Chronic coccydynia is a difficult pathology to treat due to limited understanding of the etiology and risk factors. Aim of the study was to analyse the clinical and radiological factors associated with poor outcomes in coccydynia.

Prospective observational study.

Patients who visited the spine outpatient department between September 2019 to August 2021 with coccygeal pain of more than two months were included in the study. Lateral radiographs in seated and standing position were done to evaluate their Intercoccygeal angle (ICA), Sacrococcygeal angle (SCA), Basal Angle (BA) and Coccygeal Length. MRI was done for patients who were not relieved with 2 months of conservative treatment. Baseline VAS and ODI scores were documented at the first visit and at six months follow-up to evaluate the outcomes.

168 patients were included - 106 females and 62 males (M:F ratio 1.76) with a mean age of 41.71 years. 109 out of 168 (64.9 %) were obese and 31(18.5 %) were overweight. Type 2 and 4 coccyges were the most commonly seen morphology (67 patients each). Traumatic coccydynia had a better outcome with a mean VAS score of 3.54 compared to 4.36 in the idiopathic group(p < 0.05). Higher Intercoccygeal angle (ICA) was the only radiographic parameter that had coorelation with the outcomes. Mean ICA in good outcomes group was 34.8° (13.2) compared to 42.1° (14.6) in those with poor outcomes(p < 0.05). All 7 patients with pseudoarthrosis had VAS scores reduction of more than 50 %.

Type 2 and type 4 were the most common coccyx morphology encountered in patients with chronic coccydynia. Outcomes were better in traumatic group compared to idiopathic group and in those with pseudoarthrosis on MRI. Higher Intercoccygeal angle(ICA) was the only radiographic parameter associated with poor outcome of conservative management.

To describe and compare patient and tooth characteristics determined prior to treatment among those receiving root canal treatment (RCT) from general dentists (GD) versus endodontists within the National Dental Practice-Based Research (PBRN) Network.

This National Dental PBRN study involved 153 practitioners (104 GDs and 49 endodontists) who used a consecutive enrollment strategy to enroll patients. Practitioners recorded details about pre-operative tooth characteristics. Prior to RCT, patients provided data about their socio-demographic, medication use, temporomandibular disorder (TMD), and psycho-social characteristics. We describe the overall prevalence of these characteristics and compare them by provider type.

1,723 patients were enrolled; 788 by GDs and 935 by endodontists. Endodontists treated higher proportions of female, non-Hispanic white, better-educated patients, patients from the Midwest and Southwest regions, and molar teeth compared to GDs. GDs saw a higher proportion of patients from the Northeast region and whose teeth had a probing depth of 5 mm or more. All of these characteristics were independently and significantly (at p <.05) associated with provider type. Endodontists were more likely than GDs to see patients with TMD symptoms in bivariate comparisons, but their patient groups were similar with regard to treatment outcome expectation, dental fear, depression, and anxiety.

Significant differences exist between endodontists and GDs in patient demographics, tooth characteristics, and treatment patterns, with endodontists treating more molars, female, non-Hispanic white, and educated patients, while GDs manage more cases involving antibiotics use and teeth with deep probing depths, highlighting variations in referral patterns and treatment accessibility.

Anterior cervical discectomy and fusion (ACDF) is a well-established surgical intervention for cervical radiculopathy, primarily indicated to relieve radicular symptoms. While some studies suggest that ACDF improves neck pain, historical data report inconsistent results. This study aimed to evaluate the impact of ACDF on neck pain in patients with isolated cervical radiculopathy treated at a high-volume tertiary care center.

A retrospective review of all ACDF procedures performed at Leeds General Infirmary between January 2021 and March 2023 was conducted. Inclusion criteria were patients undergoing ACDF for isolated cervical radiculopathy. Exclusion criteria included procedures performed for other indications, including myelopathy, myeloradiculopathy, trauma, or tumors. VAS (Visual Analogue Scale) scores for neck pain were collected at four time points: preoperatively, 3 months, 6 months, and 12 months postoperatively. Statistical analysis included mean score comparisons and binomial distribution testing at a 1 % significance level. A total of 41 patients with complete data were included in the final analysis.

The mean preoperative VAS score was 8.32, indicating severe pain (VAS > 7.5). The reduction in neck pain following ACDF exceeded the minimum clinically important difference (MCID) of 2.6 at all postoperative time points, with mean improvements of 3.24 ± 1.76 (39.1 % pain reduction, t(40) = 11.8, p < 0.001), 3.61 ± 1.90 (43.4 % pain reduction, t(40) = 12.2, p < 0.001), and 3.83 ± 2.11 (46.0 % pain reduction, t(40) = 12.2, p < 0.001) at 3, 6, and 12 months, respectively. The proportion of patients reporting severe neck pain decreased significantly from 78.0 % preoperatively to 14.6 % postoperatively (p < 0.01).

ACDF significantly reduces neck pain in patients with cervical radiculopathy, with the most substantial improvement observed within the first three months postoperatively. Pain reduction remained stable and clinically meaningful for up to 12 months. These findings support the efficacy of ACDF in addressing radiculopathy and associated neck pain. Future prospective studies incorporating additional outcome measures, such as quality of life and mental health, are warranted to provide a more comprehensive assessment of patient benefits.

Exercise therapy (ET) is a well-established treatment for chronic low back pain. However, the combined effect of ET with cognitive functional therapy (CFT) on chronic nonspecific low back pain (CNLBP) remains under-investigated. This study investigated how these interventions, used together or separately, affected individuals with CNLBP.

Sixty females (40-60 years) were allocated to ET, ET + CFT, and control groups. Both intervention groups received 24 sessions (3x/week) over 8 weeks. Functional disability, pain, lumbar pelvic motor control, and anxiety/depression were assessed before and after the intervention.

Fifty-one participants completed the study. The ET + CFT group showed greater improvements compared to both ET and control in all measured areas (functional disability, pain, motor control, anxiety/depression) (P < 0.05). However, both ET and ET + CFT groups improved significantly compared to control for all variables (P < 0.05).

Following eight weeks of intervention, both ET and ET + CFT improved functional disability, pain, lumbar pelvic motor control, and biopsychosocial indicators in individuals with CNLBP. Notably, while the combined intervention group (ET + CFT) showed greater improvements across most outcomes, it was significantly different from the exercise-only group only on the Kinesiophobia scale. These findings suggest that cognitive functional therapy may enhance the effectiveness of exercise therapy by addressing psychological factors, such as fear of movement, that contribute to pain and disability in CNLBP.

Forward head posture (FHP) is a common postural malalignment in young population that is associated with limitation of mobility and functional disability. Kendall exercises are one of the commonly used postural correction techniques to treat FHP. Global postural reeducation (GPR) is a postural correction exercise commonly used for musculoskeletal disorders. The current study aimed to investigate the combined effect of GPR and Kendall Exercises in the treatment of FHP.

A single-blinded parallel-groups randomized controlled trial was conducted. Forty-three participants aged 18-30 years were recruited with FHP marked by a craniovertebral angle (CVA) less than 50°. Participants were randomly allocated into two groups: group A (GrA) received GPR plus Kendall Exercises, and group B (GrB) received Kendall Exercises only. Variables were measured before and immediately after 12 sessions of treatment including CVA, gaze angle (GA), shoulder angle (SA), cervical range of motion (CROM), neck disability index (NDI), chest expansion, and spinal mobility.

Between groups analysis revealed no statistically significant difference between either treatment in CVA, CROM, and NDI. There was a statistically significant improvement of chest expansion and spinal mobility in favor to GrA. Within-group analysis revealed that both interventions were statistically significant in improving CVA, CROM, and NDI (P < 0.05). Both treatments showed no statistical difference in GA and SA.

The added effect GPR technique to Kendall exercises significantly improved craniovertebral angle, cervical mobility and functional disability, chest expansion, and spinal mobility in people with FHP.

Parkinson's disease (PD) affects both motor and non-motor functions, but their interactions are understudied. This study aims to explore the relationships between non-motor and motor effects of PD, focusing on depression, fatigue, gait parameters, concentration, and physical function.

This is a secondary analysis of baseline data from a randomized feasibility study using a commercially available Heel2Toe™ sensor, providing auditory feedback for gait quality. The sample included PD patients with gait impairments who walked without aids. Non-motor measures were depression, fatigue, and concentration, while motor measures included gait quality (angular velocity and variability during heel strike, push-off, foot swing) and physical function (6MWT, Mini-BESTest, Neuro-QoL). Path analysis was used to assess direct and indirect effects.

Among 27 participants, fatigue impacted heel strike, which affected Neuro-QoL. Mood influenced push-off and Neuro-QoL, with a direct link to 6MWT. Foot swing affected Mini-BESTest and Neuro-QoL directly.

Non-motor PD effects directly influenced specific gait parameters and physical function indicators, highlighting potential digital biomarkers of fatigue and mood for targeted interventions.

Dream-like and psychedelic experiences often display internally illogical structures. Recent theories propose that these experiences function as "spontaneous offline simulations" related to specific brain processes. This study investigates whether such perceived illogicality reflects a distinct, premodern mode of cognition-commonly referred to as "mythic" cognition-rather than a cognitive deficit.

Thirty-one participants underwent four 90-minute flotation REST (Restricted Environmental Stimulation Technique) sessions designed to induce altered, dream-like states. After each session, participants completed the Phenomenology of Consciousness Inventory (PCI) and additional questions targeting features associated with mythic cognition.

Participants showed significant phenomenological shifts toward experiences characteristic of mythic cognition. Specifically, their altered states during flotation exhibited ontological parallels with mythic conceptions of space, time, and substance.

The findings support the hypothesis that the perceived illogicality in altered states arises from a distinct cognitive framework rather than from deficits.

Few studies have analyzed the characteristics of chronic pain and its functional interference. This study aims to measure the prevalence of pain and assess the intensity, location, treatments used and functional interference in the daily living of patients with chronic pain undergoing hemodialysis treatments in Morocco.

This research has a descriptive cross-sectional design METHODS: A multicenter study was performed in four public hemodialysis centers in Morocco's northern region including 174 patients undergoing hemodialysis. Sociodemographic, chronic pain and interference were evaluated through a structured questionnaire, the Visual Analog Scale and the Brief Pain Inventory.

Descriptive statistics were applied to data analysis. The prevalence of chronic pain was 56.7%, severe in 50.6% of cases and 81.6% experienced continuous pain. The most common pain locations among patients undergoing hemodialysis were the lower limbs 58.6%, back 41.4% and hips 36.4%. Therefore, a high prevalence of severe functional interference of pain has been found in walking 60.34%, general activities 52.87% and work 48.85%. Additionally, analgesics were used by 73.6% of patients, with 46.1% of instances involving frequent use and relief for 32.81%.

Chronic pain is prevalent, undertreated and localized in the lower limbs, back and hips, leading to severe interference with functional activities.

This evidence makes professionals aware of their patient's pain and its impact, and consequently, their assessment must be conducted in a primordial and regular manner to improve management. Pain management can be based on pharmacological approaches such as opioids as well as nonpharmacological approaches.

BackgroundLumbar multifidus (LM) and transverse abdominis (TrA) muscle activation deficits have been reported in patients with chronic low back pain (CLBP). These activation deficits could be related to poor functional capacity and self-reported clinical outcomes.ObjectiveTo determine the associations between lumbopelvic muscle activation and functional capacity, as well as self-reported clinical outcomes in individuals with CLBP.MethodsThirty individuals with CLBP were recruited. Ultrasound imaging was used to measure muscle activation. Participants performed a functional reach test (FRT), 5-time sit-to-stand test (5STS), 2-min step test (2MST), prone trunk extension test (PTET), and abdominal curl test (ACT). Self-reported clinical outcomes including visual analog scale (VAS), duration of low back pain (DLBP), modified Oswestry disability questionnaire (MODQ), and short-form health survey (SF-36) were also collected.ResultsLM activation was significant associated (P < 0.05) with functional capacity (5STS and PTET) and self-reported clinical outcome (SF-36) were observed. Results also demonstrated TrA activation was significant associated (P < 0.05) with ACT, VAS, and DLBP.ConclusionOur findings suggest that clinicians should focus on LM activation to potentially improve functional capacity and quality of life, as well as minimize the chronicity. In addition, pain duration can influence TrA activation, while TrA activation training may be able to modulate pain.

Postoperative pain following spine surgery remains a challenge for patients, surgeons and healthcare facilities. This study aimed to evaluate the postoperative analgesic efficacy of gelfoam soaked in pethidine combined with levobupivacaine, compared to gelfoam soaked in levobupivacaine alone in single-level lumbar laminectomy patients.

This was a prospective, randomized, double blinded study. A total of 90 patients of either sex, aged 18 to 60 years with ASA class I or II planned for single-level lumbar laminectomy were randomly assigned into three equal groups: group A (levobupivacaine plus pethidine): epidural gelfoam soaked with 1 ml levobupivacaine 0.25 % plus 1 ml pethidine 50 mg, group B (levobupivacaine alone): epidural gelfoam soaked with 1 ml levobupivacaine 0.25 % plus 1 ml of 0.9 % sodium chloride; and group C (control group): epidural gelfoam soaked with 2 ml of 0.9 % sodium chloride. Total analgesic consumption, time to first rescue analgesic request, time to ambulate, postoperative VAS scores, vital signs and adverse effects were recorded.

Demographic and baseline patients' data were comparable among the 3 groups. Group B had lower total analgesic consumption, prolonged time to first rescue analgesia, earlier ambulation, and lower VAS scores in the first 24 h in compared to control group C. Significant differences were found between groups A and B in total analgesic consumption, time to first rescue analgesia, and VAS score in the first 24 h. However, no significant differences were found between the two groups regarding time of ambulation and average VAS scores 24 to 48 h after surgery. There were no significant differences in the occurrence of adverse effects among the 3 groups.

This study demonstrated that the addition of pethidine to epidural levobupivacaine in a gelfoam soaked form enhanced the postoperative analgesia in patients undergoing single-level lumbar laminectomy in terms of reduced total analgesic consumption, prolonged time to first rescue analgesia and lower postoperative pain scores.

Intrauterine devices (IUD) are highly effective, but insertion pain deters many. While no consensus exists on gold standard analgesia, practitioners commonly recommend over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). This systematic review evaluates NSAID efficacy for pain reduction during IUD insertion.

We searched PubMed, Embase, Web of Science, Scopus and Cochrane Library using (intrauterine device* OR IUD*) AND (NSAIDs OR non-steroidal anti-inflammatory drugs). The primary outcome was patient-reported pain during IUD insertion. The authors evaluated each publication for bias using the Centre for Evidenced-Based Medine Critical Appraisal Tool for Randomised Control Trials (CEBM).

The search yielded 6,529 studies, retrieving 29 full texts, with 20 meeting inclusion criteria. This review found limited evidence that prophylactic NSAIDs provide clinically significant pain relief for most women. The review included various NSAID types and dosages. Six studies demonstrated a statistically significant reduction in pain (p < 0.05) compared to placebo.

Prophylactic NSAIDs show limited efficacy in reducing IUD insertion pain, with 70 % of studies reporting no significant benefit. These findings, suggesting lower overall effectiveness than previous research, underscore the need for standardized approaches and further research into meaningful pain relief. Heterogeneity in NSAID types, dosages, and pain assessment methods highlights the need for targeted research to improve patient-centered reproductive healthcare.

Patient-reported outcome measures play a key role in efforts to improve the quality and safety of perioperative care. There are no English-language tools to allow children to directly contribute to these efforts. The primary aim of this study was to examine the validity, reliability, acceptability, and feasibility of the use of an English version of the pictorial Quality of Recovery-15 (QoR-15) questionnaire in the context of routine pediatric care.

A prospective observational study was performed including children aged 5-17 years presenting for care at Stony Brook University Hospital. Participants completed the adapted pictorial QoR-15, a VAS pain scoring, and a satisfaction survey before surgery and on Postoperative Day 1. Statistical methods were similar to prior studies that assessed the properties of the QoR-15. Tests were employed to confirm the validity, reliability, and responsiveness of the questionnaire.

A total of 253 children conormpleted testing. Mean (SD) preoperative and postoperative QOR-15 scores were 131.9 (±15.4) and 125.7 (±26.4), respectively. Of note, QoR-15 scores could range from a total of 0 to 150. Each question was internally consistent and correlated well with the total QoR-15 score. Construct validity tests demonstrated that the tool was able to differentiate between known determinants of poor recovery, including the duration of surgery (Spearman's Rho = -0.35 [CI = -0.45, -0.23]) and length of recovery unit admission (Spearman's Rho = -0.37 [CI = -0.47, -0.25]). Lower average postoperative QoR-15 scores were recorded in the context of higher levels of postoperative pain, defined by a VAS ≥ 7, confirming discriminative validity. The instrument demonstrated excellent internal consistency, with a Cronbach's raw alpha of 0.92, and a split-half coefficient of 0.85. These results were consistent across a variety of ages.

Our data suggest that the English-language pictorial QoR-15 has good reliability, acceptability, and responsiveness. This suggests that the tool may allow children to contribute to efforts to both improve and better understand pediatric perioperative care.

There is no existing English-language tool to allow children to describe the quality of their perioperative experience. This is a key gap in efforts to both understand and improve pediatric care.

This study demonstrates the validity, reliability, acceptability, and feasibility for the use of an English pictorial Quality of Recovery questionnaire.

The present study aimed to investigate the effects of high-intensity laser therapy and short-wave diathermy, both with exercise, on pain, physical function, and quality of life in patients with knee osteoarthritis and compare the efficacy of these modalities. This head-to-head randomized study included sixty patients diagnosed with primary knee osteoarthritis (OA) according to the American College of Rheumatology (ACR) criteria and radiologically evaluated as Kellgren-Lawrence stages 2 and 3 bilateral OA patients were divided into two groups according to the therapy: high-intensity laser (HILT) with exercise (n = 30) and short-wave diathermy (SWD) with exercise (n = 30) in which patients treated for 2 weeks (5 days a week for a total of 10 sessions). Visual Analogue Scale (VAS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Timed Up and Go, Stair Climb, 30-s chair-stand, 40-meter Fast-paced Walk, and Short Form Survey (SF-36) tests were performed before and after treatments. Compared to pretreatment, HILT + exercise therapy improved all the test results, while SWD + exercise therapy also improved test scores except for the 30-s chair-stand and 40-meter Fast-paced Walk tests. When HILT + exercise therapy was compared with SWD + exercise therapy, HILT treatment was more effective in all tests except the Stair Climb and 40-meter Fast-paced Walk tests. Although the treatments applied with exercise were effective in both groups, HILT was more effective than SWD in terms of pain, physical, functional, and quality of life. HILT was recommended in the treatment plan of patients with stage 2-3 knee osteoarthritis.

To systematically review the literature on the effectiveness, safety, and long-term outcomes of genicular artery embolization (GAE) for knee joint osteoarthritis (OA) associated pain.

After registering the protocol with the PROSPERO database, a search was conducted from inception until July 31, 2023, in MEDLINE, Cochrane Central Register of Controlled Trials, and ScienceDirect databases to gather studies evaluating GAE's safety and efficacy in knee OA. A total of 4979 studies were identified and evaluated against the inclusion criteria. Data on study characteristics, success parameters, and adverse events were collected and synthesized.

Twenty-three studies, primarily single-center prospective studies with a total of 657 patients, were included. Most studies reported a 100% technical success rates, except one study reporting a rate of 84.2%. Clinical success rates, defined variably across studies, ranged from 30% to 100%, depending on the study's follow-up period and outcome measures. The most frequent adverse events included skin discoloration without an ulcer (15.6%, n = 98) and transient post-procedural knee pain (10.2%, n = 64). Most studies were rated as fair in terms of quality, but the lack of robust randomized controlled trials highlighted the need for further comparative studies to standardize outcome reporting.

GAE appears to be a promising option for knee OA pain, particularly for patients unresponsive to conservative treatments or ineligible for surgery. High-quality studies are needed to confirm long-term effectiveness and standardize outcome measures.Clinical ImpactThis study highlights the safety and efficacy of genicular artery embolization as a minimally invasive treatment for knee osteoarthritis, particularly in patients who are unresponsive to conservative treatments or unsuitable for surgery. By targeting neovascularization and reducing inflammation, genicular artery embolization provides pain relief and functional improvement. Clinicians can consider genicular artery embolization as an alternative to surgery for mild-to-moderate OA, offering a lower adverse event rate and faster recovery.

Narcotic use after retropubic suburethral sling surgery is not unusual. Surgeons may consider using topical analgesics to minimize narcotic use.

The aim of the study was to determine if using bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first 3 days after surgery, measured as morphine milligram equivalents (MME). Secondary aims were to compare, postoperatively, average and worst pain, satisfaction with pain control and quality of recovery between groups.

This was a single-center prospective single-blinded randomized controlled trial for women undergoing retropubic sling surgery. The intervention arm received Zynrelef at the suprapubic incisions, no placebo was used in controls. Participants tracked pain levels, medication use, satisfaction with pain control and Quality of Recovery surveys in the first 3 postoperative days. Appropriate statistical analyses were applied.

A total of 119 women were randomized. For primary outcome, totalmedian MME from postoperative days 0-3, the control group used 37.5 MME compared to 30 MME in the Zynrelef group (interquartile range [IQR] 5.63-71.25; P = 0.61). Pain scores were low in both groups, participants were satisfied or very satisfied with pain control. Quality of recovery scores were similar between groups, with improvement by postoperative day 3 to near baseline scores. Patients with anxiety/depression used more oxycodone; 10 mg (IQR 0-30) vs 0 mg (IQR 0-15), P = 0.0027.

Use of Zynrelef during retropubic sling surgery does not reduce narcotic use in the first 3 days postoperatively. Patients can be reassured that pain and narcotic use after surgery are low and recovery is quick.

This study investigates the frequency and characteristics of obsessive-compulsive (OC) symptoms and Obsessive-Compulsive Personality Disorder (OCPD) in patients with Burning Mouth Syndrome (BMS).

Obsessive-Compulsive Disorder (OCD) is a chronic condition involving intrusive thoughts (obsessions) and repetitive behaviors (compulsions), while Obsessive-Compulsive Personality Disorder (OCPD) is a personality disorder characterized by specific traits such as perfectionism, rigidity and need for control. Both conditions frequently overlap, but their prevalence in patients with BMS has never been explored.

A total of 151 BMS patients were assessed using the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Visual Analog Scale (VAS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hamilton Anxiety and Depression scales (HAM-A, HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Patients were grouped based on OCI and CPAS scores.

n = 123 (81.6%) of our sample were females, with a mean age of 63.19 ± 12.2 years. Clinically significant OC symptoms (OCI-R > 21) were observed in 41.7% of the sample, while 37% met OCPD criteria; both OC symptoms and OCPD were present in 24.5% of patients.

BMS patients show a high prevalence of OC symptoms and OCPD traits, which should be taken into account by clinicians and considered in the therapeutic approach, given that they could complicate symptom management.

By identifying these symptoms and traits through OCI-R and CPAS, clinicians may improve treatment strategies, in the perspective of a multidisciplinary tailored and personalized approach.

Knee osteoarthritis (KOA) is common in Vietnam, affecting about 34 % of individuals over 40 years of age. The Knee Injury and Osteoarthritis Outcome Score (KOOS) is an internationally recognized patient-reported outcome used to assess the impact of KOA but it is not yet available in Vietnamese.

This study aimed to translate the KOOS into Vietnamese and assess the psychometric properties of the translation (KOOS-V).

The translation process involved forward/back translation, expert review and cognitive interviews for pretesting. Content validity was assessed by seven experts using the Content validity Index (CVI). A sample of 133 Vietnamese KOA patients (mean age: 63.7 years, 83 % female) completed the KOOS-V, Short Form 36 Health Survey (SF-36) and Numeric Pain Rating Scale (NPRS), and 67 of them were re-assessed after 5-8 days. Psychometric analyses included internal consistency, test-retest reliability, construct validity and cross-cultural comparison of KOOS-V subscales.

KOOS-V exhibited excellent content validity (CVI = 0.86-1.00), satisfactory internal consistency (Cronbach's α = 0.70-0.98) and good to excellent test-retest reliability (ICC = 0.77-0.90). Construct validity was confirmed by moderate to strong correlations with SF-36 Physical Functioning (Spearman's ρ = 0.66 to 0.82) and moderate correlations with NPRS (ρ = -0.49 to -0.62). The cross-cultural comparison showed that the KOOS subscales in Vietnam presents the same challenge as in other cultures.

The KOOS-V is a reliable, valid tool for assessing the functional impact of KOA in Vietnamese patients, contributing to its broader use worldwide in clinical and research settings.

Objective: It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Method: Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. Results: A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: χ2 = 47.175; p = 0.000; control; χ2 = 30.995; p < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; p = 0.015; p = 0.001; p < 0.000). Leg volume significantly decreased over time in both groups after surgery (p < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; p = 0.192; p = 0.343; p = 0.453; p = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; p = 0.002; p = 0.005; p = 0.006, respectively), it increased with exercise in the control group, first day (p = 0.004) and second day (p = 0.019). Conclusions: MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.

Effective pain recognition and treatment in perioperative environments reduce length of stay and decrease risk of delirium and chronic pain. The authors sought to develop and validate preliminary computer vision-based approaches for nociception detection in hospitalized patients.

This was a prospective observational cohort study using red-green-blue camera detection of perioperative patients. Adults (18 yr or older) admitted for surgical procedures to the San Francisco Veterans Affairs Medical Center (San Francisco, California) were included across two study phases: (1) the algorithm development phase and (2) the internal validation phase. Continuous recordings occurred perioperatively across any postoperative setting. The authors inputted facial images into convolutional neural networks using a pretrained backbone to classify (1) the Critical Care Pain Observation Tool (CPOT) and (2) the numeric rating scale. Outcomes were binary pain/no pain. We performed external validation for CPOT and numerical rating scale classification on data from the University of Northern British Columbia (Prince George, Canada)-McMaster University (Hamilton, Canada) and the Delaware Pain Database. Perturbation models were used for explainability.

The study included 130 patients for development, 77 patients for the validation cohort, and 25 patients from University of Northern British Columbia-McMaster University and 229 patients from Delaware datasets for external validation. Model areas under the curve of the receiver operating characteristic for CPOT models were 0.71 (95% CI, 0.70 to 0.74) on the development cohort, 0.91 (95% CI, 0.90 to 0.92) on the San Francisco Veterans Affairs Medical Center validation cohort, 0.91 (95% CI, 0.89 to 0.93) on University of Northern British Columbia-McMaster University, and 0.80 (95% CI, 0.75 to 0.85) on Delaware. The numeric rating scale model had lower performance (area under the receiver operating characteristics curve, 0.58 [95% CI, 0.55 to 0.61]). Brier scores improved after calibration across multiple different techniques. Perturbation models for CPOT models revealed eyebrows, nose, lips, and forehead were most important for model prediction.

Automated nociception detection using computer vision alone is feasible but requires additional testing and validation given the small datasets used. Future multicenter observational studies are required to better understand the potential for automated continuous assessments for nociception detection in hospitalized patients.

Transperineal prostate biopsy (TPPB) under local anaesthesia is a widely employed biopsy method, and is currently endorsed by the European Association of Urology (EAU). This review aimed to assess the pooled detection rates of clinically significant prostate cancer using TPPB under local anaesthetic. Additionally, pain scores and complications were also reported.

Our search was conducted in line with the most recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations up to August 2024. The study was registered on PROSPERO under the ID: CRD42024588824. An electronic search was conducted of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases along with grey literature using the Google search engine.

In total, there were 2881 patients included in this review. Biopsy histology results were reported in 11 studies comprising 2781 cases. We observed a clinically significant prostate cancer rate of 52% (95% CI 44%-60%) for studies that employed both a mix of systematic and targeted biopsies and 26% (95% CI 23%-30%) when systematic biopsies alone were taken. The pooled rate was 48% (95% CI 37%-59%), overall. Complications after prostate biopsies were reported by 9 studies with a combined 2688 patients. There were 61 patients (2.3%) who had Clavien-Dindo (CD) 1-2 complications and three patients (0.1%) who had CD 3-5 complications. The pooled rate of CD 1 and 2 complications was 2% (95% CI 1%-4%).

TPPB under local anaesthetic is a safe, efficacious and well-tolerated method of prostate biopsy when compared with other methods. Undertaking the procedure under local anaesthesia does not seem to lower cancer detection rates.

Diabetes mellitus is a chronic illness that commonly leads to progressive and incapacitating of patients' condition over the past 20 years.

The aim of the study was to evaluate the effects of the coughing technique, ShotBlockerTo evaluate the effects of the coughing technique, ShotBlocker and vibration device on pain intensity and patient satisfaction during subcutaneous (SC) insulin injections in hospitalised adults with Type 2 diabetes mellitus (T2DM).

The study was conducted at the Imam Al-Hassan Al Mujtaba Teaching Hospital, Al-Imam Al-Hasan Teaching Hospital, Al-Hindia Teaching Hospital, and Imam Al-Hussein Medical City in Holy Karbala. A simple random sampling of adults with T2DM was assigned in the current study from the previously mentioned setting. One hundred and forty patients were classified into 4 groups, 35 patients in the ShotBlocker group, 36 patients in the Vibration group 38 patients in the coughing group and 31 patients in the control group.

There were statistically significant differences in pain scores among the study groups (P = 0.000). The vibration group had significantly lower pain scores (P = 0.000). Similarly, the ShotBlocker group demonstrated significantly lower pain scores (P = 0.000), and the coughing group also exhibited significantly lower pain scores (P = 0.000) compared to the control group. Regarding satisfaction scores, there were statistically significant differences among the groups (P = 0.000). The vibration group had significantly higher satisfaction scores (P = 0.000). Similarly, the ShotBlocker group showed significantly higher satisfaction scores (P = 0.000), and the coughing group had significantly higher satisfaction scores (P = 0.004) compared to the control group.

The coughing technique, ShotBlocker and vibration device are effective, non-invasive methods for reducing pain and enhancing patient satisfaction during SC insulin injections in adults with T2DM.

Current evidence on the quality of sports activity in patients younger than 65 following dual mobility (DM) total hip arthroplasty (THA) is lacking, and whether this coupling allows better performance than single mobility (SM) still needs to be fully clarified. This clinical trial compared sport-related patient-reported outcome measures (PROMs) of the traditional SM versus DM implants in active patients younger than 65. All THAs were performed using a minimally invasive posterolateral approach, polyethylene liner and ceramic head. All implants were cementless. The University of California, Los Angeles (UCLA) activity scores, the High-Activity Arthroplasty Score (HAAS), the visual analogue scale for pain (VAS), and the Harris Hip Score (HHS) were administered to each patient. Patient assessment was conducted on admission, at 12, and at a minimum of 24 months postoperatively. A total of 403 patients were included in the study: 372 SM and 31 DM. The mean age was 56.3 ± 7.2 years. The mean length of the follow-up was 51.3 ± 21.0 months. The present clinical trial found no difference in UCLA, HHS, HAAS, and VAS. Patients returned at a similar level of sports activity in both groups.Level of evidence Level II, prospective group-controlled clinical trial.

The free fibula flap (FFF) is widely used and considered the workhorse flap for osteocutaneous head and neck reconstruction. Donor-site morbidity is considered to be low and mild, and has therefore received little attention. Although sensory deficits and chronic pain have been reported in the donor-site, the incidence of neuropathic pain remains unclear. This study aimed to identify the incidence and prognostic factors associated with neuropathic pain at the donor-site following FFF harvest and investigate its impact on leg function and quality of life.

In this multicenter, cross-sectional study, 150 patients who underwent FFF surgery between 2010-2020 were included. Baseline characteristics were collected. All patients received questionnaires to measure self-reported pain (Doleur Neuropathique 4 and visual analog scale Pain), leg function (Lower Extremity Functional Scale), and quality of life (EuroQol-5D). Multivariable regression analysis was used to identify prognostic factors associated with the outcomes.

A total of 82 patients completed the questionnaires. Neuropathic pain was present in 21% of the patients. Multivariable analysis revealed that donor-site complications (p=0.025) and younger age (p=0.003) were independently associated with neuropathic pain. No difference in neuropathic pain incidence was found between primary and skin graft closure (p=0.54). Patients with neuropathic pain showed a significantly poorer quality of life (p=0.01).

One-fifth of all patients experienced neuropathic pain at the donor-site following FFF harvest. Younger patients and patients with donor-site complications are more prone to developing neuropathic pain. Future research should focus on analyses of surgical factors and optimalization of wound care to reduce the incidence of neuropathic pain.

In the United States (U.S.), 90% of annual health care expenditures are devoted to people with chronic physical and mental health conditions. For people with HIV (PWH), two common, chronic comorbidities are pain and depression. This report assesses the impact of a brief psychotherapy intervention for PWH and comorbid chronic pain and depression on health care service utilization. Data from the HIV Pain and Sadness Study (HIV-PASS) randomized trial were used. Electronic health records were reviewed to tabulate use of the following services: (a) outpatient rehabilitation; (b) outpatient psychiatric; and (c) hospital-based (e.g., emergency department). Estimated average marginal effects were analyzed to determine how many times a participant accessed the service and the charge at each event. The sample consisted of 187 adults recruited from three U.S. sites. Individuals randomized to the three-month, seven session HIV-PASS intervention had average charges for hospital-based services that were significantly less during the post-treatment phase (months 4-12; 95%CI: -$16,612, -$131; p =.046) than those randomized to the comparison condition. On average, comparison condition participants were charged $8,371 more for hospital services in the 8-month period following intervention. No significant differences between treatment conditions were observed in use of outpatient rehabilitation, outpatient psychiatric services, or hospital-based care. Consistent with predictions, lower health care charges among those randomized to the HIV-PASS behavioral intervention were incurred for hospital services, indicating that a brief behavioral intervention could lead to decreased use of more emergent and expensive care services among persons with HIV, depression, and chronic pain.

Pain is pivotal in managing knee osteoarthritis (KOA), necessitating tailored rehabilitative strategies. The biopsychosocial framework suggests that a multifaceted approach is crucial for understanding and managing pain in KOA patients. This study explored the factors that influence pain intensity through biological and psychosocial determinants from a biopsychological perspective in KOA patients.

This cross-sectional study included 150 KOA patients with Kellgren-Lawrence (K/L) grades 2-4. Patients were classified into three groups based on their Visual Analogue Scale scores: mild (n = 79), moderate (n = 40), and severe pain intensity (n = 31). The biological determinants included the body mass index, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for knee function, the 30-second sit-to-stand (30STS) test for functional strength, and the Timed-Up and Go (TUG) test for mobility. Psychological determinants comprised the Depression Anxiety Stress Scale-21 (DASS-21) for emotional well-being, the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia, and the Activities-Specific Balance Confidence (ABC) scale for balance confidence. Social determinants included educational attainment and the Short Form-36 (SF-36) for health-related quality of life.

Significant differences in biopsychosocial determinants were identified among the various pain intensity groups. Biological factors, including WOMAC scores, TUG, and 30STS tests; psychological factors, such as depression and anxiety (DASS-21) and kinesiophobia (TSK); and social factors, including mean years of education and all SF-36 subscales, were significantly worse in the severe pain group (p < 0.05). However, balance confidence did not differ between groups (p = 0.060). Patients in the severe pain group exhibited poorer outcomes across biological, psychological, and social domains, whereas the moderate pain group displayed worse biological and social outcomes when compared to the mild pain group (p < 0.05).

This study emphasizes the significance of a biopsychosocial framework in managing pain in KOA patients. Worsened biological factors like knee function, mobility, and functional strength, alongside psychological issues such as depression and anxiety, influence pain intensity. Social determinants, including lower educational attainment and quality of life, highlight the need for patient-centered care. Future research should include diverse populations and longitudinal data to improve interventions and guide global health policies for integrating the biopsychosocial perspective for KOA management.

Magnetic stimulation has a potential therapeutic effect on patients with chronic nonspecific low back pain (CNLBP). However, the efficacy and underlying brain mechanisms of closed-loop magnetic stimulation for CNLBP remain unclear.

This study aims to investigate the analgesic efficacy and brain activation of repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS) in patients with CNLBP.

This was a single-center, double-blind, randomized controlled trial.

Huashan Hospital.

CNLBP.

Thirty patients with CNLBP were randomly allocated into the experimental group and control group, with fifteen patients in each group. Patients in both groups received CNLBP-related health education. On this basis, patients in the experimental group received a two-week rTMS combined with rPMS treatment, while the control group received rPMS treatment combined with sham-rTMS stimulation. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and Neurometer CPT sensory nerve quantitative detector were used to evaluate the participants before and after treatment. In addition, functional near-infrared imaging (fNIRS) was employed to ascertain participants' brain function.

After treatment, both groups exhibited a significant decrease in VAS and ODI scores compared to their pre-treatment levels (all P<0.05). While there was no statistical significance between the two groups. Neurometer CPT revealed that the experimental group improved the pain threshold of C-fiber on the unaffected side (P=0.036). In addition, compared with the control group, the experimental group exhibited a notable increase in the activation of the somatosensory association cortex (SAC) region and an improvement in the functional connectivity of brain regions, including SAC and the primary motor cortex (PMC), after treatment.

Combining rTMS with rPMS can significantly relieve pain and remodel brain regions in individuals with CNLBP. This closed-loop rehabilitation model paradigm merits additional clinical investigation and implementation.

Magnetic stimulation therapy based on closed-loop rehabilitation mode has a good prospect for clinical rehabilitation for patients with CNLBP.

Our objective is to study the relationship between armed conflict injuries and pain and the treatments that have been applied to Ukrainian injured soldiers in our hospital.

We performed an observational study of a sample of 91 injured soldiers. The metrics we selected for the study included time from injury, length of stay, diagnosis, treatment, type and intensity of pain and questionnaires about pain and quality of life for the group of amputees. The statistical study was carried out using SPSS v.30.

85 % of the 91 patients suffered from pain in at least one part of their body. 53 patients experienced neuropathic pain, 15 patients had somatic pain and 29 patients had a combination of both. The average pain intensity was 6 points in the Visual Analogue Scale (VAS) and 5 points in the DN-4 scale. The most common treatments for neuropathic pain were neuromodulators, nerve blocks, capsaicin patches and TMR (targeted muscle reinnervation).

The study of injuries caused in current armed conflicts can help us anticipate complications and understand and treat pain early to improve the independence of patients, especially of amputee patients.

Retrospective Review.

To assess the impact of preoperative pain and disability on patient-reported outcome measures (PROMs) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis.

Varying preoperative symptom severity in lumbar fusion patients alters perceptions of surgical success.

Degenerative spondylolisthesis patients undergoing elective, primary, single-level MI-TLIF were stratified by preoperative symptom severity: Mild (VAS-B<7/ODI<50), Moderate (VAS-B≥7/ODI<50 or VAS-B<7/ODI≥50), and Severe (VAS-B≥7/ODI≥50). PROMs, Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), ODI, VAS-B, VAS-Leg (VAS-L), and 9-item Patient Health Questionnaire (PHQ-9) were compared at baseline, 6 weeks, and final follow-up (μ=16.3±8.8 mo). Postoperative PROMs, magnitudes of improvement, and minimal clinically important difference (MCID) achievement rates were compared between cohorts through multivariable regression.

A total of 177 patients were included. Acute postoperative pain and narcotic consumption were highest in the severe cohort ( P ≤0.003). All preoperative PROMs worsened from mild to severe cohorts ( P <0.001). All PROMs continued to be significantly different between cohorts at 6 weeks and final follow-up, with the worst scores in the Severe cohort ( P ≤0.003). At 6 weeks, all cohorts improved in ODI, VAS-B, VAS-L, and PHQ-9 (P≤0.003), with the Moderate cohort also improving in PROMIS-PF (P=0.017). All Cohorts improved across PROMs at the final follow-up ( P ≤0.044). Magnitudes of improvement in ODI, VAS-B, and PHQ-9 increased with worsening preoperative symptom severity ( P ≤0.042). The Moderate and Severe cohorts demonstrated higher MCID achievement in ODI, VAS-B, and PHQ-9 rates than the Mild cohort.

Despite preoperative pain and disability severity, patients undergoing MI-TLIF for degenerative spondylolisthesis report significant improvement in physical function, pain, disability, and mental health postoperatively. Patients with increasing symptom severity continued to report worse severity postoperatively compared with those with milder symptoms preoperatively but were more likely to report larger improvements and achieve clinically meaningful improvement in disability, pain, and mental health.

Fibromyalgia pain and related symptoms are poorly managed by approved pharmacological and alternative interventions. This trial aimed to evaluate the effects of the EXOPULSE Mollii Suit-a multisite transcutaneous electrical nerve stimulation device-on fibromyalgia pain, fatigue, affective symptoms, disease impact, and quality of life.

Adult patients with fibromyalgia were enrolled. Phase 1 implied a randomized, sham-controlled, cross-over, double-blind trial, applying daily 1 h sessions of active or sham intervention, over 2 weeks (2-week washout). In the open-label phase 2, all patients received daily active intervention for 4 weeks. Comparisons on pain, fatigue, disease impact, affective symptoms, quality of life, clinical impression, and comfort ratings were performed using Friedman, Wilcoxon signed rank, and Chi2 tests.

Thirty-three patients completed the study (93.9% female, mean age: 51.3 years). Pain (primary endpoint assessed via a visual analog scale) was significantly reduced after the active (pre-active: 6.9 ± 1.4, post-active: 5.9 ± 1.8, pre-sham: 6.8 ± 1.4, post-sham: 6.6 ± 1.5) versus the sham intervention (X2 = 10.60, p = 0.014). This was also the case of other secondary endpoints (i.e., fatigue, anxiety, and disease impact), except depression and quality of life. The Clinical Global Impression of Change (CGI-C) was significantly different between the active and sham intervention periods (X2 p = 0.035), and the different proportions of categories were as follows: 'worsening' (sham: 18.2% vs. active: 0.0%), 'improvement' (sham: 48.5% vs. active 63.6%) or 'no change (sham: 33.3% vs. active 36.4%) respectively. After phase 2, significant positive effects were observed for most of the outcomes, and 78.8% of patients reported improvement according to CGI-C.

This study suggests the clinical benefits of the EXOPULSE Mollii Suit in alleviating pain and fibromyalgia-related fatigue, emotional symptoms, and disease impact. It is worth noting that the study has several limitations related to the low number of participants, the short-term analysis of effects in the first blinded and controlled phase, and the open-label nature of phase 2. Future studies with a larger cohort and longer protocol treatment are needed, to further confirm the current results, and evaluate the long-term effects of this technique.

Patients with fibromyalgia suffer from pain as well as fatigue, sleep impairment, emotional disturbances, and altered quality of life. Transcutaneous electrical nerve stimulation might help manage those symptoms, but the available systems are limited by the fact that they could be applied at best over two sites. This randomized controlled study is the first to apply a multi-site transcutaneous electrical nerve stimulation device, the EXOPULSE Mollii Suit, with significant effects on fibromyalgia pain and related symptoms.

Previous studies in lumbar spine surgery have mainly studied functioning and pain by comparing average scores from Patient Reported Outcome Measures (PROMs) at different time points. Less is known about these changes in different subgroups. It is self-evident that, while most patients may demonstrate trajectories of these changes close to the average one, some groups may follow more or less different trends. Also, it is unclear which preoperative factors may affect the probability of being classified into groups with different development trajectories of surgical outcome. The objective of this study was to identify groups exhibiting distinct trajectories within the broader cohort of patients undergoing lumbar spine surgery and to determine whether certain factors may be associated with a probability of being classified into a particular group.

This was a register-based study of 1,451 patients undergoing lumbar spine surgery. The group-based trajectory analysis was used separately for leg pain, for back pain, and for functioning. The probability of group membership was calculated based on sex, age, leg and back pain duration before surgery, and obesity.

Two kinds of group-based trajectories were identified for each of three-factor variables: a long-term and a short-term improvement group. Sex and age were not associated with being classified into short-term improvement groups, but obesity was associated for all three-factor variables with relative risk ratios (RRR) varying from 1.26 (95% CI 1.02 to 1.56) to 1.45 (95% CI 1.10 to 1.90). Preoperative leg and back pain duration was significantly associated solely with back pain severity with an RRR of 1.28 (95% CI 1.01 to 1.61).

The results of this study suggest that most of the patients may experience pain relief and improved functioning within three months after lumbar surgery, and this effect may last, at least, for two years. Higher BMI and worse preoperative pain and disability were associated with the inferior outcome of surgery. When considering surgery, planning pre- and postoperative rehabilitation, or forecasting the use of pain medications, a higher probability of worse outcome could be expected for overweight and initially more painful patients with higher level of disability.

Abortions are common and associated with procedural pain. We aimed to evaluate benefits and harms of local anaesthesia given for pain control during surgical abortion at less than 14 weeks' gestation.

We searched a systematic review on local anaesthesia for pain control for surgical abortion at less than 14 weeks' gestation using uterine aspiration. We searched multiple databases through December 2022. We evaluated study quality using the Cochrane Risk of Bias 2 (RoB2) instrument and assessed the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Outcomes included intraoperative pain (with dilation, aspiration or procedure), patient satisfaction and adverse events.

Thirteen studies with 1992 participants met the inclusion criteria and the majority were judged as low risk of bias. Intervention protocols were heterogeneous, limiting meta-analysis. A 20 mL 1% lidocaine paracervical block (PCB) reduced pain with dilation compared with sham PCB (mean difference (MD) -37.00, 95% CI -45.64 to -28.36) and aspiration (MD -26.00, 95% CI -33.48 to -18.52; 1 randomised controlled trial (RCT), n=120; high-certainty evidence). A PCB with 14 mL 1% chloroprocaine was associated with a slight reduction in pain during aspiration compared with normal saline PCB injected at two or four sites (MD -1.50, 95% CI -2.45 to -0.55; 1 RCT, n=79; high-certainty evidence). Other RCTs compared a range of local anaesthetic types, PCB techniques and topical anaesthetics. Participants reported moderately high satisfaction with any type of pain control and studies reported few adverse events that were rarely medication-related.

RCT evidence supports PCB efficacy but was inconsistent and of low certainty for topical anaesthesia.

Video-assisted thoracoscopic surgery (VATS) has been widely used for low invasiveness and shorter recovery time. However, patients receiving VATS still experienced moderate-to-severe pain even under both regional and systemic analgesia. Little is known on the effect of non-pharmaceutical method with physical stabilization for post-VATS pain control. The study aims to investigate the feasibility of physical stabilization as a surrogate method for pain control. The single-blinded, randomized-controlled trial recruited the patients into physical stabilization group and standard care group after VATS. The patients in the intervention group tied a thoracic belt for all day, while the control group did not. Both groups had intravenous patient-controlled analgesia (IVPCA) and on-demand oral analgesics. The primary outcome was the visual analogue scale for pain at the 6th, 24th and 48th hour post-VATS and at the hospital discharge. There were 18 patients assigned to the interventional group and 18 patients assigned to the control group. Four patients in the control group were dropped out from the study. Physical stabilization was found to enhance the analgesic effect post-operative 24-48 h compared to standard care (Difference of VAS: 1.11 ± 0.68 v.s. 0.5 ± 0.86, p = 0.031). It had no effect on the dose of IVPCA or the use of oral analgesic agents. No complications direct to the thoracic belt or adverse outcome from the surgery were found in the study. Physical stabilization with thoracic belt to patients receiving VATS benefits to pain control, especially between the 24th and 48th hour post-VATS. Clinical Trial Registry number: NCT04735614.

To evaluate whether transcutaneous electric nerve stimulation (TENS) decreases pain at the time of outpatient endometrial biopsy.

We conducted a randomized, double-blind trial of active TENS compared with placebo TENS at the time of endometrial biopsy. The primary outcome was pain measured on a 0- to 100-mm visual analog scale immediately after biopsy, with secondary outcomes including satisfaction and tolerability of TENS and pain scores at other procedural time points. To detect a 15-mm reduction in pain with a 30-mm SD, 80.0% power, and a significance level of 0.05, 64 participants were required in each arm.

From December 2022 to December 2023, 135 participants were randomized with 67 in the placebo TENS arm and 68 in the active TENS arm. Baseline demographic and clinical characteristics were similar between groups. The median (interquartile range) pain score immediately after biopsy was 50 mm (20-80 mm) in the active TENS group and 60 mm (40-100 mm) in the placebo TENS group ( P =.039). Pain scores at other time intervals were not statistically significantly different. In a subset analysis, participants with higher-than-median baseline anxiety had postprocedural pain scores (interquartile range) of 50 mm (40-80 mm) in the active TENS group compared with 80 mm (50-100 mm) in the placebo TENS group. Overall satisfaction (interquartile range) with pain control (with 100 mm representing completely satisfied) was 87.5 mm (60-100 mm) for active TENS and 70 mm (41-100 mm) for placebo TENS; 85.3% of active TENS participants would use TENS in a future endometrial biopsy. Minimal side effects were associated with TENS, with one participant reporting itching at the pad sites.

Despite a statistical difference in pain scores, a clinical difference was not seen between active and placebo TENS for pain during endometrial biopsy. Satisfaction was higher in the active TENS group, and there were overall minimal side effects associated with TENS.

ClinicalTrials.gov , NCT05472740.

The efficacy of the enhanced recovery after surgery (ERAS) protocols in neurosurgery has not yet been established. We performed a systematic review and meta-analysis of randomized controlled trials to compare the effects of ERAS protocols and conventional perioperative care on postoperative outcomes in patients undergoing craniotomy. The primary outcome was postoperative length of hospital stay. Secondary outcomes included postoperative pain visual analog pain scores, incidence of postoperative nausea and vomiting (PONV), postoperative complications, all-cause reoperation, readmission after discharge, and mortality. A literature search up to August 10, 2023, was conducted using PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases. Five studies, including 871 patients, were identified for inclusion in this review. Compared with conventional perioperative care, ERAS protocols reduced the length of postoperative hospital stay (difference of medians, -1.52 days; 95% CI: -2.55 to -0.49); there was high heterogeneity across studies ( I2 , 74%). ERAS protocols were also associated with a lower risk of PONV (relative risk, 0.79; 95% CI: 0.69-0.90; I2 , 99%) and postoperative pain with a visual analog scale score ≥4 at postoperative day 1 (relative risk, 0.37; 95% CI: 0.28-0.49; I2 , 14%). Other outcomes, including postoperative complications, did not differ between ERAS and conventional care groups. ERAS protocols may be superior to conventional perioperative care in craniotomy patients in terms of lower length of hospital stay, lower incidence of PONV, and improved postoperative pain scores. Further randomized trials are required to identify the impact of ERAS protocols on the quality of recovery after craniotomy.

Hallux rigidus (HR) is a prevalent arthritic condition in the foot. Cheilectomy is a common joint-preserving procedure for HR, involving the removal of prominent osteophytes to relieve impingement of the 1st MTPJ. This study aims to identify factors associated with the failure of cheilectomy in the treatment of HR. A retrospective review of a prospectively collected database from 2007 to 2021 identified all cheilectomy cases. The minimum follow-up was 2 years. Preoperative demographic data, patient-reported outcome measures (PROMs) and foot radiographs were collected. PROMs were reassessed in postoperative reviews, and cases were categorized as successes or failures. Failure was defined by meeting at least one of the following criteria at the latest review: 1) Visual analog pain score (VAS) more than or equal to 4, 2) undergoing subsequent revision procedures, or 3) reporting poor or terrible satisfaction with the surgery. The analysis involved 66 patients, with 19 failure and 47 success cases. Both groups showed similar age, BMI, and gender profiles. Preoperative radiographic parameters were comparable between groups. However, preoperative VAS was significantly higher in the failure group: 7.16 vs 5.23 (p = .0029). Logistic regression confirmed preoperative VAS as a predictor of nonresponse (p = .023). Receiver Operating Characteristic analysis established an optimal cut-off VAS score of 7.0. Patients with a preoperative VAS score of more than 7 had an odds ratio of 5.11 (p = .0055) for failure. A higher preoperative VAS score is significantly associated with cheilectomy failure in HR treatment, suggesting a cutoff score of 7.0.

Various surgical procedures for coracoclavicular (CC) ligament repair have been described for symptomatic acromioclavicular joint dislocations, with none emerging as a clear gold standard. There has been increased interest in arthroscopic approaches. This systematic review evaluates clinical outcomes after arthroscopic surgeries used to treat chronic and acute AC joint dislocations.

We searched three databases (PubMed, EMBASE, and OVID [MEDLINE]) from database inception to December 20, 2022. Studies were included if they met the following criteria: studies evaluating humans, English language studies, level of evidence I to IV, and studies investigating clinical outcomes in patients following arthroscopic surgery for coracoclavicular ligament reconstruction. Studies on open reconstruction techniques only were excluded. Primary outcomes included function/pain scores, coracoclavicular distances, complications, and revision rates.

Fifty-two studies were included. In 33 studies, postoperative Constant-Murley scores ranged from 82.8 to 99 points. Postoperative VAS scores ranged from 0.3 to 4.1 in 16 studies. In 46 studies, revision rates ranged from 0 % to 44.4 %. We did not observe a difference in revision rates between chronic and acute cases (P = 0.268). Complications were more common in chronic than acute cases (25.5 % vs. 16.4 %; P < 0.001).

Arthroscopic surgery for chronic and acute CC ligament injuries exceeds the MCID and PASS for several outcomes, with low failure rates. Arthroscopic CC reconstruction is a safe and effective alternative for chronic AC joint dislocations.

IV (Systematic Review of Level I-IV Studies).

Hip dysplasia (HD) is characterized by insufficient acetabular coverage of the femoral head, leading to a predisposition for osteoarthritis. While radiographic measurements such as the lateral center edge angle (LCEA) and Tönnis angle are essential in evaluating HD severity, patient-reported outcome measures (PROMs) offer insights into the subjective health impact on patients.

To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence (AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs.

Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database. Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score (HHS), international hip outcome tool (iHOT-12), short form (SF) 12 (SF-12), and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation.

The median patient age was 28.6 years (range 15.7-62.3 years) with 82.3% of patients being women and 17.7% being men. The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds, respectively. Manual measurements exhibited weak correlations with HHS, including LCEA (r = 0.18) and Tönnis angle (r = -0.24). AI-derived metrics showed similar weak correlations, with the most significant being Caput-Collum-Diaphyseal (CCD) with iHOT-12 at r = -0.25 (P = 0.042) and CCD with SF-12 at r = 0.25 (P = 0.048). Other measured correlations were not significant (P > 0.05).

This study suggests AI can aid in HD assessment, but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes, complementing AI-derived measurements in HD management.

This systematic review aimed to determine the prevalence of lower back pain (LBP) in equestrian athletes (EAs) and identify associated risk factors. Following the PRISMA guidelines, observational studies published between 2004 and 2024 in English, Portuguese, Spanish, and German were included. The review identified relevant studies through the Web of Science, EBSCO, MEDLINE, and SCOPUS (last search performed on 30 October 2024), yielding 14 studies with a total of 4527 participants. The question format for the included studies specified the population as equestrian athletes, the exposure as equestrian sports, and the outcome as lower back pain. The risk of bias was evaluated using the Observation Study Quality Evaluation tool, and six studies were deemed high-quality. LBP prevalence in EAs was higher than in the general and athlete population, with point prevalence ranging from 27.9% to 87.9%. Sport-specific factors, including workload and stable duties, were significant risk factors. Methodological inconsistencies, such as varying definitions of LBP and a lack of standardized exposure assessment, and the overall low quality of studies limited the comparability of findings. This review underscores the need for more high-quality research and tailored interventions addressing both riding and off-horse activities in EAs.

Cartilage defects (CDs) are regarded as early manifestation of osteoarthritis (OA). The infrapatellar fat pad (IPFP) is an important mediator in maintaining joint homeostasis, disease progression and tissue repair, with a crucial role of its secreted proteins. Here, we investigate the proteome of the IPFP in relation to clinical status and response to surgical treatment of CDs.

In order to characterize the proteome of the IPFP, samples from a cohort of 53 patients who received surgical treatment for knee CDs were analyzed with label-free proteomics. Patients were divided based on validated outcome scores for pain and knee function, preoperatively and at 1-year postoperatively, and on MRI assessment of the defect severity, fibrosis and synovitis.

Specific proteins were differentially abundant in patients with MRI features and better clinical outcome after CD surgery, including a downregulation of cartilage intermediate layer protein 2 (CILP-2) and microsomal glutathione s-transferase 1 (MGST1), and an upregulation of aggrecan (ACAN), and proteoglycan 4 (PRG4). Pathways related to cell interaction, oxidation and matrix remodeling were altered.

Proteins in the IPFP that have a function in extracellular matrix, inflammation and immunomodulation were identified as potentially relevant markers for cartilage repair monitoring.

The use of minimalist shoes can lead to enhanced foot somatosensory activation and postural stability but can also increase the incidence of overuse injuries during high-impact or prolonged activities. Therefore, it appears useful to explore new strategies that employ minimalist shoes to effectively facilitate the somatosensory activation of the foot while minimizing acute and cumulative joint stress and risk of injury. To this purpose, this study introduces a novel exercise paradigm: walking for three minutes in ultra-minimalist shoes on artificial flat surfaces designed to mimic highly rugged natural terrains. The activity of foot muscles and lumbar multifidus, pain perception level, and stabilometric parameters were recorded and analyzed to characterize the novel exercise, comparing it to walking barefoot or in conventional shoes on the same rugged surface. Compared to being barefoot, ultra-minimalist shoes effectively filter nociceptive stimuli from the rugged surface, while compared to conventional shoes, they enhance the somatosensory input supporting static stability. Walking with ultra-minimalist and conventional shoes yielded higher gastrocnemius activity and lower tibialis anterior and multifidus activity compared to barefoot walking. This study highlights a practical and safe framework for enhancing foot somatosensory activation and postural stability. The new intervention is suitable for people of all ages, requires minimal time commitment, and can be performed in controlled environments such as homes, gyms, and healthcare facilities.

This study emphasizes the general relevance of sleep disorders (SD) and temporomandibular disorders (TMD), explores their bidirectional relationship, and describes the importance of systematic reviews in the critical analysis of the literature. This review aimed to comprehensively summarize the relationship between SD and TMD in adults while ensuring a reliable and objective analysis of data from the existing literature.

Systematic reviews were evaluated to investigate this association between two conditions in adults. The study was registered with Prospero and followed the PECOT structure in identifying the research question. Searches in multiple databases were conducted until February 2024 using relevant keywords. The risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, involving two independent reviewers.

Data were extracted using different evaluation instruments, and results were analyzed and presented through the synthesis of information collected in selected systematic reviews. The selection included seven systematic reviews of observational studies, with exclusion criteria defined to ensure methodological quality. The results showed that reviewed studies presented clarity and relevance in defining the eligibility criteria, but that the identification and selection of studies, data collection, and synthesis of results varied. Most studies considered the potential risks, but some require greater transparency and methodological rigor.

This review points out the association between SD and TMD in adults, with most studies presenting a low risk of bias, although some uncertainties were observed.