Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR). The secondary purpose was to identify risk factors related to experiencing increased postoperative pain or requiring increased postoperative prescriptions.

A retrospective cohort study was performed evaluating 58 patients receiving a tramadol-based pain management protocol and 103 patients receiving an oxycodone-based protocol after ARCR. VAS pain scores were obtained preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. The change in VAS score from preoperative to 3-month follow-up was calculated. Total milligram morphine equivalent (MMEs) prescribed, number and timing of refills, and the proportion of patients failing the tramadol protocol who required oxycodone were recorded. Multivariate regression analysis was performed to determine risk factors for having higher postoperative pain scores and requiring an increased number of prescriptions.

The average total number of MMEs prescribed for patients who received oxycodone was over 8 times greater than for patients who received tramadol (993 vs. 120 MMEs). Both groups demonstrated improvements in pain scores at all time points. Patients receiving tramadol had a greater change in VAS score from pre to postoperative at all timepoints. Patients who were prescribed oxycodone received a greater number of refills and were 2.7 times more likely to need a refill within 3 months than those receiving tramadol. Only 4 patients (6.9 %) receiving tramadol required oxycodone within 3 months of surgery.

As part of a multimodal protocol, tramadol provides equivalent pain relief after ARCR compared to oxycodone while requiring fewer MMEs. Patients prescribed oxycodone exhibit a smaller magnitude of improvement in VAS pain and require more refills than those prescribed tramadol. Our findings can be used to improve opioid prescription practices to reduce dependency and over prescription of narcotics.

Neurofibromatosis type 2 (NF2) is a genetic disorder caused by mutations in the NF2 tumor suppressor gene. This disease causes the growth of multiple schwannomas and meningiomas. There are currently no Food and Drug Administration-approved treatments for these malignancies. Due to their continuous development, these tumors cause a high rate of morbidity and mortality. The aim of the present study was to observe the short-term efficacy of brigatinib in treating NF2. Patients diagnosed with NF2 at The First Medical Center of Chinese PLA General Hospital (Beijing, China) between June 2021 and April 2024 were retrospectively enrolled and treated with 90 mg oral brigatinib once daily, with changes in the size of meningiomas and vestibular schwannomas, as well as hearing, emotional state and pain, measured before and after treatment. Adverse reactions to medication administration were also seen and documented. Changes in markers before and after therapy were investigated using repeated-measures ANOVA. Patients were stratified into two age groups (<18 and ≥18 years), with disease progression evaluated by longitudinal changes in meningioma maximal diameter on magnetic resonance imaging. The log-rank test was used to determine the difference in time between drug delivery and illness development. A total of 12 patients were enrolled. After 12 months of oral brigatinib therapy, the meningioma volume significantly decreased (P<0.05) at both the 6 and 12th month. There was a significant difference in time to illness development between individuals aged <18 and ≥18 years (P=0.049). The symptom checklist-90 and visual analogue scale scores were considerably reduced at 6 and 12 months (P<0.05). However, no significant improvement was seen in acoustic neuroma volume or the mean hearing threshold (both P>0.05). In conclusion, brigatinib may relieve meningiomas and pain and improve emotional well-being in patients with NF2.

To evaluate the longer-term efficacy of 10 kHz spinal cord stimulation (SCS) in managing painful diabetic neuropathy (PDN) in a routine clinical setting after the transition from the 24-month SENZA-PDN study.

We contacted 142 participants who completed 24 months of postimplantation follow-up in the former randomized controlled trial (SENZA-PDN). Of these, 57 consented and responded to this longer-term post-study survey. Outcomes assessed included pain relief, health-related quality of life (HRQoL) measured using the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) instrument, Patient Global Impression of Change (PGIC), HbA1c, and weight.

Our survey captured patient-reported outcomes at a median of 4.1 years after implantation of a permanent 10 kHz SCS system. Among the surveyed participants, 76.8% (43 of 56) reported clinically meaningful pain relief (≥2 points), and 84.6% (44 of 52) achieved a clinically meaningful improvement in their EQ-5D-5L index score, with a final mean EQ-5D-5L index score of 0.825. Additionally, 74.5% (38 of 51) reported being "Better" or "A great deal better" on the PGIC scale. The surveyed participants reported a mean HbA1c level decrease of 0.4% (p = 0.027), with a more substantial improvement of 1.6% (p < 0.001) among those with type 2 diabetes (T2D) and a higher preimplantation HbA1c (>8%). Significant weight loss was also observed, with a mean reduction of 7.0 kg (p < 0.001) in the overall cohort and 8.7 kg (p < 0.001) in the subgroup with T2D and a higher BMI at preimplantation (≥35 kg/m2).

High-frequency SCS at 10 kHz provided sustained and clinically meaningful improvements in pain and HRQoL for PDN patients at 4.1 years postimplantation, with no explants in the cohort due to inefficacy. Alongside these benefits, participants experienced metabolic changes that included reductions in body weight and HbA1c beyond that achieved at 24 months, although changes in lifestyle and medication were not accounted for in this analysis. Notably, the cohort's final mean EQ-5D-5L index score was comparable to the US norm. These findings support 10 kHz SCS as a durable and effective treatment option for PDN in routine clinical practice.

Primary dysmenorrhea(PDM) is defined as painful menstrual cramps without any evident pathology, exhibiting central nervous system(CNS) sensitivity and functional and structural changes in brain regions responsible for pain perception and modulation. Previous imaging studies primarily focused on functional changes, with only a limited number of studies investigated changes in brain morphology, and these studies generally used small sample sizes. It remains largely unknown whether brain structural changes are coupled with functional changes in patients with PDM, as well as the association between structural alterations and prostaglandin levels. This study used voxel-based morphometry(VBM) analysis to examine total and regional gray matter volume(GMV) increases and decreases in a larger sample of 59 patients with PDM and 56 healthy controls(HC) during the pain-free periovulatory phase. Abnormally increased regional GMV were involved in emotional regulation, pain rumination, and network integration functions while decreased regional GMV were involved in pain perception, emotional response, attention regulation, and pain-related visual cortex. This study found that the left mid-cingulate cortex is an important node in pain anticipation and attention, modulation of the salience network(SN), regulation of spinal nociceptive processing via descending control pathways for patients with PDM. Finally, this study examined the directional signaling patterns among these altered regional GMV using Time-Delay method and found that structural alterations were accompanied by changes in functional integration. Our findings provide preliminary insights into the CNS mechanisms underlying the link between structural and functional changes and subjective pain perception, offering valuable information for clinical pain interventions in patients with PDM. PERSPECTIVE: This study used voxel-based morphometry, Time-Delay and NBS-predict to examine gray matter volume alterations and related directional signaling patterns in patients with PDM. Structural alterations accompanied by changes in functional segregation were found during pain-free periovulatory phase.

To investigate the feasibility and effectiveness of interventions aiming to decrease pain and anxiety during cystoscopy.

A prospective study of 190 adults undergoing flexible office cystoscopy was conducted at the University of North Carolina and the University of Texas Southwestern from January to September 2023. Patients were offered 20 mL intraurethral 2% lidocaine with a dwell time of ≤10 or >10 min and either music on headphones or real-time cystoscopy visualisation. Patients declining the offered intervention were provided their requested study intervention. Outcomes included pain (visual analogue scale [VAS], pain intensity) and anxiety. Multivariable regression models controlled for age, sex, prior cystoscopies, bladder cancer surveillance, site, and intervention preferences. Feasibility was evaluated by patient acceptance of interventions.

Of 190 patients, 35% (66/190) declined their assigned intervention, with 8% (7/90) declining visualisation and 59% (59/100) declining music alone. Patients with prior cystoscopy were more likely to decline music (69%) than cystoscopy-naïve patients (31%). Visualisation was associated with lower reported pain on the VAS and anxiety than music. Patients receiving both music and visualisation reported the highest proportion of no-to-mild pain. Lidocaine dwell time did not significantly affect outcomes.

Allowing patients to visualise or listen to music during their office cystoscopy are simple, accessible means of reducing pain and discomfort with the procedure, particularly for cystoscopy-naïve patients.

Sensorimotor training (SoMT) is a gradual balance training technique employed to treat various chronic musculoskeletal pain. Core strength training (CST) is one of the most commonly used interventions for managing low back pain (LBP). This randomied controlled trial protocol aims to determine whether the combination of SoMT and CST can significantly reduce LBP, and improve scoliosis-related outcomes and overall functional status in adult idiopathic scoliosis (AdIS) patients.

A total of 300 AdIS patients will be recruited from the outpatient clinic and randomly assigned to one of three groups: CST group, SoMT group or the combined therapy group, using stratified block randomization based on the severity of scoliosis curve. All groups will receive the intervention three times a week for 12 weeks. Sessions will be conducted in the hospital, and no home programme will be provided. Adherence and attendance will be monitored and recorded. The CST group will receive CST therapy, while the SoMT group will receive SoMT therapy, which consists of three progressive phases: static, dynamic and functional. Participants will progress to the next phase on achieving pelvic stability in the current phase. The combined therapy group will receive both CST and SoMT. Assessors and statisticians will remain blinded to participant allocation throughout the study. Assessments will be performed at baseline and at the endpoint, 12 weeks after the initiation of the intervention. The primary outcome will be the self-reported pain level, measured using the visual analogue scale. Secondary outcomes will include pain-related disability (by the Oswestry Disability Index and the Roland-Morris Disability Questionnaire), spinal morphology indicators (including Cobb angle, the angle of trunk rotation and the Sagittal Index), postural control ability (by the Tetrax IBSTM), proprioceptive sensitivity (by the repositioning error test) and health-related quality of life (by the 36-Item Short Form Health Survey). Statistical analysis will adhere to the intention-to-treat principle and will be complemented by per-protocol analysis. To compare the effects of SoMT versus CST and combined therapy versus SoMT on both primary and secondary outcomes, a linear mixed-effects model or generalised linear mixed model will be applied.

The current study received ethical approval from the Xinhua Hospital Ethics Committee Affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2024-080-3). Written informed consent will be obtained from all participants. Any interim analysis and full results will be published in an international peer-reviewed journal.

This protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2400085370).

Labour pain is an unavoidable feature of childbirth and is characterised by extreme intensity. Adequate pain management is thus essential not only from the aspect of physiological pain but also due to the adverse effects of pain on the psychological well-being of parturients. Many studies have shown the benefits of acupoint hot compress. However, to date, little is known about its use for alleviating labour pain. The purpose is to evaluate the effect of acupoint hot compress on relieving pain in primiparous women during the latent phase of the first stage of labour, as well as its effects on key maternal and neonatal outcomes.

This prospective, multicentre, randomised controlled trial will be conducted across 18 institutions in China from January 2024 to August 2025. A total of 1100 primiparous women aged 20-34 years, with singleton pregnancies at 37-41 weeks of gestation, will be enrolled and randomly allocated to two groups using a central stratified block randomisation method. The controls will be treated only with obstetrical care, while those in the intervention group will receive the same obstetrical care as the control group, with the addition of acupoint hot compress therapy at 42±2°C for 4 hours, starting 1 hour after the onset of regular uterine contractions during the latent phase of labour. The primary outcome will be the pain intensity measured at 1, 3 and 5 hours after the onset of regular uterine contractions using a Visual Analog Scale.

The study has been approved by the ethics committee of Women's Hospital, School of Medicine, Zhejiang University (No. IRB-20230379-R). The results of the main trial will be submitted for publication in a peer-reviewed journal.

This trial is registered at Chinese Clinical Trial Registry, ChiCTR2300079244.

In the context of vulvodynia, a gynecological disorder characterized by chronic vulvar pain affecting an estimated 10% of women, with significant impacts on sexual health, mental well-being, and productivity, the Common-Sense Model of Illness Self-Regulation, a well-established framework for understanding the impact of illness perceptions and coping strategies on mental health, has not yet been empirically tested.

We aimed to explore whether illness perceptions and pain-specific coping strategies-namely, pain catastrophizing and chronic pain acceptance-influence the relationship between vulvar pain severity and depression in women with vulvodynia.

A cross-sectional study was conducted on a total of 119 women with reporting diagnosis of vulvodynia.

Through an online questionnaire, we assessed demographic and clinical characteristics, vulvar pain severity, illness beliefs, pain catastrophizing, pain acceptance, and depressive symptoms.

The path analysis showed that vulvar pain positively influences directly illness perceptions (β = .56, P < .001) and depressive symptoms (β = .24, P < .001). Negative perceptions of the illness were significantly associated with increased pain catastrophizing (β = .66, P < .001), and decreased pain acceptance (β = -.59, P < .001), resulting in heightened depressive symptoms (β = .33, P < .001, β = -.27, P < .001, respectively).

Interventions that challenge negative illness perceptions and promote more positive views could reduce maladaptive coping strategies, enhance pain acceptance, and ultimately diminish psychological distress.

This study's strengths lie in its foundation on a theoretical, well-established model and the use of validated measures. However, the cross-sectional design precludes concluding causality between predictor and outcome variables, and the clinical information was self-reported and could not be verified with medical records.

The findings underscore the importance of targeting illness perceptions and coping strategies in shaping psychological outcomes for women with vulvodynia.

Older women living with HIV are uniquely situated at multiple marginalized intersections because of their gender, age, and HIV status. However, research into how gender-based stigma (GBS) affects HIV prevention and care for older women is sparse. We conducted a scoping review to explore the relationship between GBS and HIV-related psychosocial, behavioral, and well-being outcomes among older women. Our systematic search yielded 25 articles describing 22 unique studies. We identified five main themes highlighting how GBS exists at individual, interpersonal, and societal levels to adversely affect HIV prevention and treatment among older women: (a) relationship power, safe sex practices, and intimate partner violence; (b) stigma, discrimination, and harmful stereotypes; (c) quality of care; (d) caregiving roles and responsibilities; and (e) psychological and physiological manifestations. Outstanding questions remain on best methods for measuring and conceptualizing GBS in HIV research and ways to translate research findings to public health practice.

To compare cervical range of motion (ROM) between asymptomatic individuals and those with subacromial pain syndrome (SAPS), and to investigate its relationship with shoulder pain, disability, and other clinical factors.

A cross-sectional study was conducted with 50 individuals with SAPS and 50 asymptomatic controls (both sexes, aged 32-66). The Shoulder Pain and Disability Index (SPADI) assessed shoulder disability, and cervical ROM was measured using a cervical range of motion (CROM) device.

Individuals with SAPS had significantly reduced cervical ROM compared to controls, confirmed by Student's t-test or Mann-Whitney test. Large effect sizes were observed (Cohen's d = 1.08 and 1.65 for right bending and extension; Mann-Whitney effect size = -0.44 to -0.56 for other movements). Pearson correlations revealed a significant inverse relationship between cervical ROM and SPADI scores (r = -0.42 to -0.61). Chi-square analysis indicated that shoulder pain was associated with cervical ROM deficits (Χ2 = 6.83 to 27.75), with prevalence ratios ranging from 1.5 (flexion) to 4.25 (left rotation) higher in individuals with SAPS. These deficits were also associated with longer duration of shoulder pain, higher neck pain intensity, and older age.

Individuals with SAPS have reduced cervical mobility compared to asymptomatic individuals, especially for cervical rotation. Cervical ROM deficits were more prevalent in individuals with SAPS and correlated with greater shoulder disability. Clinical factors such as duration of shoulder pain, neck pain intensity, and age contribute to these deficits. These findings highlight the need to assess cervical mobility in patients with SAPS.

The objective of this paper is to report on the origin of the EQ VAS and current understanding of the EQ VAS conceptual framework via a literature search based on the snowball approach.

A review was conducted in two steps: (1) a citation search and (2) a search of the EuroQol group's grey literature.

The findings indicate that the EQ VAS was originally designed as a warm-up task for valuing hypothetical health states. The characters of the EQ VAS reflect its valuation origin, such as drawing a line (the previous version), vertical orientation, and choice of end labels. None of these design elements of the EQ VAS were chosen for the purpose of measuring self-reported overall health. Despite this, the EQ VAS proves to be a valid self-reported health status measure with its psychometric properties demonstrated in various general and clinical populations. We found a dearth of literature addressing the conceptual framework of EQ VAS as a measure of self-rated overall health.

With its potential as a powerful measure of overall health, further research into EQ VAS design, conceptual framework and empirical function is warranted.

While virtual reality exposure (VRE) has shown effectiveness in treating social anxiety in adults, research on its efficacy for adolescents remains limited. Given that adolescence is a critical period for early intervention, this study aims to address this gap by evaluating the efficacy and acceptability of VRE compared to in vivo exposure (IVE) in a non-referred sample of socially anxious adolescents. Additionally, we seek to identify mechanisms of change-such as expectancy violation, habituation, and self-efficacy-as well as predictors of treatment response, including clinical, personality, and VR-related factors. Using a randomized controlled trial (RCT), 120 adolescents (ages 12-16) with subclinical to moderate social anxiety will be assigned to one of three conditions: VRE, IVE, or a waitlist control (WL). Participants in the active conditions will undergo a seven-session exposure-based intervention (either in VR or in vivo). Primary (SPAI-18, LSAS-avoidance) and secondary (SPWSS) measures of social anxiety, along with general well-being indicators (e.g., resilience, depression, psychosocial functioning), will be assessed at baseline, post-treatment, and 3- and 6-month follow-ups. A series of linear mixed model (LMM) analyses will be used to examine and compare the effects of the interventions. We hypothesize that both VRE and IVE will significantly reduce social anxiety symptoms compared to WL at post-assessment, with comparable long-term efficacy between the two exposure methods. Additionally, thematic analyses will be conducted to explore participants' experiences and acceptance of VRE and IVE through qualitative interviews. The findings of this study aim to advance digital mental health research by evaluating the potential of VRE as an early intervention and identifying mechanisms and predictors to inform personalized treatments for socially anxious youth.Trial registrationClinicaltrials.gov: NCT06379633, registered on April, 23, 2024.

Arterial stiffness is a cardiovascular risk factor that increases with age. Kyolic aged garlic extract has been shown to reduce arterial stiffness, while normalizing blood pressure, cholesterol and blood thickness. The present study hypothesized that increased flexibility of arteries could lead to slower blood flow and increased oxygen uptake and overall aerobic fitness. The present 12 week trial aimed to assess the effect of Kyolic aged garlic extract (AGE) on arterial stiffness, aerobic fitness, lactate threshold, recovery from muscle soreness and cardiovascular proteomic biomarkers in middle-aged (40-65 years) endurance athletes with elevated arterial stiffness. A total of 75 middle-aged recreational endurance athletes completed the trial, after being randomly allocated for 12 weeks to either the placebo or Kyolic aged garlic extract groups: low-dose cohort 1 (n=37), 2 capsules/day containing 1.2 g AGE powder and 1.2 mg S-allylcysteine (SAC); and the high-dose cohort 2 (n=38), 4 capsules/day of 2.4 g AGE powder and 2.4 mg SAC. Arterial stiffness was assessed through pulse wave velocity measurements and aerobic fitness was measured by volume-maximal-oxygen-consumption (VO2max) and lactate thresholds during high-intensity exercise using a cycle-ergometer-test-station, as well as measuring the levels of muscle fatigue and recovery time at 12 weeks compared with the baseline results. Urinary proteomic analysis was performed in a subgroup of participants and measured the levels of certain relevant proteins used as biomarkers for risk of cardiovascular events, at 12 weeks compared with baseline results. The Kyolic aged garlic extract group significantly improved their aerobic fitness, as was evidenced by increased VO2max, increased aerobic power, higher lactate threshold-to-oxygen uptake, higher lactate threshold-to-power output and quicker recovery times compared with the placebo group. Pulse wave velocity, a measure for arterial flexibility, was improved in the Kyolic aged garlic extract group compared with the placebo. The proteomics analysis demonstrated that a subset of polypeptides associated with cardiovascular risk, such as heart attacks and stroke, decreased in the Kyolic aged garlic extract group at 12 weeks compared with the baseline, which was contrary to the effects observed in the placebo group. Therefore, the results of the present study suggested that Kyolic aged garlic extract significantly improved aerobic fitness, lactate threshold, recovery and cardiovascular proteomic biomarkers in middle-aged endurance athletes within 12 weeks. The present clinical trial was registered on 11/03/2020 at the Australian New Zealand Clinical Trial Registry (trial registration no. ACTRN12620000340932).

Individuals who struggle to regulate their gaming involvement, particularly those with gaming disorder, often report strong subjective urges to play games. Desire thinking has been proposed to be an active driver of urge, and therefore disrupting desire thinking processes may reduce urges to play. Detached mindfulness, a meta-cognitive therapy technique, is a candidate option for reducing desire thinking, but the available research in relation to gaming is limited. To address this gap, this pre-registered study employed a 3 (Group: mindfulness, relaxation, control) x 3 (Time: baseline, pre-task, post-task) mixed experimental design to evaluate the effectiveness of different techniques to reduce gaming urges. Gamers (N = 337) were recruited via the crowd-sourcing platform Prolific. Participants were administered interactive video-based tasks that induced gaming-related desire thinking and were then randomly delivered one of three techniques. Results showed that the desire thinking exercise significantly increased gaming urge. However, the detached mindfulness technique had no significant effect on urge to play, whereas relaxation significantly reduced urge compared to control. The effect of relaxation on urge was stronger for those with moderate to high impulsivity. These results support the proposed link between desire thinking and gaming urge. Gaming urges may be reliably induced using a brief self-guided protocol, which has applications for interventions involving exposure exercises without the use of physical gaming stimuli. Relaxation techniques may have short-term utility in reducing gaming-related urges. Further research should examine other meta-cognitive therapy-based techniques to support a broader research program on CBT for gaming disorder.

Burning mouth syndrome (BMS) is a chronic condition with no effective treatment currently available. Low-level laser therapy (LLLT) shows promise for neuropathic pain management, but evidence comparing its efficacy across different wavelengths in BMS patients remains limited. This study aimed to assess the clinical efficacy of LLLT with three distinct wavelengths in BMS patients, and to determine the optimal therapeutic wavelength. This study was a single-blind randomized controlled trial, with blinding applied only to the participants. 201 participants were scheduled for enrollment, divided into three groups with 67 individuals each. Finally, 63 participants with BMS were enrolled from April 2019 to December 2022, with 53 completing the study. Randomization was performed using SPSS software to generate random numbers. Participants were sequentially assigned based on their enrollment order to the 660 nm group (n = 10, 50 mW, 1.5 J/cm2, 30 s/point), 810 nm group (n = 26, 500 mW, 3 J/cm2, 6 s/point), or 975 nm group (n = 17, 30 mW, 10 J/cm2, 33 s/point). Each participant underwent LLLT once a week for 4 sessions. Outcomes, including pain intensity, numbness, and altered taste, were assessed using the visual analogue scale (VAS). Efficacy was assessed by comparing VAS scores at baseline and after the last treatment, using the Kruskal-Wallis test for comparisons among the three groups and the Mann-Whitney U-test for pairwise analysis. Effect sizes were reported using Cohen's d. Statistically significant pain relief was observed in all groups (median reduction of 40%). The improvement of numbness in the 810 nm and 975 nm groups (median reduction of 40%) was also significant (p < 0.05). However, no significant differences in efficacy were noted among the three groups (p > 0.05). These results suggested that LLLT with three different wavelengths effectively reduced pain and that the 810 nm and 975 nm wavelengths also significantly alleviated numbness in BMS patients. However, further investigation is warranted to elucidate any potential differences in efficacy among the three groups. Clinical trial registration: ChiCTR1900021674 (March 5, 2019).

This study investigated the mid- to long-term postoperative outcomes of patients with adult spinal deformity (ASD), focusing on physical function and quality of life (QOL). We also compared age-related changes between patients aged 75 years or older (high elderly) and those younger than 75 years (low elderly).

A total of 47 patients with ASD underwent thoracic-iliac long spinal fusion between August 2013 and September 2014. The study spanned from the preoperative period to at least 5 years postoperatively. Physical function was assessed using isometric hip flexion and knee extension muscle strength, the 6-min walk distance test, the 10-m walk test, and the timed up and go test. QOL was assessed using the Scoliosis Research Society-22 and Oswestry Disability Index. Repeated-measures analysis of variance with a mixed model approach, corrected for multiple comparisons using Bonferroni, was performed.

Of the 47 patients, 21 participated in the study. Patients with ASD showed improved gait ability postoperatively. Hip flexor strength decreased at more than 5 years postoperatively compared with the preoperative strength. Patient-reported outcome (PRO) scores showed continuous improvement postoperatively, regardless of age. Although older patients had lower preoperative and postoperative physical function, their PRO scores significantly improved and remained favorable for more than 5 years postoperatively.

Patients with ASD experienced sustained improvements in walking ability and PRO for more than 5 years postoperatively. The results of this study showed that even among the elderly, PRO scores consistently improved after surgery and remained positive for an extended period.

This study aims to evaluate the status of periodontitis patients and changes in their quality of life (QoL) after non-surgical and surgical periodontal treatment using OHIP-14, OHRQoL-UK questionnaires, and VAS.

Of the 50 periodontitis patients included in the study, 27 received only non-surgical treatment. The remaining 23 individuals received additional surgical treatment because full recovery was not achieved with non-surgical periodontal treatment. OHIP-14, OHRQoL-UK questionnaires, and VAS were administered to these patients before periodontal treatment and after (4th and 12th weeks) to assess QoL measurements.

OHRQoL-UK results found that there was a statistically significant increase in the 3rd month (T2) values after the flap operation compared to the initial session (T0) (p < 0.05). Compared to non-surgical periodontal treatment (T1) with T2, the difference was not statistically significant except in the pain/discomfort category (p > 0.05). Although the results of the OHIP-14 questionnaire at T1 and T2 showed a significant difference compared to T0 values (p < 0.05), no significant difference was found between T1 and T2 (p > 0.05). An increase in some values was observed in VAS results compared to T0, but it was not significant (p > 0.05).

VAS, OHIP-14, and OHRQoL-UK questionnaires have shown that periodontal treatment improves the QoL of patients with periodontitis.

ClinicalTrials.gov identifier: NCT06539364.

The aim of this cross-sectional study was to assess the test-retest reliability and concurrent validity of the Unilateral Seated Shot-Put Test (USSPT) in patients with subacromial pain syndrome (SAPS). Twenty three patients were included in the study. The participants were assessed using the USSPT for functional power; Visual analog scale (VAS) for pain at activity; Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Shoulder Pain and Disability Index (SPADI) for disability, hand-held dynamometer for shoulder flexion and shoulder abduction muscle strength, and grip strength. Test-retest reliability of the USSPT was found excellent with an intraclass correlation coefficient (ICC2,1) score of 0.976, a standard error of measurement (SEM) of 12.47, and a minimum detectable change (MDC95) score of 34.54. There was high to excellent correlations between the USSPT and the SPADI (r = -0.756, p = <0.001), shoulder flexion muscle strength (r = 0.834, p = <0.001), and shoulder abduction muscle strength (r = 0.711, p = <0.001). SPADI score and shoulder flexion muscle strength were the most important factors influencing USSPT performance, accounting for 73.3% of the variance. The USSPT is a reliable and valid test for assessing upper extremity functional power.

This study examined the statistical and clinical benefits of using bipolar versus unipolar scaling in dynamic network analysis of Ecological Momentary Assessment (EMA) data.

Forty-seven students completed EMA reports three times daily for five weeks via either unipolar (n = 24) or bipolar (n = 23) scales. The data were analyzed to construct idiographic network models.

The bipolar scaling group presented significantly lower zero inflation (2.37% vs. 10.31%, U = 2407756, r = 0.75, p < .05) and greater response variability. Network analysis revealed more participants with significant network edges in the bipolar group (69.57% vs. 41.67%, χ²(1) = 12.06, p = .0007). Additionally, the bipolar group had lower odds of zero responses than the unipolar group did (p = .038).

Bipolar scaling enhances EMA data quality by reducing zero inflation and increasing variability, resulting in richer dynamic network models. Further research is needed to confirm these findings in clinical populations.

Transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH) is considered technically demanding, with varying results among institutions. This is due to the complex soft tissue exposure and determination of the osteotomy line. We report a case in which the osteotomy line was assessed using the Stryker OrthoMap® three-dimensional (3D) computed tomography (CT)-based navigation system and determined as preoperatively planned.

The patient was a 24-year-old male with alcohol-related ONFH. Japanese Investigation Committee Classification Type C2/C2 Stage 3b/3b was confirmed through magnetic resonance imaging, and TRO was performed bilaterally on the same day using the Stryker OrthoMap® 3D CT-based navigation system. The patient was hospitalized for 55 days, and full loading was allowed at 6 months postoperatively. Eight months after surgery, the patient could return to work at his previous job in the restaurant industry relatively quickly. One and a half years postoperatively, the functional score improved from a preoperative visual analog scale of 90 to 12 mm at and the Japanese Hip Society Hip Evaluation Questionnaire improved from 31 points preoperatively to 59 points.

This is the first report of a bilateral TRO for bilateral ONFH performed on the same day using CT-based navigation. For osteonecrosis, which is often bilateral, accurate determination of the osteotomy line as planned preoperatively using CT-based navigation contributes to shorter operative time, less intraoperative blood loss, and allows for bilateral same-day surgery. This may improve situations in which patients are hesitant to undergo bone-preserving surgery because of the long period of time required to return to work, thereby facilitating their early reintegration into society.

There are no published studies that have investigated the occurrence of pain sensitization in patients with postoperative shoulder stiffness. The aim of this study was to describe the presence of pain sensitization and its association with risk factors in patients with shoulder stiffness following arthroscopic rotator cuff (RC) repair.

From 2016 to 2020, a total of 115 patients with shoulder stiffness after RC repair were consecutive and prospectively recruited. All patients completed the Pain Sensitivity Questionnaire (PSQ). Additionally, sociodemographic, comorbidities, anthropometrics, clinical (Tampa Scale of Kinesiophobia [TSK]), and functional outcomes measures (Constant-Murley [CM], Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaires, and Visual Analog Scale [VAS]) were analyzed as baseline predictors; measurements were assessed at 6 weeks after surgery.

A total of 75 patients (65.2%) showed pain sensitization. The results showed a positive association between higher values of PSQ-total and a high number of comorbidities (β ​= ​3.5; p ​< ​0.001), higher values of body mass index (β ​= ​1.1; p ​= ​0.04), longer duration of symptoms (β ​= ​2.6; p ​< ​0.001), high level of irritability (β ​= ​4.1; p ​= ​0.01), higher values on the TSK (β ​= ​4.1; p ​< ​0.001), lower scores on the CM (β ​= ​1.4; p ​< ​0.01), higher scores on the DASH (β ​= ​1.9; p ​< ​0.001), and higher values on the VAS (β ​= ​4.2; p ​< ​0.001).

A high percentage of patients with shoulder stiffness following arthroscopic RC showed pain sensitization 6 weeks after surgery. Factors such as a high number of comorbidities, fear of movement, and pain intensity are predictors of pain sensitization in these patients. Knowledge and understanding of risk factors should be used in the decision-making process for identification of risk factors for chronic pain after arthroscopic RC repair to enable better care of patients.

III.

Migraine is acknowledged as an intricate and incapacitating neurological malady, profoundly exerting a potent influence on the health-related quality of life of patients causing disability, and augmented burden on families, and entire communities. Notwithstanding the strides made in the field of headache disorder management, there remains a cohort of migraine-afflicted patients who do not encounter satisfactory alleviation. This emphasizes the need for alternative systems in addressing the issue and there is a growing interest in exploring Indian system of medicine to address migraine symptoms.

Due to the dearth of prospective, high-quality randomized controlled trials, this protocol aims to conduct a scientific study of the polyherbal formulation 'Ayush M3' to assess its safety and efficacy in patients suffering with migraine.

A prospective, randomized, double blind, parallel-group, placebo controlled, multi - centric, two-arm, exploratory study has been designed to enrol a total of 360 patients at three sites. Migraine patients with or without aura diagnosed as per International Headache Society-ICHD-III below Grade III of MIDAS will be randomized in a 1:1 ratio and administered the trial drug, Ayush M - 3 or placebo for twice a day after food for 16 weeks.

The primary outcomes measures for the study will be changes in the character of disease in terms of frequency, intensity of headache as per VAS (0-10) and duration of episode of headache. Secondary outcome measure will be changes in MIDAS, MSQ2.1, changes in associated symptoms of migraine, change in the use of analgesics/symptom alleviating medication & Change in the required dose/withdrawal of Anti-hypertensive drugs if any. Assessment will be conducted on an interval of 28 days till 16 weeks and an intervention free follow up at the end of week 20.

Recently, Repetitive Transcranial Magnetic Stimulation (rTMS) has gained attention for its potential in relieving neuropathic pain (NP). NP encompasses central and peripheral neuralgia, characterized by sensory abnormalities and spontaneous pain. Pharmacological treatments often provide partial relief with significant side effects, making rTMS an attractive alternative. This study aimed to assess the efficacy of rTMS in treating NP and its impact on quality of life over three months.

A total of 51 patients with drug-resistant NP were included, undergoing 15 sessions of rTMS targeting motor cortex areas over three weeks. Clinical response was evaluated using various psychometric scales, including VAS for pain and PGIC. Quality of life was assessed using the SF-36 questionnaire.

Results showed significant clinical improvements in pain severity and quality of life following rTMS treatment. Predictive factors of quality of life improvement were identified, with mental health being crucial across all NP areas. Notably, patients with cerebral NP showed improvements linked to physical dimensions, emphasizing tailored treatment approaches.

This study underscores the efficacy of rTMS in managing NP, highlighting sustained improvements in pain severity and quality of life. The findings offer valuable insights for personalized treatment approaches and optimizing patient outcomes in NP management.

Arthroscopic partial meniscectomy (APM) is performed for symptomatic meniscal tears that fail conservative treatment. Patients often report pain at night, although little research has been done to evaluate corresponding outcomes.

To (1) evaluate patients with and without preoperative nighttime pain who underwent APM and (2) assess postoperative resolution of symptoms and associated patient-reported outcome measures (PROMs).

Case series; Level of evidence, 4.

Consecutive patients undergoing primary APM with or without chondroplasty at a tertiary academic center were prospectively enrolled in a database. Patient characteristics and PROMs were obtained pre- and postoperatively up to 2 years-including the visual analog pain scale, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Scale, and Veterans RAND 12-Item Health Survey (VR-12) physical and mental components. Patients were included if they had a minimum 3-month PROMs follow-up. Pain at night was defined as reporting greater than mild pain on KOOS P7. Intraoperatively, cartilage was assessed using the Outerbridge Classification.

A total of 587 patients were included, with 299 (50.9%) reporting preoperative pain at night, which corresponded with worse baseline PROMs. These patients were older and more likely to be women and smokers. No significant difference was observed in Outerbridge grade between patients with and without preoperative pain at night. Postoperatively, nighttime pain resolved by 2 years in 274 (91.6%) patients, 219 of whom (79.9%) reported improvement by 3 months. Patients whose pain at night persisted had a longer duration of symptoms preoperatively, higher body mass index, and a lack of baseline mechanical symptoms. PROMs significantly improved for patients with and without preoperative pain at night, although patients with baseline pain had worse scores compared with those without preoperative nighttime pain.

Over half of patients undergoing APM reported preoperative pain at night, which was associated with worse baseline functional scores. Postoperatively, >90% of patients with baseline pain at night noted resolution of symptoms by 2 years, with nearly 80% showing improvement by 3 months. Functional scores improved after surgery for patients with and without initial pain at night, remaining lower for patients who had preoperative nighttime pain.

What is the pain intensity of oocyte retrieval (OCR) without anaesthesia and analgesia in women with a low or medium number of follicles?

Multicentre observational study analysing IVF cycles without anaesthesia and analgesia in seven IVF centres in Germany and Switzerland between January 2022 and March 2023. In total, 2290 cycles of natural cycle IVF or minimal stimulation IVF from 1039 patients were recorded. Pain score was assessed using a VAS graded 0 to 10. A descriptive analysis was conducted, followed by a statistical evaluation using a linear mixed model to analyse the effect on the pain score of the number of oocytes retrieved and the number of repeated IVF cycles.

The number of oocytes retrieved varied from 0 to 16 (IQR 1-2). Pain score varied from 0 to 10, with a median pain score of 3.0 (IQR 2-4), defined as 'mild' pain. Compared with a reference value of aspirations with one oocyte, the pain score increased slightly by 0.5 points if no oocyte was retrieved, by 0.42 points if two to five oocytes were retrieved and by 1.14 points if six or more oocytes were retrieved, all with little clinical relevance. Pain decreased slightly with repeated aspirations (-0.05 points per cycle) (P = 0.028). The complication rate requiring hospitalization per aspiration was less than 0.1%.

Pain intensity during OCR of one or few follicles is mild. Therefore, OCR can be offered without anaesthesia and analgesia to reduce aspiration time and cost.

To assess the postoperative outcomes of double-level knee derotational osteotomy (KDRO) combined with medial patellofemoral ligament reconstruction (MPFLR) and to compare it with tibial tuber transfer (TTT) and MPFLR without derotational osteotomy in patients with recurrent patellar instability and a marked torsional deformity.

From March 2020 to December 2021, patients with torsion deformity (combined femoral torsion [FT] and tibial torsion [TTn] ≥30°) were retrospectively included. The minimum follow-up time was 18 months. Patients who received KDRO and MPFLR were categorized as the KDRO group and patients who received a combined TTT and MPFLR were categorized as the control group. Preoperative and postoperative clinical symptoms, patient-reported outcomes (Kujala, visual analog scale, Lysholm, International Knee Documentation Committee, Tegner, and Knee Injury and Osteoarthritis Outcome scores), and imaging parameters (FT, TTn, patellar height, femoral trochlear dysplasia, congruence angle, patellar tilt angle, lateral patellar angle, lateral patellar translation, and tibial tubercle-trochlear groove distance) were analyzed.

In all, 36 patients were included with 18 in KDRO group and 18 in control group. The mean follow-up time was 30 (range 21-39) months. At the latest follow-up, no patient experienced redislocation in either group. Except for the FT and TTn in the control group, postoperative imaging parameters were significantly reduced to the normal range. KDRO group had a lower patellar tilt angle (P = .043, effect size 0.64). All clinical scores in both groups significantly improved postoperatively. The KDRO group had better functional scores than control group except the KOOS daily living activities subscore and the KOOS sports and recreation subscore. More patients in the KDRO group met the minimal clinically important difference for most patient-reported outcomes than the control group. Eight patients (44%) in the control group complained of postoperative anterior knee pain, compared with 1 patient (6%) in the KDRO group (P = .018).

KDRO combined with MPFLR was associated with better postoperative outcomes than TTT combined with MPFLR in patients with recurrent patellar instability and a torsion deformity.

Level III, retrospective cohort study.

No previous studies have reported the presence of sleep disturbances or their association with baseline factors in elderly patients with distal radius fracture (DRF). This study aimed to describe the proportion of patients with sleep disturbances and analyze their association with baseline factors in patients older than 60 years with conservatively treated DRFs.

This prospective observational study included 220 patients with extra-articular DRFs who completed the Pittsburgh Sleep Quality Index at two time points: two weeks after cast removal and at the one year follow-up. Sociodemographic, anthropometric, clinical, radiological, and patient-reported outcome measures were analyzed as baseline predictors, with measurements performed two weeks after cast removal.

At two weeks after cast removal, 166 (75.5%) patients had sleep disturbances. Sleep disturbances were associated with the affected dominant hand (β = 1.6; p = 0.04), high-energy injury (β = 3.8; p < 0.001), extra-articular comminuted metaphyseal DRFs (β = 2.3; p < 0.001), higher Tampa Scale of Kinesiophobia scores (β = 2.4; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.4; p < 0.001), higher Pain Anxiety Symptoms Scale-20 scores (β = 2.1; p < 0.001), and higher visual analogue scale scores (β = 4.1; p < 0.001). At the one year follow-up, 85 (38.6%) patients had sleep disturbances, which were associated with higher Tampa Scale of Kinesiophobia scores (β = 2.6; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.5; p < 0.001), and higher Pain Anxiety Symptoms Scale-20 scores (β = 1.8; p = 0.02).

A high proportion of elderly patients with DRF experienced sleep disturbances. Expanding our understanding of the interplay between sleep disturbances and baseline risk factors may lead to improved care and clinical outcomes for these patients. Future studies should incorporate the clinical management of sleep disturbances in patients with DRFs.

Periodontal diseases could cause halitosis and may impair taste and smell. While non-surgical periodontal therapy is known to reduce halitosis, its effects on taste and smell are less studied. This study aims to investigate the factors influencing self-perceived halitosis, taste, and smell, as well as the changes in these perceptions after periodontal therapy.

A total of 183 participants were divided into three groups: 61 patients with periodontitis, 61 with gingivitis, and 61 who were gingivally healthy. Periodontal parameters and self-perceived halitosis, taste, and smell were evaluated at baseline and four weeks after non-surgical periodontal treatment using a visual analog scale (VAS). Robust regression analysis was used to assess independent variables influencing baseline VAS ratings.

The periodontitis group had the lowest taste perception and the highest self-perceived halitosis scores (p < 0.05). Taste perception was negatively associated with ≥ 4 mm pockets (p = 0.002). A positive relationship was also observed between the plaque index and self-perceived halitosis (p = 0.030). Post-treatment, taste perception improved significantly in all groups (p < 0.05), in parallel with improvements in periodontal parameters. Additionally, self-perceived halitosis showed a significant decrease (p < 0.05). The improvement in smell perception was statistically significant in the gingivally healthy and periodontitis groups (p < 0.05).

Periodontal disease may contribute to the development of chemosensory disorders. While the main goal of periodontal treatment is disease management, it can also improve taste and smell function. Oral hygiene practices play an essential role in the development of these improvements. However, further research is needed on the subject.

The study was registered as "Investigation of Halitosis, Taste, and Smell in Terms of Periodontal Condition Stated by Patients and Periodontal Diagnosis by Dentists, and Then Evaluation of Change Before and After Treatment" with the registration number NCT06063460 (13/09/2023) at https://www.

gov Protocol Registration and Results System.

This clinical trial was registered prior to participant recruitment on ClinicalTrials.gov (NCT06063460,13.09.2023).

Pain, a leading reason people seek medical care, has become a social issue. Automated pain assessment has seen notable advancements over recent decades, addressing a critical need in both clinical and everyday settings.

The objective of this survey was to provide a comprehensive overview of pain and its mechanisms, to explore existing research on automated pain recognition modalities, and to identify key challenges and future directions in this field.

A literature review was conducted, analyzing studies focused on various modalities for automated pain recognition. The modalities reviewed include facial expressions, physiological signals, audio cues, and pupil dilation, with a focus on their efficacy and application in pain assessment.

The survey found that each modality offers unique contributions to automated pain recognition, with facial expressions and physiological signals showing particular promise. However, the reliability and accuracy of these modalities vary, often depending on factors such as individual variability and environmental conditions.

While automated pain recognition has progressed considerably, challenges remain in achieving consistent accuracy across diverse populations and contexts. Future research directions are suggested to address these challenges, enhancing the reliability and applicability of automated pain assessment in clinical practice.

Posterior cervical fusion (PCF) is widely used for cervical spinal cord decompression with/without fusion. In our hybrid operating room, intraoperative computed tomography (iCT) is routinely used to verify screw placement. This study analyzed clinical and radiological outcomes after PCF and evaluated iCT benefits for detecting screw misplacement.

Nineteen patients underwent PCF between March 2012 and April 2016 for degenerative (n = 6), neoplastic (n = 7), and traumatic (n = 6) conditions. Seven patients had primary PCF, while twelve underwent PCF following anterior fusion due to segmental instability with cervical malalignment (n = 11) or tumor progression (n = 1).

The mean patient age was 59 ± 11 years, with 63% male patients. The median follow-up was 21 months. PCF averaged 4.74 segments (range: 1-9). At follow-up, 79% reported pain improvement and normal sensorimotor function. Of six patients with preoperative paresis, five showed improved muscle strength. No persistent gait disturbances occurred. Complications requiring revision occurred in four patients (21%): three surgical site infections and one cerebrospinal fluid leak. One perioperative death occurred (5%). iCT detected incorrect screw placement in seven patients (36%), allowing the immediate repositioning of eight screws, preventing later revision surgeries. The overall fusion rate was 92%.

PCF with iCT is safe and effective for various cervical spine pathologies, yielding good long-term clinical outcomes. iCT effectively detects and enables immediate correction of screw malposition, reducing revision surgery needs. This imaging modality demonstrates high sensitivity and specificity for identifying clinically relevant screw malpositions.

Weakness of the rotator cuff has been reported in patients with subacromial impingement syndrome (SIS). A novel therapeutic approach proposes adding exercises for the core musculature to aid in functional recovery in these patients.

The aim of this study was to assess the short-term effects of adding a core exercise program to supervised physiotherapy on improve lateral rotator strength and functional outcomes in patients with SIS.

A pre-post single-group study.

A total of 47 participants with SIS were recruited. All patients were treated with five weeks of supervised physiotherapy plus a core exercise program. The primary outcomes were isometric lateral rotator strength and grip strength, measured with a dynamometer. Secondary outcomes included muscular endurance assessed with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), shoulder function with the Constant-Murley (CM) questionnaire, and pain intensity reported using the Visual Analog Scale (VAS). Need a brief statement of statistical approach.

At end of the five week intervention, isometric lateral rotator strength showed an increase of 9.2 kg (d = 2.1; p < 0.001) and grip strength an increase of 10.6 kg (d = 2.4; p < 0.001). The CKCUEST showed an increase of 5.6 repetitions (d = 3.7; p < 0.001), the CM questionnaire showed an increase of 30.3 points (d = 4.9; p < 0.001) and the VAS showed a decrease of 3.9 cm (d = 6.0; p < 0.001). All outcomes showed large effect sizes and statistically significant differences.

In the short term, adding a core exercise program to supervised physiotherapy showed statistically and clinically significant differences in lateral rotator strength and functional outcomes in patients with SIS.

Level 3.

While existing studies have predominantly focused on negative body image and its potential link to female sexual distress in women with endometriosis, no studies have investigated how positive body image (ie, body functionality appreciation) mediates the association between dyspareunia severity and sexual distress in this population.

This study aimed to investigate the mediating role of body functionality appreciation in the relationship between severity of dyspareunia and sexual distress in women living with endometriosis.

A total of 232 women with endometriosis (M = 35 years) took part in the study. Participants completed an anonymous questionnaire evaluating dyspareunia severity, functionality appreciation, female sexual distress, sociodemographic factors, and endometriosis-related clinical information. All participants were administered the following questionnaires: numerical rating scale, body functionality appreciation, female sexual distress scale.

Using a mediation model, the study analyzed both the direct and indirect effects of dyspareunia severity on sexual distress, with functionality appreciation as a mediator.

The findings suggest that the severity of dyspareunia significantly contributes to sexual distress both directly and indirectly, by diminishing the appreciation for body functionality.

Clinicians should not only focus on the severity of dyspareunia when evaluating sexual distress in women; instead, they should also acknowledge the protective role of positive body image. Integrated treatments that promote body functionality appreciation could enhance treatment outcomes.

The study is the first to examine the mediating role of body functionality appreciation in the relationship between dyspareunia severity and sexual distress in a sample of women with endometriosis; however, the assessment was cross-sectional and did not encompass other factors that may influence the connection between dyspareunia severity and sexual distress.

These findings, in addition to advancing theoretical understanding of the role of positive body image in women with dyspareunia, may be valuable in guiding the design of interventions aimed at reducing sexual distress in women with high levels of dyspareunia severity.

To systematically review and conduct a meta-analysis of studies on peripheral magnetic stimulation (PMS) for fibromyalgia (FM) treatment.

MEDLINE, EMBASE, CENTRAL, CINHAL, Web of Science, and ProQuest databases were searched from inception to July 2023 for studies in adult patients with FM treated with PMS. Studies using transcranial magnetic stimulation were excluded.

Six randomized controlled trials (RCTs) (n = 279 patients) were identified and included in the review. PMS regimens varied, ranging from 8 to 40 min per session over 3-84 days. All studies compared PMS to a visually and physically identical sham device without magnetic fields. Most of the included studies demonstrated positive findings for PMS on pain and functional outcomes. In our meta-analysis, PMS significantly reduced pain scores within 1-3 months (mean difference -1.86 on NRS, 95% confidence interval -2.85 to -0.87, p = 0.0002, I2 = 68%, 4 studies [154 participants], low quality of evidence), but not at ≥3 months (low quality of evidence). Minimal adverse effects were reported.

Evidence for PMS use in FM is encouraging for short-term benefit. However, heterogeneous patient populations, varied PMS regimens, and limited number of studies are important limitations. Large, high-quality RCTs are needed to confirm PMS benefits and to make definitive recommendations.

PROSPERO Identifier is CRD42021235164.

Despite progress made in antiemetic control, most cancer patients still experience chemotherapy-induced nausea and vomiting. In oncology departments, nurses can evaluate the effects of complementary therapies such as use of essential oil on reducing nausea and vomiting of patients undergoing chemotherapy. Therefore, this study was conducted to explore the effect of cinnamon essential oil on the chemotherapy-induced nausea and vomiting of cancer patients.

This is a two-group experimental study with a pretest-posttest design that was conducted between January 20 and March 15 of the year 2020. Through convenience sampling, 70 patients experiencing chemotherapy-induced nausea and vomiting were recruited to participate in this study. The participants were randomly allocated to two control and intervention groups. A pad moistened with 2 ml of isotonic saline and 0.2 ml of cinnamon essential oil was first placed inside a plastic bag, and then patients in the intervention group were asked to take three deep breaths while their face was towards the bag for two times at five-minute intervals. Patients in the control group used a placebo (a pad moistened with 2 ml of isotonic saline) instead of cinnamon essential oil during the intervention period. Participants in the two groups received routine antiemetic treatment. Using Visual Analog Scale (VAS), the severity of nausea and vomiting was measured in both groups before the intervention. For this reason, the severity of nausea and vomiting was measured after the first three breaths, and then after the second three breaths. Data were analyzed by SPSS software, using independent t-test, Chi-squared test, and Fisher's exact test. Repeated measures ANOVA were also used to evaluate nausea and vomiting between the two groups across times. The significant level of 0.05 was considered for all tests.

There were no significant differences between the two groups in terms of demographic characteristics and the severity of chemotherapy-induced nausea and vomiting before the intervention. The severity of chemotherapy-induced nausea and vomiting was significantly lower in the cinnamon group than the control group after the first 3.08 (0.55), (F2 = 13.27, p < 0.001) and second breaths 1.91 (0.33) (F2 = 11.39, p < 0.001).

Nurses can educate patients and their families to use of cinnamon essential oil. Nursing managers can also emphasize on the use of cinnamon essential oil, which is one of the non-pharmacological, low-cost, and effective methods of reducing chemotherapy-induced nausea and vomiting, by holding in-service training classes.

Immersive Virtual Reality (VR) has been applied in pain management for various conditions, but its use in fibromyalgia (FM) remains underexplored. While physical activity plays a role in treating FM, patients' low tolerance often limits its effectiveness. After reviewing the literature on VR and games for FM, we designed a novel VR exergame to assist FM patients in performing physical activity, and evaluate its feasibility.

This pilot study involved three female subjects with FM and four healthy female volunteers. The main outcomes included qualitative assessments of exertion, pain levels, psychological states experienced during the VR session, but also device comfort.

Improvements in perceived exertion and pain intensity were observed during the VR exergame session in comparison to pre-exergame levels, along with a reduction in depression, stress and anxiety levels while using the VR immersive system. Most participants experienced also increase of relaxation and positive emotions during the exergame. Only one participant was not able to complete all levels of the exergame due to musculoskeletal pain exacerbation; nevertheless, this patient reported an improvement in motivation and enjoyment during the gameplay. Many participants expressed a greater motivation to perform the exercises in the VR environment compared to traditional training methods.

The proposed VR exergame is a feasible system that might reduce depression, stress and anxiety, while boosting motivation and relaxation in both healthy and FM subjects. A calibration protocol is required to tailor the system to each user's pain levels and physical abilities.

Intractable vascular anomalies (VAs), including vascular tumors and venous, lymphatic, and mixed malformations, often have severe symptoms and a poor prognosis, highlighting the need for new treatments. We conducted a prospective trial of sirolimus (tablet and granule forms) for the treatment of VAs.

In this open-label, single-arm, multicenter trial across four Japanese institutions, patients with VAs received oral sirolimus daily, targeting a trough concentration of 5-15 ng/mL. We evaluated response rates (radiological volume changes in lesions), skin lesions, performance status, respiratory function, visceral symptoms (bleeding, pain), laboratory data, quality of life, and safety at 12, 24, and 52 weeks.

Thirteen patients with VAs were treated with sirolimus. Seven patients (53.8%; 95% confidence interval: 25.1%-80.8%) showed a partial radiological response at 24 weeks, with no complete responses, and 61.5% had a partial response by 12 weeks, with little subsequent change in patients who had stable disease thereafter. Improvements in skin lesions, blood coagulation, and activities of daily living were noted. Common adverse events included stomatitis, dermatitis, diarrhea, and fever.

Sirolimus may reduce VA tissue volume and potentially improve symptoms and activities of daily living in patients with VAs.

Endometriosis is a prevalent chronic gynecological condition characterized by severe pelvic pain, negatively affecting women's health-related quality of life. The Common-Sense Model of Illness Self-regulation has revealed the importance of illness perceptions and coping strategies in explaining the impact of illness on across several conditions. These aspects have never been assessed in endometriosis.

We aimed to explore the relationship between pelvic pain severity and health-related quality of life in women with endometriosis, hypothesizing that illness representations and pain-specific cognitive and behavioral maladaptive coping strategies influence this relationship.

This cross-sectional study analyzed data from 273 women with endometriosis who completed an online questionnaire assessing pelvic pain severity, illness perceptions, specific pain-related coping strategies, and health-related quality of life. A path analysis through MPlus was conducted to examine the direct and indirect relationships between variables.

The analysis showed that pelvic pain severity directly influenced illness representations and health-related quality of life. Threat illness perceptions, characterized by negative views of endometriosis, were associated with maladaptive coping strategies (ie, catastrophizing and illness-focused coping). These strategies further mediated the impact of illness perceptions on health-related quality of life, resulting in reduced health-related quality of life.

The findings support the Common-sense model of Illness Self-Regulation framework, suggesting the role of illness representations and coping strategies in the association between pelvic pain severity and health-related quality of life in women with endometriosis. Clinicians are encouraged to assess and address negative illness representations and maladaptive coping strategies in this population. Future research should focus on experimental interventions aimed at modifying illness perceptions and evaluating their effects on health outcomes.

Objective: The aim of this study was to assess at 6-month and 1-year follow-up the effect of graded motor imagery (GMI) in addition to usual care on the affective and clinical outcomes in patients with chronic shoulder pain. Methods: A pre-post-intervention single-group study was conducted. One hundred forty-eight patients with chronic shoulder pain were included. All participants received a 6-week GMI program in addition to usual care. The primary outcome assessed was pain intensity using visual analog scale (VAS), the secondary outcomes were fear of movement with the Tampa Scale of Kinesiophobia (TSK), catastrophization with the pain catastrophization scale (PCS), shoulder flexion active range of motion (AROM) with a goniometer, and central sensitization with the central sensitization inventory (CSI). All outcomes were assessed at baseline and 6-month and 1-year follow-up. Results: At 6 months, GMI showed to be statistically significant for all outcomes assessed (p < 0.001). At 1-year follow-up, the VAS showed a decrease of 3.3 cm (p < 0.001), TSK showed a decrease of 16.1 points (p < 0.001), PCS showed a decrease of 17.4 points (p < 0.001), AROM showed an increase of 29.9° (p < 0.001), and CSI showed a decrease of 17.9 (p < 0.001). Conclusions: At medium- and long-term follow-up, the individuals who received the GMI program in addition to usual care showed a clinically and statistically significant change for all outcomes assessed. Further studies, including clinical trials, are needed to confirm our findings.

Rotator cuff tendinitis (RCT) is a tendon inflammation often following subacromial impingement syndrome. One of the non-surgical management modalities for RCT is subacromial injection of corticosteroids. Some studies have claimed a correlation between ACTH (Adrenocorticotropic Hormone) deficiency and rotator cuff lesions; hence, intramuscular ACTH analogue injection has been recommended as an option. This research aimed to compare the effectiveness of these two treatment methods.

We conducted a study with 86 patients suffering from RCT. The patients were randomly divided into two groups of 43; one group received a subacromial injection of 40 mg of triamcinolone acetonide, while the other group received 1 mg of intramuscular tetracosactide injection. We recorded the Constant-Murley (CM) and visual analogue scale (VAS) scores for each patient before and 4 weeks after injections to measure pain acuity and joint functionality. Later, we compared and analysed the two scores in each group.

Based on the statistical analysis, the mean ages of the participants in the triamcinolone and tetracosactide groups were 53.21 ± 11.37 and 54.56 ± 11.98, respectively. Both groups demonstrated an improvement in VAS for pain and CM scores (P < 0.05). However, the VAS for pain score decreased, and the CM score increased more significantly in the triamcinolone group than in the tetracosactide group (P < 0.05).

Although both treatment methods exhibit promise for pain relief, subacromial injection of triamcinolone appears more efficacious than intramuscular injection of tetracosactide in patients with RCT, based on a 4-week follow-up.

Iranian Registry of Clinical Trials, https://irct.behdasht.gov.ir, IRCT20240110060673N1.