Pain Levels Following Cosmetic Breast Surgery and An Easy-To-Use Pain Treatment Algorithm for Plastic Surgeons.

INTRODUCTION: The purpose of this study was to examine the degrees of pain experienced following various breast cosmetic surgery procedures and to evaluate the existing pain treatment methods. MATERIALS AND METHODS: Patients who underwent subpectoral breast augmentation, mastopexy, or breast reduction between 2017 and 2022 were evaluated retrospectively. A total of 90 patients were randomly selected, with 30 patients in each group. The visual analog scale (VAS) was used to assess pain levels. The data were analyzed using the statistical program SPSS 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: The subpectoral breast augmentation group exhibited the highest recovery VAS score. Postoperative 1, 2, 4, 6, 12, and 24-h VAS values were higher in the breast augmentation group than in the breast reduction and mastopexy groups. No statistically significant difference observed between mastopexy and breast reduction in terms of VAS scores during the evaluation periods. Statistically significant higher VAS scores were observed for subpectoral breast augmentation at all times compared to the preoperative period. CONCLUSIONS: Subpectoral breast augmentation is associated with higher levels of postoperative pain compared to breast reduction and mastopexy. Effective postoperative pain prevention is crucial following aesthetic breast surgeries. It not only helps to reduce hospital stays but also aids in patient recovery, facilitates a quicker return to daily activities, and enhances patient satisfaction. To achieve this objective, it is advantageous to utilize a practical pain treatment algorithm that is readily applicable. LEVEL OF EVIDENCE III: 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 .

Vasodilatory Peripheral Response and Pain Levels following Radiofrequency Stressor Application in Women with Fibromyalgia.

Fibromyalgia (FM) is a syndrome of unknown pathogenesis that presents, among other symptoms, chronic widespread musculoskeletal pain. This study aims to analyze the effects of radiofrequency on core body temperature and the peripheral temperature of the dorsal surfaces and palms of the hands and its association with pain levels in patients with FM. A case-control observational study was conducted with a total of twenty-nine women diagnosed with FM and seventeen healthy women. Capacitive monopolar radiofrequency was applied to the palms of the hands using the Biotronic Advance Develops device. Peripheral hand temperature was analyzed using a thermographic camera, and core body temperature was analyzed with an infrared scanner. Pressure pain thresholds (PPTs) and electrical pain were recorded with an algometer and a Pain Matcher device, respectively. A significant decrease was observed in women with FM in pain electrical threshold (95% CI [0.01-3.56], p = 0.049), electrical pain (95% CI [2.87-10.43], p = 0.002), dominant supraspinatus PPT (95% CI [0.04-0.52], p = 0.023), non-dominant supraspinatus PPT (95% CI [0.03-0.60], p = 0.029), and non-dominant tibial PPT (95% CI [0.05-0.89], p = 0.031). Women with FM have increased hypersensitivity to pain as well as increased peripheral temperature after exposure to a thermal stimulus, such as radiofrequency, which could indicate disorders of their neurovascular response.

Revolutionizing Sports Rehabilitation: Unleashing the Power of Tele-Rehabilitation for Optimal Physiotherapy Results.

Background: Tele-rehabilitation programs have emerged as a promising approach to improve access to physiotherapy services for athletes with sports-related injuries. This randomized controlled trial aimed to compare the effectiveness of a tele-rehabilitation program with traditional in-person physiotherapy in improving outcomes for this population. Methods: This randomized controlled trial enrolled a large sample of 780 athletes with sports-related injuries to compare the effectiveness of tele-rehabilitation and traditional in-person physiotherapy. Blinding procedures were implemented to minimize bias. The intervention group received tele-rehabilitation physiotherapy, whereas the control group received traditional in-person physiotherapy. Pre- and post-intervention assessments were conducted to measure outcome measures, including range of motion, muscle strength, pain levels, and functional performance. Results: Significant improvements were observed in all outcome measures in both the tele-rehabilitation and in-person groups from baseline to postintervention. Independent t tests demonstrated no significant differences between the two groups in any of the outcome measures. These findings indicate that the tele-rehabilitation program was as effective as traditional in-person physiotherapy in improving the outcomes of athletes with sports-related injuries, even in a large sample size of 780 participants. Conclusion: This study provides robust evidence supporting the feasibility and effectiveness of tele-rehabilitation programs as viable alternatives to traditional in-person physiotherapy for athletes with sports-related injuries. These findings highlight the potential of tele-rehabilitation to significantly expand access to high-quality physiotherapy services for a large number of athletes. Further research should focus on evaluating the long-term effectiveness and cost-effectiveness of tele-rehabilitation programs in sports rehabilitation using larger sample sizes.

The Total Intra Venous Anesthesia Effect Versus Volatile Anesthesia, on Stress and Pain Levels, in Patients Undergoing Breast Reconstruction in Ambulatory Surgery Center Total Intra Venous Anesthesia Protocol and Stress Response.

AIM: To compare pain and stress response through cortisol and DHEA levels, implementing. Total intra venous anesthesia (TIVA) versus general anesthesia with volatile anesthetics (VOL). DESIGN: This is a prospective randomized correlation study with consecutive measurements. METHODS: In an ambulatory surgical center from October of 2019 to August of 2020, patients who underwent breast reconstruction with autologous fat grafting were randomized into 2 groups. Patients in the TIVA group (n = 23) received intravenous anesthesia and those in the VOL group (n = 23) received volatile anesthesia (desflurane). Demographic, anthropometric and clinical data were recorded. Arterial systolic (SP) and diastolic (DP) blood pressure, heart rate and oxygen saturation were recorded. Pain and stress levels were evaluated through salivary cortisol and DHEA levels at 4 different time points: T0) 1 hour before induction, T1) during the induction, T2) during anesthesia maintenance, and T3) in recovery phase. Statistical analysis was performed with SPSS 25.0 at significant level α = .05. FINDINGS: There were no statistically significant differences between the 2 groups regarding demographic features. Interestingly that there was a statistically significant difference in the vital sign monitoring where patients in the TIVA group reported with higher levels of SP(T2) and DP (T2), whilst DHEA (T1) levels was correlated positively with patient's age and cortisol (T1) levels and negatively with DP (T3). CONCLUSIONS: This study supports the use of TIVA as a safe and effective option for anesthesia in patients undergoing breast reconstruction with autologous fat grafting.

Comparison of Pain Levels With Postoperative Intramuscular Administration of Single-Dose Ketoprofen Versus Diclofenac Sodium in Patients Undergoing Lower Third Molar Surgery.

Background Third molar surgeries are commonly performed in oral and maxillofacial surgery practice. Pain associated with this procedure is usually a frequent reason for patient apprehension and discomfort. Oral analgesics, though effective, do not provide sufficient pain relief in the immediate postoperative period.  Aim To assess the postoperative effect on pain levels of single-dose administration of ketoprofen and diclofenac sodium as an injection in patients undergoing third molar removal surgeries.  Methods This study was conducted among 30 patients divided into two groups (n=15). Patients in Group K received injection ketoprofen 100 mg and Group D included patients receiving injection diclofenac sodium 75 mg, both intramuscularly postoperatively. The intensity of pain was assessed at 30 minutes, two, six, and eight hours post-surgical removal of the impacted tooth using the visual analogue scale (VAS). The statistical data was analyzed using SPSS for Windows version 23.0 (IBM Corp., Armonk, NY, USA). The comparative statistical test adopted to compare pain scores between the two groups was the Independent samples t-test. A p-value of <0.05 was considered to be statistically significant. Results Our study results revealed that Group K patient's VAS scores after two hours, six hours, and eight hours were 3.9 ± 2.7, 4.5 ± 3.23, 2.93 ± 2.27 respectively. In Group D patient's VAS scores after two hours, six hours, and eight hours were 4.83 ± 2.82, 5.03 ± 2.9, 3.73 ± 2.91 respectively. Patients who were administered ketoprofen had lower pain levels when compared to patients who were given diclofenac but the difference was not statistically significant at any time point (p=0.172 after eight hours). Our results depicted that the pain levels uniformly reached their maximal levels six hours after the procedure and thereafter steadily declined in both groups.  Conclusion It can be concluded from the study that both the drugs ketoprofen and diclofenac sodium analyzed in this study can be used interchangeably for the reduction of pain following lower third molar surgery.

Technology-guided assessment of vocalisations and their diagnostic value as pain indicators for people living with dementia.

BACKGROUND: during pain assessment in persons unable to self-report, such as people living with dementia, vocalisations are commonly used as pain indicators. However, there is a lack of evidence from clinical practice regarding their diagnostic value and relationship with pain. We aimed to explore vocalisations and pain in people with dementia undergoing pain assessments in clinical practice settings. METHODS: a total of 22,194 pain assessments were reviewed in people with dementia (n = 3,144) from 34 different Australian aged care homes and two dementia specific programs. Pain assessments were conducted by 389 purposely trained health care professionals and cares using PainChek pain assessment tool. Vocalised expressions were determined based on nine vocalisation features included in the tool. Linear mixed models were used to examine the relationship of pain scores with vocalisation features. Using a single pain assessment for each of the 3,144 people with dementia, additional data analysis was conducted via Receiver Operator Characteristic (ROC) analysis and Principal Component Analysis. RESULTS: vocalisation scores increased with increasing pain intensity. High pain scores were more likely with the presence of sighing and screaming (8 times). The presence of vocalisation features varied depending on the intensity of pain. The ROC optimal criterion for the voice domain yielded a cut-off score of ≥2.0 with a Youden index of 0.637. The corresponding sensitivity and specificity were 79.7% [confidence interval (CI): 76.8-82.4%] and 84.0% (CI: 82.5-85.5%), respectively. CONCLUSION: we describe vocalisation features during presence of different levels of pain in people with dementia unable to self-report, therefore providing evidence in regard to their diagnostic value in clinical practice.

The effect of Orem's nursing theory on the pain levels, self-care abilities, psychological statuses, and quality of life of bone cancer patients.

OBJECTIVE: This study aims to explore the impact of Orem-based nursing intervention on the pain levels, self-care abilities, psychological statuses, and quality of life in bone cancer patients. METHODS: A total of 91 patients with primary bone cancer admitted to our hospital from January 2019 to January 2020 were randomly placed into one of two groups. The patients in the control group (n=43) underwent routine nursing care, and the patients in the experimental group (n=48) underwent Orem-based nursing care during the perioperative period. The two groups were compared in terms of their postoperative recovery times and treatment effects, and their adverse emotion scores, pain levels, self-care abilities, and quality of life before and after intervention. RESULTS: The treatment efficacy in the two groups was similar, but the postoperative recovery times in the experimental group were shorter than they were in the control group (P < 0.05). Compared with before the intervention, the SDS, SAS, and VAS scores were significantly decreased in both groups (P < 0.05), and their self-care abilities and quality of life were significantly higher (P < 0.05) after intervention. CONCLUSION: Orem-based nursing combined with perioperative care can mobilize patients' initiative, significantly improve patients' adverse emotions and pain levels, shorten their postoperative recovery times, and help improve their self-care abilities and quality of life.

Investigation of grip strength, pain threshold, pain tolerance and function in smartphone users.

PURPOSE/AIM OF THE STUDY: Few studies have demonstrated the effects of smartphone use on grip strength and upper extremity function. The present study was purposed to compare smartphone users' grip/lateral pinch strength, pain threshold/tolerance and upper limb function. MATERIALS AND METHODS: A prospective cross-sectional study was conducted with 241 individuals. Participants were divided into three groups with the cut-off values of the Smartphone Addiction Scale (SAS). The Edinburgh Handedness Inventory (EHI) was used to determine the dominant side. Thumb pain threshold and tolerance were evaluated with the algometer. A hand dynamometer measured the grip and lateral pinch strength. Upper extremity functions were evaluated with the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick-DASH). RESULTS: Handgrip strength of the dominant/non-dominant extremities and Quick-DASH scores were higher in low-level smartphone users (p < 0.05). There was no significant difference between the groups on lateral pinch strength and pain threshold/tolerance (p > 0.05). Smartphone usage significantly affected dominant and non-dominant hand grip strength (Standardized ß1 = -0.15, ß2 = -0.15, p < 0.05). In addition, the smartphone use level negatively affected dominant lateral pinch strength (Standardized ß = -0.12, p = 0.05). On the other hand, smartphone use positively affected upper extremity function (Standardized ß = 0.17, p < 0.05). CONCLUSIONS: As smartphone addiction increases, standard handgrip strength and functionality decrease. Pain threshold/tolerance is not affected by smartphone use. Future studies should focus on fine motor skills to present a more comprehensive upper limb function evaluation.

Seasonal impact on the outcome of multidisciplinary pain therapy.

Multidisciplinary pain treatment programs (MPTP) have been considered to be the most effective treatment of chronic pain. In this study, we analyzed the influence of seasons on the outcome of chronic pain patients undergoing MPTP. Therefore, a prospective, observational trial was conducted in patients with chronic pain undergoing a 5-week interdisciplinary treatment program. Psychological stabilization (measured by ADS - Allgemeine Depressionsskala) and pain levels (measured by NRS - numeric rating scale) were considered as primary endpoints. As a result of this study, we could show that chronic pain patients (exempt patients with chronic headache) showed a highly significant better improvement in terms of ADS after MPTP when participating in autumn (coefficient: -11.67, p = .004). Patients treated during winter showed a tendency towards a better improvement in ADS scores (coefficient: -6.89, p = .051). These effects were not found in patients suffering from chronic headache. Finally, patients participating in MPTPs during summer, autumn, and winter presented a tendency of higher reduction in pain scores when compared to patients participating in spring. In conclusion, the effect of MPTPs in terms of psychological stabilization is considered to be best during autumn. This should be therefore considered in planning an MPTP in all patients who do not need immediate psychological stabilization. The treatment effect of MPTP on pain seems not being dependent on a specific season.

Are physical therapy pain levels affected by surgical approach in total hip arthroplasty? A randomized controlled trial.

The main objective of this study was to evaluate the difference in pain levels during postoperative physical therapy pathways in patients who underwent a cement less total hip replacement either through a muscle sparing direct anterior approach (DAA), or the classic trans-gluteal lateral approach (LA). One hundred and twelve (112) patients were randomized into two equal groups. Baseline values of myoglobin levels were acquired prior to surgery and repeated at 6 hours postoperatively as a biomarker for muscle damage. Pain levels during the first passive and consecutive 3 active physical therapy sessions were noted using a visual analogue-numeric scale (VAS). Pain levels were also acquired at 6 weeks, 3 months, 6 months and 1 year, following a 20-meter (65.6 feet) walking test. Postoperative myoglobin (ng/mL) levels were significantly higher (p< 0.05) in the LA group (335.05±83.54) then the DAA group (237.71±57.54). Pain levels were significantly lower (p<0.001) in the DAA group for both passive (2.5±1.45 vs. 4.28±2.19) and active physical therapy sessions and there was a positive correlation between postoperative myoglobin levels and pain levels until 6 postoperative weeks. There was no significant difference in demographics between the two groups except for gender distribution. The direct anterior approach's main advantage of being a minimally invasive muscle sparing technique is showing a better rehabilitation experience with lower pain levels during passive and active physical therapy when compared to the classic trans-gluteal lateral approach.

Acute whiplash associated disorders (WAD).

BACKGROUND: Whiplash-associated disorder (WAD) is the term given for the collection of symptoms affecting the neck that are triggered by an accident with an acceleration-deceleration mechanism such as a motor vehicle accident. The incidence of whiplash injury varies greatly between different parts of the world with significant monetary burden on the individual as well as the wider community. OBJECTIVE: Which treatments are best for reducing pain and disability experience in acute WADs? LEVEL OF EVIDENCE: Clinical practice guidelines, systematic reviews, meta-analysis, randomized controlled trials. SEARCH SOURCES: PubMed, Cochrane Library, Medline, EMBASE, AUST health, AMED. OUTCOMES: From the patient perspective the main outcomes considered are pain and disability. CONSUMER SUMMARY: Whiplash-associated disorders include a range of symptoms related to the neck and head. They commonly occur after motor vehicle accidents or diving mishaps. There is good evidence to suggest that active exercise, acting as usual and combination therapy are the most effective treatment choices in an acute presentation.