Evaluation of Shoulder Microcirculation Abnormality Using Laser Doppler Flowmetry

Severe neck-shoulder pain induces functional limitations in both life and work. The purpose of this study was to determine the characteristics of shoulder microcirculation abnormality in workers. This study recruited 32 workers and patients, both n = 16. Questionnaires were administered, and Laser Doppler Flowmetry (LDF) was used to measure microcirculatory blood flow (MBF) at the myofascial trigger points (MTrPs) on the shoulders. The absolute-deviationMMBF represented the mean MBF (MMBF) variability among subjects. The differences in the life characteristics, shoulder pain level, and microcirculatory characteristics at MTrPs between the two groups were compared. It was found that shoulder pain level was significantly higher in the patient than in the control group (p < 0.001). Deviation of the MMBF value beyond the postulated “normal range” of 60–80 was significantly higher in the patient than in the control group (p < 0.001). The MMBF deviation was significantly correlated with shoulder pain level, pain duration, and the symptom effect (p < 0.01, n = 32). A normal range for the MMBF of 60–80 on the shoulder near MTrPs is hypothesized for the first time based on this study. Noninvasive LDF can be used to assess abnormality in the MBF on shoulder MTrPs at an early stage.

Determination of the Effect of Two Different Methods of Dental Anaesthesia on Pain Level in Pediatric Patients: A Cross-Over, Randomised Trial

ObjectiveTo compare intraosseous (IOA) and needle-free dental anaesthesia (NFA) methods that painless anaesthesia.Materials and MethodsTwenty patients aged 8–10 years were included in this cross-over study. To determine the anxiety levels and pain experienced by the patients, Face, Legs, Activity, Cry, Consolability (FLACC) and Frankl Behavioural scales were used. The pulse rate (PR) and salivary opiorphin levels (SOL) determined. The Friedman and Wilcoxon signed-rank tests were used. p<0.01 was considered significant.ResultsAccording to FLACC scores, IOA and NFA exhibited significantly pain alteration patterns in during local and topical anaesthesia, respectively (p=0.004,0.001; p<0.01). Also, only NFA showed significantly decreased SOL values in 5- and 10- minutes after local anaesthesia periods compared to the before levels (p=0.004, p=0.001; p<0.01).ConclusionsPatients feel similar pain perceptions during local anaesthesia application in both injection systems. According to the SOL values, NFA may provide more higher anaesthetic efficiency than IOA.Clinical RelevanceThis study provides to compare two different new anaesthetic systems for pain reduction during local anesthesia for pediatric population.

A STUDY TO ASSESS THE EFFECTIVENESS OF HELFER SKIN TAP TECHNIQUE ON THE LEVEL OF PAIN REDUCTION DURING INTRA MUSCULAR INJECTION AMONG ORTHOPAEDIC PATIENT OF PANDIT DEEN DAYAL UPADHYAYA (CORONATION) GOVERNMENT HOSPITAL DEHRADUN UTTARAKHAND

Pain is an unpleasant sensory and emotional feeling accompanying existing or impending tissue damages or reference to such damage.According to WHO annual report more than 16 billion IM injections are administered throughout the word. Aim: This study is intended to determine the effectiveness of Helfer skin tap technique on the level of pain reduction during IM injection among orthopedic patient of PanditDeenDayalUpadhaya (Coronation)Government Hospital, Dehradun Uttarakhand. Methodology: An experimental approach with cross-over design was adopted for the study. The study samples were orthopedic patients who receiving IM diclofenac injection. There were 50 subjects that fulfill the inclusion and exclusion criteria are divided into two experimental groups (25 samples in each groups) by simple random sampling technique. The pain level was assessed by universal numerical pain rating scale .The pain level with the administration of intramuscular injection by Helfer skin tap technique was compared with a pain level with conventional Technique. Result:The result shows that in experimental group I majority of sample 52%perceived mild pain with Helfer skin tap technique whereas with majority of samples 64% perceived moderate pain with conventional technique. The mean pain score with Helfer skin tap technique was 3.88 was less than conventional technique 5.32.The obtained t value was 3.80 was significant at p<0.05 level of significance.Inexperimental group II majority of sample 64% perceived mild pain with Helfer skin tap technique whereas with majority of samples 68% perceived moderate pain with conventional technique. The mean pain score with Helfer skin tap technique was 3.52 was less than conventional technique 5.16.The obtained t value was 5.479 was significant at p<0.05 level of significance In period I the mean pain score using Helfer skin tap technique in experimental group I 3.88 was less than mean pain score of conventional technique in experimental group II 5.15.the obtained t value was found statistically significant at p<0.05 level. In period II the mean pain score using Helfer skin tap technique 3.52 was less than the mean pain scores of conventional technique 5.32.the obtained t value 4.5 was statistically significant at p<0.05 level of significance. There was no significant association found between level of pain during intramuscular injection with selected demographic variables. The overall result shows that Helfer skin tap technique was helpful in reducing the level of pain during intramuscular injection among orthopedic patients.

20-Degree Elevation to Reduce Swelling and Pain After Lower Extremity Open Reduction and Internal Fixation Surgery

Surgery for open reduction and internal fixation (ORIF) causes tissue swelling and pain in the surgical area. Swelling and pain can be reduced by performing distal elevation in the area of surgical ORIF. This study aimed to determine the effect of a 20° elevation on swelling and pain level of patients after surgery for ORIF of the lower extremities. A quasi-experimental design with one intervention group (pretest and posttest) and one control group was implemented. Thirty-four post-operative ORIF patients treated in one hospital in South Sumatera met the inclusion criteria and were divided into intervention and control groups. Swelling circumference was measured using tape meters, and pain level was assessed with a numeric rating scale. Dependent t-test, independent t-test, and Pearson correlation were applied for data analysis. Results showed that the average difference in swelling circumference and pain level between pre and post intervention was 1.93 ± 0.25 and 1.29 ± 0.35, respectively. Significant differences were found in the mean swelling circumference and pain level between the intervention and control groups (p = 0.000). Therefore a 20° elevation of lower extremity on the second day after ORIF for two days can be an alternative for nursing intervention to reduce swelling and pain. AbstrakElevasi 20 Derajat untuk Menurunkan Pembengkakan dan Nyeri Pasca Bedah Open Reduction and Internal Fixation Ekstremitas Bawah. Pembedahan open reduction and internal fixation (ORIF) menyebabkan pembengkakan jaringan dan nyeri pada area pembedahan. Pembengkakan dan nyeri dapat dikurangi dengan melakukan elevasi distal pada area bedah ORIF. Penelitian ini bertujuan untuk mengetahui pengaruh elevasi 20° terhadap tingkat pembengkakan dan nyeri pada pasien pasca operasi ORIF ekstremitas bawah. Desain kuasi-eksperimental dengan satu kelompok intervensi (pretest dan posttest) dan satu kelompok kontrol diterapkan pada penelitian ini. Tiga puluh empat pasien ORIF pasca operasi yang dirawat di salah satu rumah sakit di Sumatera Selatan memenuhi kriteria inklusi dan dibagi menjadi kelompok intervensi dan kontrol. Lingkar pembengkakan diukur menggunakan meteran pita, dan tingkat nyeri dinilai dengan skala numerik. Dependent t-test, independent t-test, dan korelasi Pearson digunakan untuk analisis data. Hasil penelitian menunjukkan bahwa rerata perbedaan lingkar bengkak dan tingkat nyeri antara sebelum dan sesudah intervensi masing-masing adalah 1,93 ± 0,25 dan 1,29 ± 0,35. Perbedaan bermakna ditemukan pada rerata lingkar pembengkakan dan tingkat nyeri antara kelompok intervensi dan kelompok kontrol (p = 0,000). Oleh karena itu, elevasi 20° ekstremitas bawah pada hari kedua setelah ORIF selama dua hari dapat menjadi alternatif intervensi keperawatan untuk mengurangi pembengkakan dan nyeri.Kata Kunci: bengkak, ekstremitas bawah, elevasi, nyeri, open reduction and internal fixation

Invariance of the PAINAD Scale Between the Black and White Residents Living With Dementia

The purpose of this study was to test the reliability and validity of the Pain Assessment in Advanced Dementia (PAINAD) and particularly consider whether or not this measure was invariant when used among the Black and White residents. Baseline data from an implementation study testing that included a sample of 553 residents, 30% of who were Black, from 55 nursing were included in this study. The Winsteps statistical program was used to perform the Rasch analysis and evaluate the reliability and validity of the measure based on internal consistency, infit and outfit statistics, mapping, and a differential item functioning (DIF) analysis. The AMOS statistical program was used for confirmatory factor analysis. The findings supported the reliability and validity of the PAINAD when used with these individuals and demonstrated that there was no evidence of invariance between the Black and White residents. All the items fit the model, but there was not a good spread of the items across the pain level of the participants. The majority of the participants (75%) were so low in pain signs or symptoms that they could not be differentiated. Based on the clinical practice and observations, it is recommended that additional items can be added to the measure such as observing the individual for evidence of resisting care, retropulsion when trying to stand, hitting or kicking when turning in bed, hitting or kicking when transferring from bed to chair, hitting or kicking when ambulating, or hitting or kicking when raising arms, less engagement with others, and decreased participation in the activities previously enjoyed.

Literature Review : Pengaruh Aromaterapi Lemon Terhadap Penurunan Skala Nyeri Pasien Post Operasi Laparatomi

Laparatomy is one of the major surgical procedure, by making an incision in the lining of the abdomen that causes pain complain. One of the alternatives intervention to decrease the pain level in postoperative patients is lemon aromatherapy. Aromatherapy uses of plant essential extracts oil that improves mood and health. The study aimed to evaluate the effectiveness of lemon aromatherapy on decreasing pain level in post-laparatomy patients. The study apllied literature review method. There are three articles reviewed that obtained from Google Scholar website. The keywords used “lemon aromatherapy, pain and post laparatomy surgery”. The result show that lemon aromatherapy can decrease the pain levels in post-laparatomy patients from 5.17 to 3.7 (p-value <0.05). In conclusion, lemon aromatherapy is effective in decreasing pain levels in post-laparatomy patients. Accordingly, nurses are recommend to provide lemon aromatherapy to postoperative patients who experiences pain.Keywords: Lemon Aromatheraphy; Pain; Post laparatomy AbstrakLaparatomi adalah salah satu metode pembedahan mayor di bagian abdomen yang menyebabkan masalah nyeri. Salah satu tindakan untuk menurunkan skala nyeri post operasi laparatomi adalah aromaterapi lemon. Aromaterapi menggambarkan pemakaian ekstrak minyak essensial tanaman yang digunakan untuk memperbaiki mood dan kesehatan. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh aromaterapi lemon terhadap penurunan skala nyeri post operasi laparatomi. Desain penelitian ini berupa literature review dengan jumlah tiga artikel yang diambil dari laman jurnal google scholar dengan kata kunci “aromaterapi lemon, nyeri dan post operasi laparatomi”. Hasil dari ketiga penelitian menunjukkan aromaterapi lemon dapat menurunkan rata-rata skala nyeri pada pasien post operasi laparatomi dari5,17 menjadi 3,7 dengan p-value < 0,05. Simpulan aromaterapi lemon efektif untuk menurunkan nyeri pasien post operasi laparatomi. Saran kepada perawat diharapkan dapat memberikan aromaterapi lemon pada pasien post operasi yang mengalami nyeri.Kata kunci: Aromaterapi Lemon; Nyeri; Post Operasilaparatomi

Effects of Lumbar Stability and Hip Joint Mobility Exercise with Pilates Devices on Pain Level and Muscle-Joint Function in Middle-Aged Women with Chronic Low Back Pain

PURPOSE: This study aimed to compare the effects of 10 weeks of lumbar stability and hip mobility exercises using Pilates devices on pain level and muscle joint function in middle-aged women with chronic low back pain (CLBP). Further, we aimed to investigate the efficacy of Pilates hip mobility exercise (HME) as an exercise for improving CLBP in middle-aged women by comparing the effectiveness of lumbar stability exercise (LSE) and HME.METHODS: Thirty-two middle-aged women with CLBP were enrolled and randomly divided and placed into two groups: the LSE group (n=16) and HME group (n=16). Both groups performed Pilates exercises for 50 minutes twice a week for 10 weeks.RESULTS: The Korean Oswestry Disability Index score in both the LSE and HME groups decreased at 5 weeks (p<.05). Hip internal rotation range of motion (ROM) and external rotation ROM increased at 5 and 10 weeks in both the LSE and HME groups (p<.01). Lumbar mobility increased at 5 weeks in both the LSE (p<.01) and HME groups (p<.001). Lumbar stability in the prone plank test significantly increased at 5 weeks in the LSE group (p<.001) and at 5 and 10 weeks in the HME group (p<.001). Lumbar stability by the side plank test significantly increased at 5 and 10 weeks in both the LSE and HME groups (p<.001).CONCLUSIONS: We found that using Pilates to perform both LSE and HME helped relieve back pain and improve muscle joint function in middle-aged women with CLBP. There was no significant difference between LSE and HME in terms of efficacy. HME is a highly effective exercise for improving CLBP in middle-aged women.

Treatment of Women with Heavy Menstrual Bleeding with a Combination Therapy of Agnus Castus and Tranexamic Acid - Experiences of a German Single Centre

Background: Heavy menstrual bleeding (HMB) is a common gynaecological problem and is the reason for 18-30% of gynaecological visits. In a European study in 4,502 women, 27.2% were diagnosed with HMB (Fraser et al., 2015). On the other hand, HMB is often associated with bleeding disorders (Shankar et al., 2004). The definition of HMB has different perspectives; from a subjective perspective HMB is defined as e excessive menstrual blood loss impacting on women's physical, social, emotional and/or mental quality of life, whereas from an objective perspective it is defined as excessive blood loss &gt;80 ml per cycle (Munro et al., 2012). There are different approaches for treating HMB such as the administration of non-steroidal drugs, Desmopressin, herbal Vitex Agnus Castus (VAC), Tranexamic acid (TXA) or a hormonal therapy; moreover, HMB can also be treated surgically. The aim of this study was to test the efficacy of the specific HMB management used in our center: Women with HMB are treated usually with VAC, which optimizes the relation of estrogen to progesterone in the female body (Yavarikia et al., 2013). VAC can be used without using any hormones (Shahnazi et al, 2016), providing a treatment with a low impact on women's bodies. Additionally, TXA is given during the menstruation due to its antifibrinolytic effect. Furthermore, the "Pictural Blood-Loss-Assessment- Chart" (PBAC Score) is administered to analyze the menstrual blood loss. Methods: Two ad hoc patient-reported questionnaires were developed to test the efficacy of the HMB management in our center The baseline questionnaire includes the following aspects: menarche, duration, regularity, number of sanitary products, pain level, medical background and family history. During the first visit in our center women with HMB filled in the baseline questionnaire. In addition, laboratory tests are done including a comprehensive coagulation test and the examination of iron and hemoglobin levels. Moreover, we presented an application called "My Flow Score" to the patients, which calculates the PBAC score as a result of all entered sanitary products women use during their period. Women are prescribed VAC and/or TXA for the management of their HMB. After four months patients are scheduled for a follow up appointment. At that time they complete the follow-up questionnaire including the following aspects: compliance with the medication or the reason for the non-compliance, health complaints due to the medication, duration of the period, improvement, pain level, PBAC score if the patient did use the APP "My Flow Score" or if not the number of sanitary products. A blood test was taken and the HMB management was adapted to the patients' needs. Results: So far, 100 women with HMB with a median age of 14 years (range 9-50) were enrolled in our study. They had their menarche with a median age of 12 years (range 8-17). Diagnosis of women ranged from iron or folic acid deficiency to different forms of bleeding disorders; with the majority suffering from von Willebrand disease (43/100) followed by iron deficiency (14/100). One fifth of the patients had more than one diagnosis. 1/3 of patients received a treatment for the HMB previously, mainly contraceptives, TXA or VAC. 49% reported anomalies with regard to previous other bleeding; 25.8% had increased hematomas and 19.6% recurrent epistaxis. Most of them reported anomalies already in the family (60.2%). Before treatment women had a median PBAC Score of 169 (range 77-800) and reported a median pain level of 6.5 during menstruation on a scale ranging from 1 (low pain) to 10 (extreme pain). 87/100 women received VCA, of these 75.4% regularly and 85/100 women received TXA, of these 84.6% regularly. 81% of them received a combination of both medicines. Compared to before 28.8% of patients reported shorter duration of menstruation and reduced bleeding with treatment, 11.9% did not experience any improvement; the PBAC score decreased significantly (p&lt;.0001). Conclusions: Although the type of diagnosis in women suffering from HMB had a great variation, these patients had a high disease burden with a relatively high level of pain and a high loss of blood assessed with the PBAC score. Thanks to a combination of VAC and TXA the disease burden in these women could be reduced, especially for the time of menstruation and amount of bleeding. VAC proved to be highly accepted by women due to its low treatment burden. Disclosures Von Mackensen: University Medical Centre Hamburg-Eppendorf: Current Employment; Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy; Novo Nordisk: Consultancy; Biomarin: Speakers Bureau; CSL Behring: Speakers Bureau; Chugai/Roche: Membership on an entity's Board of Directors or advisory committees.

Study of Pain Level Control Targets After Arthroscopic Surgery

Objective: To explore the goal of pain control in patients after arthroscopic surgery.Design: Investigation. Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated.Setting: Department of Sports Medicine,Peking University 3rd Hospital,Beijing, P.R.ChinaSubjects: 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. The patient inclusion criteria were an age of at least 18 years, no history of diagnosis of mental illness, the ability to clearly express his or her pain and an agreement to voluntarily cooperate with the investigators. The exclusion criteria were patients who were unable to complete follow-up.Methods: Postoperative pain, pain control satisfaction and the effect of pain on daily activities were investigated and evaluated by administering a homemade questionnaire to 514 patients selected by convenience sampling from patients hospitalized in a level A hospital in Beijing from 2020.06-2020.11. Pain was assessed using a digital pain numerical rating scale (NRS) (0-10), and a digital score ranging from 0 to 10 was used for satisfaction with pain control and the impact of pain on aspects of daily living.Results: The pain level was most severe in patients 6-24 hours after arthroscopic surgery, during which pain control satisfaction was at its worst. The pain score was significantly related to the effects of pain on aspects of daily life, and the degree of these effects changed significantly for pain scores greater than 2 points.Conclusion: Pain control 6 to 24 hours after surgery is not satisfactory. It is recommended that a pain score of 2 points is used as the goal for pain control after arthroscopic surgery to guide both doctors and patients to effectively control postoperative pain.

The Effect of Psychodrama on Fibromyalgia Syndrome: A Case Report

Fibromyalgia Syndrome (FMS) is a chronic pain syndrome that often coexists with common musculoskeletal pain, sleep disorders, bowel syndrome, mood disorders, and fatigue. Although the aetiology of FMS pain has not been elucidated yet, psychotherapy methods are used in addition to physical methods to treat these pains. This study aims to examine the effect of psychodrama on a 62-year-old patient with back and chest pain and who lived alone. This patient participated in psychodrama group psychotherapy with 8 members who were all female and diagnosed with FMS. An informed consent form was obtained from the case for the study. This research is important because there are very few studies on fibromyalgia complaints with psychodrama group therapy, and it contributes to the literature. Studying the case with past trauma and losses in the psychodrama scene has led to a significant reduction in fibromyalgia complaints. As a result, the patient's pain level decreased from 90% to 32.5%, and the anxiety level decreased from advanced to normal. Thus, psychodrama group psychotherapy was found to be effective in reducing FMS pain.