Comparative Study of 2 Bone Anchors Using a Limited Open Procedure for the Management of Distal Radioulnar Joint Instability

Background: Arthroscopic and open surgical procedures are commonly used to repair distal radioulnar joint (DRUJ) instability. Both may result in patient dissatisfaction and recurrence of DRUJ instability. An alternative treatment that yields improved outcomes is a limited open approach using a bone anchor to support the DRUJ. Methods: A retrospective chart review of 58 patients (59 extremities) aged 18 to 60 years with type 1B Palmer rupture (3 months or more after injury) of the triangular fibrocartilage complex (TFCC) without distal radius fracture was conducted. Inclusion criteria are: 3 to 12 months after injury, clinical DRUJ instability, and minimum of 6 months of postoperative follow-up. Operative fixation with Stryker Sonic or Depuy Mitek anchor was done by the same surgeon using a limited open procedure. Preoperative and postoperative assessments included Disability of the Arm, Shoulder, and Hand; Brief Pain Inventory; Wong-Baker FACES Pain Rating Scale; Numeric Pain Scale; range of motion; and recurrence of instability. A multivariate analysis of variance model was fit to imputed data to assess the effect of both anchors. Results: Clinical and statistical differences were found in preoperative and postoperative assessments for either the Stryker Sonic or the Depuy Mitek anchor but not between anchor types. There was no recurrence after 3 years with either anchor. Conclusion: Patients requiring TFCC repair using the Stryker Sonic or Depuy Mitek anchor experienced: (1) significant clinical and statistical improvement in postoperative assessments; (2) patient satisfaction; and (3) corrected DRUJ instability. Consequently, major determinants in deciding which bone anchor to use may be based on cost or surgeon’s preference.

Building evidence to reduce inequities in management of pain for Indigenous Australian people

Objectives Pain is a universal experience which each person encounters differently, guided by the psycho-socio-environmental context in which it occurs. Although more research is underway yet very little is known about pain from Indigenous Australian perspective. Therefore, this study aims to examine, experience of pain and coping, and utility of three measures: Brief Pain Inventory short form, McGill Pain Questionnaire and Numerical rating scale, from Indigenous South Australian people perspective. Methods Thirteen in-person interviews were conducted which lasted around 90 min and were audio-recorded. The transcripts were coded and analysed thematically with NVivo. Results Six key themes were identified; 1: Spiritual conceptualisation of pain; 2: Frequent experience of trauma and injury; 3: Influence of familial history of pain; 4: Acceptance of pain as normal; 5: Outlook on biomedical management of pain; 6: Preference for non-pharmacological management of pain. Also, the three measures did not fully capture pain from an Indigenous Australian perspective which is more deeply rooted in a bio-psycho-socio-spiritual context which is cardinal to conceptualization of health and wellbeing in Indigenous Australian communities. Conclusions Findings highlight some commonalities as well as unique differences between Indigenous experiences of pain as compared to non-Indigenous. Factors such as spiritual connection with pain, grief and loss, history of trauma and injury, fear of addiction to pain medication and exposure to pain from early childhood had important implications for how participants viewed pain.

Caregiver-Assisted Pain Coping Skills Training for Patients With Dementia: A Pilot Study

Pain is common and undertreated in patients with dementia, and contributes to disability, psychological distress, neuropsychiatric symptoms and caregiver stress. The goal of this study was to develop a caregiver-assisted pain coping skills training protocol tailored for community-dwelling adults with mild-moderate dementia and their family caregivers. We conducted interviews with patients and caregivers to develop the protocol. We then conducted a single arm pilot test of the intervention’s feasibility and acceptability. Patients were recruited from an outpatient memory care clinic and screened for pain using the validated Pain, Enjoyment, General Activity (PEG) scale. The intervention included five sessions of training in pain assessment, relaxation, pleasant activity scheduling, and integrative movement. Initially sessions were conducted in person or by videoconference according to the dyad’s preference; during COVID-19 (latter half of study) all sessions were conducted remotely. Eleven dyads consented and provided baseline data [patients: mean age=77.7 years (SD=4.8), 70% non-Hispanic white; caregivers: mean age=69.6 years (SD=13.3); 91% non-Hispanic white; 73% spouses]. Nine dyads (82%) completed all five sessions. Caregivers reported high levels of satisfaction with the intervention (mean=3.4 on 1-4 scale) and frequent use of pain coping skills (mean=3-4 days/week). On average, patients reported pre-post decreases in pain severity (mean=-1.2, SD=1.8) and pain interference (mean=-0.64, SD=0.67) on the Brief Pain Inventory. Overall these findings suggest that a behavioral pain coping intervention for patients with mild-moderate dementia and their caregivers is feasible, acceptable, and potentially helpful for managing pain.

Comparison of Infrared Thermal Imaging with Two Canine Pain Assessment Tools in Dogs Undergoing Treatment for Chronic Back Pain

Historically, the evaluation and assessment of the clinical response to treatment for canine back pain is subjective and relies on owner and clinician assessment of pain. Sequential infrared thermal images (IRTIs) objectively measure the patient’s physiological response after a prescribed series of photobiomodulation therapy (PBMT) treatments. Qualifying participants had histories of pain and dysfunction associated with spinal osteoarthritis or intervertebral disk disease, or of non-specific uni- or bilateral back pain along the paravertebral epaxial muscles. Each patient was initially IRT imaged prior to PBMT treatment and then received multiple PBMT treatments delivered to the appropriate spinal area on days 1, 2, 3, and 4. Participants were reimaged on day 7. IRT images provided an objective assessment of the physiologic status of each patient after the PBMT regimen. The thermal changes in IRT images correlated with statistically significant changes in Colorado State University Canine Chronic Pain Scale scoring (CSU-CCPS) and owner assessment using the Canine Brief Pain Inventory (CBPI), which includes a Pain Severity Score (CBPI-PS) and Pain Interference Score (CBPI-PI). This proof-of-concept study demonstrates that IRTI provides an objective evaluation of response to PBMT treatment and correlates with observed and measured clinical response.

Validation of the Turkish version of the Pain Sensitivity Questionnaire in patients with chronic pain

Objective The Pain Sensitivity Questionnaire (PSQ) is a clinically beneficial instrument that has been proven to be correlated with various experimental pain sensitivity assessments in healthy people and in patients with chronic pain. In this study, we aimed to translate the PSQ into Turkish (PSQ-T) and validate it for the measurement of pain sensitivity among Turkish people. Methods Seventy-three patients with chronic back pain who were planning to undergo an interventional procedure completed the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory (BDI), Beck Anxiety Inventory, Pain Catastrophizing Scale, and PSQ prior to their procedure. Subcutaneous infiltration of lidocaine was used as a standardized experimental pain stimulus. Pain was evaluated using a visual analog scale (VAS 1: infiltration in the hand, and VAS 2: infiltration in the procedure area) Results Scores on the PSQ-T were significantly correlated with those on the BPI-SF. A significant positive relationship was observed between VAS 1 and VAS 2 values and the PSQ-T score, BPI pain score, and BPI interference score. Conclusions The PSQ-T can be used as a valid and reliable tool for the assessment of pain sensitivity in the Turkish population.

Linguistic Validation of the Canine Brief Pain Inventory (CBPI) for Global Use

A valid and reliable quantitative measure of chronic pain is essential for developing and evaluating interventions that aim to treat pain. In dogs, the Canine Brief Pain Inventory (CBPI) was originally adapted from a human measure, the Brief Pain Inventory, to assess owner-perceived pain and the impact of such pain on a dog's daily functioning. To be reliable and valid, data collected using a translated instrument should have evidence it is an accurate representation of the original instrument and is culturally appropriate for use in the intended context. To achieve this, instruments should undergo a rigorous translation process and be debriefed in the intended population of use. The CBPI is widely accepted and has been fully validated for use in US-English, Swedish, Italian, and French (France); further translation and validation of the CBPI is required to increase access to and use in other languages and countries. The objective of this study was to linguistically validate the CBPI for global use (Australia, China, Germany, Hungary, Ireland, Japan, Netherlands and Portugal). In cognitive debriefing with a representative sample of dog owners in the target countries it was confirmed that the translations of the CBPI adequately convey the concepts in the original US-English version and that items are easily understood by dog owners. The results of the linguistic validation process thus produced measures that are conceptually equivalent to the original US-English-language CBPI and are culturally appropriate for use in the target countries.

Lidocaine infusions in chronic pain management: A prospective case series analysis

Chronic pain conditions are prevalent and cause a significant burden of disease. Intravenous lidocaine infusions have been reported to have an analgesic effect in patients with chronic neuropathic pain, but there is limited data supporting the efficacy of lidocaine across other chronic pain phenotypes. Our study aimed to evaluate the efficacy of a single infusion of intravenous lidocaine for pain relief and the impact on quality of life. We evaluated data from 74 patients with chronic pain who were treated with intravenous lidocaine at a specialist pain centre. Participants completed a questionnaire consisting of the Brief Pain Inventory (BPI) Short Form and additional EQ-5D quality of life metrics, before treatment and at follow-up. Data comparing pain severity did not demonstrate a statistically significant change after treatment when averaged across the entire patient cohort (6.15–5.88, p = .106), irrespective of gender or pain phenotype. Scores for pain interference showed statistically significant reductions following treatment (7.05–6.41, p = .023), which may have been driven through improvements in sleep (7.41–6.35, p = .001); however, these reductions are not clinically significant. The patient cohort was stratified into responders and non-responders based on >30% improvement in response to an overall impression of pain reduction question following treatment. In the ‘responder’ cohort, pain intensity scores showed a statistically significant reduction post-infusion (6.18–5.49, p = .0135), but no change was apparent for non-responders (6.07–6.09, p = .920). There were no differences between responders and non-responders for pain sub-types in our study. This study found no difference in pain outcomes in a cohort of patients with chronic pain, a mean of 63 days following a single lidocaine infusion. However, a specific subgroup of responders may show slight improvements in some pain outcomes that may warrant further exploration.

Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial

Background Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. Objective This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. Methods This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. Results In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. Conclusions The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Trial Registration University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

Efficacy of interrupted cyclic treatment with prednisolone on cancer pain: a randomized crossover study

Background Interrupted cyclic treatment with a low oral dose of prednisolone combined with stepladder analgesics would reduce the pain scores in cancer patients with reported less side effects. Following ethical approval, 39 cancer patients were randomized to receive prednisolone 10 mg every other day or every 4th day for 4 successive weeks followed with tapering prednisolone by 2.5 mg every 4 days over 2 weeks after each interval, primary outcome visual analog score (VAS), and other secondary outcomes such as (A) patient demographics; (B) pain scores; brief pain inventory score (BPI), pain severity score (PSS), pain interference score (PIS), analgesia level score, pain level score (PLS), and pain management index (PMI)); and (C) patient safety (adverse effects) with interrupted cyclic treatment with low-dose prednisolone. Results Compared with baseline values, patients had statistically significant lower VAS and PSS pain scores at 14 and 28 days after starting the 2 days cyclic treatment with prednisolone. Patients had comparative VAS and PSS pain scores during the 4-day cyclic treatment with prednisolone. Compared with the 4-day cyclic treatment, patients in the 2-day cyclic treatment had significant statistically lower VAS pain scores at 28 days. Adverse effects showed no significant statistical differences during both study sequences. Conclusion Interrupted cyclic prednisolone 10 mg combined with stepladder analgesic regimen is effective and safe in terms on improved quality of analgesia for 28 days in cancer patients more when used every 2nd day than every 4th day with appetite improvement during both. Trial registration The study protocol was approved by the local Institutional Board Review Committee on 8-11-2019. The study was prospectively registered with the www.clinicaltrials.gov