patient satisfaction can also be affected. The effect of two instillation gels, Endosgel versus ExEmgel, using both the Visual Analogue Scale (VAS) and a Continuous Pain Score Meter (CPSM) was therefore compared. METHODS: This single centre double blind randomised controlled trial included 80 women planned for outpatient GIS, diagnosed with abnormal intrauterine bleeding or fertility disorders and suspicion on an intrauterine abnormality. Patients were randomly allocated to the instillation of Endosgel containing chlorhexidine or ExEmgel without chlorhexidine. Primary outcome was reported pain during the procedure using VAS. Secondary outcomes included pain score measured using CPSM, satisfaction to the procedure and preference at 3 weeks and 3 months after the procedure and image quality. A cost benefit analysis was also performed. RESULTS: The reported median VAS concerning pain during gel instillation was comparable in the Endosgel and ExEmgel group, 2.50 (IQR 0.00-5.00) and 2.00 (IQR 0.00-5.75) respectively (p = 0.69). The median VAS of the entire procedure was also similar: both 2.00 (IQR 0.00-5.00) (p = 0.86). CPSM-scores were not significantly different either. Both groups were similar in image quality (p = 0.83) and patient's satisfaction (p = 0.36). CONCLUSION: Concerning the pain experienced during a GIS procedure and patients' satisfaction, the ExEmgel was not proven to be superior to the Endosgel. Our advice is to use the gel that is available at the lowest costs, as the image quality is the same for both Endosgel and ExEmgel.

The use of 0.5% or 3% NaOCl for irrigation during root canal treatment results in similar clinical outcome: A 6-year follow-up of a quasi-randomized clinical trial.

AIM: To evaluate the 6-year outcome of root canal treatment irrigated with 0.5% or 3% sodium hypochlorite (NaOCl). METHODOLOGY: The baseline trial was designed as a quasi-randomized clinical trial. Patients referred for root canal treatment to an endodontic specialist clinic were recruited to the study (n = 298). The concentration of NaOCl was allocated quasi-randomized to 271 subjects (0.5% [n = 139], 3% [n = 132]). Bacterial sampling was performed immediately before root canal filling. Samples were cultured and evaluated as growth or no growth. Patients were invited to a clinical and radiological follow-up >5 years postoperatively. The clinical outcome measurements were tooth survival, cumulative incidence of endodontic retreatments, patients' assessment of pain, clinical findings and radiological signs of apical periodontitis (AP). RESULTS: Tooth survival was 85.6% in the 0.5% NaOCl group and 81.1% in the 3% NaOCl group (p = .45). There was no record of retreatment in 94.4% in the 0.5% NaOCl group and in 92.2% in the 3% NaOCl group (p = .76). The percentage of asymptomatic cases were 87.8% in the 0.5% group and 85.3% in the 3% NaOCl group (p = .81). Absence of clinical signs of AP was seen in 86.6% in the 0.5% NaOCl group and in 83.6% in the 3% NaOCl group (p = .80). Absence of radiological signs of AP was seen in 74.0% in the 0.5% NaOCl group and 64.1% in the 3% NaOCl group (p = .20). Subjects with positive culture before root filling reported subjective pain with a significantly higher frequency as compared to negative-culture subjects (p = .014). CONCLUSIONS: The use of 0.5% or 3% NaOCl for irrigation during root canal treatment resulted in similar clinical outcomes 5-7 years postoperatively. Persisting bacteria immediately before root filling may predict future episodes of subjective pain.

Influence of the Olfatín Project on the reduction of pain related to intranasal influenza vaccination, as part of a school influenza vaccination program.

PURPOSE: To evaluate the influence of viewing the Olfatín Project video on the assessment of school LAIV-associated pain in three and four-year-old children through the Wong Baker Faces® pain classification scale. DESIGN AND METHODS: A three-arm randomized multicenter clinical trial with a placebo control group was carried out. The main variable measured was pain, assessed through the score on the Wong Baker Faces® Pain Rating Scale. There were a total population of 4591 children three and four-year-olds (born in 2019 and 2020) and who attended the 1st and 2nd year of early childhood education. Before the school vaccination, researchers randomly assigned participant schools corresponding to each of the basic health areas to each of the three study groups: Olfatín's video viewing, a control video viewing not related to influenza and no video viewing. RESULTS: No significant differences according to sex, age or the minor's grade according to the assigned intervention were detected. 72.3% of those vaccinated assigned a 0 from the Wong Baker Faces® scale: 75.4% of those who watched Olfatín's video, 68.3% for those in Drilo's group and 72.8% for those who didn't watch any video, but without significant differences (p = 0.08). There were no significant differences either stratifying by sex. CONCLUSION: LAIV is a painless vaccine for children, which has to be taken into account by the health authorities when planning the pediatric influenza vaccination campaign. PRACTICE IMPLICATIONS: Olfatín's cartoon video can be used by professionals to create a greater experience for children and therefore a better acceptance.

First-Ray Distal Metatarsal and Proximal Phalangeal Osteotomies Without Soft Tissue Procedure for Severe Hallux Valgus: A Case Series.

Background: This case series reported the outcomes of severe hallux valgus treated with first-ray distal metatarsal and proximal phalangeal osteotomies without soft tissue procedure. Methods: The medical records of patients who underwent this surgery from February 2018 to December 2021 were reviewed, including patients with a hallux valgus angle (HVA) ≥40 degrees who were followed up for >2 years. The analyzed data included age, sex, height, weight, and body mass index at the surgery, HVA and intermetatarsal angle (IMA) on the weighted anteroposterior radiograph of the affected foot, the Japanese Society for the Surgery of the Foot score, visual analog scale (VAS) score, and passive plantarflexion and dorsiflexion angles of the first metatarsophalangeal joint 1 month before surgery and at final follow-up. Results: The study group included 35 feet in 29 patients (26 females) with a mean age of 67 ± 10.6 years and mean follow-up of 3.5 ± 0.8 years. Average preoperative and final follow-up measures were HVA, 46.8 to 7.7 degrees; IMA, 18.8 to 9.5 degrees; and VAS score, 61.5 ± 29.6 to 2.7 ± 4.6. Range of motion decreased on average: dorsiflexion, 83.6 ± 14.7 to 71.3 ± 12.0 degrees; and plantarflexion, 63.0 ± 14.7 to 53.0 ± 11.8. All changes were statistically significant (P < .001). Conclusion: This surgery achieved good correction and clinical outcomes for severe hallux valgus, but the postoperative range of motion decreased.Level of Evidence: Level IV, case series.

Vortioxetine treatment for neuropathic pain in major depressive disorder: a three-month prospective study.

Introduction and objective: Several studies revealed the therapeutic potential of vortioxetine (Vo) for pain. In this context, we aimed to evaluate the efficacy of Vo as a safe and tolerable novel pharmacologic agent in treating neuropathic pain (NP) in patients with major depressive disorder (MDD). Materials and methods: The population of this cross-sectional prospective study consisted of all consecutive patients who were newly diagnosed with MDD by a neurology doctor at a psychiatric clinic and had NP for at least 6 months. All patients included in the sample were started on Vo treatment at 10 mg/day. They were assessed with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), Douleur Neuropathique 4 Questions (DN4), Montreal Cognitive Assessment (MoCA), and Neuropathic Pain Impact on Quality of Life (NePIQoL) at the beginning of treatment and during the follow visits conducted at the end of the first, second and third months of the treatment. During these follow-up visits, patients were also queried about any side effects of Vo. Results: The mean age of 50 patients included in the sample, 76% of whom were female, was 45.8 ± 11.2 years. There was a significant reduction in patients' NP complaints based on DN4 and S-LANNS, the subscales of NePIQoL, and significant improvement in MoCA. There was a significant reduction in patients' NP complaints based on DN4 and S-LANNS scores and a significant improvement in scores of the subscales of NePIQoL and MoCA. Conclusion: The study's findings indicate that Vo, with its multiple mechanisms of action, can effectively treat NP independently of its mood-stabilizing effect. Future indication studies for Vo are needed to establish Vo's efficacy in treating NP.

The combined effect of transcutaneous electrical nerve stimulation and transcutaneous auricular vagus nerve stimulation on pressure and heat pain thresholds in pain-free subjects: a randomized cross-over trial.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive modality that utilizes electrical currents to modulate pain in populations with acute and chronic pain. TENS has been demonstrated to produce hypoalgesic effects in postoperative pain, fibromyalgia, knee osteoarthritis, and healthy subjects. Transcutaneous auricular vagus nerve stimulation (TaVNS) is a non-invasive modality that modulates the vagus nerve by stimulating its auricular branches. The effects of the combination of TENS and TaVNS on producing an analgesic response have not been studied. Considering that TENS and TaVNS both stimulate similar analgesic pathways but through different means of activation, we can hypothesize that a combination of both methods can produce a more pronounced analgesic response. Therefore, the objective of this study is to assess the hypoalgesic effect of a combination of TENS and TaVNS in pain-free subjects. METHODS/DESIGN: The study will be a simple crossover design conducted at the University of Hartford. Subjects will be recruited from the University of Hartford population via oral communication, digital flyers, and posters on campus. Thirty participants will undergo two sessions in a crossover manner with one week in between. During one session, the participants will receive TENS with active TaVNS and the other session will be a placebo procedure (TENS with placebo TaVNS). The order of these sessions will be randomized. Importantly, the pressure pain threshold (PPT) and heat pain threshold (HPT) assessors will be blinded to the treatment category. For active TaVNS, a frequency of 25 Hz will be applied with a pulse duration of 200 µs. For placebo TaVNS, the intensity will be increased to a sensory level and then decreased to 0 mA. High-frequency TENS of 100 Hz will be applied in both sessions, with a pulse duration of 200 µsec, asymmetrical biphasic square waveform, and intensity of maximal tolerance without pain. TENS and TaVNS will be turned on for 30 min after a baseline measurement of outcomes. TENS and TaVNS will then be turned off, but the electrodes will remain on until completion of post-treatment assessment. Pressure pain threshold, heat pain threshold, blood pressure, oxygen saturation, and heart rate will be tested 4 times: Once pre-intervention, once during intervention, once immediately after the intervention, and once 15 min post-intervention. Statistical analysis of the data obtained will consider a significance level of p < 0.05. DISCUSSION: This study will provide evidence concerning the combined effects of TENS and TaVNS on pain threshold in pain-free participants. Based on the outcomes, a greater understanding of how TENS and TaVNS, when used in conjunction, can modulate pain pathways. TRIAL REGISTRATION: ClinicalTrials.gov NCT06361381. Registered on 09 April 2024.

A smart device application for acute pain service in surgical patients at a tertiary hospital in South Korea: a prospective observational feasibility study.

BACKGROUND: Pain assessment and patient education are essential for successful postoperative pain management. However, the provision of personnel for performing these tasks is often insufficient. Recently, attempts have been made to implement smartphone applications for educating and monitoring surgical patients. We developed a smartphone application (app) for postoperative pain management, and conducted a feasibility study. METHODS: This single-center prospective observational study included 60 patients aged < 70 years who underwent elective surgery. This study evaluated the SmartAPS application, which offers tools for postoperative pain assessment and educational materials for pain management. The primary outcome was the active usage rate, defined as responding at least twice daily on postoperative days (PODs) 1 and 2. Additionally, we investigated patient satisfaction with the app and educational videos as well as any challenges encountered during use. RESULTS: Sixty patients were enrolled in the study and active app use was achieved in 56.7% of them. Response rates peaked at 85.0% for pain intensity and 83.3% for opioid-related side effects at 14:00 on POD 1 but dropped to 56.7% and 58.3%, respectively, at 18:00 on POD 2. Among the patients who responded to the survey regarding the app usage, 84.0% reported satisfaction with the app and 80% found it beneficial for managing postoperative pain. Furthermore, 92.0% did not encounter difficulties using the app, indicating a generally positive user experience. CONCLUSIONS: Our findings support the utility of the SmartAPS application in acute pain services, highlighting its potential for improving postoperative pain management.

The impact of using pain scales by untrained students on the decision to provide analgesia to multiple species.

OBJECTIVE: To evaluate if students without training assess pain similarly to an expert, and to compare indications for analgesic intervention based on student opinions versus scale scoring. STUDY DESIGN: Prospective, blind, randomized, cross-sectional study. ANIMALS: Video recordings of a bull, horse, cat, pig and sheep. METHODS: First-year veterinary medicine students assessed one video of a horse (n = 44) and one video of a bull (n = 39). Third-year veterinary medicine students assessed one video of a cat (n = 23) and one video of a pig (n = 21). Fourth-year animal science students (n = 16) assessed one video of a sheep. The species assessed by different student classes were determined randomly. Students were unaware of animal history or existing pain assessment and decided whether they would provide analgesia according to their opinion. They then scored each video using species-specific validated pain scales. Scores were compared with those of a board-certified anesthesiologist (expert). Chi-square test was used to compare students and expert. RESULTS: Students underestimated the expert's score by 8-20%, except for the horse. There was no difference between the analgesic indication according to the assessment of the expert (143/143, 100%) and students (141/143, 98.6%) considering the defined analgesic intervention threshold for each scale (p = 0.478). The indication for analgesic intervention according to students' opinion (116/143, 81.1%) was lower than that according to their scale scores (141/143, 98.6%) (p < 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE: Students tended to underestimate pain; however, they detected pain that requires analgesic intervention in animals similarly to an expert. The use of scales optimized the indication for providing analgesia when animals were experiencing pain that required analgesic intervention.

Effect of Bilateral Erector Spinae Plane Block on Postoperative Analgesia in Cesarean Section Under Spinal Anaesthesia: A Prospective Randomized Controlled Trial.

Objective: Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS. Methods: A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 µg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off. Results: The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2nd, 4th, 6th, and 12th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated. Conclusion: As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.