Comparing Patient-Reported Outcomes From Sham and Saline-Based Placebo Injections for Knee Osteoarthritis: Data From a Randomized Clinical Trial of Lorecivivint

Background: Durable, meaningful symptom responses to intra-articular saline placebo injections are observed in knee osteoarthritis (OA) trials, but it is unclear if these are due to physiological effects. Purpose: To perform a prospective comparison of patient-reported outcome responses among participants with knee OA who underwent intra-articular injection of saline-based placebo or sham (dry needle). Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From a 24-week randomized double-blind trial, participants with moderate to severe knee OA received 2-mL intra-articular injections of saline-based placebo (PBO; 99.45% PBS) or sham (dry needle) to the target knee. Least squares mean differences of changes from baseline to week 24 were compared between the PBO and sham groups for the following: pain Numeric Rating Scale; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function; and patient global assessment. Bang Blinding Index was used to evaluate all-group blinding on day 1 and week 24. Results: In total, 116 and 117 participants were randomized to the PBO and sham groups, respectively. Within the full trial population, the mean ± SD age and body mass index were 59.0 ± 8.5 years and 28.97 ± 4.01, respectively. An overall 406 (58.4%) were female, and 394 (57.3%) had Kellgren-Lawrence grade 3 target knee OA. The PBO and sham groups demonstrated clinically meaningful improvements (≥10%) from baseline in all patient-reported outcomes at all time points (ie, weeks 4-24). Mean differences (95% CI) at week 24 between the PBO and sham groups were as follows: pain Numeric Rating Scale, –0.10 (–0.79 to 0.59; P = .78); WOMAC pain, –2.89 (–9.70 to 3.92; P = .40); WOMAC stiffness, –2.37 (–9.37 to 4.63; P = .51); and WOMAC function, –1.39 (–8.06 to 5.29; P = .68). Bang Blinding Index indicated that blinding was maintained. Conclusion: PBO and sham groups demonstrated equivalent patient-reported outcomes at all time points through week 24, suggesting that responses attributed to saline were contextual (ie, to the procedure) and not physiological. Registration: NCT03122860 (ClinicalTrials.gov identifier).

Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

This observational study aimed at investigating pain in stroke patients with upper limb spastic dystonia. Forty-one consecutive patients were enrolled. A 0–10 numeric rating scale was used to evaluate pain at rest and during muscle tone assessment. Patients were asked to indicate the most painful joint at passive mobilization (shoulder, elbow, wrist-fingers). The DN4 questionnaire was administered to disclose neuropathic pain. All patients were assessed just before and 1 month after incobotulinumtoxin-A treatment. Pain was present in 22 patients, worsened or triggered by passive muscle stretching. DN4 scored < 4 in 20 patients. The most painful joints were wrist–fingers in 12 patients, elbow in 5 patients and shoulder in the remaining 5 patients. Both elbow and wrist–fingers pain correlated with muscle tone. BoNT-A treatment reduced pain in all the joints, including the shoulder. We discussed that nociceptive pain is present in a vast proportion of patients with upper limb spastic dystonia. BoNT-A treatment reduced both spastic dystonia and pain in all the joints but the shoulder, where the effect on pain could be mediated by the reduction of pathological postures involving the other joints.

Pericapsular Nerve Group Block (PENG Block) and Spinal Anesthesia as Multimodal Analgetic in Patient with Bipolar Hip Arthroplasty: A Case Report

Introduction. Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Bipolar hip arthroplasty is one of the most common major orthopaedic procedures to improve patient’s functional status and quality of life. Spinal anesthesia is a regional anesthetic technique that is performed by injecting local anesthetic drugs into the subarachnoid space to obtain dermatome-level analgesia and skeletal muscle relaxation. Pain after hip replacement originates mainly from the anterior pelvic capsule. The main target for pelvic analgesia is the anterior capsule which is the most richly innervated part of the joint. PENG block is used to block the articular branches to the pelvis. The patient was assessed with an NRS (numeric rating scale) instrument pre and post operative. Case presentation. A-74 year old woman admitted with complaints of pain in the right hip and diagnosed with a closed fracture of the right intertrochanter and planned for bipolar hip arthroplasty with PENG block and spinal anesthesia. Preoperatively the patient was assessed with an NRS (numeric rating scale) instrument with a score of 6. After the procedure, we reevaluated the pain score using NRS was 2 post operative. Conclusion. Patients receiving a PENG block and spinal anesthesia for intraoperative and postoperative analgesia during hip fracture surgery. Prior to spinal anesthesia, PENG block can be performed as a multimodal analgesia in the patient, PENG block expected to facilitate a sitting position during spinal anesthesia and for postoperative pain management

Clinical Comparison of Diode Laser Assisted “v-Shape Frenectomy” and Conventional Surgical Method as Treatment of Ankyloglossia

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow’s classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.

Pemberian terapi murattal terhadap penurunan nyeri pada pasien kanker kolorektal pre operasi

Salah satu gejala kanker kolorektal yaitu adanya rasa nyeri. Nyeri adalah perasaan tidak menyenangkan baik secara fisik maupun emosional akibat adanya kerusakan jaringan. Mengatasi nyeri dapat menggunakan cara non farmakologis diantaranya terapi murattal Ar-Rahman. Studi kasus ini bertujuan untuk mengetahui penurunan nyeri pada pasien kanker kolorektal pre operasi setelah diberikan terapi murattal Ar-Rahman. Desain studi ini menggunakan deskriptif dengan pendekatan studi kasus berdasarkan penerapan Evidence Based Nursing Practice yaitu terapi murattal terhadap penurunan nyeri. Subjek studi kasus adalah pasien kanker kolorektal yang belum dilakukan tindakan pembedahan, tingkat skala nyeri 2-5, dan beragama Islam. Subjek studi kasus berjumlah 2 pasien. Pengambilan data menggunakan pengukuran skala Numeric Rating Scale (NRS) sebelum dan sesudah dilakukan terapi murattal Ar-Rahman. Hasil studi kasus menunjukkan adanya penurunan nyeri pada kedua subjek penelitian setelah diberikan terapi murattal Ar-Rahman. Subjek studi kasus 1 terjadi penurunan nyeri sebesar 1 skala nyeri. Subjek studi kasus 2 terjadi penurunan nyeri sebesar 2 skala nyeri. Terapi murattal Ar-Rahman mampu menurunkan nyeri pada pasien kanker kolorektal pre operasi.

Penurunan intensitas nyeri luka post-sectio caesarea menggunakan mobilisasi dini

Nyeri merupakan respon sensori tidak menyenangkan yang dialami oleh individu secara unik yang diekspresikan secara berbeda oleh tiap individu serta dapat berdampak terhadap kondisi fisik dan psikis seseorang. Nyeri akibat luka post sectio caesarea dalam rentang ringan hingga berat dapat mengganggu mobilitas fisik, pemenuhan kebutuhan dasar, bahkan sampai mengakibatkan syok neurogenik pada pasien. Studi kasus ini bertujuan untuk mengaplikasikan mobilisasi dini secara bertahap pada pasien post sectio caesarea yang mengalami nyeri akibat luka post sectio caesarea. Penelitian ini menggunakan metode deskriptif dengan pendekatan asuhan keperawatan yang dilakukan pada tiga pasien yang mengalami nyeri intensitas sedang-berat akibat luka post sectio caesarea. Pengukuran intensitas nyeri dilakukan pre dan post mobilisasi dini secara bertahap dengan menggunakan alat ukur Numeric Rating Scale (NRS). Terdapat penurunan intensitas nyeri paska dilakukan mobilisasi dini secara bertahap rata-rata menurun 5 skala. Penurunan intensitas nyeri ini terjadi karena mobilisasi akan menjadikan konsentrasi pasien pada lokasi nyeri berkurang serta dapat meminimalkan transmisi saraf nyeri menuju syaraf pusat. Mobilisasi akan melancarkan sirkulasi darah termasuk sirkulasi yang menuju area luka post sectio caesarea sehingga mampu mengurangi aktivasi mediator kimiawi pada proses peradangan, sehingga intensitas nyeri berkurang. Mobilisasi dini merupakan intervensi yang dapat dilakukan untuk menurunkan intensitas nyeri luka post sectio caesarea pada pasien.

Efektivitas pemberian terapi kompres hangat jahe merah untuk mengurangi nyeri sendi pada lansia

Penyakit sendi yang biasa dikenal masyarakat yaitu penyakit rematik. Namun penyakit sendi yang paling banyak ialah osteoarthritis, remathoid arthrthis, dan gout, penyakit ini dikelompokan berdasarkan diagnose dan keluhan pasien diantaranya nyeri yang disertai dengan kemerahan, bengkak dan kekauan pada sendi. Penelitian ini bertujuan untuk mengetahui efektifitas pemberian kompres jahe merah untuk mengurangi nyeri sendi pada lansia. Metode penelitian deskriptif dengan pendekatan studi kasus proses asuhan keperawatan dilakukan dalam pengelolaan klien nyeri sendi, meliputi pengkajian, diagnosa keperawatan, intervensi keperwatan implementasi dan evaluasi. Pengambilan sampel dilakukan dengan menggunakan tehnik purposive sampling dalam lingkup komunitas wilayah Kelurahan Mangunharjo Kec. Tembalang. Responden sejumlah 2 orang yang diberikan terapi kompres jahe merah di kelola selama 7 hari dengan frekuensi 1 kali/hari di berikan terapi 10-15 menit Penerapan ini untuk mengukur tingkat nyeri dengan menggunakan skala nyeri Numeric Rating Scale (NRS). Pengukuran dilakukan pre-post test. Hasil studi menunjukkan bahwa ada perubahan skala nyeri sebelum dan sesudah dilakukan terapi kompres hangat, baik pada responden pertama maupun responden kedua. Terapi kompres hangat jahe merah dapat menurunkan skala nyeri sendi pada lansia.

Radiofrequency Thermoablation and Hypofractionated Radiotherapy Combined Treatment for Bone Metastases: A Retrospective Study

<b><i>Introduction:</i></b> Bone metastases (BMs) are the common cause of cancer-related pain, as approximately 45% of cancer patients suffer from bone pain (BP). Radiotherapy (RT) is well established as BP treatment strategy; also, other approaches have been shown to be effective in this setting. Radiofrequency thermoablation (RFA) in a combined strategy with RT appears to be feasible and effective in the treatment of metastatic BP ensuring a better quality of life. Aim of this retrospective study was to describe a case series of patients with painful osteolytic lesions at risk of fracture treated with the RFA-RT combined approach, analyzing local control and pain control as outcomes. <b><i>Methods:</i></b> Data of all patients with BM treated with combined approach in our center from April 2016 to June 2020 were retrospectively analyzed. Patients underwent RFA followed by cementoplasty on the same day and RT in a second phase. RT dose ranged between 30 and 37.5 Gy in 5/10 fractions. BP was evaluated according to the numeric rating scale (NRS), at the beginning of treatment and at 1, 2, 3, 6, 9, and 12 months from the end of combined treatment. <b><i>Results:</i></b> A total of 27 patients were treated from April 2016 to June 2020 with RFA-RT combined approach. The large majority of patients underwent stereotactic body radiotherapy (SBRT) (23/27). All patients experienced an NRS value decrease &#x3e;2 at 1 month and between the first and second months. NRS mean value reached 0 at 3, 6, 9, and 12 months’ evaluations. <b><i>Discussion/Conclusion:</i></b> The results of this retrospective analysis of patients treated with RFA-RT combined approach for BP support its safety and efficacy in terms of pain reduction. SBRT role in this combined approach has to be investigated in randomized trials.

Literature Review : Penerapan Senam Hamil Terhadap Penurunan Nyeri Punggung Pada Ibu Hamil Trimester III

Back pain is a problem commonly experienced by pregnant women in the third trimester. One of the effective ways to reduce that pain is pregnancy exercise. This scientific writing aims to describe the implementation of pregnancy exercise to pregnant women who experience back pain based on a literature review. The review was done to three articles from similar journal, which were published during 2018 – 2020. The Numeric Rating Scale (NRS) was used as the instrument. From 39 pregnant women who participated, 97.4% of them were 20-35 years old and 69.2% were fulltime housewives. The result showed that average value of the pain scale before the intervention was 5.42, and after the intervention was 2.70. The conclution of this literature review was that the implementation of pregnancy exercise was effective in reducing the intensity of back pain in pregnancy. Hence, health workers are supposed to encourage pregnant women to do pregnancy exercise, especially in the third trimester.Keywords: Keywords: Pregnancy; Back Pain, Pregnancy Exercise AbstrakKetidaknyamanan nyeri punggung umum dialami oleh ibu hamil Trimester III. Salah satu tindakan untuk menurunkan nyeri punggung yang efektif adalah senam hamil. Karya Tulis Ilmiah ini bertujuan untuk menggambarkan penerapan senam hamil pada ibu hamil yang mengalami nyeri punggung berdasarkan literature review. Subyek literature review yang digunakan yaitu 3 jurnal dengan laman jurnal yang yang sama, terbit tahun (2018-2020). Instrumen pada ketiga artikel ini menggunakan NRS (Numeric Rating Scale). Hasil analisa karakteristik responden dari 3 jurnal menunjukkan dari jumlah responden 39 ibu hamil. Sebagian umur responden adalah 20-35 tahun (97,4%), mayoritas status pekerjaan adalah IRT (69,2%). Nilai rata-rata skala nyeri sebelum intervensi 5,42, setelah intervensi 2,70. Kesimpulkan dari literature review adalah senam hamil efektif dalam menurunkan intensitas nyeri punggung pada kehamilan. Saran bagi pelayan kesehatan hendaknya menigkatkan penerapan senam hamil kepada seluruh ibu hamil terutama trimester III.Kata kunci: Kehamilan, Nyeri Punggung, Senam Hamil