Endometriosis may manifest through various pain symptoms, such as dysmenorrhea, dyspareunia, dyschezia, dysuria and abdominal pain. While retrospective evaluation of these pain symptoms is less expensive and time-consuming compared to a prospective evaluation, there is potential for recall bias, and the reliability of such data needs to be assessed. We aimed to evaluate the reliability of questions on past endometriosis-related pain.

We conducted a reliability study within ComPaRe-Endometriosis, an ongoing prospective e-cohort including patients with endometriosis. We assessed past endometriosis-related pain over a lifetime using the WERF-EPHect Patient Questionnaire-Standard (EPQ-S). Participants rated the worst intensity of dysmenorrhea, dyspareunia, dyschezia, dysuria and abdominal pain that they experienced at ≤ 15, 16-20, 21-30, 31-40 and > 40 years using a numeric-rating scale (NRS). We asked the same questions about 1 year later and measured the agreement between participant responses by calculating intraclass correlation coefficients (ICC) (continuous NRS level) and weighted kappa coefficients (κw) (pain intensity categories).

A total of 1752 participants completed both surveys. The global reliability was close to the 'good' and 'substantial' thresholds for dysmenorrhea (ICC = 0.74; κw = 0.57) and dyspareunia (ICC = 0.72; κw = 0.57), 'moderate' and close to the 'substantial' threshold for dysuria (ICC = 0.68; κw = 0.59), and 'moderate' for dyschezia (ICC = 0.62; κw = 0.54) and abdominal pain (ICC = 0.58; κw = 0.49).

In this population, questions on worst pain intensity over the life course showed moderate-to-good reliability depending on the type of pain, with higher reliability when pain level was considered as a continuous variable.

While prospective measures are the most robust approach in epidemiological research, longitudinal data with pain recorded since childhood or adolescence are scarce. This study shows that the worst level of pelvic and abdominal pain over the life course are reliably reported by endometriosis patients after a 1-year interval. These findings suggest that retrospective pain assessment may reliably be used to assess trajectories of pain over the life course in order to gain insights into the progression of pain-related conditions such as endometriosis.

Pupillary reflex dilation (PRD) quantifies nociception in anaesthetised patients, enabling tailored opioid administration, which in turn reduces catecholamine levels and postoperative pain intensity. However, its utility in objectively assessing pain in awake individuals remains challenging.

To investigate whether PRD can differentiate between painful and nonpainful stimuli in awake volunteers.

This was a randomised, placebo-controlled, stimuli-randomised study conducted after ethical approval and registration (DRKS00024791).

This single-centre study was performed at BG University Hospital Bergmannsheil Bochum, Germany, between November 2021 and January 2022.

Thirty healthy volunteers (25 ± 2 years, 50% male) were included in the study.

After a rest, the following stimuli were applied to one ventral forearm: an unannounced electric pain stimulus (UPS) and a randomised sequence of either an announced painful stimulus (APS), a placebo or a nonpainful stimulus (NPS).

Pupil dilatation was measured as PRD (%) for 60 s during the experimental condition "rest", and during and after each stimulus application using an AlgiScan device. The participants rated stimulus pain intensity via a numeric rating scale (NRS: 0 = no pain, 10 = most intense pain imaginable). Statistics: Paired t -test, rmANOVA, Spearman's correlation and receiver operating characteristics (ROC), P  < 0.05.

The subjective pain intensity ratings were higher after APS (6.0 ± 1.9) than after UPS (5.5 ± 1.7, P  = 0.007), placebo (0.0 ± 0.0, P  = 0.027) and NPS (0.0 ± 0.0, P  = 0.001). Similarly, objective pupillary reaction to the stimuli measured using PRD was higher for APS: 13 (97.6% CI, 10.0 to 19.0)% vs. NPS 13 (97.6% CI, 7.0 to 20.0), P  = 0.024). UPS elicited the highest PRD of 25 (95.7% CI, 18.0 to 30.0)% vs. rest, P  < 0.001; significantly greater than placebo at 13.5 (96.4% CI, 10.0 to 22.0)%, P  < 0.001); and NPS at 13 (97.6% CI, 7.0 to 20.0)%, P  < 0.0001). However, no significant differences in PRD were observed between APS and UPS despite their electrical similarity. PRD correlated with pain intensity ( r  = 0.35, P  < 0.0001).

In awake volunteers, PRD differentiates between painful and nonpainful stimuli and correlates with pain intensity. Noninvasive PRD measurement may be suitable for nociception monitoring in awake individuals.

Prospectively DRKS00024791, March 2021.

Postoperative pain management is an important determinant of patient recovery, as it directly influences rehabilitation efficiency, hospitalization duration, and the risk of postoperative complications. Despite its significance, traditional pain management strategies often fail to adequately address individual variability and the multidimensional nature of pain, thereby limiting their effectiveness. To address these limitations, we designed this comprehensive narrative review to systematically summarize relevant literature published between 2000 and 2024, from databases such as PubMed and Web of Science, with a particular focus on personalized pain assessment and multimodal interventions to optimize postoperative recovery. Personalized pain assessment, guided by the biopsychosocial model, captures the biological, psychological, and social dimensions of pain, offering a more comprehensive and individualized evaluation of patient needs. In parallel, multimodal interventions, which integrate pharmacological and non-pharmacological strategies, are designed to target multiple pain mechanisms simultaneously, thereby enhancing analgesic efficacy while minimizing adverse effects. Emerging evidence indicates that combining personalized pain assessment with multimodal interventions can significantly improve clinical outcomes, as demonstrated by reductions in postoperative pain scores by approximately 20-30%, shorter hospital stays by 1-2 days, and decreased opioid consumption by 25-40%. Notable clinical applications supporting these findings include the use of dynamic pain monitoring devices, virtual reality-based therapies, and prehabilitation programs to facilitate recovery. Building upon these findings, this review further discusses the theoretical foundations underlying personalized pain management, explores its clinical applications, and examines the practical challenges associated with its implementation. Additionally, future directions are proposed, including the development of AI-driven pain assessment tools, the promotion of interdisciplinary collaboration, and the establishment of standardized clinical protocols. Collectively, these advancements support the potential of personalized, multidimensional strategies to improve postoperative outcomes and enhance overall patient satisfaction.

Patient satisfaction is important in pain management. Satisfaction with prescribed pain relievers and continued use of these drugs may be affected by a patient's understanding of their efficacy and safety. We investigated the association between patients' satisfaction and understanding of their prescribed medication for three oral pain relievers (lasmiditan, mirogabalin, and tramadol) that recently became available in Japan.

This questionnaire-based, cross-sectional study included adult patients taking these oral pain relievers after April 2023. The primary endpoint was overall satisfaction (five-point rating) and the secondary endpoint was overall understanding (five-point rating) of the oral pain relievers.

In total, 328 patients (lasmiditan, 36.9%; mirogabalin, 55.5%, tramadol, 8.8%; four patients had been prescribed more than one medication) were included, and 71.6% of patients reported high satisfaction (score 4, 5) with their oral pain relievers (lasmiditan, 62.0%; mirogabalin, 76.1%; tramadol, 85.2%). The proportion of patients in the total population who reported a high understanding (score 4, 5) of their oral pain relievers was 68.0% (lasmiditan, 77.7%; mirogabalin, 63.3%; tramadol, 55.6%). In the total population and the lasmiditan and mirogabalin subgroups, the patient satisfaction level was significantly associated with scores on medication understanding (Cochran-Armitage test, p < 0.0001 for all). Discontinuation rates were higher in patients who were unsatisfied with their treatment than those who were satisfied (38.7% and 9.8%, respectively).

This study showed that a higher level of understanding of oral pain relievers is associated with higher satisfaction, which may be associated with lower discontinuation rates.

UMIN000052629.

Unhealthy alcohol use is prevalent among people with HIV, particularly among men who have sex with men (MSM). Pain frequently co-occurs with unhealthy alcohol use and is associated with suboptimal HIV care outcomes. The present study examined the effects of pain severity and experiences with pain management care (i.e., satisfied, dissatisfied, managing pain on own) on alcohol use. Participants were MSM with HIV reporting heavy alcohol use and pain in the past 30 days who were enrolled in a clinical trial targeting alcohol use (N = 125, 78.4% White, Mage=41.2). Participants completed measures of unhealthy alcohol use [alcohol-related problems, heavy drinking days, drinks per week, drinking to manage pain (yes/no)], pain severity, and pain management care experiences. An analysis of variance examined differences in pain severity by pain management experience. Regression analyses examined the associations of pain severity and pain management experience with unhealthy alcohol use. Pain severity was significantly associated with drinking to manage pain and heavy drinking days, but not drinks per week or alcohol-related problems. MSM with HIV who were dissatisfied with pain care reported significantly greater pain severity compared to those who were satisfied or managing pain on their own. Compared to satisfaction, dissatisfaction with pain care was also associated with significantly higher odds of drinking to manage pain, although the inclusion of pain severity attenuated this association. Results highlight pain severity as a key factor related to pain management experience and unhealthy alcohol use among MSM with HIV. Future studies should prioritize pain-alcohol integrated intervention development.

A kinetic chain approach to shoulder rehabilitation is recommended. This study aimed to compare muscle activity between the isolated external rotation exercise and an exercise incorporating a kinetic chain approach in adults with shoulder pain. It also sought to identify muscle activation differences with the same tasks between asymptomatic adults and those experiencing shoulder pain.

This is a randomized crossover trial. Twenty-four adults participated; 12 with shoulder pain and 12 without. Both groups performed isolated external rotation and kinetic chain exercises, with the sequence randomly allocated. Shoulder and scapular muscles were measured using surface electromyography. Mixed-effects models were used for the main statistical analysis.

Significant changes in muscle activation levels were observed with the kinetic chain strategy compared to isolated resistance exercise. In the exercise factor, a significant decrease of 8.9% was observed in the maximum activation of the infraspinatus muscle with kinetic chain implementation. Conversely, the latissimus dorsi muscle showed a significant increase of 16.5% in maximal activation with kinetic chain compared to external rotation exercise.

Implementing the kinetic chain approach led to significant changes in muscle activation. It offers potential benefits for shoulder rehabilitation, making it an alternative to isolated external rotation exercises.

This study compares the effects of an artificial intelligence app-based exercise program with group exercise therapy on pain intensity and neck-related disability in patients with neck pain.

84 patients with neck pain. 70 fulfilled the study requirements. 52 were in the intervention and 18 in the comparison group.

The intervention group utilized an AI-based exercise program accessible via digital devices. The AI provided 3-5 daily exercises tailored to individual feedback, pain intensity, and well-being. The exercise duration was up to 15 min per day. The comparison group attended up to two 45-min group exercise sessions weekly.

Pain intensity and neck-related disability were assessed using an 11-point numerical rating scale and the Neck Disability Index via online questionnaires at baseline, 4 weeks, and 8 weeks. The non-parametric Mann-Whitney U test was used to test for between group differences.

After 8 weeks, the intervention group showed a significantly lower pain intensity than the comparison group (U = 287, Z = -2.447, p = 0.042, r = 0.3). Compared to baseline, the intervention group showed a significant reduction in neck pain (Chi2 (2) = 15.775, p < 0.001, W = 0.15) and an improvement in neck-related disability (Chi2 (2) = 25.094, p < 0.001, W = 0.24). The comparison group showed no significant change over time.

The app-based exercise program demonstrated promising results for the reduction of pain intensity and neck-related disability, offering a personalized and mobile alternative to group exercise therapy for patients with neck pain.

The aim of this systematic review and meta-analysis was to assess whether pain, swelling and trismus following surgical removal of the lower third molar could be reduced by twin-mix injection.

MEDLINE, Embase and Cochrane Trials were searched for randomized controlled trials (RCTs) until 17th November 2022. Eight RCTs were included in the systematic review, and 7 in the meta-analysis. In this study, the twin-mix was compared with the conventional anesthetic solution. Outcomes were assessed on postoperative days 1, 3 and 7. Primary outcomes were swelling and trismus. Secondary outcomes were postoperative pain, pain score on local anesthetic injection, duration of soft tissue anesthesia, and latency of anesthesia. Risk of bias was assessed using the Cochrane ROB2 tool. Certainty of evidence was evaluated with the GRADE tool.

On postoperative day 1, the twin-mix group showed significant reductions in facial swelling (MD: -3.51 mm; [-5.04 to -1.97]), trismus (MD: -1.7 mm; [-2.48 to -0.92]) and pain (MD: -1.07; [-1.49 to -0.65]). On day 3, swelling (MD: -4.64 mm; [-6.34 to -2.94]), trismus (MD: -1.08 mm; [-1.55 to -0.61]) and pain (MD: -0.62; [-1.09 to -0.15]) remained significantly reduced. On day 7, differences persisted for swelling (MD: -0.58 mm; [-0.76 to -0.40]) and trismus (MD: -0.42 mm; [-0.72 to -0.12]), but no significant difference was found in pain (MD: -0.29; [-0.65 to 0.07]). The twin-mix also significantly reduced pain under local anesthesia, shortened latency and prolonged duration of anesthesia.

In conclusion, the use of twin-mix is highly beneficial for pain relief, facial swelling and trismus following mandibular third molar surgical removal.

The study explores the impact of physical activity on the functional autonomy of older adults affected by Chikungunya, a viral disease that causes chronic pain and limits joint mobility. Given the increasing ageing population and the risks posed by climate change in the spread of this infection, the study examines whether regular physical activity can help to preserve functional autonomy in elderly individuals affected by Chikungunya.

A descriptive, cross-sectional, and comparative study was conducted with 54 physically active older adults. Participants were divided into two groups: one affected by Chikungunya and the other with no history of the disease. Variables such as the presence and intensity of joint pain were assessed using the Visual Analogue Scale (VAS), and the GDLAM protocol was employed to evaluate the functional autonomy of the participants. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS).

Although Chikungunya affected several joints of the elderly, particularly the knees and shoulders, the perception of pain varied according to the phase of the disease, being moderate in the acute phase and mild in the chronic and subacute phases. Both groups (affected and unaffected) showed similar performance in the functional autonomy tests, with no statistically significant differences.

Regular physical activity, regardless of the phase of Chikungunya, could help preserve functionality despite the disease's sequelae.

Although fentanyl and esketamine, administered intravenously (IV) or intranasally (IN), are standard of care for treatment of acute traumatic pain in the prehospital setting in the Netherlands, comparative evidence regarding their efficacy and safety is lacking. Therefore, this study aims to assess the efficacy and safety of fentanyl IN, esketamine IV and esketamine IN as compared to fentanyl IV for management of acute traumatic pain in the prehospital setting.

This is a double-blind, monocenter, multi-arm, randomized non-inferiority trial in the prehospital setting in the Netherlands. Adult subjects receiving emergency care from Emergency Medical Services Ambulance Amsterdam and suffering from acute severe traumatic pain are randomized in an 1:1:1:1 ratio to receive fentanyl IV (1.0 µg/kg), fentanyl IN (1.25 µg/kg), esketamine IV (0.2 mg/kg), or esketamine IN (0.625 mg/kg). The primary endpoint is the reduction in Numeric Rating Scale (NRS, 0-10) score at 10 min after first administration of study medication. The prespecified non-inferiority margin is 1.0 for the between-group absolute difference in primary outcome. The primary endpoint is analyzed according to the intention-to-treat and per-protocol principles conforming to recommendations for non-inferiority analysis. Other endpoints include reduction in NRS score at other timepoints, need for additional analgesia, patient satisfaction, and adverse events.

This trial is one of few double-blind randomized controlled trials in the prehospital setting and aims to answer questions that have relevance to prehospital practice. Research in a prehospital emergency setting also comes with challenges, including concerns about prehospital data quality, limited research experience among personnel and a limited timeframe for data collection and follow-up. Also, informed consent needs to be deferred.

ClinicalTrials.gov NCT06051227. Registered on 9 September 2023.

This study aimed to adapt the Burn-Specific Pain Anxiety Scale (BSPAS) for use in the Czech language and evaluate its validity and reliability. Conducted across three university hospitals in the Czech Republic-Prague, Brno, and Ostrava-from September 2022 to February 2024, the study involved 203 inpatients and outpatients from burn units who met inclusion criteria and consented to participate. The adaptation process included rigorous analysis of validity and reliability, employing language, content, and construct validity assessments. Language validity was ensured through back translation, whereas content validity was confirmed through expert evaluations. Exploratory factor analysis revealed at least a two-factor structure with satisfactory factor loading. Loading of factors to questions was consistent between BSPAS-9 and BSPAS-5. Confirmatory factor analysis further substantiated the model fit for both five- and nine-item versions (RMSEA 0.06 and 0.1 respectively). Internal consistency was assessed using item-total correlation, yielding acceptable results (range 0.63-0.82 for nine items and 0.71-0.82 for five items). Cronbach's alpha coefficients were 0.94 for the nine-item version and 0.91 for the five-item version. These findings indicate that the Czech version of the BSPAS is a valid and reliable tool for assessing pain-related anxiety in patients with burns. Additionally, we show that in our population, the information from the nine-item version is well captured by the five-item version and pain alone explains most of the variance in BSPAS scores.

Background/Objectives: Knee osteoarthritis (KOA) is one of the most common causes of chronic pain and disability in older adults. Its mechanisms are both peripheral and central, causing discordance between pain intensity and disease severity. To provide better, mechanism-driven treatments for KOA, it is important to understand the emotional, physical, and neurophysiological factors that influence pain intensity. Thus, we proposed a multivariate model investigation of the multimodal predictors of pain intensity in patients with chronic KOA pain. Methods: We conducted an extensive assessment of 105 KOA patients. We used two different types of outcomes: (i) activity-related (Western Ontario and McMaster Universities Osteoarthritis [WOMAC] pain scale), and (ii) non-specific (visual analog scale [VAS]) pain assessments. Results: We found the following. (1) A higher WOMAC pain score was predicted by sensory-motor markers (lower intracortical inhibition [p = 0.021] and higher beta-band oscillations [p = 0.027]) and central sensitization (dysfunctional CPM response [p < 0.001]), in addition to the psychological and peripheral sensitization factors (adjusted R2 = 52%, F (5, 99) = 22.81, p < 0.0001). (2) Conversely, higher VAS pain intensity was only predicted by psychological factors (higher depression [p = 0.021] and pain catastrophizing [p = 0.003]), peripheral sensitization (lower pain thresholds), and worse motor function (balance test) (adjusted R2 = 36%, F (5, 99) = 12.57, p < 0.0001). Interestingly, no TMS or EEG markers were associated with VAS pain. Conclusions: Our study supports the notion that pain during physical activity is associated with a neural signature that demonstrates a lack of compensatory mechanisms for pain (decreased cortical inhibition, higher beta-band oscillations, and defective CPM), and it is different from the pain at rest, measured by the VAS, which is related mostly to emotional circuit dysregulation. These findings are important for developing better-targeted neural therapies given the contribution of different neural mechanisms to OA pain.

Effective perioperative blood glucose control is crucial for reducing postoperative complications in patients with diabetes mellitus (DM) who are undergoing total knee arthroplasty (TKA). The aim of this study was to assess the impact of intravenous (IV) dexamethasone on blood glucose levels, insulin requirements, postoperative pain, and postoperative nausea and vomiting (PONV) in patients with well-controlled type-2 DM.

A total of 83 Asian patients with well-controlled type-2 DM (defined as a preoperative glycated hemoglobin level of ≤7.0%) undergoing primary TKA were randomized to receive either IV dexamethasone or normal saline solution. Blood glucose and insulin requirements were monitored postoperatively up to day 5, and pain and PONV were assessed using a numeric rating scale.

Compared with the control, IV dexamethasone transiently elevated blood glucose levels on the day of surgery and on postoperative day 1, with the levels returning to baseline by day 3. Insulin requirements were higher in the intervention group on postoperative day 1 (p = 0.004). While IV dexamethasone did not significantly reduce PONV, it effectively alleviated postoperative pain up to day 3.

In patients with DM who underwent TKA, IV dexamethasone administration transiently increased blood glucose on the day of surgery and on postoperative day 1 and elevated insulin requirements on postoperative day 1. Despite having no impact on PONV, IV dexamethasone provided clinical benefits by reducing early postoperative pain. These findings suggest the potential benefits of IV dexamethasone in enhancing perioperative management strategies for patients with DM who are undergoing TKA.

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

ObjectivesEpidural blood patch (EBP) is the current standard of care for postdural puncture headache (PDPH). However, when EBP fails to provide relief, patients may experience discomfort and functional impairments. This study reports the safety and efficacy of a novel approach that uses autologous platelet-rich fibrin (PRF) as an alternative epidural patch.MethodsSixty-seven patients with persistent PDPH symptoms after conservative medical treatment were screened. Among them, 12 (18%) patients underwent multiple EBP (range: 1-6), which failed to resolve the PDPH symptoms. As an alternative method, an epidural PRF patch (EPP) was used, in which PRF was injected percutaneously epidurally under fluoroscopic guidance. Patient symptoms were collected perioperatively, and a follow-up period of up to 6 months was conducted.ResultsThe 12 patients included showed good tolerance for the EPP procedure, with injection volumes ranging from 15 to 39 ml. Compared to EBP, patients reported a significant reduction in injection-associated pain, as measured by the unidimensional numeric rating scale, with a mean reduction of 52.8% (p ≤ 0.05). The headache impact test scores (HIT-6) obtained before and 6 months after EPP revealed a statistically significant reduction in symptoms by a mean of 33.3% (p ≤ 0.05). Moreover, no adverse effects were observed during follow up. It is noteworthy that all patients experienced significant relief from PDPH-associated symptoms 6 months after the intervention.ConclusionEPP may be a viable solution for patients with persistent PDPH symptoms. Notably, the discomfort experienced due to pain during the EPP procedure was markedly less than that experienced during the EBP procedure. The fact that clinical improvement was observed after 6 months is encouraging and lays the groundwork for additional clinical investigations.

Patients who experience hip fractures often undergo bipolar hip arthroplasty (BHA) or open reduction and internal fixation (ORIF); however, acute postoperative pain remains a significant concern, often delaying rehabilitation and impairing recovery. This study compared acute phase pain characteristics (intensity and trajectory, and duration of analgesic use) between BHA and ORIF. Previous studies have suggested that patients undergoing ORIF may experience higher pain levels than those undergoing BHA, although most assessments have been limited to single time points, which may not capture the full scope of postoperative pain.

This prospective cohort study was conducted between February and August 2024. Pain intensity was evaluated on postoperative day (POD) 1, 3, 5, 7, and 14 using a numerical rating scale. Pain trajectories (slope and intercept) were calculated based on pain intensity assessed on POD 1, 3, 5, and 7. The duration of analgesia was assessed from the time of surgery until discontinuation. Multiple linear regression analysis was performed to examine the effect of surgical type (0, BHA; 1, ORIF) on pain-related outcomes, adjusting for confounders including age, sex, preoperative C-reactive protein level, and operative duration.

Data from 48 patients who underwent BHA and 32 who underwent ORIF were analyzed. There were no significant differences in pain intensity between the groups on POD 1 and 3. However, pain was significantly greater in the ORIF group on POD 5 (p < 0.01), 7 (p < 0.01), and 14 (p < 0.01). Regression analysis revealed that surgery type significantly influenced pain intensity on POD 14 (β = 1.27, p = 0.01) and pain trajectory slope (β = 0.52, p = 0.03). The intercept and analgesic duration were not significantly different between the groups.

Acute phase postoperative pain characteristics differed between BHA and ORIF, highlighting the need for targeted pain management during recovery in patients undergoing ORIF.

This study aims to explore the role of sex as a confounder and effect modifier in the associations of clinical outcomes, pain-related outcomes, and neurophysiological measurements in chronic knee OA pain subjects.

Sociodemographic, clinical, and neurophysiological data were extracted from 113 knee OA subjects with chronic pain. We performed exploratory multivariate regression models assessing the association of physiological outcomes (Quantitative Sensory Testing [QST], Electroencephalography [EEG], and Transcranial Magnetic Stimulation [TMS]) and clinical characteristics (pain, anxiety, and motor function). In each independent model we tested the role of biological sex as confounder and effect modifier (adding the interaction term).

Females reported higher pain intensity, lower quality of life, diminished pain thresholds, and less EEG alpha power compared to males. Sex negatively confounded the association between pain interference and pain intensity with pain threshold confounding (ranged between -19% to -125%). Moreover, sex acted as an effect modifier, predominantly influencing the relationship between pain interference and frontocentral alpha-delta power in EEG. Similarly, sex modified the association between pain interference and pain threshold. In females EEG and PPT variables explained less variability of pain interference compared to males.

Our study suggests that sex is a confounder and effect modifier mainly in the relationship between neurophysiological variables and pain-related outcomes in a chronic OA pain population. Females may have weaker associations between pain intensity and mechanistic outcomes (EEG and QST). Thus, the use of these biomarkers in females requires further optimization. We therefore reinforce the need for accounting for biological sex in the analysis, not only as a confounder, but as an effect modifier in further randomized trials and observational studies in the field of pain.

BackgroundDorsal scapular nerve (DSN) entrapment commonly causes an inconvenient pain in the peri-scapular area and arm.ObjectiveTo assess the efficacy of adding scapulothoracic stabilization exercises (StSE) to DSN blockade on pain intensity, upper extremity disability, DSN conductivity and fatigue severity in people with DSN entrapment.MethodsIn this randomized controlled trial, 60 patients with chronic DSN entrapment, were assigned to control (n = 30) and intervention (n = 30) groups. Both groups received DSN blockade injection and only the intervention group received an additional StSE for six successive weeks. The primary outcome measures included the Numeric Pain Rating Scale (NPRS) and the Disability of Arm, Shoulder and Hand Questionnaire (DASH), while the secondary measures were the motor distal latency (MDL) of DSN and the Fatigue Assessment scale (FAS), which were all tested pre-and post-treatment.ResultsPost-treatment, both groups showed significant changes in all measures. On comparing groups, the results revealed a significant difference in favor to the intervention group observed in the NPRS, DASH and FAS (p < 0.001).ConclusionAdding the StSE alongside DSN blockade could reduce patient's scapular pain, decrease the upper extremity's disability and fatigue severity in people with DSN entrapment.

This randomized clinical trial evaluated a copaiba oil-based gel in controlling dental sensitivity (DS) and color change after dental bleaching.

Seventy-five volunteers were randomized into three groups (n = 25): GC (placebo gel - negative control); GKF2% (gel of 5% potassium nitrate and 2% sodium fluoride - positive control); and GCO (copaiba oil gel). Three bleaching sessions were performed using 35% hydrogen peroxide (HP 35%), with 7-day intervals. The desensitizing gels were applied for 10 min in each group. The DS was evaluated over 21 days using a visual analog scale (VAS). Color evaluation was done with a spectrophotometer before and after bleaching using the CIEDE2000. The DS was assessed between groups (Kruskal-Wallis test) and within groups (Friedman test). The color change was analyzed using one-way ANOVA and Tukey's test.

GCO and GKF2% showed the lowest sensitivity values, with no significant difference (p < 0.05). In the intragroup analysis, GCO and GKF2% showed no differences across the three whitening sessions (p = 0.974, p = 0.213, p = 0.143, respectively). Conversely, GC exhibited an increase in DS after the last session (p = 0.035). All groups showed color change, without statistically significant differences between the groups (p = 0.725).

The copaiba gel reduced dental sensitivity after treatment with 35% hydrogen peroxide, without affecting the bleaching effectiveness.

The topical application of the experimental copaiba oil gel was effective in reducing dental sensitivity after bleaching with 35% hydrogen peroxide.

Quality of life (QoL) and sleep quality are critical to the well-being of night-shift nurses. This study evaluates the therapeutic effects of an 830 nm laser array on QoL and sleep quality among this population. A total of 60 night-shift nurses participated in the study. The 830 nm laser array was applied to the palm and a localized painful area at an energy density of 252 J/cm2. Changes in QoL and sleep quality were assessed using standardized questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), the Athens Insomnia Scale (AIS), the MOS 36-item short-form health survey, v. 2 (SF-36v2), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). Following treatment, participants exhibited significant reductions in global PSQI (p < 0.001) and AIS scores (p < 0.001), indicating improved sleep quality. Positive changes were also observed in global scores on the SF-36v2 (p < 0.01) and the WHOQOL-BREF (p < 0.05). Additionally, pain levels were significantly reduced during the one-month treatment period (p < 0.001). The beneficial effects of photobiomodulation are sustained for a duration of at least one month. This approach offers a promising means of mitigating the adverse effects of night shifts and improving overall well-being.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that severely impairs quality of life. Treatment typically involves a patient-oriented combination of medical therapies, surgery, and lifestyle modifications. However, data on the impact of surgical treatments on quality of life remain limited. This prospective monocentric study aimed to evaluate the effect of wide surgical excision in patients with moderate to severe HS (Hurley stage II/III) who were naïve to systemic biologic treatments. Between March 2017 and November 2022, 82 patients (51% female; 80% Hurley II, 20% Hurley III) underwent major surgical excision. Assessments were performed before surgery and at three and six months postoperatively. The primary endpoint was the change in Dermatologic Life Quality Index (DLQI); secondary endpoints included changes in pain (NRS-11) and disease severity scores. DLQI improved from 11.7 at baseline to 8.3 at three months and 4.7 at six months (p < 0.001). Pain scores and the modified Hidradenitis Suppurativa Score (mHSS) also significantly decreased (p < 0.001). In conclusion, major surgery significantly improved quality of life and pain in HS patients, confirming its essential role in a multimodal treatment approach. Patient-reported outcome measures are crucial for assessing treatment efficacy in HS.

To identify studies reporting patient acceptable symptom state (PASS) thresholds in diverse shoulder pain populations and to investigate whether patient-reported outcome measurements measuring shoulder pain severity provide similar estimates of the PASS across groups of people experiencing shoulder pain.

Web of Science, Scopus, CENTRAL, and OVID (MEDLINE) databases were searched for studies on PASS related to shoulder pain using terms for PASS, shoulder pathologies, and pain-related patient-reported outcome measurements. Risk of bias (RoB) was categorized using a modified the Quality in Prognosis Studies Tool. The meta-analysis applied random effects models, with heterogeneity assessed via I2 and Cochran's Q-test. Subgroup analysis was performed, with bias evaluated using funnel plots and the Egger test.

Twenty-one studies were included, involving 8.992 participants with an average age of 50.55 years. The PASS thresholds for shoulder pain varied across the interventions and follow-up periods. The pooled PASS estimate was 20.18 (95% confidence interval 16.63-23.73, prediction interval 2.98 to 37.38), with significant heterogeneity (I2 = 97%). Surgical interventions had lower PASS thresholds than nonsurgical approaches. Studies with longer follow-up duration and moderate RoB had lower PASS thresholds. A significant publication bias was identified.

This systematic review and meta-analysis established a pooled PASS threshold for shoulder pain, highlighting substantial heterogeneity and significant differences in PASS thresholds across RoB levels, follow-up durations, and types of intervention.

Level IV, systematic review and meta-analysis of Level II-IV studies.

The primary analysis of the MiroTAS study in patients with lumbar spinal stenosis (LSS) taking non-steroidal anti-inflammatory drugs showed that mirogabalin add-on therapy further improved pain and quality of life (QOL) without new safety concerns.

This post hoc analysis of the MiroTAS study examined the timing of onset of mirogabalin-related adverse drug reactions (mrADRs) (composite of somnolence, dizziness, edema, and peripheral edema), factors affecting safety and efficacy, and the relationships between baseline numbness severity (by spine painDETECT questionnaire [SPDQ] score), EQ-5D-5L scores, leg pain improvement (by visual analogue scale [VAS]), and patient satisfaction (by Patient Global Impression of Change [PGIC] scores).

Among 110 patients, there were no significant differences in the incidence rates of mrADRs by patient characteristics. The mrADRs occurred mainly after the first administration and uptitration period of mirogabalin. EQ-5D-5L scores significantly improved from baseline to week 12 in patients with mrADRs vs those without (difference 0.0767; p = 0.0304 by t test). The proportion of patients with PGIC scores ≤ 3 at week 12 was numerically higher in patients with mrADRs vs those without. There were no differences in the percentage of patients with reduced leg pain by VAS score (improvement ≥ 20 mm) at week 12 by patient characteristics except for spondylolysis/spondylolisthesis as a complication. Baseline SPDQ numbness scores were positively correlated with improvement in EQ-5D-5L at week 12 (Spearman's rank correlation coefficient 0.2811, p = 0.0092).

Mirogabalin was not related to specific patient characteristics regarding the onset of mrADRs and was effective for LSS regardless of patient characteristics. Caution is needed regarding the onset of mrADRs after first administration and uptitration of mirogabalin, but these may not reduce QOL or patient satisfaction. Patients with high numbness scores may be more likely to benefit from treatment with mirogabalin in terms of QOL.

Japan Registry of Clinical Trials (jRCTs021200007).

Dural tenting sutures are a well-known neurosurgical technique. However, claims of them preventing extradural hematomas (EDHs) lack evidence-based support. For that reason, we decided to evaluate the noninferiority of routinely not tenting the dura in elective supratentorial craniotomies.

A randomized, multicenter, investigator-blinded and participant-blinded, controlled interventional trial with 1:1 allocation. We included adults undergoing elective, supratentorial craniotomies. Not tenting the dura was an intervention, and the control group consisted of patients with at least 3 dural tenting sutures. The primary outcome was the risk of reoperation because of EDH, and secondary outcomes included a selection of clinically relevant outcomes.

We randomized 490 patients into intervention (238, 49%, not tenting the dura) and control (252, 51%, dural tenting) study groups, as per intention-to-treat analysis. Proportions of EDH surgeries in the intervention group were noninferior in comparison with the control group and not significantly different using the intention-to-treat (0.8% and 0.4%, P = .98), per-protocol (0.5%, 0.4%, P > .99), and as-treated (0.5%, 0.7%, P > .99) analyses. There were no significant differences in secondary outcomes: postoperative 30-day mortality (0.8%, 1.2%, P > .99), postoperative 30-day readmission (1.7%, 4.4%, P = .99), new neurological deficit or deterioration of a previous (19.7%, 15.5%, P = .81), cerebrospinal fluid leak (1.3%, 4.4%, P > .99), deterioration of postoperative headache over 5 numerical rating scale (4.4%, 2.4%, P = .85), epidural collection thickness over 3 mm (90.8%, 87.3%, P = .81), and midline shift over 5 mm (7.6%, 4.8%, P = .791) in the intervention and control study groups in intention-to-treat analysis. Similarly, secondary outcomes were not different in per-protocol and as-treated analyses. Other than cerebrospinal fluid leaks and EDHs, there were 17 adverse events in the intervention group and 19 in the control group (intention-to-treat analysis, 7.1% and 7.5%, respectively).

This trial demonstrates the noninferiority of omitting prophylactic dural tenting for postoperative EDH requiring surgery in elective, supratentorial craniotomies.

Treating older adults with acute pain in the emergency department is complicated. Undertreated pain can lead to delirium and functional decline. Conversely, common analgesics pose risks of serious drug-drug interactions and adverse drug events. In this review, we discuss issues essential to pain management in older adults including (1) assessing pain in the cognitively impaired, (2) review of analgesic medication classes, (3) principles of geriatric pharmacology, and (4) selecting an analgesic for an older adult with acute pain.

Chikungunya virus (CHIKV), transmitted through Aedes mosquitoes, has witnessed a global surge in distribution and outbreaks, posing a significant public health threat. This study conducted two systematic literature reviews (SLRs) to examine the socio-economic burden associated with chikungunya.

Two SLRs were conducted employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) standards. The SLRs covered electronic databases, grey literature, and bibliographic searches. Inclusion criteria were guided by the PICOS (Population, Intervention, Comparator, Outcomes, Study type) framework.

A total of 34 studies on cost and resource use and 37 studies on health-related quality of life (HRQoL) were included. Direct costs, driven by hospitalization, consultations, diagnostics, and drugs, were frequently reported, with significant variability across studies. Indirect costs, mainly attributed to absenteeism, constituted a substantial portion of the total economic burden. HRQoL studies consistently revealed high pain levels and diminished physical functioning among chikungunya patients, particularly in chronic cases, where these impacts persisted for months to years.

This study highlights the significant economic and public health impact of chikungunya, driven by high treatment costs, productivity losses, and chronic disability. Despite the severity of the disease, limited awareness regarding the severity and economic burden, particularly in resource-limited regions, persists. Our findings underscore the need for targeted public health strategies, standardized management approaches, and increased research to better understand the socio-economic burden of the disease and inform effective interventions.

We prospectively examined the prevalence, co-existence, and change of geriatric giant syndromes in older people over 2 years.

Two hundred and five older subjects were examined before and after 2 years. Ten geriatric giants were assessed at both time points: cognitive impairment, depression, orthostatic hypotension, polypharmacy, sarcopenia, dynapenia, falls, chronic pain, faecal and urinary incontinence.

Chronic pain, cognitive impairment, and urinary incontinence were three of the most commonly occurring geriatric giants at baseline (57%, 46%, and 40%). The presence of faecal incontinence, urinary incontinence, falls, depression, cognitive impairment, orthostatic hypotension, and polypharmacy was most strongly related to the number of geriatric giants in total at baseline (P < 0.05). A higher intake of dietary antioxidants by one point was related to fewer geriatric giants after 2 years (by 0.04, after adjusting for confounding factors (P = 0.03)).

Geriatric giant syndromes tend to co-exist and change with high variability over 2 years. Higher intake of antioxidants with diet could be related to fewer geriatric giants over time.

Previous studies have shown that chronic multimorbidity is associated with frailty in older adults. However, the mechanisms of this association are unclear. This study aimed to determine the mediating role of pain and depressive symptoms in the relationship between chronic multimorbidity and frailty.

We examined the relationship between chronic multimorbidity, pain, depressive symptoms, and frailty in a cross-sectional survey of 501 older adults (48.5% male, median age = 74 years).

There was a positive correlation between chronic multimorbidity and frailty in older adults. In addition, pain and depressive symptoms mediated the relationship between chronic multimorbidity and frailty both independently and serially. The total indirect effect of the three mediation paths was 36%.

Active treatment of the primary conditions of older adults, supplemented by attention given to physical and mental health issues such as pain and depressive symptoms, could prevent the development of frailty in older adults.

Mirikizumab, a p19-directed antibody against interleukin-23 (IL-23), is administered by subcutaneous (SC) injection. Injection site pain (ISP) associated with citrate buffers may negatively affect patient adherence to SC-administered treatments. We assessed the bioequivalence and safety of the citrate-free (CF) and original formulations of mirikizumab.

The formulations were assessed in three phase 1, two-arm, randomized, single-dose, parallel design studies in healthy participants: study A (NCT04548219), study B (NCT05515601), and study C (NCT05644353). Participants were randomized 1:1 to either formulation, then further randomized to injection site locations of abdomen, arm, or thigh. The relative bioavailability (RBA) study A had a primary objective of assessing the RBA of a single 200 mg dose. Bioequivalence (BE) studies B and C had the primary objective of assessing the BE of a 200 and 300 mg dose, respectively. In all studies, the primary endpoints were Cmax, AUC(0-∞), and AUC(0-tlast). The secondary objective was to assess safety and tolerability by treatment-emergent adverse events and serious adverse events. In study A, ISP was quantified prospectively using the 100-mm validated visual analogue scale (VAS) assessment form.

The primary objective was met in all studies. The RBA study found no significant difference in exposure between the formulations. BE was demonstrated between CF and original mirikizumab in both BE studies, with the 90% confidence intervals of the ratios of geometric least squares means within the pre-specified equivalence limits of 0.80 and 1.25. The frequency of ISP and injection site reactions (ISRs) was lower for CF than original mirikizumab in all studies. Furthermore, a significant difference in mean VAS score was observed in study A.

Mirikizumab CF and original formulations were bioequivalent. The CF formulation was associated with less pain and fewer ISRs, with no other notable differences in safety profiles.

ClinicalTrials.gov identifier NCT04548219, NCT05515601, NCT05644353.

Questions remain on the relationship between pain and hepatitis C virus cure among persons who inject drugs (PWID). This study aimed to explore whether achieving hepatitis C virus cure reduced pain severity.

Prespecified secondary analysis utilized data from a pragmatic clinical trial of care delivery models that enrolled PWIDs between 2016 and 2018 and treated with sofosbuvir/velpatasvir. Current pain severity (0-100) was assessed before and after treatment and 5-point Likert pain scales were used to determine moderate or greater current pain at baseline; the duration and etiology of current pain were not assessed. We used generalized mixed-effects linear models to test whether achieving sustained virologic response (SVR), that is, cure, was associated with lower numeric pain scores (primary outcome) posttreatment, adjusting for potential confounders (age, sex, intervention assignment, time/visit, and baseline pain severity category) and to examine changes in pain over time. Adjusted means estimated from a fitted model for pain severity at each visit were compared between participants who did and did not achieve SVR, both for the sample overall and for the subsample of participants who reported moderate or greater pain at baseline.

Of the 501 participants who were randomized, treated with DAAs and had SVR data, moderate or greater pain was reported at baseline in 174 (34.7%) of participants. Numeric pain severity did not significantly differ by SVR status at any study visit except for the week 48 visit from baseline, when the estimated pain score was significantly higher for those who failed treatment (38.0 vs 26.3, P  = 0.033). Among the subsample with baseline moderate or greater pain, pain severity scores were significantly lower in subsequent visits compared to the baseline visit, with the exception of week 48 among participants who did not achieve SVR.

Among PWID, achieving SVR did not improve pain severity. However, participants who failed treatment had significantly greater pain at the visit immediately following visit for SVR, which may relate to adverse psychological effects of treatment failure. Among those with baseline moderate or greater pain, pain scores declined post treatment, suggesting that treatment itself (irrespective of SVR) may be associated with improved pain.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of exercise interventions for work-related complaints of the arm, neck or shoulder (CANS) in adults. The outcomes of interest are pain, function, work outcomes, adverse events, quality of life, healthcare use and injury recurrence.

To report individual early and long-term functional outcomes of 43 women who underwent double circular stapler technique (DCST) for colorectal deep endometriosis (DE).

This multidisciplinary observational study was a retrospective case series report exploiting a long-established database of clinical information from a single private institution. The cohort consists of consecutive patients from January/2010 through July/2021 who underwent minimally invasive surgical treatment of DE. Inclusion criteria: all women whose bowel DE was managed by DCST. The assessment of bowel function was based on Obstructed Defecation Syndrome score, Gastrointestinal Symptom Rating Scale and Bowel Function in the Community Tool. Outcomes also included intra and postoperative complications, lower urinary tract symptoms, endometriosis-related menstrual and nonmenstrual pain (numeric rating scale), and conception. The analysis of the results was guided by a semi-qualitative reasoning based on individual changes.

The follow-up ranged from 1.4 to 123.8 months (median 38.2). All women presented with DE (mostly rASRM stage 4) and underwent large resections. No procedure was converted to open surgery nor required blood transfusion or ostomies. There was no anastomotic leakage. The risk of rectovaginal bowel fistula was 2.3% (CI 95%: <0.1-7.0) - one case. No patient had long-term urinary retention after surgery. At the most recent follow-up on dysuria, dyschezia, dysmenorrhea, dyspareunia and cyclic low back pain, 88 to 100% of women had favorable responses (improvements ≥ 3 points in symptomatic women or asymptomatic women who remained pain-free). One patient reported important worsening of her intestinal function, requiring continuous use of laxatives. Considering the 20 women with pregnancy intent, 14 (70%) conceived after surgery.

Preliminary results were encouraging in the past. The current assessment including long-term follow-up supports DCST for colorectal DE as a feasible, useful, and safe strategy for avoiding segmental colorectal resection when appropriately indicated and properly performed.

BackgroundStair ascent/descent pose significant challenges after total knee arthroplasty (TKA); however, the exact knee flexion range of motion (ROM) and quadriceps strength requirements remain unclear.ObjectiveTo establish criteria for knee flexion ROM and quadriceps strength to determine independence in stair ascent/descent and evaluate the accuracy of the combination of these factors in patients with bilateral TKA.MethodsPatients with bilateral TKA were cross-sectionally assessed at 1 year postoperatively for independence in stair ascent/descent. Receiver operating characteristic curves provided cutoff values for knee flexion ROM and quadriceps strength. The area under the curves (AUC) of each factor and logistic regression models including both factors were evaluated.ResultsEighty-two participants were included. Fifty-eight participants could independently ascend and 52 could descend stairs, with equal cutoff values for both: 121° for knee flexion ROM (AUC: 0.66 and 0.67) and 1.09 Nm/kg for quadriceps strength (AUC: 0.70 and 0.73). Logistic regression models produced AUCs of 0.73 and 0.76 for ascent and descent, respectively.ConclusionsA quadriceps strength of 1.09 Nm/kg is a useful cutoff for independent stair ascent/descent, but combining it with knee flexion ROM did not enhance accuracy. Other functions such as coordination of the knee or other joints may influence stair performance post-TKA.

Chronic pain and dieting represent significant threats to public health. Larger individuals and individuals with chronic pain are often stigmatized for their conditions and subsequently internalize stigma, exacerbating their negative mental and physical health impacts. Given the multiplicative effects of pain, stigma, and excess weight, research should examine associations among chronic pain, dieting behaviors, and experiences of health-related stigma. Adults (N = 286; Mage = 36.75, SD = 11.56; 62.6% female) with chronic pain participated in an online survey. Over half (57.9%) reported engaging in maladaptive weight loss behaviors. Higher levels of both experienced and internalized stigma were associated with more dieting behavior among smaller-bodied individuals. Maladaptive attempts at weight loss are fairly common among adults with chronic pain, and stigma can relate to these attempts among smaller-bodied individuals who have chronic pain. Screenings for disordered eating among chronic pain patients may be beneficial in clinical settings.

An effective treatment strategy for pediatric hypertrophic burn scars has yet to be established. This study aimed to evaluate the efficacy and safety of a dynamic treatment approach that combines non-ablative fractional laser (NAFL) therapy with intralesional triamcinolone (TAC) injections for post-burn hypertrophic scars in children. Participants were assigned to three groups: the combination treatment group (22 patients), the laser-only group (19 patients), and the triamcinolone-only group (17 patients). After a 6-month follow-up period, all three groups demonstrated a significant decrease in the modified Vancouver Scar Scale (m-VSS) scores compared to their pre-treatment values, with the combination group experiencing the most substantial reduction. The median post-treatment m-VSS score in the combination group was significantly lower than in the laser-only and triamcinolone-only groups (5 vs. 7 vs. 9, P = 0.003). The obvious effective rate of combination group was 54.5%, significantly higher than that of laser group (26.3%) and injection group (23.5%) (P = 0.012). Combining non-ablative fractional laser therapy with intralesional triamcinolone injections is an effective and safe treatment for post-burn hypertrophic scars in children. This approach significantly alleviates pain and itching, resulting in high levels of satisfaction among both physicians and patients, warranting clinical recommendation.

To evaluate the relationship between the pain severity and the injection speed, anxiety, and intraocular pressure changes during the intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents.

The 84 eyes were prospectively registered in the study. The severity of the pain was evaluated with the visual analogue scale (VAS). The severity of the anxiety was measured with the Beck Anxiety Inventory. All patients were naive to IVI. Bevacizumab or Ranibizumab 0.05 mL was administered intravitreally. The intraocular pressure (IOP) was measured before and after the procedure.

Correlation analyses were performed between VAS and the injection speed, the IOP difference, and anxiety. There was a negative significant correlation between injection speed and VAS (p = 0.024 r=-246). There was a positive significant correlation between the IOP difference and VAS (p = 0.001, r = 0.365). In addition, there was strong positive correlation between the anxiety level and VAS (p˂0.001 r = 0.77). Linear stepwise regression analysis was used to determine which of these three independent variables (VAS, IOP difference, Anxiety) influenced pain the most, and Anxiety and IOP difference were found to affect the dependent variable of VAS more. There was no significant difference between the IOP difference (p > 0.05) and anxiety scale values (p > 0.05) between the two anti-VEGF agents while there was statistically significantly more pain felt during the Bevacizumab IVI (p = 0.005).

The parameter with the most influence on pain severity was anxiety in this study, followed by the postop-preop IOP difference. There was also a significant negative correlation between injection speed and VAS.

Percutaneous balloon compression (PBC) is a surgical intervention for trigeminal neuralgia. This study hypothesized that PBC under regional anesthesia (RA) could reduce intraoperative hemodynamic fluctuations and postoperative adverse effects with efficacy equivalent to general anesthesia (GA).

In this retrospective cohort study, 159 patients who underwent PBC for trigeminal neuralgia at Xuanwu Hospital Capital Medical University between January 2022 and June 2023 were divided into RA (n = 60) and GA (n = 99) groups. Comparative analysis included intraoperative hemodynamics, postoperative efficacy, and adverse reactions over 12-month follow-up.

Compared with GA, RA resulted in more stable intraoperative hemodynamics and significantly reduced trigeminocardiac reflex risk (P < 0.01). Patients had shorter operative duration; had reduced medical expenses; and experienced lower extent and faster recovery of postoperative numbness, hypoesthesia, and bite force decrease (P < 0.05). The groups were similar regarding pain scale decrease, oral analgesic reduction, patient satisfaction, and specific adverse events over 1-year follow-up (P > 0.05).

PBC under RA has efficacy similar to GA without the need for GA management and resuscitation. RA was associated with more stable intraoperative hemodynamics and lower trigeminocardiac reflex incidence; reduced perioperative risk; enabled intraoperative communication with conscious patients, allowing for real-time assessment and adjustment of balloon compression extent, so that adverse events such as numbness were milder with faster recovery; resulted in shorter operative duration; and reduced medical expenses. This study demonstrated the clinical advantages and broad application prospects of PBC under RA, benefiting more patients with trigeminal neuralgia in remote areas.

Manual therapy and exercise are recommended for patients with neck pain. In a recent randomized controlled trial, home stretching exercises with or without manual therapy were offered to subjects with persistent or recurrent neck pain. No difference in pain or disability between the treatment groups were found after the two-week intervention period. We aimed to investigate whether these patients had a better outcome after individual tailoring of the treatment content two months after the initial structured intervention period.

This manuscript is a secondary analysis of a previous clinical trial where 131 patients with persistent or recurrent neck pain received treatments over two weeks (the intervention period). Pain and disability were assessed for two months following the intervention period. During this period, the treating therapists could recommend further individualized tailored treatment, including any treatment modality, regardless of the intervention group and whether the participants responded to the intervention (responders) or not (non-responders). Responders from the intervention period were defined as reporting a minimal clinical improvement on the numeric rating scale (NRS-11) at a 20-percentage points improvement (2 increments), regardless of group belonging in the original trial. All other participants were considered non-responders. We also evaluated the number of treatments, differences in disability, quality and affective component of pain, and quality of life during the individualized care period.

For responders to a randomized trial of manual therapy and stretching exercises, a significant worsening in pain was associated with an increasing number of treatments during a two-month individualized care period. Among non-responders to the initial intervention period, improvement in neck pain disability was observed with individually tailored treatments.

For responders to a randomized trial of manual therapy and stretching, worsening pain in the individualized care period was associated with increasing numbers of individually tailored treatments. Among non-responders to the initial intervention period, improvement in neck pain disability was observed with individually tailored treatments.

The trial was registered at ClinicalTrials.gov, registration number NCT03576846, on 23rd of June 2018.

Pain assessment is essential in nursing care. The Numerical Rating Scale (NRS) is widely used but may not fully capture pain's multidimensional nature. The Pain Assessment in Advanced Dementia (PAINAD) scale is reliable for assessing pain in cognitively impaired patients. This study aims to evaluate the validity of the Italian version of PAINAD (PAINAD-IT) for postoperative pain assessment in geriatric patients with femur fractures.

This study employs the PAINAD-IT, which was translated and validated for the Italian context by Costardi et al. (2007). Face and content validity (I-CVI and S-CVI) for non-cognitively impaired patients were evaluated by experts. Pain assessments were conducted at rest (T0) and during movement (T1). Convergent validity was tested using Spearman correlation, discriminant validity with the Wilcoxon test, and inter-rater reliability with Cohen's kappa. Sensitivity and specificity were calculated.

I-CVIs were ≥0.90 and S-CVI was 0.96. 75 patients were included. Cohen's kappa was 0.918 at T0 and 0.881 at T1. Both PAINAD and NRS detected a significant increase in pain from T0 to T1 (Wilcoxon p < 0.001). Sensitivity was 26 % and specificity was 99 % for PAINAD-IT scores ≥3.

PAINAD showed strong reliability and correlation with NRS, effectively distinguishing between rest and pain stages, these results suggest that PAINAD-IT may be a useful tool for pain assessment in geriatric patients operated for femur fracture. PAINAD-IT scores ≥3 may suggest severe pain. Further multi-centre studies with larger sample sizes are needed to fully validate PAINAD-IT for postoperative pain assessment in geriatric patients with.

Over one-third of patients with chronic pain report pain at multiple anatomical sites. The current study examined the co-localization of pain and its intensity over a 2-year follow-up period. Kendall rank correlation coefficient (denoted as tau) was applied for the co-occurrence of pain in specific locations. Individuals over the age of 60 years were recruited from the general population in Poland (N = 205, 60-88 years old). The lumbar spine was the most frequently occurring site for chronic pain, present in 31% of individuals at baseline and in 38% after 2 years. The number of pain sites did not change over 2 years (p = 0.53). An increase of co-occurrence between anatomical sites for pain was noted after 2 years. Cervical spine pain co-occurred with pain in the thoracic spine (tau = 0.31), lumbar spine (tau = 0.45), chest (tau = 0.18), hips (tau = 0.17), legs (tau = 0.18), knee(s) (tau = 0.31), and feet (tau = 0.17). The observed increase in pain co-occurrence over 2 years suggests the need for modified approaches to pain treatment in older adults.

Gait alterations associated with postural deviations are a significant factor contributing to functional limitations in older adults. Among these, sway-back posture has been linked to chronic low back pain (CLBP), defined as pain persisting for more than three months. This study aimed to analyze ground reaction forces (GRFs), loading and unloading rates, spatiotemporal gait parameters, and the asymmetry index (ASI) in older adults with sway-back posture and CLBP (SBCLBP) without adjusting for walking speed.

A total of 36 older adults were included and categorized into three groups: 12 with SBCLBP, 12 with CLBP without sway-back posture, and 12 without CLBP. GRFs and spatiotemporal gait parameters-including stride time, cadence, stride length, gait speed, and stance phase duration-were recorded for all participants. GRFs were analyzed at the anteroposterior peaks during heel contact (Fx1) and push-off (Fx2) phases, as well as at the vertical force peaks at heel contact (Fy1), mid-stance (Fy2), and push-off (Fy3) phases. Additionally, mediolateral force peaks (Fz) during heel contact were assessed. The ASI was calculated for all participants. Between-group differences were examined using one-way ANOVA and ANCOVA.

Cadence, stride length, gait speed, and Fy2 values were significantly lower in the SBCLBP and CLBP groups compared to the control group. Additionally, these parameters were significantly lower in the SBCLBP group than in the CLBP group. However, the loading rate demonstrated greater variability across participants. No significant differences in ASI were observed among the groups.

Older adults with SBCLBP exhibit distinct gait characteristics compared to those with CLBP alone and those without CLBP. These differences may be attributed to structural postural alterations, distinguishing this subgroup from individuals with isolated CLBP. These findings underscore the need for targeted rehabilitation strategies tailored to the specific biomechanical alterations observed in this population. Future research should focus on optimizing intervention protocols to enhance stability and mitigate pain-related gait impairments associated with aging.

Current Controlled Trials using the UMIN Clinical Trials Registry website with ID number of, UMIN000055653 "Retrospectively registered" at 27/09/2024.

This study investigates the effects of theta burst stimulation (TBS) on inflammatory markers in patients with isolated upper limb fractures (IULF). Participants underwent a 10-day TBS intervention following a randomized matched pair design. Blood samples collected at three time points were analyzed for inflammatory biomarkers, mainly including interleukin-1 receptor antagonist (IL-1Ra), IL-1β, and IL-6. Results revealed a significant interaction between TBS and time for IL-1Ra, indicating a more pronounced decrease in IL-1Ra expression over time in the active TBS group. However, IL-6 levels decreased over time regardless of TBS intervention, suggesting a natural decline in response to injury. No significant interaction was found for IL-1β. While IL-1Ra levels were associated with higher functional disability prior to treatment initiation, active TBS intervention led to a decrease of IL-1Ra levels at both follow-up time points. These changes were not associated with alterations in pain or disability, suggesting that TBS may primarily influence recovery processes independent of pain modulation. Notably, IL-1β levels were negatively correlated with disability in the active TBS group at the 3-month follow-up. This study sheds light on the potential of TBS to modulate inflammatory responses in orthopedic trauma, emphasizing the need for further research to elucidate its therapeutic implications. Clinical Significance: TBS may offer a promising adjunctive therapy for promoting functional recovery in patients with upper limb fractures.