Search results for: pain sensitivity

Authors: Valeriu Mihai But, Sorana Daniela Bolboacă, Adriana Elena Bulboacă

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The nutraceutical compound Curcumin (Curcuma longa L.) is known for its anti-inflammatory, anti-cancer, and antioxidant effects. This study aimed to evaluate the antioxidative and analgesic effects of Curcumin (CC) compared to Tramadol (T) in chemical-induced nociceptive pain in rats. Thirty-five rats were randomly divided into five groups of seven rats each and were treated as follows: C group (control group): treated with saline solution 0.9%, (1 ml, i.p. administration), ethanoic acid (EA) group: pretreated with saline solution 0.9% - 30 min before EA nociceptive pain induction, (1 ml, i.p. administration), T group: pretreated with Tramadol, 10 mg/kg body weight (bw), i.p. administration - 30 min before EA nociceptive pain induction, CC1-group: pretreated with 1 mg/100g bw Curcumin i.p. administration - 2 days before EA pain induction and CC2-group: pretreated with Curcumin 2 mg/100g bw i.p. administration - 2 days before EA nociceptive pain induction. The following oxidative stress parameters were assessed: malondialdehyde (MDA), nitric oxide (NOx), total oxidative status (TOS), total antioxidative capacity (TAC), and thiol (Th). The antalgic activity was measured by the ethanoic acid writhing test. Treatment with Curcumin, both 1 mg/100g bw, and 2 mg/100g bw, showed significant differences as compared with the control group (p<0.001) regarding malondialdehyde (MDA), nitric oxide (NOx), and total oxidative status (TOS) oxidative biomarkers. Pretreatment with 2 mg/100g bw of Curcumin presented a significant decrease in MDA values compared with Tramadol (p<0.001). The TAC significantly increased in pretreatment with Curcumin compared with group control. (p<0.001) The nociceptive response to EA was significantly reduced in Curcumin and Tramadol groups. Treatment with Curcumin at a higher concentration was more effective. In an experimental pain model, this study demonstrates an important antioxidant and antinociceptive activity of Curcumin comparable with Tramadol treatment.

Keywords: curcumin, nociception, oxidative stress, pain

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Authors: Muhammad Farooq Baig

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Objective: The purpose of this study was to compare results obtained using a single fecal specimen for O&P examination, direct immunofluorescence assay (DFA), and two conventional staining methods. Design: Hundred and fifty children fecal specimens were collected and examined by each method. The O&P and the DFA were used as the reference method. Setting: The study was performed at the laboratory in the Basic Medical Science Institute JPMC Karachi. Patients or Other Participants: The fecal specimens were collected from children with a suspected Giardia lamblia infection. Main Outcome Measures: The amount of agreement and disagreement between methods.1) Presence of giardiasis in our population. 2) The sensitivity and specificity of each method. Results: There was 45(30%) positive 105 (70%) negative on DFA, 41 (27.4%) positive 109 (72.6%) negative on iodine and 34 (22.6%) positive 116(77.4%) on saline method. The sensitivity and specificity of DFA in comparision to iodine were 92.2%, 92.7% respectively. The sensitivity and specificity of DFA in comparisoin to saline method were 91.2%, 87.9% respectively. The sensitivity of iodine method and saline method in compariosn to DFA were 82.2%, 68.8% respectively. There is mark diffrence in sensitivity of DFA to conventional method. Conclusion: The study supported findings of other investigators who concluded that DFA method have the greater sensitivity. The immunologic methods were more efficient and quicker than the conventional O&P method.

Keywords: direct immunofluorescence assay (DFA), ova and parasite (O&P), Giardia lamblia, children, medical science

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Authors: Joseph Salim

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This paper proposes the development of a supervised machine learning system to predict the consequences of untreated bruxism (teeth grinding) on gingival (gum) recession and jaw pain (most often bilateral jaw pain with possible headaches and limited ability to open the mouth). As a general dentist in a multi-specialty practice, the author has encountered many patients suffering from these issues due to uncontrolled bruxism (teeth grinding) at night. The most effective treatment for managing this problem involves wearing a nightguard during sleep and receiving therapeutic Botox injections to relax the muscles (the masseter muscle) responsible for grinding. However, some patients choose to postpone these treatments, leading to potentially irreversible and costlier consequences in the future. The proposed machine learning model aims to track patients who forgo the recommended treatments and assess the percentage of individuals who will experience worsening jaw pain, gingival (gum) recession, or both within a 3-to-5-year timeframe. By accurately predicting these outcomes, the model seeks to motivate patients to address the root cause proactively, ultimately saving time and pain while improving quality of life and avoiding much costlier treatments such as full-mouth rehabilitation to help recover the loss of vertical dimension of occlusion due to shortened clinical crowns because of bruxism, gingival grafts, etc.

Keywords: artificial intelligence, machine learning, predictive insights, bruxism, teeth grinding, therapeutic botox, nightguard, gingival recession, gum recession, jaw pain

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Authors: Farid Rezaei, Zahra Reza Soltani, Behrouz Tavana, Afsaneh Dadarkhah, Masoume Bahrami Asl, S. Alireza Mirghasemi

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Introduction: Fibromyalgia is a syndrome comprised of a group of symptoms. The primary symptom of fibromyalgia is pain propagation is associated by Secondary symptoms include fatigue, cognitive disorders, sleep disorders and hypersensitivity to painful stimuli. Recent studies have shown that there is a direct relationship between fibromyalgia and certain changes in brain activity. Aim: The aim of this study is determining the effect of tDCS in pain and quality of life in patients with fibromyalgia. Method: 68 patients with fibromyalgia who had inclusion criterias were randomly divided into two groups of case and control. Groups were matched in terms of gender, age, education, duration of pain and PMS. Patient groups treated with tDCS device manufacture by Enraf company made in Netherlands (M1 anodal stimulation, 2 mA constant current, 20 minutes, for 10 sessions (3 days a week)). Also the protocol was done for control group, in sham mode of tDCS device that had no current, for 10 sessions of 20 minutes. Before treatment, immediately after the end of 10 sessions treatment (short-term) and 10 week later (long-term effect), pain intensity questionnaires (VAS) and quality of life in fibromyalgia patients questionnaire was completed by the patient. Results: Pain intensity were significantly lower in the treatment group than the sham group 2 weeks and 10 weeks after treatment than before treatment (P < 0.001). Although the quality of life of patients 2 weeks after treatment showed no significant change, but ten weeks after treatment were more than sham group (P < 0.0001). Conclusion: Our results suggest that tDCS is a safe and effective in treating fibromyalgia patients and an important effect in reducing pain and increasing quality of their life.

Keywords: fibromyalgia, tDCS, quality of life, VAS score

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Authors: Alireza Jafarzadeh, Samad Mosaferi, Mansour Khakpour

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Mastitis is an inflammation of the parenchyma of mammary gland regardless of the causes. Mastitis is characterized by a range of physical and chemical changes in the glandular tissue. The most important change in milk includes discoloration, the presence of clots and large number of leucocytes. There is swelling, heat, pain and edema in mammary gland in many clinical cases. Positive coagulase S. aureus is a major pathogen of the bovine mammary gland and a common cause of contagious mastitis in cattle. The aim of this study was to evaluate the outbreaks of Staphylococcus aureus mastitis. This study is conducted in ten dairy herds about one thousand cows. After doing CMT and identifying infected cows, the milk samples obtained from infected teats and transported to microbiological laboratories. After microbial culture of milk samples and isolating S. aureus, antimicrobial, sensitivity test was performed with disk diffusion method by ciprofloxacin, co-amoxiclav, erythromycin, penicillin, oxytetracyclin, sulfonamides, lincomycin and cefquinome. The study defined that the outbreak of subclinical positive coagulase Staphylococcus mastitis in dairy herd was 13.11% (5.6% S. aureus and 7.51% S. intermedicus). The antimicrobial sensitivity test shown that 87.23% of Staphylococcus aureus isolated from bovine mastitis in dairy herd was susceptible to ciprofloxacin, 93.9% to cefquinome, 4.67% to co-amoxiclav, 12.16% to erythromycin 86.11% to sulfonamides (co-trimoxazole), 3.35% lincomycin, 12.7% to oxytetracyclin and 5.98% to penicillin. Results of present defined that ciprofloxacin has a great effect on Staphylococcus aureus isolated from subclinical bovine mastitis dairy herd. It seems that cefquinome sulfonamides has a great effect on isolated Staphylococcus aureus in vivo.

Keywords: ciprofloxacin, mastitis, Staphylococcus aureus, dairy herd

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Authors: Vu Hoang Thu Huong

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Background and Purpose: The effects of Extracorporeal Shockwave Therapy (ESWT) in the participants with knee osteoarthritis (KOA) were unclear on physical performance although its effects on pain had been investiagted. This study aims to explore the effects of ESWT on pain relief and physical performance on KOA. Methods: The studies with the randomized controlled design to investigate the effects of ESWT on KOA were systematically searched using inclusion and exclusion criteria through seven electronic databases including Pubmed etc. between 1990 and Dec 2022. To summarize those data, visual analog scale (VAS) or pain scores were determined for measure of pain intensity. Range of knee motion, or the scores of physical activities including Lequesne index (LI), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were determined for measure of physical performances. The first evaluate after treatment period was define as the effect of post-treatment period or immediately effect; and the last evaluate was defined as the effect of following period or the end effect in our study. Data analysis was performed using RevMan 5.4.1 software. A significant level was set at p<0.05. Results: Eight studies (number of participant= 499) reporting the ESWT effects on mild-to-moderate severity (Grades I to III Kellgren–Lawrence) of KOA were qualified for meta-analysis. Compared with sham or placebo group, the ESWT group had a significant decrease of VAS rest score (0.90[0.12~1.67] as mean difference [95% confidence interval]) and pain score WOMAC (2.49[1.22~3.76]), and a significant improvement of physical performance with a decrease of the scores of WOMAC activities (8.18[3.97~12.39]), LI (3.47[1.68~5.26]), and KOOS (5.87[1.73~ 10.00]) in the post-treatment period. There were also a significant decrease of WOMAC pain score (2.83[2.12~3.53]) and a significant decrease of the scores of WOMAC activities (9.47[7.65~11.28]) and LI (4.12[2.34 to 5.89]) in the following period. Besides, compared with other treatment groups, ESWT also displayed the improvement in pain and physical performance, but it is not significant. Conclusions: The ESWT was effective and valuable method in pain relief as well as in improving physical activities in the participants with mild-to-moderate KOA. Clinical Relevance: There are the effects of ESWT on pain relief and the improvement of physical performance in the with KOA.

Keywords: knee osteoarthritis, extracorporeal shockwave therapy, pain relief, physical performance, shockwave

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Authors: Adam J. Carinci

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Background: The opioid epidemic is the most pressing healthcare crisis of our time. There is increasing recognition that opioids have limited long-term efficacy and are associated with hyperalgesia, addiction, and increased morbidity and mortality. Therefore, alternative strategies to combat chronic pain are paramount. We initiated a multicenter retrospective case series to review the efficacy of DRG stimulation in facilitating opioid tapering, opioid discontinuation and as a viable alternative to chronic opioid therapy. Purpose: The dorsal root ganglion (DRG) plays a key role in the development and maintenance of pain. Recent innovations in neuromodulation, specifically, dorsal root ganglion stimulation, offers an effective alternative to opioids in the treatment of chronic pain. This retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy. Procedure: This small multicenter retrospective case series provides preliminary evidence that DRG stimulation facilitates opioid weaning, opioid tapering and is a viable option to opioid therapy in the treatment of chronic pain. A retrospective analysis was completed. Visual analog scale pain scores and pain medication usage were collected at the baseline visit and after four weeks, 3 months and 6 months of treatment. Ten consecutive patients across two study centers were included. The pain was rated 7.38 at baseline and decreased to 1.50 at the 4-week follow-up, a reduction of 79.5%. All patients significantly decreased their opioid pain medication use with an average > 30% reduction in morphine equivalents and four were able to discontinue their medications entirely. Conclusion: This Retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy.

Keywords: dorsal root ganglion, neuromodulation, opioid sparing, stimulation

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Authors: Ruhollah Heydari Sheikh Ahmad, Sara Alaie Khoraem

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Introduction: Substance use disorder is conceptualized as a chronic relapsing condition where relapse is usually defined as the return to problematic substance use following treatment. An issue of great importance is the identification of the predictors of relapse and the development of treatments that may help prevent relapse. One of the strongest predictors of relapse is craving. The purpose of the present study was to study the effect of anxiety, anxiety sensitivity, and coping motives on craving. Materials and method: Participants (n=74) were male opiate users recruited from a semi-private clinic providing de-toxification and treatment services for substance users. Anxiety, anxiety sensitivity, coping motives and craving were assessed using relevant questionnaires. The addiction severity index was used to assess addiction severity. Results: All patients were methadone maintained and one year after detoxification, 36 patients (48.64%) relapsed. Stress and anxiety, anxiety sensitivity, addiction severity and coping motives predicted craving and relapse. Anxiety sensitivity specifically predicted early relapse. Conclusion: Substance use is a severe mental disorder, with high relapse rates. Substance users high in anxiety sensitivity are particularly prone to relapse during the first six months of treatment. Addiction severity and coping motives need to be taken into account when providing interventional services for substance users. Findings imply the significance of additional psychological attention to methadone maintained patients to prevent craving and relapse.

Keywords: anxiety sensitivity, coping motives, relapse, substance use craving

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Authors: Ahmed R. Z. Baghdadi, Ibrahim M. I. Hamoda,  Mona H. Gamal Eldein, Ibrahim Magdy Elnaggar

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Background: High-velocity low amplitude thrust (HVLAT) manipulation and low-velocity low amplitude (LVLA) mobilization are an effective treatment for low back pain (LBP). Purpose: This study compared the effects of HVLAT versus LVLA on pain, functional deficits and segmental mobility in treatment of chronic mechanical LBP. Methods: Ninety patients suffering from chronic mechanical LBP are classified to three groups; Thirty patients treated by HVLAT (group I), thirty patients treated by LVLA (group II) and thirty patients as control group (group III) participated in the study. The mean age was 28.00±2.92, 27.83±2.28 and 28.07±3.05 years and BMI 27.98±2.60, 28.80±2.40 and 28.70±2.53 kg/m2 for group I, II and III respectively. The Visual Analogue Scale (VAS), the Oswestry low back pain disability questionnaire and modified schoper test were used for assessment. Assessments were conducted two weeks before and after treatment with the control group being assessed at the same time intervals. The treatment program group one was two weeks single session per week, and for group II two sessions per week for two weeks. Results: The One-way ANOVA revealed that group I had significantly lower pain scores and Oswestry score compared with group II two weeks after treatment. Moreover, the mobility in modified schoper increased significantly and the pain scores and Oswestry scores decreased significantly after treatment in group I and II compared with control group. Interpretation/Conclusion: HVLAT is preferable to LVLA mobilization, possibly due to a beneficial neurophysiological effect by Stimulating mechanically sensitive neurons in the lumbar facet joint capsule.

Keywords: low back pain, manipulation, mobilization, low velocity

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Authors: Mahesh Mitra

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Introduction and Purpose: Patellofemoral Pain Syndrome [PFPS] is characterized by pain or discomfort seemingly originating from the contact of posterior surface of Patella with Femur. Given the multifactorial causes and high prevalence there is a need of proper management technique. Also a more comprehensive and best possible Physiotherapy treatment approach has to be devised to enhance the performance of the individual with PFPS. Purpose of the study was to: - Prevalence of PFPS in various sports - To determine if there exists any relationship between the Body Mass Index[BMI] and Pain Intensity in the person playing a sport. - To evaluate the effect of conventional Physiotherapy program, Mobilization and Taping with Proprioceptive training on PFPS. Hypothesis 1. Prevalence is not the same with different sporting activities 2. There is a relationship between BMI and Pain intensity. 3. There is no significant difference in the improvement with the different treatment approaches. Methodology: A sample of 200 sports men were tested for the prevalence of PFPS and their anthropometric measurements were obtained to check for the correlation between BMI vs Pain intensity. Out of which 80 diagnosed cases of PFPS were allotted into three treatment groups and evaluated for Pain at rest and at activity and KUJALA scale. Group I were treated with conventional Physiotherapy that included TENS application and Exercises, Group II were treated with compression mobilization along with exercises, Group III were treated with Taping and Proprioceptive exercises. The variables Pain on rest, activity and KUJALA score were measured initially, at 1 week and at the end of 2 weeks after respective treatment. Data Analysis - Prevalence percentage of PFPS in each sport - Pearsons Correlation coefficient to find the relationship between BMI and Pain during activity. - Repeated measures analysis of variance [ANOVA] to find out the significance during Pre, Mid and Post-test difference among - Newman Kuel Post hoc Test - ANCOVA for the difference amongst group I, II and III. Results and conclusion It was concluded that PFPS was more prevalent in volley ball players [80%] followed by football and basketball [66%] players, then in hand ball and cricket players [46.6%] and 40% in tennis players. There was no relationship between BMI of the individual and Pain intensity. All the three treatment approaches were effective whereas mobilization and taping were more effective than Conventional Physiotherapy program.

Keywords: PFPS, KUJALA score, mobilization, proprioceptive training

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Authors: Mohammadreza Khanmohammadi, Noureddin Nakhostin Ansari, Soofia Naghdi

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Purpose: Our study aimed to validate single item presenteeism question (SIPQ) into the Persian language for patients with low back pain. Background information: low back pain is a common health problem, and it is one of the most prevalent disorder in working people. There are the different subjective way to evaluate the effect of back pain on work productivity that one of them is by implementing single item presenteeism question. This question has not been validated into the Persian language. Method: Patients were asked to answer SIPQ and pain from 0 to 10 according to numerical rating scale (NRS). The functional rating index was administrated to evaluate construct validity. For test-retest reliability, almost 50 patients re-completed the Persian SIPQ. The construct validity of SIPQ was assessed by analyzing Spearman rank correlation between this question and the Persian version of Functional rating index questionnaire. To analyze test-retest reliability, we assessed intraclass correlation coefficient (agreement) (ICC agreement) (two-way random effects model, single measure). Results: The SIPQ score of two groups of patients (84 males, 16 females, mean age ±SD: 33.85±11.16 years, range: 19-67 years) and healthy subjects (48 male, 2 female ones, mean age ±SD: 24.24 ±8.07 years) was statistically significant. (Mann-Whitney U =198.00, P<.001). The Spearman correlation of data showed that there is a significant correlation between Persian SIPQ score and Persian FRI band (r= .559, P<.001). The ICC was .62. So, the analysis indicated good, test-retest reliability. Conclusion: This study showed that Persian version of SIPQ is reliable and valid when applied to back pain patients.

Keywords: cross cultural adaptation, economic burden, low back pain, Persian language, translation

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Authors: Joe Collins, Matthias Rother

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Background: Oral non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of joint pain during and post-exercise. However, oral NSAIDs increase the risk of systemic side effects, even in healthy individuals, and retard recovery from muscle soreness. TDT 064 (Flexiseq®), a topical formulation containing ultra-deformable drug-free Sequessome™ vesicles, has demonstrated equivalent efficacy to oral celecoxib in reducing osteoarthritis-associated joint pain and stiffness. TDT 064 does not cause NSAID-related adverse effects. We describe clinical study data and a case report on the effectiveness of TDT 064 in reducing joint pain after exercise. Methods: Participants with a pain score ≥3 (10-point scale) 12–16 hours post-exercise were randomized to receive TDT 064 plus oral placebo, TDT 064 plus oral ketoprofen, or ketoprofen in ultra-deformable phospholipid vesicles plus oral placebo. Results: In the 168 study participants, pain scores were significantly higher with oral ketoprofen plus TDT 064 than with TDT 064 plus placebo in the 7 days post-exercise (P = 0.0240) and recovery from muscle soreness was significantly longer (P = 0.0262). There was a low incidence of adverse events. These data are supported by clinical experience. A 24-year-old male professional rugby player suffered a traumatic lisfranc fracture in March 2014 and underwent operative reconstruction. He had no relevant medical history and was not receiving concomitant medications. He had undergone anterior cruciate ligament reconstruction in 2008. The patient reported restricted training due to pain (score 7/10), stiffness (score 9/10) and poor function, as well as pain when changing direction and running on consecutive days. In July 2014 he started using TDT 064 twice daily at the recommended dose. In November 2014 he noted reduced pain on running (score 2-3/10), decreased morning stiffness (score 4/10) and improved joint mobility and was able to return to competitive rugby without restrictions. No side effects of TDT 064 were reported. Conclusions: TDT 064 shows efficacy against exercise- and injury-induced joint pain, as well as that associated with osteoarthritis. It does not retard muscle soreness recovery after exercise compared with an oral NSAID, making it an alternative approach for the treatment of joint pain during and post-exercise.

Keywords: exercise, joint pain, TDT 064, phospholipid vesicles

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Authors: Siamak Yaghoubi, Vahideh Rashtchi, Marzieh Khezri, Hamid Kayalha, Monadi Hamidfar

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Background and objectives: Effective postoperative pain management in abdominal surgeries, which are painful procedures, plays an important role in reducing postoperative complications and increasing patient’s satisfaction. There are many techniques for pain control, one of which is Patient-Controlled Analgesia (PCA). The aim of this study was to compare the analgesic effects of morphine, paracetamol and ketorolac in the patients undergoing open cholecystectomy, using PCA method. Material and Methods: This randomized controlled trial was performed on 330 ASA (American Society of Anesthesiology) I-II patients ( three equal groups, n=110) who were scheduled for elective open cholecystectomy in Shahid Rjaee hospital of Qazvin, Iran from August 2013 until September 2015. All patients were managed by general anesthesia with TIVA (Total Intra Venous Anesthesia) technique. The control group received morphine with maximum dose of 0.02mg/kg/h, the paracetamol group received paracetamol with maximum dose of 1mg/kg/h, and the ketorolac group received ketorolac with maximum daily dose of 60mg using IV-PCA method. The parameters of pain, nausea, hemodynamic variables (BP and HR), pruritus, arterial oxygen desaturation, patient’s satisfaction and pain score were measured every two hours for 8 hours following operation in all groups. Results: There were no significant differences in demographic data between the three groups. there was a statistically significant difference with regard to the mean pain score at all times between morphine and paracetamol, morphine and ketorolac, and paracetamol and ketorolac groups (P<0.001). Results indicated a reduction with time in the mean level of postoperative pain in all three groups. At all times the mean level of pain in ketorolac group was less than that in the other two groups (p<0.001). Conclusion: According to the results of this study ketorolac is more effective than morphine and paracetamol in postoperative pain control in the patients undergoing open cholecystectomy, using PCA method.

Keywords: analgesia, cholecystectomy, ketorolac, morphine, paracetamol

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Authors: Priyanka Kalra

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Background: Complementary and alternative medicine (CAM) includes various practices like Ayurveda, Yoga & Meditation Acupressure Acupuncture and Reiki. These practices are frequently used by patients with spinal cord injury (SCI). They have shown effectiveness in the management of pain and stress consequently improving overall quality of life post injury. Objective: The goals of the present case series were to evaluate the feasibility of 1) Using of Ayurvedic herbal oil massages in shoulder pain management, 2) Using yoga & meditation on managing the stress in spinal cord injury. Methodology: 15 SCI cases with muscular pain around shoulder were treated with Ayurvedic herbal oil massage for 10 days in CAM Department. Each session consisted of 30 min oil massage followed by 10 min hot towel fomentation. The patients continued regular therapy medications along with CAM. Another 15 SCI cases were treated with yoga and meditation for 15 days 30 min yoga (20 min Asana+ 10 min Pranayam + 15 min Meditation) in isolated yoga room of CAM department. Results: On the VAS scale the patients reported a reduction in their pain score by 70 %. On the PSS scale, the patients reported a reduction in their stress score by 80 %. Conclusion: These case series may encourage more people to explore CAM therapies.

Keywords: spinal cord injury, Ayurveda, complementary and alternative medicine, yoga, meditation

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Authors: Subhankar Karmakar, Madhan Kumar Vasudevan, Manivannan Muniyandi

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Thermal Grill Illusion (TGI) elicits a strong and often painful sensation of burn when interlacing warm and cold stimuli that are individually non-painful, excites thermoreceptors beneath the skin. Among several theories of TGI, the “disinhibition” theory is the most widely accepted in the literature. According to this theory, TGI is the result of the disinhibition or unmasking of the pain-sensitive HPC (Heat-Pinch-Cold) nerve fibers due to the inhibition of cold-sensitive nerve fibers that are responsible for masking HPC nerve fibers. Although researchers focused on understanding TGI throughexperiments and models, none of them investigated the prediction of TGI pain intensity through a computational model. Furthermore, the comparison of psychophysically perceived TGI intensity with neurophysiological models has not yet been studied. The prediction of pain intensity through a computational model of TGI can help inoptimizing thermal displays and understanding pathological conditions related to temperature perception. The current studyfocuses on developing a computational model to predict the intensity of TGI pain and experimentally observe the perceived TGI pain. The computational model is developed based on the disinhibition theory and by utilizing the existing popular models of warm and cold receptors in the skin. The model aims to predict the neuronal activity of the HPC nerve fibers. With a temperature-controlled thermal grill setup, fifteen participants (ten males and five females) were presented with five temperature differences between warm and cold grills (each repeated three times). All the participants rated the perceived TGI pain sensation on a scale of one to ten. For the range of temperature differences, the experimentally observed perceived intensity of TGI is compared with the neuronal activity of pain-sensitive HPC nerve fibers. The simulation results show a monotonically increasing relationship between the temperature differences and the neuronal activity of the HPC nerve fibers. Moreover, a similar monotonically increasing relationship is experimentally observed between temperature differences and the perceived TGI intensity. This shows the potential comparison of TGI pain intensity observed through the experimental study with the neuronal activity predicted through the model. The proposed model intends to bridge the theoretical understanding of the TGI and the experimental results obtained through psychophysics. Further studies in pain perception are needed to develop a more accurate version of the current model.

Keywords: thermal grill Illusion, computational modelling, simulation, psychophysics, haptics

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Authors: Jared Cheves, Amanda DeChent, Joyce Pan

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Total knee replacements (TKAs) are one of the most common but painful surgical procedures performed in the United States. Currently, the gold standard for postoperative pain management is the utilization of opioids. However, in the wake of the opioid epidemic, the healthcare system is attempting to reduce opioid consumption by trialing innovative opioid sparing analgesic techniques such as continuous peripheral nerve blocks (CPNB) and continuous periarticular infiltration (CPAI). The alleviation of pain, particularly during the first 72 hours postoperatively, is of utmost importance due to its association with delayed recovery, impaired rehabilitation, immunosuppression, the development of chronic pain, the development of rebound pain, and decreased patient satisfaction. While both CPNB and CPAI are being used today, there is limited evidence comparing the two to the current standard of care or to each other. An extensive literature review was performed to explore the safety profiles and effectiveness of CPNB and CPAI in reducing reported pain scores and decreasing opioid consumption. The literature revealed the usage of CPNB contributed to lower pain scores and decreased opioid use when compared to opioid-only control groups. Additionally, CPAI did not improve pain scores or decrease opioid consumption when combined with a multimodal analgesic (MMA) regimen. When comparing CPNB and CPAI to each other, neither unanimously lowered pain scores to a greater degree, but the literature indicates that CPNB decreased opioid consumption more than CPAI. More research is needed to further cement the efficacy of CPNB and CPAI as standard components of MMA in TKA procedures. In addition, future research can also focus on novel catheter-free applications to reduce the complications of continuous catheter analgesics.

Keywords: total knee arthroplasty, continuous peripheral nerve blocks, continuous periarticular infiltration, opioid, multimodal analgesia

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Authors: J. Scott Kenney

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Not all pain is created equal. In recent decades, the concept of Illegitimate pain has begun to shed light on the phenomena of emotional and physical pain that is misunderstood, neglected, or stigmatized, broadly conceptualized along dimensions of relative legitimation and physicality. Yet, beyond a pioneering study of the suffering of closeted LGBTQ + individuals, along with an analysis of the pains experienced by students at a religious boarding school, there has been insufficient attention to what lies behind such marginalized suffering beyond the original claim that it relates to broad interpretive standards and structured power relations, mediated through interaction in various groups/settings. This paper seeks to delve theoretically into this underdeveloped terrain. Building on earlier work, it takes direct aim at the definitional aspect that lies analytically prior to such matters, theoretically unpacking the role of ideology. Following a general introduction focused on theoretical relationships between social structure, power, and ideas, the paper reviews a range of sociological literature on relevant matters. After condensing the insights from these various literatures into a series of theoretical statements, the paper analytically engages with these to articulate a series of theoretical and methodological elaborations intended to practically assist researchers in empirically examining such matters in today's complex social environment.

Keywords: deviance, ideology, illegitimate pain, social theory, victimization

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Authors: Akulov M. A., Zaharov V. O., Jurishhev P. E., Tomskij A. A.

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Introduction: Spasticity is a severe consequence of stroke, leading to profound disability, decreased quality of life and decrease of rehabilitation efficacy [4]. Spasticity is often associated with pain syndrome, arising from joint damage of paretic limbs (postural arthropathy) or painful spasm of paretic limb muscles. It is generally accepted that injection of botulinum toxin into a cramped muscle leads to decrease of muscle tone and improves motion range in paretic limb, which is accompanied by pain alleviation. Study aim: To evaluate the change in pain syndrome intensity after incections of botulinum toxin A (Xeomin) in stroke patients with upper limb spasticity. Patients and methods. 21 patients aged 47-74 years were evaluated. Inclusion criteria were: acute stroke 4-7 months before the inclusion into the study, leading to spasticity of wrist and/or finger flexors, elbow flexor or forearm pronator, associated with severe pain syndrome. Patients received Xeomin as monotherapy 90-300 U, according to spasticity pattern. Efficacy evaluation was performed using Ashworth scale, disability assessment scale (DAS), caregiver burden scale and global treatment benefit assessment on weeks 2, 4, 8 and 12. Efficacy criterion was the decrease of pain syndrome by week 4 on PQLS and VAS. Results: The study revealed a significant improvement of measured indices after 4 weeks of treatment, which persisted until the 12 week of treatment. Xeomin is effective in reducing muscle tone of flexors of wrist, fingers and elbow, forearm pronators. By the 4th week of treatment we observed a significant improvement on DAS (р < 0,05), Ashworth scale (1-2 points) in all patients (р < 0,05), caregiver burden scale (р < 0,05). A significant decrease of pain syndrome by the 4th week of treatment on PQLS (р < 0,05) и VAS (р < 0,05) was observed. No adverse effect were registered. Conclusion: Xeomin is an effective treatment of pain syndrome in postural upper limb spasticity after stroke. Xeomin treatment leads to a significant improvement on PQLS and VAS.

Keywords: botulinum toxin, pain syndrome, spasticity, stroke

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Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. Alomari, Abdullah A. Al Qurashi, Ahmed S. Abdulhamid, Mohammed S. Alshehri, Majed Alosaimi

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Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD=–0.28, 95% CI –0.53 to –0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR= 0.77, 95% CI –0.58 to 1.03). Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

Keywords: botulinum toxin type A, limb lengthening, distraction osteogenesis, deformity correction, pain management

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Authors: Fatma Abdel Moneim Al Tawil

Abstract:

Low back pain (LBP) among nurses has been the subject of research studies worldwide. However, evidence of the influence of patients lifting behaviors and LBP among nurses in Saudi Arabia remains scarce. The purpose of this study was to investigate the relationship between LBP and nurses lifting behaviors. LBP questionnaire was distributed to 100 nurses working in Alsadairy Hospital distributed as Emergency unit(9),Coronary Care unit (9), Intensive Care Unit (7), Dialysis unit (30), Burn unit (5), surgical unit (11), Medical (14) and, X-ray unit (15). The questionnaire included demographic data, attitude scale, Team work scale, Back pain history and Knowledge scale. Regarding to emergency unit, there is appositive significant relation between teamwork scale and Knowledge as r = (0.807) and P =0.05. Regarding to ICU unit, there is a positive significant relation between teamwork scale and attitude scale as r= (0.781) and P =0.05. Regarding to Dialysis unit, there is a positive significant relation between attitude scale and teamwork scale as r=(0.443) and P =0.05. The findings suggest enhanced awareness of occupational safety with safe patient handling practices among nursing students must be emphasized and integrated into their educational curriculum. Moreover, back pain prevention program should incorporate the promotion of an active lifestyle and fitness training the implementation of institutional patient handling policies.

Keywords: low back pain, lifting behaviors, nurses, team work

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Authors: P. B. Sob, A. A. Alugongo, T. B. Tengen

Abstract:

The activation volume of 6082T6 aluminum is investigated at different temperatures on grain size variants. The deformation activation volume was computed on the basis of the relationship between the Boltzmann’s constant k, the testing temperatures, the material strain rate sensitivity and the material yield stress of grain size variants. The material strain rate sensitivity is computed as a function of yield stress and strain rate of grain size variants. The effect of the material strain rate sensitivity and the deformation activation volume of 6082T6 aluminum at different temperatures of 3-D grain are discussed. It is shown that the strain rate sensitivities and activation volume are negative for the grain size variants during the deformation of nanostructured materials. It is also observed that the activation volume vary in different ways with the equivalent radius, semi minor axis radius, semi major axis radius and major axis radius. From the obtained results it is shown that the variation of activation volume increased and decreased with the testing temperature. It was revealed that, increased in strain rate sensitivity led to decrease in activation volume whereas increased in activation volume led to decrease in strain rate sensitivity.

Keywords: nanostructured materials, grain size variants, temperature, yield stress, strain rate sensitivity, activation volume

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Authors: Krishna Dahiya

Abstract:

Introduction: Labour pain has been described as the most severe pain experienced by women in their lives. Pain management in labour is one of the most important challenges faced by the obstetrician. The opioids are the primary treatment for patients with moderate and severe pain but these drugs are not always tolerated and are associated with dose-dependent side effects. Nonsteroidal anti-inflammatory drugs, too, are associated with variable adverse effects. Considering these factors, our study compared the efficacy and side effect of intravenous tramadol and paracetamol. Objective: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of tramadol for intrapartum analgesia. Methods: In a randomized prospective study at Pt. BDS PGIMS, 200 women in active labor were allocated to received either paracetamol (n=100) or tramadol (n=100). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. Results: The mean age of cases were 25.55 ± 3.849 years and 25.60 ± 3.655 years respectively As recorded by the VAS score, there was significant pain reduction at 30 minutes, and at 1 and 2 hours in both groups (P<0.01). In comparison, between group I and II, a significantly higher rate of nausea and vomiting in tramadol group (14% vs 8%; P < 0.03) patients. Similarly, drowsiness (0% vs 11%; P<0.01), dry mouth (0% vs 8%; P<0.04) and dizziness (0% vs 9%; P<0.02) was also significant in group II. Conclusion: Due to difficulty in administering epidural analgesia to all parturients, administration of paracetamol and tramadol infusion for analgesia is simple and less invasive alternative. In the present study, both paracetamol and tramadol were equally effective for labour analgesia but paracetamol has emerged as safe alternative as compared to tramadol due to a low incidence of side effects.

Keywords: paracetamol, tramadol, labor, analgesia

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Authors: Allyson Augusta Shrikhande, Alexa Rains, Tayyaba Ahmed, Marjorie Mamsaang, Rakhi Vyas, Janaki Natarajan, Erika Moody, Christian Reutter, Kimberlee Leishear, Yogita Tailor, Sandra Sandhu-Restaino, Lora Liu, Neha James, Rosemarie Filart

Abstract:

Characterized by consistent difficulty getting and keeping an erection firm enough for intercourse, Erectile Dysfunction may affect up to 15% of adult men. Although awareness and access to treatment have improved in recent years, many patients do not actively seek diagnosis or treatment due to the stigma surrounding this condition. Patients who do seek treatment are often dissatisfied by the efficacy of the medication. The condition inhibits patients’ quality of life by worsening mental health and relationships. The purpose of this study was to test the effectiveness of an outpatient neuromuscular treatment protocol in treating the symptoms of Chronic Pelvic Pain and Erectile Dysfunction, improving pain and function. 56 patients ages 20-79 presented to an outpatient clinic for treatment of pelvic pain and Erectile Dysfunction symptoms. These symptoms had persisted for an average of 4 years. All patients underwent external ultrasound-guided hydro-dissection technique targeted at pelvic peripheral nerves in combination with pelvic floor musculature trigger-point injections. To measure the effects of this treatment, a five question Erectile Dysfunction questionnaire was completed by each patient at their first visit to a clinic and three months after treatment began. Answers were summed for a total score of 5-25, with a higher score indicating optimal function. The average score before treatment was 14.125 (SD 5.411) (a=0.05; CI 12.708-15.542), which increased by 18% to an average of 16.625 (SD 6.423) (a=0.05; CI 14.943-18.307) after treatment (P=0.0004). Secondary outcome variables included a Visual Analogue Scale (VAS) to measure pelvic pain intensity and the Functional Pelvic Pain Scale (FPPS) to measure function across multiple areas. VAS scores reduced by 51% after three months. Before treatment, the mean VAS score was 5.87, and the posttreatment mean VAS score was 2.89. Pelvic pain functionality improved by 34% after three months. Pretreatment FPPS scores averaged at 7.48, decreasing to 4.91 after treatment. These results indicate that this unique treatment was very effective at relieving pain and increasing function for patients with Erectile Dysfunction.

Keywords: chronic pelvic pain, erectile dysfunction, nonsurgical, outpatient, trigger point injections

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Authors: Tobias Stephan Kaeding, Rebecca Schwarz, Momme Kück, Lothar Stein

Abstract:

Introduction: The goal of this randomized and controlled study is to examine whether whole-body vibration (WBV) training is able to reduce self-reported physical disability in office employees with chronic low-back pain. Materials and methods: 41 subjects (68.3% female/mean age 45.5 ± 9.1 years/mean BMI 26.6 ± 5.2) were randomly allocated to an intervention group (INT (n= 21)) or a control group (CON (n=20). The INT participated in WBV training 2.5 times per week for 3 months. The primary outcome was the change in the Roland and Morris disability questionnaire (RMQ) score over the study period. In addition, secondary outcomes included changes in the Oswestry Disability Index (ODI). Results: The compliance with the intervention in the INT reached a mean of 81.1% ± 31.2% with no long-lasting unwanted side effects. We found significant positive effects of 3 months of WBV training in the INT compared to the CON regarding the RMQ (p=0.027) and the ODI (p=0.002). Conclusions: WBV training seems to be an effective, safe and suitable intervention for the reduction of the self-reported physical disability in seated working employees with chronic low-back pain.

Keywords: back pain, exercise, occupational health management, vibration training

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Authors: Jin Sup Kim, Min Seo

Abstract:

An improved cross-shaped hall plate with high sensitivity is described in this paper. Among different geometries that have been simulated and measured using Helmholtz coil. The paper describes the physical hall plate design and implementation in a 0.18-µm CMOS technology. In this paper, the biasing is a constant voltage mode. In the voltage mode, magnetic field is converted into an output voltage. The output voltage is typically in the order of micro- to millivolt and therefore, it must be amplified before being transmitted to the outside world. The study, design and performance optimization of hall plate has been carried out with the COMSOL Multiphysics. It is used to estimate the voltage distribution in the hall plate with and without magnetic field and to optimize the geometry. The simulation uses the nominal bias current of 1mA. The applied magnetic field is in the range from 0 mT to 20 mT. Measured results of the one structure over the 10 available samples show for the best sensitivity of 2.5 %/T at 20mT.

Keywords: cross-shaped hall plate, sensitivity, CMOS technology, Helmholtz coil

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Authors: Mengjia Zhi, Xingmei Wei, Xiang Gao, Shiyang Liu, Zhiran Huang, Li Yang, Jing Sun

Abstract:

Background: To understand the consumption trend of opioid analgesics and the consumption adequacy of opioid analgesic treatment for moderate to severe pain in China, as well as the pain control level of China with international perspective. Importance: To author’s best knowledge, this is the first study in China to measure the adequacy of opioid analgesic treatment for moderate to severe pain considering disease pattern and with the standardized pain treatment guideline. Methods: A retrospective analysis was carried out to show the consumption frequency (daily defined doses, DDDs) of opioid analgesics and its trend in China from 2006 to 2016. Adequacy of consumption measure (ACM) was used to measure the number of needed morphine equivalents and the overall adequacy of opioid analgesic treatment of moderate to severe pain in China, and compared with international data. Results: The consumption frequency of opioid analgesics (DDDs) in China increased from 13,200,000 DDDs in 2006 to 44,200,000 DDDs in 2016, and showed an increasing trend. The growth rate was faster at first, especially in 2013, then slowed down, decreased slightly in 2015. The ACM of China increased from 0.0032 in 2006 to 0.0074 in 2016, with an overall trend of growth. The ACM level of China has been always a very poor level during 2006-2016. Conclusion: The consumption of opioid analgesics for the treatment of moderate to severe pain in China has always been inadequate. There is a huge gap between China and the international level. There are many reasons behind this problem, which lie in different aspects, including medical staff, patients and the public, health systems and social & cultural aspects. It is necessary to strengthen the training and education of medical staff and the patients, to use mass media to disseminate scientific knowledge of pain management, to encourage communications between doctors and patients, to improve regulatory system for the controlled medicines and the overall health systems, and to balance the regulatory goal for avoidance of abuse, and the social goal of meeting the increasing needs of the people for better life.

Keywords: opioid analgesics, adequate consumption measure, pain control, China

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Authors: Madiha Liaqat, Rehan Ahmed Khan, Shahid Kamal

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Multiple imputation with delta adjustment is a versatile and transparent technique for addressing univariate missing data in the presence of various missing mechanisms. This approach allows for the exploration of sensitivity to the missing-at-random (MAR) assumption. In this review, we outline the delta-adjustment procedure and illustrate its application for assessing the sensitivity to deviations from the MAR assumption. By examining diverse missingness scenarios and conducting sensitivity analyses, we gain valuable insights into the implications of missing data on our analyses, enhancing the reliability of our study's conclusions. In our study, we focused on assessing logPSA, a continuous biomarker in incomplete prostate cancer data, to examine the robustness of conclusions against plausible departures from the MAR assumption. We introduced several approaches for conducting sensitivity analyses, illustrating their application within the pattern mixture model (PMM) under the delta adjustment framework. This proposed approach effectively handles missing data, particularly loss to follow-up.

Keywords: loss to follow-up, incomplete response, multiple imputation, sensitivity analysis, prostate cancer

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Authors: Misbah Nizamani, Saira Malik

Abstract:

Introduction: Bariatric surgery is the most effective treatment for patients suffering from morbid obesity. Laparoscopic sleeve gastrectomy (LSG) accounts for over 50% of total bariatric procedures. The aim of our meta-analysis is to investigate the effectiveness and safety of Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing laparoscopic sleeve gastrectomy. Method: To gather data, we searched PubMed, Google Scholar, ScienceDirect, and Cochrane Central. Eligible studies were randomized controlled trials and cohort studies involving adult patients (≥18 years) undergoing bariatric surgeries, i.e., Laparoscopic sleeve gastrectomy. Outcome measures included LOS, postoperative narcotic usage, postoperative pain score, postoperative nausea and vomiting, postoperative complications and mortality, emergency department visits and readmission rates. RevMan version 5.4 was used to analyze outcomes. Results: Three RCTs and three cohorts with 1522 patients were included in this study. ERAS group and control group were compared for eight outcomes. LOS was reduced significantly in the intervention group (p=0.00001), readmission rates had borderline differences (p=0.35) and higher postoperative complications in the control group, but the result was non-significant (p=0.68), whereas postoperative pain score was significantly reduced (p=0.005). Total MME requirements became significant after performing sensitivity analysis (p= 0.0004). Postoperative mortality could not be analyzed on account of invalid data showing 0% mortality in two cohort studies. Conclusion: This systemic review indicated the effectiveness of the application of ERAS protocols in LSG in reducing the length of stay, post-operative pain and total MME requirements postoperatively, indicating the feasibility and assurance of its application.

Keywords: eras protocol, sleeve gastrectomy, bariatric surgery, enhanced recovery after surgery

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Authors: Ji-Yeul Bae, Hyung Mo Bae, Jihyuk Kim, Hyung Hee Cho

Abstract:

An air to air infrared missile poses a significant threat to the survivability of an aircraft due to an advanced sensitivity of sensor and maneuverability of the missile. Therefore, recent military aircraft is equipped with MAW (Missile Approach Warning) to take an evasive maneuver and to deploy countermeasures like chaff and flare. In this research, an effect of MAW sensitivity and resulting evasive maneuver on the survivability of the fighter aircraft is studied. A single engine fighter jet with Mach 0.9 flying at an altitude of 5 km is modeled in the research and infrared signature of the aircraft is calculated by numerical simulation. The survivability is assessed in terms of lethal range. The MAW sensitivity and maneuverability of an aircraft is used as variables. The result showed that improvement in survivability mainly achieved when the missile approach from the side of the aircraft. And maximum 30% increase in survivability of the aircraft is achieved when existence of the missile is noticed at 7 km distance. As a conclusion, sensitivity of the MAW seems to be more important factor than the maneuverability of the aircraft in terms of the survivability.

Keywords: air to air missile, missile approach warning, lethal range, survivability

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Authors: Amirul Adlan, Motaz AlAqeel, Scott Evans, Vaiyapuri sumathi, Mark Davies, Rajesh Botchu

Abstract:

Background & Objectives: Osteoid osteoma (OO) is a benign tumor of the bone commonly found in childhood and adolescence, causing bone pain, especially during the night. CT-guided radiofrequency ablation (RFA) is currently the mainstay treatment for OO. There is currently no literature reporting the outcomes of OO following RFA based on the histological presence of a nidus seen on a biopsy taken at the time of RFA. The primary aim of this study was to compare the clinical outcomes of OO between the group of patients with the presence of nidus on biopsy samples from RFA with those without nidus. Secondly, we aimed to examine other factors that may affect the outcomes of OO, reflecting our experience as a tertiary orthopedic oncology center. Methods: We retrospectively reviewed 88 consecutive patients diagnosed with osteoid osteoma treated with RFA between November 2005 and March 2015, consisting of 63 males (72%) and 25 females (28%). Sixty-six patients (75%) had nidus present in their biopsy samples. Patients’ mean age was 17.6 years (4-53). The median duration of follow-up was 12.5 months (6-20.8). Lesions were located in the appendicular skeleton in seventy-nine patients (90%), while nine patients (10%) had an OO in the axial skeleton. Outcomes assessed were based on patients’ pain alleviation (partial, complete, or no pain improvement) and the need for further interventions. Results: Pain improvement in the patient group with nidus in the histology sample was significantly better than in the group without nidus (OR 7.4, CI 1.35-41.4, p=0.021). The patient group with nidus on biopsy demonstrated less likelihood of having a repeat procedure compared to the group without nidus(OR 0.092, CI 0.016-0.542, p=0.008). Our study showed significantly better outcomes in pain improvement in appendicular lesions compared to the axially located lesions (p = 0.005). Patients with spinal lesions tend to have relatively poor pain relief than those with appendicular or pelvic lesions (p=0.007). Conclusions: Patients with nidus on histology had better pain alleviation compared to patients without nidus. The histological presence of nidus significantly reduces the chance of repeat interventions. The pain alleviation of osteoid osteoma following RFA is better in patients with appendicular lesions than spinal or axially located lesions.

Keywords: osteoid osteoma, benign tumour, radiofrequency ablation, oncology

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