BACKGROUND: Peripheral artery disease (PAD) in hemodialysis (HD) patients has a significant social impact due to its prevalence, poor response to standard therapy and dismal prognosis. Rheopheresis is indicated by guidelines for PAD treatment.
METHODS: Twenty-five HD patients affected by PAD stage IV Lerichè-Fontaine and ischemic ulcer 1C or 2C according to the University of Texas Wound Classification System (UTWCS), without amelioration after traditional medical therapy and/or revascularization, were selected and underwent 12 Rheopheresis sessions in 10 weeks. Improvements in pain symptoms using Numerical Rating Scale (NRS), healing ulcers and laboratory hemorheological parameters have been evaluated.
RESULTS: A clinically and statistically significant mean value reduction and of relative percentage differences between estimated marginal means (Δ), calculated at each visits, of NRS was observed, with a maximum value (-48.5%) between the first and last visit. At the end of the treatment period 14.3% of ulcers were completely healed, 46.4% downgraded, 53.6% were stable. Overall, no ulcers upgraded. A statistically significant reduction of the Δ, between the first and last visit, for fibrinogen (-16%) was also observed.
CONCLUSIONS: Rheopheresis reduced overall painful symptoms; data suggest that it could heal or improve ulcers and hemorheological laboratory parameters in HD patients with PAD and ischemic ulcers resistant to standard therapies.

OBJECTIVE: This empirical study aims to investigate the efficacy of pre-emptive cryotherapy in reducing pain that is caused by the deltoid intramuscular (IM) injection of long-acting injectable (LAI) antipsychotics in clinical settings.
METHODS: This study included 29 outpatients receiving LAI antipsychotic treatment. The evaluations of pain during (1) the usual procedure (control), (2) pre-emptive use of ice pack cryotherapy (pre-cooling), and (3) pre-emptive use of a room-temperature ice pack (pre-touching) were conducted using a numerical rating scale (NRS) for comparison. All patients were administered with LAI antipsychotics via deltoid IM. Furthermore, the results of the Positive and Negative Symptom Scale (PANSS), clinical global impressions (CGI) scale, and Global Assessment of Functioning (GAF) scale that were administered during the control procedure were evaluated.
RESULTS: The median NRS pain scores during the IM injection of LAI antipsychotics were 4.0 (3.0-5.0), 2.0 (1.0-3.0), and 3.0 (2.5-6.0) for the control, pre-cooling, and pre-touching conditions, indicating a significant difference (p = 6.0 × 10-6). The NRS pain scores for the pre-cooling condition were significantly lower than those for the control and pre-touching conditions (p = 2.5 × 10-5 and 6.7 × 10-5, respectively). No significant correlation was observed between the NRS pain scores for the control condition and the PANSS, CGI scale, or GAF scale scores. Furthermore, no adverse events were recorded during the study period.
CONCLUSIONS: Pain during the deltoid IM injection of LAI antipsychotics was found to be reduced by pre-emptive skin cooling. To date, this is the first study to confirm the effectiveness of pre-emptive cryotherapy for relieving such pain in clinical situations.

UNASSIGNED: Ischaemic stroke often leaves serious sequelae affecting patients\' daily activities and quality of life, especially shoulder pain. Shoulder pain after stroke often occurs in the first 3 months with an occurrence rate of 25-72% due to the strong natural neurological mechanism during the time, interferes with the recovery of motor function, increases hospital stay, is associated with depression, and limits mobility as well as inhibits treatment results. In Vietnam, Traditional Medicine (TM) has played an essential role in treating and rehabilitating shoulder pain after stroke for quite a long time. Studies on the pathology of shoulder pain (Jian Tong) after stroke in TM in Vietnam are still inadequate. Therefore, this study evaluated the severity and characteristics of post-stroke Jian Tong in patients with ischaemic stroke.
UNASSIGNED: The study was conducted from January 1, 2023-May 1, 2023. The study consisted of two phases: Phase 1: Searching TM documents and selecting the characteristics that appear in the documents as components for the questionnaire of phase 2. Phase 2: Conduct a cross-sectional study to investigate the characteristics of Jian Tong in 65 patients after ischaemic stroke in the early rehabilitation phase.
UNASSIGNED: In phase 1, the study encoded 17 features of Jian Tong from 10 literary documents. In phase 2, we surveyed over 65 patients, and the result was that shoulder pain aggravated by exertion had the highest rate, whereas shoulder pain alleviated by cold and distended shoulder had the fewest. Pain level measured by Number Rating Scale (NRS) points and gender was significantly related to the characteristics of TM shoulder pain - Jian Tong (p < 0.05).
UNASSIGNED: The study demonstrated the pain level and the characteristics of Jian Tong in patients with ischaemic stroke in the early rehabilitation phase to contribute to the process of personalized diagnosing and treating Jian Tong after stroke for each patient, especially based on the theoretical basis and reasoning methods of Traditional Medicine.

Context Spinal cord stimulation (SCS) is an approved treatment for chronic pain of neuropathic origin. Initial research suggests a close relationship between pain relief and patient satisfaction with SCS. Objectives To see whether similar patterns were observed in our center and to identify areas of improvement, this single-site, cohort audit explored the association between pain relief and satisfaction as well as specific factors that influence satisfaction at follow-up in patients with fully implanted SCS. Methods Age, gender, pain condition, SCS system, average pain (numerical rating scale, NRS), and worst pain (NRS) scores at baseline and the most recent follow-up visit were collected. Percentage change in average pain was calculated, and the patients were allocated to one of three pain improvement groups: <30%, 30%-50%, or >50%. A telephone survey explored patient outcomes including patient satisfaction, sleep, fatigue, quality of life (QoL), walking ability, and medication use. Chi-square tests of independence were performed. Results The final sample comprised 87 patients (<30%: n = 26; 30%-50%: n = 29; >50%: n = 32). The pain improvement group was significantly associated with satisfaction (p = 0.010): all patients in the >50% improvement group reported being either very satisfied or somewhat satisfied with SCS. The pain improvement group was also significantly associated with change in sleep (p < 0.001), fatigue (p = 0.001), QoL (p = 0.003), and opioid consumption (p = 0.010). Improvements were most frequently reported in the >50% improvement group. Conclusion Findings point to an association between pain relief and patient satisfaction with SCS. Other factors, including sleep, fatigue, QoL, and opioid consumption, may influence this association and deserve further exploration.

The Well-being Numerical Rating Scales (WB-NRSs) can be used to assess rapidly and accurately different types of well-being. However, the spiritual well-being scale showed slightly weaker psychometric properties. This study aimed to further investigate its suitability in measuring spiritual well-being. Participants (N = 270, age: M = 32.98; SD = 15.64; 67% females) were administered a questionnaire including spiritual well-being, gratitude, compassionate love, and personality traits measures. A network analysis (based on correlations) was used to display graphically the pattern of relationships among the measured constructs (i.e. the nomological net). Results provided evidence that the scale measures spiritual well-being as defined in the literature, that is, a component distinct from faith and compassionate love, but connected to meaning in life, quality of relationships, personality traits, and gratitude. These findings confirm the WB-NRSs is a psychometrically sound and easy-to-use tool with clear benefits for both research and clinical assessment.

OBJECTIVE: This study aimed to assess whether an artificial intelligence model based on facial expressions can accurately predict significant postoperative pain.
METHODS: A total of 155 facial expressions from patients who underwent gastric cancer surgery were analyzed to extract facial action units (AUs), gaze, landmarks, and positions. These features were used to construct various machine learning (ML) models, designed to predict significant postoperative pain intensity (NRS ≥ 7) from less significant pain (NRS < 7). Significant AUs predictive of NRS ≥ 7 were determined and compared to AUs known to be associated with pain in awake patients. The area under the receiver operating characteristic curves (AUROCs) of the ML models was calculated and compared using DeLong\'s test.
RESULTS: AU17 (chin raising) and AU20 (lip stretching) were found to be associated with NRS ≥ 7 (both P ≤ 0.004). AUs known to be associated with pain in awake patients did not show an association with pain in postoperative patients. An ML model based on AU17 and AU20 demonstrated an AUROC of 0.62 for NRS ≥ 7, which was inferior to a model based on all AUs (AUROC = 0.81, P = 0.006). Among facial features, head position and facial landmarks proved to be better predictors of NRS ≥ 7 (AUROC, 0.85-0.96) than AUs. A merged ML model that utilized gaze and eye landmarks, as well as head position and facial landmarks, exhibited the best performance (AUROC, 0.90) in predicting significant postoperative pain.
CONCLUSIONS: ML models using facial expressions can accurately predict the presence of significant postoperative pain and have the potential to screen patients in need of rescue analgesia.
BACKGROUND: This study was registered at ClinicalTrials.gov (NCT05477303; date: June 17, 2022).

BACKGROUND: Lumbar disc herniation (LDH) is one of the primary causes of back and leg pain affecting today\'s working population and is a major contributor to sickness absenteeism, creating a substantial socio-economic burden. Low back pain is one of the leading causes of physical disability in both old and younger age groups. Low back pain has a point prevalence of 12%, a year-on-year prevalence of 38%, and a lifetime prevalence of 40%. The aging population leads to a rising number of individuals affected by lower back pain. The study aims to compare the outcome of percutaneous transformational epidural steroid injection (TFESI) for LDH using the traditional safe triangle approach versus Kambin\'s triangle approach. Materials and methods: A retrospective cohort hospital-based observational study was conducted among a total of 90 patients who had underwent percutaneous epidural steroid injection using the traditional safe triangle approach versus Kambin\'s triangle approach for LDH. Patients were identified through electronic medical record (EMR) documentation submitted to the Department of Orthopaedics, R.L. Jalappa Hospital Centre, during the period of May 2022 to May 2023.
RESULTS: The majority of patients in Group A belonged to the 61-65 years and in Group B to the 71-75 years, respectively. The overall success rate of the procedure was higher in the safe triangle approach, and there was an association found between the type of procedure and the successful rate. There was no statistically significant difference between the two approaches, namely, traditional safety triangle approach and Kambin\'s triangle approach, in terms of Numerical Rating Scale (NRS) score and Oswestry Disability Index (ODI) score at pre-injection and at one month and three months post-injection.  Conclusion: The Kambin\'s triangle approach is just as effective for the interim outcome as the subpedicular approach and provides significant advantages. The Kambin\'s triangle approach may be used as an alternative to TFESI in situations where needle tip placement in the anterior epidural is challenging.

OBJECTIVE: It is essential to have validated and reliable pain measurement tools that cover a wide range of areas and are tailored to individual patients to ensure effective pain management. The main objective of this review is to provide comprehensive information on commonly used pain scales and questionnaires, including their usefulness, intended purpose, applicability to different patient populations, and associated advantages and disadvantages.
RESULTS: Acute pain questionnaires typically focus on measuring the severity of pain and the extent of relief achieved through interventions. Chronic pain questionnaires evaluate additional aspects such as pain-related functional limitations, psychological distress, and psychological well-being. The selection of an appropriate pain scale depends on the specific assessment objectives. Additionally, each pain scale has its strengths and limitations. Understanding the differences among these pain scales is essential for selecting the most appropriate tool tailored to individual patient needs in different settings.
CONCLUSIONS: Medical professionals encounter challenges in accurately assessing pain. Physicians must be familiar with the different pain scales and their applicability to specific patient population.

暂无摘要。

Pain intensity assessment scales are important in evaluating postoperative pain and guiding management. Different scales can be used for patients to self-report their pain, but research determining cut points between mild, moderate and severe pain has been limited to studies with < 1500 patients. We examined 13,017 simultaneous acute postoperative pain ratings from 913 patients taken at rest and on activity, between 4 h and 48 h following surgery using both a verbal rating scale (no, mild, moderate or severe pain) and 0-100 mm visual analogue scale. We determined the best cut points on the visual analogue scale between mild and moderate pain as 35 mm, and moderate and severe pain as 80 mm. These remained consistent for pain at rest and on activity, and over time. We also explored the presence of category disagreements, defined as patients verbally describing no or mild pain scored above the mild/moderate cut point on the visual analogue scale, and patients verbally describing moderate or severe pain scored below the mild/moderate cut point on the visual analogue scale. Using 30 and 60 mm cut points, 1533 observations (12%) showed a category disagreement and using 35 and 80 mm cut points, 1632 (13%) showed a category disagreement. Around 1 in 8 simultaneous pain scores implausibly disagreed, possibly resulting in incorrect pain reporting. The reasons are not known but low rates of literacy and numeracy may be contributing factors. Understanding these disagreements between pain scales is important for pain research and medical practice.