Rebozo Technique Effectively Reduces Maternal Pain during Childbirth Stage 1 Active Phase

Background: Pain is the main complaint felt by mothers during childbirth. Pain management can be done with non-pharma-cological techniques, one of which is using the Rebozo technique. Objective(s): This study aimed to determine the effectiveness of the rebozo technique for active phase 1 labour pain in primipa-rous women. Method(s): The study used a quasi-experimental design with a pretest and posttest control group. An accidental sampling technique divided a sample of 30 people into control and intervention groups. The intervention group received Rebozo therapy, a therapy using a traditional cloth wrapped around the pelvis and buttocks with the mother kneeling, then shaking it slowly. The pain was measured using the Visual Analogue Scale (VAS), ranging from 0-10. Bivariate test using Wilcoxon. Result(s): The majority of respondents were aged 21-29 years (56.7%), had high school education (83.3%) and were house-wives (50%). The majority of the control group showed moderate pain (53.3%), while the intervention group showed severe (60%). The reduction in pain in the intervention group was more significant than in the control group (2.27 > 0.73). Both the control group and the intervention group showed p < 0.001. Conclusion(s): The Rebozo technique effectively reduces labour pain in the active phase of the first stage in primiparous women. This technique is easy and inexpensive, so it can be an option for non-pharmacological therapy to treat labour pain.Copyright © 2023 Japan University of Health Sciences.

Feasibility of a pain informed movement program for people with symptomatic knee osteoarthritis

Purpose: Disability in knee osteoarthritis (KOA) is known to be largely due to pain, the mechanism of which is complex and multidimensional with alterations in nociceptive processing in the peripheral and central nervous system (CNS) leading to persistent pain. Current clinical practice guidelines for KOA provide strong recommendations for education and exercise including land-based or mind-body approaches. However, individually these strategies are only moderately effective. One potential reason for this is a lack of understanding of their underlying mechanisms and how their combination might impact nervous system modulation. Neuromuscular exercise is known to improve lower extremity strength. Mind-body approaches as well as pain neuroscience education (PNE) are uniquely positioned to potentially reverse CNS adaptations by inducing positive neuroplastic changes and improving descending modulation of pain resulting in decreased pain. To our knowledge, neuromuscular exercise, mind-body techniques, and PNE have not been studied in combination. We therefore aimed to establish the feasibility of an intervention consisting of these three elements referred to as Pain Informed Movement (PIM). The results of this study will inform necessary modifications for a two-arm pilot randomized controlled trial (RCT). Method(s): This study was a single-arm feasibility trial with a nested qualitative component and the primary feasibility outcome of complete follow up. Inclusion criteria: age >= 40 years, KOA clinical diagnosis or people fulfilling the NICE diagnostic criteria, and average pain intensity >=3/10 on the numeric pain rating scale. PIM consisted of twice weekly in-person exercise sessions and a third home exercise session for 8 weeks. In addition, PNE, provided as online videos, covered the following topics: purpose of pain, neurophysiological changes associated with pain, movement guidelines when pain persists, mind-body techniques to impact neurophysiology and support moving with ease that included breath awareness and regulation, muscle tension regulation, awareness of pain related thoughts and emotions, and relaxation. The mind-body techniques and the PNE topics were implemented during the group exercise sessions that included evidence-based neuromuscular exercises aimed at improving sensorimotor control and functionality of the knee joint. Participants completed questionnaires and in-person assessments at baseline and at program completion. Assessments included weight and height, chair stands as a measure of functional leg strength, and conditioned pain modulation to assess efficiency of the descending modulatory pathways. Participants also had their blood drawn to monitor changes in brain derived neurotrophic factor (BDNF), a marker of neuroplasticity. Questionnaires included the Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale, the Knee Injury and Osteoarthritis Outcome Score - function and pain subscales, Chronic Pain Self Efficacy scale, pain intensity rated in the past 24 hours, the past week, and worst pain in the past 24 hours. Secondary feasibility outcomes included acceptability of the intervention, burden of assessments, recruitment rate, compliance rate, adherence rate, and self-reported adverse events. Feasibility findings were evaluated against a-priori success criteria. In the qualitative component, participants were invited to an online focus group and were asked about their experience and perceptions of the program. Interview recordings were analyzed using thematic content analysis to identify suggestions for program modification. Result(s): In total, 19 participants (mean age 63.3 years (SD 10.5), 73% female) were enrolled, with a complete follow up rate of 74% (n=14) for our primary objective, indicating that modifications would be needed to proceed. Of the 5 dropouts, only one was study related. We will be adding additional inclusion criteria of: ability to get up and down from the floor independently, and no use of mobility aids. Adherence to in-person treatment sessions was 91%, hich indicates proceeding with the protocol for the next phase (i.e., pilot RCT). Some absences were due to unmodifiable factors (e.g., COVID-19). We will make protocol amendments for the purpose of improving the adherence rate to include 'no planned absences'. All other success criteria were met: recruitment rate, compliance to exercise sessions, program acceptability, duration, frequency, and delivery, likelihood of recommending the program to others and taking the program again, burden, and adverse events (Table 1). Analysis of the focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations by the instructor to assist with participants' execution of breath and muscle tension regulation. The majority of participants improved in most of the physical assessment outcomes and questionnaires (Table 2). Conclusion(s): The PIM program is feasible, acceptable, not burdensome, does not cause adverse events, and had an excellent compliance rate. Minor modifications are needed to optimize enrolment and adherence rates. Although improvements in pain, function, and psychological measures were observed, the feasibility nature of this study precludes any conclusions regarding efficacy. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of PIM when compared to conventional neuromuscular exercise and standard OA education. [Formula presented] [Formula presented]Copyright © 2023

Quality of life of palliative care cancer patients during COVID-19 lockdown phase

Background: Coronavirus pandemic in 2019 led India to implement a complete lockdown except for essential services. Cancer patients faced hindrances in seeking medical help. This caused stress and worry, leading to reduced quality of life (QoL). This study evaluated QoL and pain management in palliative care cancer patients during the lockdown. Patients and Methods: This was a cross-sectional observational study at a tertiary cancer hospital, over one month period with convenience sampling. Participants included all who were unable to visit the palliative outpatient department during the lockdown during the COVID-19 pandemic. They were contacted telephonically and a valid QoL questionnaire was filled out. Disease, demographic details and pain were assessed. Result(s): A total of 51 were interviewed, 45% (n = 23) patients reported difficult access to medication during the lockdown;18 (35.3%) required morphine to alleviate pain and 6 (33.33%) faced difficulty in acquiring morphine tablets. QoL scores did not differ based on access to morphine (p = 0.648). Mean QoL scores were 12.7 +/- 3.76 and 15.0 +/- 3.60 amongst patients who did not have access to other medications and those who did have access, respectively (p = 0.03). Overall QoL FACT G7 mean score was 14 +/- 3.8. The variables NRS (pain intensity) and QoL scores were found to be negatively correlated (Pearson's Correlation Coefficient: r (49) = -0.69, p < 0.00001). Conclusion(s): Evaluation of QoL of palliative care cancer patients during global crises plays an important role in the assessment of patients' overall condition as well as to maintain a continuum of care.Copyright © Via Medica.

Impact of Different Exercise Techniques on Menstrual Pain Severity in Postacute Covid-19 Women

Background: The purpose of this investigation was to determine the impact of different exercise techniques on menstrual pain severity in post-acute covid-19 women. Method(s): Thirty post-acute COVID-19 women suffering from primary menstrual pain. Their body mass index ranged from 25 to 35 kg/m2, and their age was between 18 and 25 years old. They were split up into two groups randomly. The control group (n=15) were instructed to avoid regular physical exercise during the study period, and the exercise group (n=15) were requested to perform set of home-based exercise protocol, from the fourth day of the menstrual cycle till the onset of the second menstrual cycle. Both groups were examined for pain intensity Pre-treatment and post-treatment using visual analogue scale (VAS). Result(s): Menstrual pain intensity was significantly reduced in the exercise group (p=0.000) but not statistically different in the control group (p=0.089). Conclusion(s): Different exercise techniques has a positive impact on menstrual pain severity in post-acute covid-19 women. Therefore, it can be recommended for menstrual pain relief in post-acute covid-19 women to promote their daily activities, independent living and quality of life.Copyright © 2021 Muslim OT et al.

Superior Cerebellar Artery Dissection in a Patient Diagnosed with Reversible Cerebral Vasoconstriction Syndrome: A Case Report

Arterial dissection is an uncommon complication of reversible cerebral vasocon-striction syndrome (RCVS). We describe the case of a 35-year-old woman with a migraine history who presented with recurrent thunderclap headache and focal neurological signs, including right hemiataxia. She had been diagnosed with COVID-19 disease two weeks earlier. Neuroimaging revealed multifocal stenosis of the posterior circulation arteries and dissection of the right superior cerebellar artery. She improved significantly throughout her one-week hospitalization and maintained only mild ataxia. The interplay between COVID-19 disease, RCVS, and arterial dissection requires further investigation.Copyright © Author(s) (or their employer(s)) and Sinapse 2022.

Effect of the COVID-19 Pandemic on Headache in Pediatric Migraine Patients at a Single Tertiary Center

Purpose: The aim of this study was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on children and adolescents with migraine. Method(s): This longitudinal cohort study enrolled children and adolescents with migraine from the Department of Pediatric Neurology at our hospital from January 2017 to June 2021. Self-re-ported data from individual headache diaries were used. The patients were questioned about their headache frequency and intensity, stress, physical activity, changes in mood and sleep, and their school and home lives during the COVID-19 pandemic. The Pediatric Migraine Disability Assessment (Ped-MIDAS) scoring system was applied to assess headache-related disability. Result(s): In total, 325 pediatric migraine patients (mean age 12.8+/-5.6 years, 62.5% female) were included in this study. The average monthly frequency of migraine headaches was 2.17+/-1.32 and 4.62+/-3.29 before and during the COVID-19 pandemic (P<0.001), respectively. The Ped-MIDAS score was obtained for 207 patients both before and during the pandemic, and the total score slightly increased from 13.8 to 14.7 points (P=0.295). Sixty patients (18.5%) showed significantly worsening migraine headaches. Younger age (P=0.017), mood deterioration (P<0.001), sleep problems (P<0.001), increased acute medication use (P=0.010), and larger changes in the Ped-MIDAS score (P=0.002) were significantly associated with worsening headache in the logis-tic regression analysis. Conclusion(s): Headache attacks in children and adolescents with migraine were more frequent during the COVID-19 pandemic than before it. Worsening headaches could be independently at-tributed to younger age, mood deterioration, and poor sleep during the COVID-19 pandemic.Copyright © 2022 Korean Child Neurology Society.

METABOLIC SUPPORT FOR PATIENTS WITH MILD COGNITIVE (DODECAMENTAL) IMPAIRMENT IN THE OUTCOME OF COVID-19.

An open comparative study was conducted to assess the efficacy and safety of cytoflavin in the treatment of 50 patients who underwent SARS-CoV-2 infection, with subsequently developed mild cognitive impairment after leaving an infectious disease hospital. The survey was carried out using the Montreal Cognitive Assessment Scale (MoCA test) for the study of cognitive status, as well as the SF-36 questionnaire to determine parameters of the quality of life of patients and to assess the level of asthenia, anxiety and depression during follow-up (at the beginning of study and after 10 days of fluid therapy). Patients of the main group received intravenous infusion of cytoflavin for 10 days at a dose of 10 mL per 100 mL of 0.9% sodium chloride solution, while the comparison group received "active placebo" (100.0 mL of 0.9 sodium chloride solution) also for 10 days. During observation, the main test group patients showed significant discrepancies in the amount of complaints such as dizziness, headache, and decreased cognitive performance versus placebo group. According to the MoCA test results, patients of the main group showed higher total score on the background of improved cognitive functions: attention improved by 13.2%, p < 0.05 (subtest "repetition" of the number series in forward and reverse order and the "cotton" subtest with letter "A");regulatory skills improved by 9.8%, p < 0.05 (speaking "fluency" subtest);visual-constructive skills improved by 11.4%, p < 0.05 ("clock drawing" subtest);phrase repetition improved by 11.3%, p < 0.05, and literature associations improved by 11.3%, p < 0,05. Based on the results of the SF-36 questionnaire, the life quality was also significantly improved, by 19.5%, p < 0.05 on the average (including physical functioning and condition, pain intensity, general condition, vitality and mental health indicators). The tolerance of cytoflavin in all patients was good and there were no side effects related to the drug. Thus, the use of cytoflavin in the complex treatment of SARS-CoV-2 patients, who suffered from the infection with encephalopathy/mild cognitive impairment developed as part of the postvoid syndrome, reduces neurological deficit and helps to restore neurocognitive functions.Copyright © 2021 Eieeaeoea aaoiia

comparative effectiveness of remotely delivered biopsychosocial interventions for the treatment of osteoarthritic pain. A network meta - analysis

Purpose: Osteoarthritis (OA) can cause pain, discomfort, stiffness and progressively limit your ability to perform everyday tasks. Currently, there is no cure for OA, hence most patients experience chronic pain. Evidence suggests a shared mechanism between chronic pain and mental disorders. Patients living with OA- related chronic pain and depression have complex needs due to high rates of persistent physical and mental health symptoms, issues around inadequate pain relief, risks with opioid use, frequent lack of access to primary care, 80% unemployment rates, and complicated family/social relationships. Thus, they require physical, cognitive, and social treatments delivered by a multidisciplinary team that integrates physical and mental health approaches. The pandemic posed a major challenge for patients with osteoarthritis. Public health measures postponed non-emergency in-person treatment programs. People suffering from osteoarthritis are typically older which makes them more vulnerable to SARS-COV-2 infection. Telemedicine is a method that enables remote or virtual appointments between patients and health care practitioner. While remote care offers a wide range of benefits it is unclear if these interventions can provide similar effects with face-to-face care. In this study, we aimed to evaluate the effectiveness of remote biopsychosocial interventions in comparison to sham, traditional, or alternative remote treatments in patients with osteoarthritic pain and mental health symptoms using a network meta-analysis approach. Method(s): Eligible studies were randomized trials of remote biopsychosocial interventions that included at least one treatment arm provided remotely/virtually and compared to an alternative (sham, non-intervention, face-to-face treatment or alternative virtual/remote intervention). Patients had OA-related chronic musculoskeletal pain and at least 60% of participants had a mental health comorbidity or the analysis was disaggregated by mental health comorbidity. The primary outcome of interest was pain intensity at 12-weeks follow-up. Secondary outcomes were depression levels, dropouts/withdrawals and any adverse or serious adverse events reported. Potential mediators extracted were patient characteristics such as mean age, sex/gender and duration of symptoms/follow-up. We extracted data from the closest timepoint to 12-weeks follow-up for all outcomes. We critically appraised the included trials with the Cochrane risk of bias tool. Effect estimates were presented as standardized mean differences (SMD) and were comparisons between remote interventions and wait-list control. For all estimates, we reported the medians with corresponding 95% credibility intervals (CrIs) from the 2.5th and 97.5th percentile of the posterior distribution. The prespecified minimal clinically important between-group difference was -0.37 SD units. We estimated the probability of the effect of remote interventions of being superior to facilitate the interpretation of estimated treatment effects. We used a Bayesian random-effects network meta-analysis model. Analysis was conducted with OpenBUGS and STATA 16.0. Result(s): Overall, 21 trials with 4,426 patients with OA were included in this network meta-analysis. We identified 11 different interventions (combination or alone) such as usual care, exercise, education, cognitive behavioural therapy (CBT) guided or unguided delivered in different remote formats (internet, tele, mobile application or face-to-face). At 12-weeks follow-up, internet-delivered exercise (SMD -0.25, 95%Crl -0.59 to -0.09), Tele-CBT (SMD -0.22, 95%Crl -0.56 to 0.12) and a combination of Tele-CBT with education plus exercise (SMD -0.25, 95%Crl -0.66 to 0.15) had more pronounced treatment effects on pain reduction compared to wait-list control and 94%, 92% and 90% probability of being superior (respectively). For depression outcomes, a combination of tele-CBT with education plus exercise, had more pronounced treatment effects (SMD -0.31 95%Crl -1.16 to 0.53) when compared to wait-list-control and 86% pr bability of being superior. Conclusion(s): Internet-delivered exercise, Tele-CBT, and a combination of Tele-CBT with education plus exercise displayed higher probability of being superior than the other interventions, and had more pronounced effects in reducing pain intensity and depression levels when compared to wait-list control. However, none of these interventions excluded the null threshold.Copyright © 2023

Pain characteristics in long COVID syndrome patients one year after infection

Introduction: Although respiratory manifestations are the most common manifestations of COVID-19, the clinical presentations of the disease are very variable including extrapulmonary signs and symptoms. One of the most common extrapulmonary manifestations is pain, which can occur in the acute phase as well as in the short and long term. Identifying the characteristics of this pain will allow the development of treatment programmes tailored to the needs of long COVID patients. Objetive: The main objetive of this study was to identify the pain characteristics in long COVID syndrome patients one year after infection. Patients and Methods: In this observational study, long COVID patients were included. These patients were evaluated one year after infection and they were compared to a control group matched by age and gender. The affective and sensory characteristics of pain was evaluated with McGuill Pain Questionnaire (MPQ). Pain intensity was assessed with the pain intensity subscale of the Brief Pain Inventory (BPI) and pain interference was evaluated with the pain interference subscale of Brief Pain Inventory (BPI) and total score of PROMIS-Pain Interference (PROMIS P-I). Result(s): A total of 455 patients and 451 controls were included in this study. The affective and sensory characteristics (p<0,001), intensity (p<0,001) and interference (p<0,001) of pain showed significant results compared to the control group. Conclusion(s): This study found that long COVID syndrome patients presented poorer affective and sensory characteristics of pain and greater levels of pain intensity and interference.

Physiotherapy results of a patient with critical illness polyneuropathy due to COVID-19: A case report

The aim of this study is to examine the results of physiotherapy in a patient with critical illness polyneuropathy (CIP) due to coronavirus disease 2019 (CO-VID-19). The 48-year-old male patient with CIP due to COVID-19 was enrolled in a physiotherapy program for 3 months with 5 sessions/week. Pain intensity, motor skills, daily living activities, fatigue level, cognitive status, and decubitus ulcer were evaluated with a visual analogue scale, the Medical Research Coun-cil-Sum Score, the Functional Independence Scale, the Fatigue Severity Scale, the Standardized Mini-Mental Test, and pressure wound staging, respectively. Positive improvements were achieved in functional level, fatigue, pain, and pressure sores with the physiotherapy program for this patient with CIP due to COVID-19. This report provides an idea about the effects of physiotherapy programs for COVID-19-related CIP to academics and clinicians working in this field.Copyright © 2022, Derman Medical Publishing. All rights reserved.

What is the relationship between fatigue, pain and urgency in people with inflammatory bowel disease? Results of the IBD-BOOST survey in 8486 participants

Background: Fatigue, pain and faecal incontinence are common in people with IBD. However, little is known about co-existence of these multiple symptoms, how they inter-relate and whether people want help for these symptoms. In qualitative interviews, patients have reported that these symptoms are often ignored in clinical consultations where the focus is on inflammation, but that they are very bothered by these symptoms, even when disease is apparently in remission The aim of this study was to determine the presence and relationship between fatigue, pain and incontinence in people with inflammatory bowel disease, and desire for intervention for these symptoms Methods: A purpose-designed survey (online or postal), incorporating validated tools and demographic details, was sent to unselected UK clinic and UK IBD-BioResource adult patients. When the covid-19 pandemic halted clinic recruitment, additional self-selected UK recruits were solicited via social media. Using the validated PROMIS tools the following definitions were used for presence of symptoms: Fatigue: PROMIS fatigue T-score of 60 or more;pain: PROMIS pain intensity T-score of 60 or more;PROMIS bowel incontinence: Raw score of 50 or more. Participants also reported disease activity using the relevant PRO-2 score, IBD-Control, anxiety (GAD-7), depression (PHQ-9) and quality of life (EQ-5D-5L) which will all be reported elsewhere Results: A total of 8486 useable responses were received (7716 online 770 postal). 4176 reported Crohn's disease, 4255 had ulcerative colitis or other form of IBD. There were 3281 men and 4883 women. Median age was 51 years (range 18 - 92). 2550 (30%) reported fatigue 1766 (21%) pain and 4565 (54%) faecal incontinence according to the above definitions;925 (10.9%) reported having all three symptoms Demographics by symptom are shown in Table 1. Table 2 reports those participants indicating the presence of each symptom and each combination of symptoms. Table 3 shows a summary of self-defined severity and impact of symptoms (scoring scale 0-10 for both severity and impact of each symptom). Participants scored severity and impact a mean between 3.3 and 4.8, with a wide variation. 56% of all respondents (not just those with symptoms) "definitely" wanted help for fatigue;42% wanted help for pain;53% wanted help for incontinence. 29% reported "definitely" wanting help for all three symptoms (Table 4) Conclusion(s): This study confirms that fatigue, pain and urgency are common in IBD and for the first time reports the co-existence and unmet need for help with these symptoms.

Pain perception in COPD patients across the COVID-19 pandemic

Background: The COVID-19 pandemic impacts on general population, although patients with COPD have been affected to a greater extent due to their previous condition of disability. Recent studies indicate that pain is a significant symptom in COPD patients with an estimated prevalence of 32-60%. Objective(s): The objective of this study was to analyze the pain perception variables in COPD patients across the COVID-19 pandemic. Method(s): In this cross-sectional study, stable COPD patients without a COVID-19 diagnosis were evaluated before and during the pandemic. The main outcomes were the pain perception (general pain sensitivity, pain intensity, pain interference, and pressure pain sensitivity) and the psychological vulnerability (overall health status, anxiety, and depression). Result(s): The descriptive data of participants showed no significant differences between COPD patients before the pandemic and COPD patients during the pandemic. COPD patients experienced an enhanced pain perception, highlighted with statistical differences in general pain sensitivity, pain intensity, and pain interference (p<0.05) during the COVID-19 pandemic. Furthermore, the overall perceived health status of COPD patients during the pandemic was significantly lower than before the pandemic (p<0.05). Conclusion(s): We concluded that COPD patients during the COVID-19 pandemic presented an increase in pain perception accompanied by the enhanced psychological vulnerability.

The Effect of Topical Dexamethasone on Postoperative Pain Intensity in Patients Undergoing Dacryocystorhinostomy Procedure

Background and Objective: It is very important and necessary to use certain methods in order to prevent or reduce the intensity of pain after surgery. Of all known methods, those that avoid the dangerous side effects of opioids or nonsteroidal anti-inflammatory drugs (NSAIDs) can be useful. The present study was conducted with the aim of investigating the effect of topical dexamethasone on postoperative pain intensity in patients undergoing dacryocystorhinostomy (DCR). Method(s): This double-blind randomized clinical trial was conducted on 80 patients aged 18-75 who were candidates for DCR and referred to Khatam Al-Anbia Hospital in Mashhad. Patients were randomly divided into control and intervention (dexamethasone) groups. In the intervention group, at the end of the procedure, a tampon impregnated with dexamethasone was placed in the upper part of the middle concha. In the control group, a tampon washed in distilled water was placed in the same place. Pain intensity was recorded on a verbal rating scale (VRS) 0, 3, 6, 12, 18 and 24 hours after the operation. Finding(s): There was no significant difference in pain intensity at different time points in the two groups of intervention and control;the frequency of severe pain during recovery was equal to 22.5% and 15.7%, within 3 hours after the operation was equal to 17.5% and 10.0%, within 6 hours after the operation was equal to 12.5% and 0.5%, within 12 hours after the operation was equal to 12.5% and 2.5%, within 18 hours after the operation was equal to 0% and 2.5% and within 24 hours after the operation was equal to 0% and 0%, respectively. There was no significant difference in the process of changes in pain intensity during the 24 hours of the study based on the follow-up test. Conclusion(s): The results of the study showed that topical use of a single dose of dexamethasone (8 mg) could not reduce postoperative pain as well as the need for opioids in DCR surgery. Copyright © 2023, Babol University of Medical Sciences. All rights reserved.

Quality of Life and Intensity of Pain among Students with Low Back Pain during the Covid-19 Pandemic

Background The Covid-19 pandemic affects students' physical, psychological, social, and quality of life (QOL).Objectives To identify the prevalence of LBP, pain, and QOL;and determine the association between pain and QOL among students with LBP.Methods 420 students were recruited from the Faculty of Health Sciences.Limitations There was a lack of studies investigating QOL and pain among students with LBP.Findings 350 students were included for analysis with 60.6% experiencing LBP. Significant differences were found in QOL and pain among students with and without LBP.Implications A high prevalence of LBP among students affects pain and QOL.

CHANGES IN MENSTRUATION AFTER COVID-19 AND VACCINATION.

Objective: To study association between COVID-19, vaccination and severity of subjective sensations during menstruation. Material(s) and Method(s): 538 women were interviewed using questionnaire posted at social networks. Result(s): Intensification of unpleasant sansations during menstruation was reported by 19 % of patients who had COVID-19 and by 10.9% of women who were not infected with COVID-19 (p=0.017);the results of PCR tests for COVID-19 were positive in 24,6% of respondents, and unconfirmed coronavirus infection was in 9.9% (p<0.001);20.3% of women had positive test results for SARS-CoV-2 antibodies, and 11.2% of respondents women had negative test results or did not undergo test for antibodies;55.6% of women were hospitalized in the acute phase of COVID-19 infection, and 18.3% of women received outpatient treatment. The dynamics of unpleasant sensations in vaccinated and non-vaccinated patients did not differ significantly. The score assessment of the duration, intensity of menstrual bleeding and intensity of pain in women, who had COVID-19, did not find significant differences compared with women, who were not infected with COVID-19. The duration of the last menstruation was shorter in women vaccinated against COVID-19 than in women, who were not vaccinated: 5 (4-6) and 5 (5-6) days, respectively, (p=0,043). Conclusion(s): Despite the fact that women who were infected with COVID-19 infection reported on intensification of unpleasant sensations during menstruation more often compared with those who were not infected, detailed questionnaire survey did not confirm significant association betweem the disease and symptoms intensity. Any association between vaccination and intensity of unpleasant sensations during menstruation was also not found. Copyright © A group of authors, 2021.

Durability of Symptom Relief with Restorative Neurostimulation for Mechanical Chronic Low Back Pain: Three-Year Follow-up Results of the Pivotal Trial: Track 3: Neurostimulation for Back and Leg Pain

Introduction: Mechanical chronic low back pain (CLBP) can be caused by impaired neuromuscular control and degeneration of the multifidus muscles, the most important stabilizers of the lumbar spine. An implantable Restorative Neurostimulation system bilaterally stimulates the medial branches of the L2 dorsal rami to override underlying multifidus inhibition to facilitate motor control restoration. A randomized sham-controlled pivotal trial provided evidence of safety, effectiveness and durability of this therapy (clinicaltrials.gov/show/NCT02577354).[1,2] Here we will report the three-year durability results. Materials / Methods: Eligible patients had activity limiting mechanical CLBP (VAS >=6cm;Oswestry Disability Index (ODI) >=21 points) despite medical management, which included at least pain medications and physical therapy. They had evidence of impaired multifidus motor control (positive prone instability test) and no indication for spine surgery. All patients were implanted with a Restorative Neurostimulation system (ReActiv8, Mainstay Medical, Dublin, Ireland). During the long-term follow-up phase, all participants delivered stimulation for up to 30 minutes twice daily eliciting repetitive, tonic multifidus contractions. Result(s): At baseline (N=204), participants were 47+/-9 years of age, had history of backpain for 14+/-11 years, had an average low back pain VAS of 7.3+/-0.7 cm, ODI of 39+/-10, EQ-5D of 0.585+/-0.174 points and had pain on 97+/-8% of days in the year prior to enrollment. Three-year data are available for 124 participants*. Average VAS improved by 5.0+/-2.4 cm, ODI by 23+/-15 points and EQ-5D by 0.223+/-0.199 (All P<0.0001);78% of participants had a >=50% VAS improvement;69% reported LBP-Resolution (VAS<=2.5 cm);65% had a >=20-point ODI improvement and 86% of participants were "definitely satisfied" with the treatment. Pain intensity and disability are interdependent symptoms and treatment success is determined by composite improvements in ODI and VAS: 84% had a substantial improvement of >=50% in VAS and/or >=20points in ODI, and 59% had these improvements in both VAS and ODI. Of participants using opioids at baseline, 72% had voluntarily discontinued or decreased consumption. Overall safety compares favorably to other neurostimulation systems, and no lead migrations were observed. During the third year of follow-up, 6 participants requested device removal citing resolution of pain. Discussion(s): See conclusions. Conclusion(s): Restorative-Neurostimulation is an effective, durable, and safe treatment for patients with refractory, activity-limiting CLBP secondary to impaired multifidus neuromuscular control. Consistent with the restorative mechanism, improvements accrue progressively over time. *Twenty-five follow-ups pending (Covid-19 restrictions) Learning Objectives: 1. Understand the long term pain outcomes (three year outcomes) of restorative neurostimulation for refractory chronic low back pain. 2. Understand the long term function outcomes (three year outcomes) of restorative neurostimulation for refractory chronic low back pain. 3. Understand the long term safety outcomes (three year outcomes) of restorative neurostimulation for refractory chronic low back pain. Keywords: nociceptive low back pain, multifidus, motor control, Restorative neurostimulation, chronic low back pain Copyright © 2022

Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study

Background/aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic. Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March-12 June 2020 and 2 November 2020-9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge. Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 +/- 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test);dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH(2)O, and the maximal expiratory pressure was 59.1 cmH(2)O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points;walked distance by 200 metres;the number of repetitions at the 1-minute sit-to-stand test by 5.6;the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand);maximal inspiratory pressure by 7.7 cmH(2)O;and maximal expiratory pressure by 9.5 cmH(2)O. Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting.

PERFORMANCE of AN EARLY TRIAGE SYSTEM for IDENTIFICATION of PATIENTS with INFLAMMATORY RHEUMATIC DISEASES

Background: The preselection of patients with suspicion of an infammatory rheumatic disease is not easy for general practitioners and orthopedists. In countries with a limited number of practicing rheumatologists waiting lists are often long, since a full rheumatologic examination often needs a long consultation time. Objectives: To test the performance of an early triage strategy for early identif-cation of patients with infammatory rheumatic diseases. Methods: Prior to the SARS-CoV 2 pandemic, physicians caring for patients contacting a tertiary rheumatologic cente were frst contacted by a health-care professional (HPR) who offered an appointment the timing of which was based on the symptoms reported (Step 1). Patients were then seen by a rheumatolo-gist who, within a 10-minute consultation (Step 2), shortly examined the patient to determine the urgency of a planned full work up. The main outcome of the study was the comparison between the initial assessment and the fnal expert diagnosis (Step 3). Results: Within 9 months, physicians caring for 1.180 patients contacted the hospital, 972 of whom kept their appointment (82.4%). Most patients were transferred by GPs (73.1%) and orthopedists (22.1%). The mean time between Step 1 and Step 2 was 10.4 days, while 6.2% of patients were seen within 4 days, 24.4% within 7 days and 69.3% within 12 weeks. Only 36 patients (3.7%) of patients had an already established rheumatic disease. Complaints lasting between 0-4 weeks were reported by 69 (7.1%), of > 4-12 weeks by 100 (10.3%), and of > 12 weeks by 973 (82.6%) patients. Almost 90% of patients reported a pain intensity >4/10 (NRS) for < 2 weeks. An elevated CRP was found in 207 patients (24.5%). Prior treatment with glucocorticoids was reported in 163 (16.8%) and with NSAIDs in 730 (75.1% of) patients. The confirmed diagnosis at Step 3 was rheumatoid arthritis in 127 (13.1%), spondyloarthritis including pso-riatic arthritis in 72 (7.4%), systemic diseases including connective tissue diseases in 112 (11.5%), vasculitides in 41 (4.2%), and crystal arthropathy in 38 (3.9%) patients, while 38 (3.9%) had an infection, a malignancy or a differential diagnosis such as Raynaud's phenomenon or sicca syndrome. Degenerative joint diseases (n=254;26.1%) and non-inflammatory soft tissue syndromes such as fibromyalgia (n=369;38%) accounted for more than half of the patients. Conclusion: This study describes the performance of a standardized triage system hereby confrming the need for an early identifcation and preselection of patients with rheumatic musculoskeletal symptoms, including involvement of HPRs in the initial phase of contact. Based on the results, three patients with musculoskeletal complaints had to be examined in order to identify one patient with an infammatory rheumatic disease.

MUSCULOSKELETAL PAIN AS A PART of the RHEUMATIC SPECTRUM in COVID-19

Background: Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) (1), our understanding of the underlying pathophysiology is constantly evolving in order to explain the wide range of heterogenic clinical manifestations (2). Nevertheless, limited data are available for the severity and multifactorial causality of musculoskeletal pain in COVID-19 patients (3). Objectives: This study aimed to evaluate the prevalence and intensity of rheumatic pain symptoms-arthralgia and myalgia and their association with anxiety and depression in a cohort of COVID-19 patients, hospitalized at the COVID-19 rheumatology department of the University Hospital St. Marina, Varna, Bulgaria. Methods: In the present single-center cohort study, a prospective analysis was performed among COVID-19 patients who were hospitalized from 1 Oct 2021 to 20 Jan 2022 and self-reported for new-onset of musculoskeletal pain. All 226 patients (age 26-91 years) were treated for moderate or severe SARS-CoV-2 infection confrmed by laboratory tests, including positive antigen test or polymer-ase chain reaction (PCR) test, and imaging modality. Detailed disease history and clinical examination were carried out by a fully certifed rheumatologist. All patients who reported new-onset of musculoskeletal pain during the acute phase of the infection, participated on a voluntary basis in a questionnaire survey, by completed Zung self-rating anxiety scale (SAS), Zung self-rating depression scale (SDS) and visual analogue scale (VAS) for arthralgia and myalgia. The questionnaire form also elicited information on sociodemographic characteristics of the patients. In all patients, infammation and thrombotic biomarkers were assessed. The level of signifcance was set to 0.05. Results: Among all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n = 121), were men. Mean age was 65.6 years. We found a signifcant correlation of depression and anxiety scales scores with pain intensity (both arthralgia and myalgia), all < 0.001. A multiple regression analysis found that SDS and SAS accounted for signifcant variance in the prediction of muscle pain (β = 0.441, p < 0.001;β = 0.293, p = 0.003, respectively) while SDS signifcantly predicted joint pain (β = 0.341, p = 0.043). On the other hand, musculoskeletal pain does not correlate with any of infammation and thrombotic biomarkers assessed in SARS-CoV-2 patients (p > 0.05). Conclusion: Rheumatic pain manifestations are part of the heterogeneous spectrum of COVID-19 disease. The pain intensity is signifcantly associated with anxiety and depression symptoms and does not correlate with infammation and thrombotic biomarkers.

EFFECT of PRO-INFLAMMATORY CYTOKINE-INTERLEUKIN 6 on the COURSE of ANKYLOSING SPONDYLITIS in PATIENTS after COVID-19

Background: Everyone knows that COVID-19 not only has a severe effect on the pulmonary system, but also triggers a whole cascade of autoimmune reactions. The study of the effect of the pro-infammatory cytokine-interleukin 6 (IL6) on the clinical course of patients with ankylosing spondylitis (AS) undergoing COVID-19 is an important problem in rheumatology. Objectives: To study the signifcance of the pro-infammatory cytokine-IL-6 on the clinical features of the course of AS in patients who have undergone COVID-19. Methods: In the period from 2020-2021, 44 patients with a diagnosis (AS) were hospitalized in the City Clinical Hospital # 3 of Tashkent city. The patients were divided into two groups: Group I-20 patients with AS who underwent COVID-19 and Group II of 24 patients with no history of AS who had COVID-19 infection. The average age of patients in group I was 32 ± 4.1 years and in group II-36.5 ± 5.2 years. All patients underwent clinical and laboratory studies, including studies of serum IL-6 levels. Disease activity was assessed using the BASDAI and ASDAS scales, pain was assessed using a numerical rating scale (NRS), and peripheral joint damage was assessed by the presence of pain and swelling in 44 joints. All patients underwent PCR, as well as ELISA-IHLA tests for the presence of antibodies to COVID-19. Results: Clinical examination of the patients revealed the presence of pain in the spine, which was assessed using the numerical rating scale-(NRS) in group I it was 8.5 ± 1.2 points and 5.9 ± 2.3 points in patients of group II. Examination of peripheral joints showed an average number of painful joints (PJ) of 16.9 ± 3.2 in group I and 8.6 ± 2.7 in group II, the number of swollen joints (NSJ) 8.8 ± 2.1 in group I and 4.2 ± 1.7 in group II. group. The study of AS activity using the BASDAI scale showed an average level of 5.1 ± 1.7 points in group I and 4.4 ± 2.1 points in group II. And the study of activity on the ASDAS scale showed an average level of 4.0 ± 1.7 points in group I and 2.5 ± 0.8 points in group II, which indicates a very high activity of the pathological process in group I and medium-high activity in group II. The IL-6 level in group I was 10.2 ± pg/mL, 4.2 pg/mL in group II and 1.39 pg/mL in the control group. Conclusion: 1. The clinical course of AS in patients who have undergone COVID-19 is characterized by a more pronounced disease activity according to the BASDAI and ASDAS scales, a high intensity of pain syndrome according to a NRS, as well as a high level of IL-6. 2. A high level of IL-6 in group I indicates the impact of COVID-19 on the course, activity and severity of the autoimmune process in patients with AS, which is many times higher than in patients of group II, which allows us to consider it as a biomarker of damage to the articular and connective tissue in this infection.