Search

Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.

Background Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results A total of 451 patients were included in three randomized and two non-randomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

Background Different views have been proposed on the radiofrequency treatment modes and parameters of radiofrequency thermocoagulation of the spinal dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). It is urgent to identify a more effective therapy for patients with PHN. Methods Patients who underwent radiofrequency thermocoagulation therapy for PHN were retrospectively reviewed and were divided into a radiofrequency thermocoagulation (CRF) and double neddles radiofrequency thermocoagulation (DCRF). The pain scores (numerical rating scale, NRS) were evaluated at the following time points before the operation, 1 day, 3 months, 6 months, 1 year, and 2 years after operation. The incidence of complications and the degree of pain relief were evaluated. The in vitro ovalbumin experiment was used to indicate the effects of radiofrequency thermocoagulation. Results Compared with the preoperative NRS scores, the postoperative NRS scores decreased significantly; the NRS scores of the DCRF group was lower than that of the CRF group at all time points from 6 months to 2 years following the operation. The total effective rate of the DCRF group was significantly higher than that of the CRF group at 2 years following the operation. The incidence of numbness in the DCRF group was higher than that noted in the CRF group. The ovalbumin experiments in vitro indicated that the effects of radiofrequency thermocoagulation were optimal when the distance between the two needles was 5 mm. Conclusions DCRF with a 5 mm spacing exhibits a longer duration and higher effective rate in the treatment of PHN and is worth promoting.

Background The effect of lumbar spinal stenosis (LSS) and peripheral vascular disease (PVD), which occurs with similar degenerative conditions, when seen together, has not been studied. The aim of this study is to examine and compare the relationship between pain, balance, disability, fear of falling, and kinesiophobia in LSS patients with intermittent vascular claudication (IVC). Methods Seventy-two patients diagnosed with LSS using magnetic resonance imaging participated in this study. Thirty-five patients with IVC symptoms and showing vascular lesions by lower extremity venous and arterial Doppler ultrasonography imaging were included in the IVC-LSS group. The pain, static balance, dynamic balance, disability, fear of falling, and kinesiophobia were evaluated using the numeric rating scale, single leg stance test, Time Up and Go (TUG), the Oswestry Disability Index (ODI), Fall Efficacy Scale-International (FES-I), and Tampa Scale for Kinesiophobia (TSK), respectively. Results Age and female sex were found to be higher in the IVC-LSS group (P = 0.024; P = 0.012). The IVC-LSS group had a shorter single leg stance time and TUG test duration, pain intensity, ODI, FES-I, and TSK scores were higher than patients with LSS (P = 0.001). Pain, fear of falling, and kinesiophobia were moderately correlated with disability in the IVC-LSS group. No relationship was found between pain and dynamic balance. Also, the pain was not related to kinesiophobia. Conclusions The findings indicated that IVC causes loss of balance and an increase in pain, disability, fear of falling, and kinesophobia in patients with LSS.

Background Prior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain. Methods A retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB. Results Among the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB. Conclusions Celiac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

Background Yellow flags are psychosocial factors shown to be indicative of long-term chronicity and disability. The purpose of the study was to evaluate the psychometric properties of the Turkish Yellow Flag Questionnaire (YFQ) in patients with chronic musculoskeletal pain (CMP). Methods The cross-cultural adaptation was conducted with translation and back-translation of the original version. Reliability (internal consistency and test-retest) was examined for 231 patients with CMP. Construct validity was assessed by correlating the YFQ with the Hospital Anxiety and Depression Scale (HADS), Orebro Musculoskeletal Pain Questionnaire (OMPQ), and Tampa Kinesiophobia Scale (TKS). Factorial validity was examined with both exploratory and confirmatory factorial analysis. Results The YFQ showed excellent test/retest reliability with an Intraclass correlation coefficient of 0.82. The internal consistency was moderate (Cronbach’s alpha of 0.797). As a result of the exploratory factor analysis, there were 7 domains compatible with the original version. As a result of confirmatory factor analysis, the seven-factor structure of YFQ was confirmed. There was a statistically significant correlation between YFQ-total score and OMPQ (r = 0.57, P < 0.001), HADS-anxiety (r = 0.32, P < 0.001), HADS-depression (r = 0.44, P < 0.001), and TKS (r = 0.37, P < 0.001). Conclusions This study’s results provide considerable evidence that the Turkish version of the YFQ has appropriate psychometric properties, including test-retest reliability, internal consistency, construct validity and factorial validity. It can be used for evaluating psychosocial impact in patients with CMP.

Background Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system's role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. Methods Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh: CD4+CXCR5+PD1+), Th17 (CD4+CCR6+ and CD4+IL17A+), regulatory T cells (Treg: CD4+ CD25+foxp3+), Th1 (CD4+ CXCR3+ and CD4+ IFN-γ+) and Th2 (CD4+ IL-4+) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. Results When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3+, CD4+) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase (P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase (P = 0.036). Conclusions Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.

Background Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. Methods Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. Results The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. Conclusions Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.

Background Postherpetic neuralgia (PHN) is a refractory complication of herpes zoster (HZ). To prevent PHN, various strategies have been aggressively adopted. However, the efficacy of these strategies remains controversial. Therefore, we aimed to estimate the relative efficacy of various strategies used in clinical practice for preventing PHN using a network meta-analysis (NMA). Methods We performed a systematic and comprehensive search to identify all randomized controlled trials. The primary outcome was the incidence of PHN at 3 months after acute HZ. We performed both frequentist and Bayesian NMA and used the surface under the cumulative ranking curve (SUCRA) values to rank the interventions evaluated. Results In total, 39 studies were included in the systematic review and NMA. According to the SUCRA value, the incidence of PHN was lower in the order of continuous epidural block with local anesthetics and steroids (EPI-LSE), antiviral agents with subcutaneous injection of local anesthetics and steroids (AV + sLS), antiviral agents with intracutaenous injection of local anesthetics and steroids (AV + iLS) at 3 months after acute HZ. EPI-LSE, AV + sLS and AV + iLS were also effective in preventing PHN at 1 month after acute HZ. And paravertebral block combined with antiviral and antiepileptic agents was effective in preventing PHN at 1, 3, and 6 months. Conclusions The continuous epidural block with local anesthetics and steroid, antiviral agents with intracutaneous or subcutaneous injection of local anesthetics and a steroid, and paravertebral block combined with antiviral and antiepileptic agents are effective in preventing PHN.

Background This study was performed to reveal the relationships between the cross-sectional areas (CSAs) of the paraspinal muscles and the severity of low back pain (LBP), including the level of disability. Methods This single-center cross-sectional study was conducted on 164 patients with chronic LBP. The effects of demographic characteristics, posture, level of physical activity, disc herniation type, and sarcopenia risk on the CSAs of paraspinal muscles were evaluated along with the relationship between the CSAs and severity of pain and disability in all patients. The CSAs of paraspinal muscles were evaluated using the software program Image J 1.53. Results A negative significant correlation was found between age and the paraspinal muscle’s CSA (P < 0.05), whereas a positive correlation was present between the level of physical activity and the CSA of the paraspinal muscle at the L2-3 and L3-4 levels. The CSAs of paraspinal muscles in patients with sarcopenia risk was significantly lower than those in patients without sarcopenia risk (P < 0.05). The CSAs of paraspinal muscles at the L2-3 and L3-4 levels in obese patients were significantly higher than those in overweight patients (P = 0.028, P = 0.026, respectively). There was no relationship between the CSAs of paraspinal muscles and pain intensity or disability. Conclusions Although this study did not find a relationship between paraspinal CSAs and pain or disability, treatment regimens for preventing paraspinal muscles from atrophy may aid pain physicians in relieving pain, restoring function, and preventing recurrence in patients with chronic LBP.

Background Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery. Methods We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery. Results Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation. Conclusions Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.

Background Trigeminal neuralgia (TN) is one of the most painful disorder in the orofacial region, and many patients have suffered from this disease. For the effective management of TN, fundamental epidemiologic data related to the target population group are essential. Thus, this study was performed to clarify the epidemiological characteristics of TN in the Korean population. This is the first national study to investigate the prevalence of TN in Korean patients. Methods From 2014 to 2018, population-based medical data for 51,276,314 subscribers to the National Health Insurance Service of Korea were used for this study. Results The incidence of TN was 100.21 per 100,000 person-years in the year of 2018 in Korea, and the male to female ratio was 1:2.14. The age group of 51-59 years had the highest prevalence of TN. Constant increases in medical cost, regional imbalance, and differences in prescription patterns by the medical specialties were showed in the management of TN. Conclusions The results in this study will not only help to study the characteristics of TN, but also serve as an important basis for the effective management of TN in Korea.

Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as “successful CEI.” We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions: Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e. , the main target level) without the need for fluoroscopy.

Background: Pillar pain may develop after carpal tunnel release surgery (CTRS). This prospective double-blinded randomized trial investigated the effectiveness of extracorporeal shock wave therapy (ESWT) in pillar pain relief and hand function improvement. Methods: The sample consisted of 60 patients with post-CTRS pillar pain, randomized into two groups. The ESWT group (experimental) received three sessions of ESWT, while the control group received three sessions of sham ESWT, one session per week. Participants were evaluated before treatment, and three weeks, three months, and six months after treatment. The pain was assessed using the visual analogue scale (VAS). Hand functions were assessed using the Michigan hand outcomes questionnaire (MHQ). Results: The ESWT group showed significant improvement in VAS and MHQ scores after treatment at all time points compared to the control group (P < 0.001). Before treatment, the ESWT and control groups had a VAS score of 6.8 ± 1.3 and 6.7 ± 1.0, respectively. Three weeks after treatment, they had a VAS score of 2.8 ± 1.1 and 6.1 ± 1.0, respectively. Six months after treatment, the VAS score was reduced to 1.9 ± 0.9 and 5.1 ± 1.0, respectively. The ESWT group had a MHQ score of 54.4 ± 7.7 before treatment and 73.3 ± 6.8 six months after. The control group had a MHQ score of 54.2 ± 7.1 before treatment and 57.8 ± 4.4 six months after. Conclusions: ESWT is an effective and a safe non-invasive treatment option for pain management and hand functionality in pillar pain.

Background Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions Based on the present systematic review, with one RCT and 5 non-randomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed. The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions: Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

Background Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

Background The present study employed National Health Insurance Data to explore complex regional pain syndrome (CRPS) updated epidemiology in a Korean context. Methods A CRPS cohort for the period 2009-2016 was created based on Korean Standard Classification of Diseases codes alongside the national registry. The general CRPS incidence rate and the yearly incidence rate trend for every CRPS type were respectively the primary and secondary outcomes. Among the analyzed risk factors were age, sex, region, and hospital level for the yearly trend of the incidence rate for every CRPS. Statistical analysis was performed via the chi-square test and the linear and logistic linear regression tests. Results Over the research period, the number of registered patients was 122,210. The general CRPS incidence rate was 15.83 per 100,000, with 19.5 for type 1 and 12.1 for type 2. The condition exhibited a declining trend according to its overall occurrence, particularly in the case of type 2 (P < 0.001). On the other hand, registration was more pervasive among type 1 compared to type 2 patients (61.7% vs. 38.3%), while both types affected female individuals to a greater extent. Regarding age, individuals older than 60 years of age were associated with the highest prevalence in both types, regardless of sex (P < 0.001). Conclusions CRPS displayed an overall incidence of 15.83 per 100,000 in Korea and a declining trend for every age group which showed a negative association with the aging shift phenomenon.

Background: It has been reported that a new type of headache may develop as a result of face mask use during the COVID-19 pandemic. The aim of this study is to investigate the clinical features of face mask-related headache during the COVID-19 pandemic. Methods: This is a cross-sectional study carried out on healthcare workers at the Afyonkarahisar Health Sciences University. The number of workers at our university was established. Sample size was calculated using the G*Power program. A questionnaire consisting of questions relating to pre-existing headache, an aggravation in headache, and de-novo headache was filled out by 3 neurologists with all participants. Results: Data was collected from a total of 375 participants, after the exclusion of 5 individuals who refused to participate. Out of all participants, 26 (6.9%) used a filtering mask, 274 (73.1%) used a surgical mask, 75 (20.0%) participants used a combination of both masks. The number of participants with preexisting headache was 114 (30.4%) had pre-existing headache. Of those with pre-existing headache, 77 (67.5%) healthcare workers had reported an aggravation in their headache after mask use. De-novo headache was observed in 116 (30.9%) of participants. De-novo headache characteristics included throbbing in 17 (14.7%) participants and pressing in 99 (85.3%) participants. In addition, symptoms such as tachypnea, sleep disturbance, and fatigue were found to be significantly higher. Conclusions: This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak.

Background Iliotibial band friction syndrome (ITBFS) is a common disorder of the lateral knee. Previous research has reported that the iliotibial band (ITB) thickness (ITBT) is correlated with ITBFS, and ITBT has been considered to be a key morphologic parameter of ITBFS. However, the thickness is different from inflammatory hypertrophy. Thus, we made the ITB cross-sectional area (ITBCSA) a new morphological parameter to assess ITBFS. Methods Forty-three patients with ITBFS group and from 43 normal group who underwent T1W magnetic resonance imaging were enrolled. The ITBCSA was measured as the cross-sectional area of the ITB that was most hypertrophied in the magnetic resonance axial images. The ITBT was measured as the thickest site of ITB. Results The mean ITBCSA was 25.24 ± 6.59 mm2 in the normal group and 38.75 ± 9.11 mm2 in the ITBFS group. The mean ITBT was 1.94 ± 0.41 mm in the normal group and 2.62 ± 0.46 mm in the ITBFS group. Patients in ITBFS group had significantly higher ITBCSA (P < 0.001) and ITBT (P < 0.001) than the normal group. A receiver operator characteristic curve analysis demonstrated that the best cut-off value of the ITBT was 2.29 mm, with 76.7% sensitivity, 79.1% specificity, and area under the curve (AUC) 0.88. The optimal cut-off score of the ITBCSA was 30.66 mm2, with 79.1% sensitivity, 79.1% specificity, and AUC 0.87. Conclusions ITBCSA is a new and sensitive morphological parameter for diagnosing ITBFS, and may even be more accurate than ITBT.

Background Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

Background: Sciatic nerve injury due to intramuscular injection (SNIII) is still a health problem. This study aimed to determine whether there is a correlation between neuropathic pain and electrodiagnostic findings in SNIII. Methods: Patients whose clinical and electrodiagnostic findings were compatible with SNIII participated in this retrospective cohort study. Compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the sural, superficial peroneal, peroneal, and tibial nerves were graded from 1 to 4. Leeds assessment of neuropathic symptoms and signs scale (LANSS) was applied to all patients. Results: Forty-eight patients were included in the study, 67% of whom had a LANSS score ≥ 12. Sural SNAP amplitude abnormalities were present in 8 (50%) out of 16 patients with a LANSS score < 12, and 28 (87.5%) out of 32 patients with a LANSS score ≥ 12, with significant differences between the groups (P = 0.011). There was a positive correlation between the LANSS score and the sural SNAP amplitude grading (P = 0.001, r = 0.476). A similar positive correlation was also found in the LANSS score and the tibial nerve CMAP amplitude grading (P = 0.004, r = 0.410). Conclusions: This study showed a positive correlation between the severity of tibial nerve CMAP/sural SNAP amplitude abnormality and LANSS score in SNIII. Neuropathic pain may be more common in SNIII patients with sural nerve SNAP amplitude abnormality.

Background: Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other non-mechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. Methods: We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. Results: A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. Conclusions: Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

Background: Evaluation of the effectiveness of caudal epidural injection on pain, spine mobility, disease activity, and activity of daily living in axial spondyloarthritis (SpA) patients. Methods: A total sample of 47 patients were registered in this study. They were randomly assigned into 2 groups; Group I received caudal epidural injections, ultrasound- guided, with 1% lidocaine hydrochloride mixed with triamcinolone, whereas Group II did not receive any injections. All participants fulfilled the ASAS criteria for axial SpA. Outcome measures were as follows: visual analogue scale, Oswestry disability index (ODI), modified Schober test, lateral lumbar flexion, and Ankylosing Spondylitis Disease Activity Score (ASDAS) with assessment at baseline, 2 weeks, and 8 weeks post-treatment. This clinical trial was registered on clinicaltrials.gov under the number NCT04143165. Results: There was a significant difference between both groups regarding pain, ODI, spine mobility and ASDAS scores in favor of group I. This effect was at its maximum after 2 weeks. Despite the decline of this effect after 2 months, the difference between the groups remained significant. Higher disease activity, younger age, and shorter disease duration were associated with better outcomes. Conclusions: Epidural injection of lidocaine and triamcinolone is a cost effective and a practical technique for controlling pain, as well as improving the function of the spine and disease activity scores in axial SpA patients with acceptable complications and relatively sustained effect.

Background This study aimed to assess the potential efficacy of purified porcine atelocollagen (PAC) for the management of refractory chronic pain due to suspected connective tissue damage. Methods Patients treated with PAC were retrospectively evaluated. Patients with chronic refractory pain, suspected to have originated from musculoskeletal damage or defects with the evidence of imaging studies were included. Pain intensity, using the 11-point numerical rating scale (NRS), was assessed before the procedure, and 1 month after the last procedure. Results Eighty-eight patients were finally included for investigation. The mean NRS score was decreased from 5.8 to 4.1 after 1 month of PAC injection (P < 0.001). No independent factor was reported to be directly related to the decrease in NRS score by more than half. Conclusions Application of PAC may have potential as a treatment option for refractory chronic musculoskeletal pain. PAC might promote tissue recovery, act as a scaffold for repair, or directly reduce inflammation.

Background Korean society is afflicted with rapid aging. Aging is a risk factor for pain, and pain can reduce patients' quality of life. Thus, adequate management and monitoring of changing trends accompanying the demographic shift are highly valuable. However, this study was conducted because no studies have investigated the recent changes in the prevalence of pain. Methods The extent of the prevalence of pain was determined by questions related to quality of life based on the data derived from the Korea National Health and Nutrition Survey (KNHNS) from 2005 to 2016. The annual frequencies of the pain group and severe pain group were calculated using the survey questionnaire. Multiple logistic regression analysis was performed to determine possible differences in prevalence by year. Results The prevalence of pain in all populations was 30.6% in 2005 and 18.9% in 2016. The average prevalence from 2005 to 2016 was 21.9%. A declining trend occurred over time with an odds ratio of 0.929 per year (95% CI: 0.921-0.938). The prevalence of severe pain was 2.35% in 2005 and 1.88% in 2016. Likewise, a decrease was observed over time, with an odds ratio of 0.920 per year at 95% CI 0.901-0.939. The decline in age-/sex-stratified analysis also showed a statistically significant trend in all groups. Conclusions The prevalence of pain in Korean society, based on the KNHNS, has declined since 2005. Such a trend was observed in all ages and sexs, and was most significant in the elderly.

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

Background In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. Methods This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. Results A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). Conclusions Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.

Background The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing. Methods This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively. Results At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°; P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999). Conclusions FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.

Background To explore the association between low back pain (LBP) and pelvic pain (PP) and rectus abdominis diastasis (RAD) in postpartum women and identify the characteristics and risk factors. Methods Women diagnosed with RAD and a history of labor and delivery, between 2009 and 2018, were identified from six hospitals within the Partners Healthcare System. Univariate and multivariable binary logistic regression analyses were used to identify the risk factors associated with pain. Results Age at onset of RAD in the non-cesarean delivery group was earlier than those in cesarean delivery (CD) group (P = 0.017). Women who underwent CD demonstrated 4.5 times greater risk of RAD than those who had no CD exposure. The cumulative composition ratio of LBP at every age stage of the period from 8 years pre-first delivery to 8 years post-first delivery was significantly higher than the other five conditions (RAD, umbilical hernia, PP, depressive disorder [DD], and strain of muscle, fascia, and tendon [SMFT]) (P for trend < 0.001). Women with DD, SMFT, and PP were more likely to have LBP (odds ratio [OR] = 1.91, 95% confidence interval [CI] 1.06 to 3.47, P = 0.032; OR = 4.50, 95% CI 1.64 to 12.36, P = 0.003; OR = 2.14, 95% CI 1.17 to 3.89, P = 0.013; respectively). Conclusions In postpartum women with RAD, DD, SMFT, and PP were found to be risk factors contributing to the development of LBP. Race and LBP also played roles in the development of PP.

Background: The study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic. Methods: In this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed. Results: Procedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study. Conclusions: VR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

Background Pharmacological and non-pharmacological therapies have been used to treat patients with chemotherapy-induced peripheral neuropathy (CIPN). However, the effect of therapies in cancer patients has yet to be investigated comprehensively. We hypothesized that cyclic thermal therapy would improve blood flow and microcirculation and improve the symptoms driven by CIPN. Methods The criteria of assessment were blood volume in region of interest (ROI) in the images, and European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 questionnaire scores. The blood volume was quantified by using red blood cell (RBC) scintigraphy. All patients were treated 10 times during 10 days. The thermal stimulations, between 15° and 41°, were repeatedly delivered to the patient's hands. Results The total score of the questionnaires, the score of questions related to the upper limbs, the score of questions closely related to the upper limbs, and the score excluding the upper limbs questions was decreased. The blood volume was decreased, and the variance of blood volume was decreased. During cooling stimulation, the blood volume was decreased, and its variance was decreased. During warming stimulation, the blood volume was decreased, and its variance was decreased. Conclusions We suggest that cyclic thermal therapy is useful to alleviate CIPN symptoms by blood circulation improvement. RBC scintigraphy can provide the quantitative information on blood volume under certain conditions such as stress, as well as rest, in peripheral tissue.

Background Various truncal block techniques with ultrasonography (USG) are becoming widespread to reduce postoperative pain and opioid requirements in video-assisted thoracoscopic surgery (VATS). The primary aim of our study was to determine whether the USG-guided serratus anterior plane block (SAPB) is as effective as the thoracic paravertebral block (TPVB) in VATS. Our secondary aim was to evaluate patient and surgeon satisfaction, block application time, first analgesic time, and length of hospital stay. Methods Patients in Group SAPB received 0.4 mL/kg bupivacaine with a USG-guided SAPB, and patients in Group TPVB received 0.4 mL/kg bupivacaine with a USG-guided TPVB. We recorded the pain scores, the timing of the first analgesic requirement, the amount of tramadol consumption, and postoperative complications for 24 hours. We also recorded the block application time and length of hospital stay. Results A total of 62 patients, with 31 in each group (Group SAPB and Group TPVB) completed the study. Between the two groups, there were no significant differences in rest and dynamic pain visual analog scale scores at 0, 1, 6, 12, and 24 hours after surgery. The total consumption of tramadol was significantly lower in the TPVB group (P = 0.026). The block application time was significantly shorter in Group SAPB (P < 0.001). Conclusions An SAPB that is applied safely and rapidly as a part of multimodal analgesia in patients who undergo VATS is not inferior to the TPVB and can be an alternative to it.

Background Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. Methods Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients' sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. Results The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. Conclusions Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

Background: Many patients with complex regional pain syndrome (CRPS) have been known to be at risk of suicide, due to severe pain and its comorbid conditions. The risk of suicide may be associated with affective instability, which is an indicator of emotional dysregulation. Particularly, unstable shifts in negative emotions are difficult to cope with, which may result in individuals feeling uncontrollable, hopeless, and entrapped. This study aimed to examine the role of affective instability in the relationship between pain intensity and suicide risk (suicidal ideation and impulsivity) in patients with CRPS, by employing a daily diary. Methods: Twenty-three patients registered at the CRPS Association in Korea were asked to complete a day-to-day routine for 15 days, followed by a diary composed of pain intensity, suicidal ideation, impulsivity, and positive and negative affects. Results: Results showed that the interactions between negative affective instability and daily pain intensity were statistically significant on daily suicidal ideation (coefficient = 0.41, t (21) = 2.56, P < 0.050) and daily impulsiveness (coefficient = 1.20, t (19) = 3.35, P < 0.010). However, those between positive affective instability and daily pain intensity were not. Conclusions: This study is the first attempt to investigate the role of affective instability on the relationship between daily pain intensity and daily suicide risk in patients with CRPS. Our findings suggest that health professionals pay considerable attention to the instability of negative affects when assessing and managing patients with CRPS at risk of suicide.