A finite element analysis of patellofemoral joint biomechanics: Exploring potential causes of postoperative anterior knee pain following unicompartmental knee arthroplasty.

Purpose: Anterior knee pain is a common complication following unicompartmental knee arthroplasty (UKA). This study aimed to elucidate the mechanism of anterior knee pain after UKA by examining the biomechanical characteristics of the patellofemoral joint. Methods: This study employs the finite element analysis method. A healthy model of the right lower limb was created using CT scans of an intact right lower limb from a healthy woman. Based on this model, a preoperative pathological model was generated by removing the meniscus and part of the articular cartilage. The UKA prosthesis was then applied to this model with five different bearing thicknesses: 5 mm, 7 mm, 10 mm, 11 mm, and 13 mm. To simulate various degrees of knee joint flexion, the femur was rotated relative to the knee joint's rotational axis, producing lower limb models at flexion angles of 0°, 30°, 60°, 90°, and 120°. We applied a constant force from the center of the femoral head to the center of the ankle joint to simulate lower limb loading during squatting. The simulations were conducted using Ansys 17.0. Results: Both overstuffing and understuffing increased the peak stress on the patellar cartilage, with overstuffing having a more pronounced effect. Compared to healthy and balanced models, overstuffed and understuffed models exhibited abnormal stress distribution and stress concentration in the patellar cartilage during knee flexion. Conclusion: Overstuffing and understuffing lead to residual varus or valgus deformities after UKA, causing mechanical abnormalities in the patellofemoral joint. These abnormalities, characterized by irregular stress distribution and excessive stress, result in cartilage damage, exacerbate wear in the patellofemoral joint and consequently lead to the occurrence of anterior knee pain.

Direct analysis in real time mass spectrometry (DART-MS/MS) for rapid urine opioid detection in a clinical setting.

BACKGROUND AND AIMS: Current laboratory methods for opioid detection involve an initial screening with immunoassays which offers efficient but non-specific results and a subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation which offers accurate results but requires extensive sample preparation and turnaround time. Direct Analysis in Real Time (DART) tandem mass spectrometry is evaluated as an alternative approach for accurate opioid detection with efficient sample preparation and turnaround time. MATERIALS AND METHODS: DART-MS/MS was optimized by testing the method with varying temperatures, operation modes, extraction methods, hydrolysis times, and vortex times. The method was evaluated for 12 opioids by testing the analytical measurement range, percent carryover, precision studies, stability, and method-to-method comparison with LC-MS/MS. RESULTS: DART-MS/MS shows high sensitivity and specificity for the detection of 6-acetylmorphine, codeine, hydromorphone, oxymorphone, hydrocodone, naloxone, buprenorphine, norfentanyl, and fentanyl in urine samples. However, its performance was suboptimal for norbuprenorphine, morphine and oxycodone. CONCLUSION: In this proof-of-concept study, DART-MS/MS is evaluated for its rapid quantitative definitive testing of opioids drugs in urine. Further research is needed to expand its application to other areas of drug testing.

Rare presentations of small bowel endometriosis.

Despite endometriosis being a relatively common chronic gynecological condition in women of childbearing age, small bowel endometriosis is rare. Presentations can vary from completely asymptomatic to reported symptoms of abdominal pain, bloating, and diarrhea. The following two cases depict very atypical manifestations of ileal endometriosis that presented as obscure intermittent gastrointestinal bleeding and bowel obstruction requiring surgical intervention. The first case describes a previously healthy 40-year-old woman with severe symptomatic iron deficiency anemia and intermittent melena. A small bowel enteroscopy diagnosed multiple ulcerated strictures in the distal small bowel as the likely culprit. Despite nonsteroidal anti-inflammatory drug-induced enteropathy being initially considered as the likely etiology, histopathological examination of the resected distal ileal segment revealed evidence of endometriosis. The second case describes a 66-year-old with a presumptive diagnosis of Crohn's disease who reported a 10-year history of intermittent perimenstrual abdominal pain, diarrhea, and nausea with vomiting. Following two subsequent episodes of acute bowel obstruction and surgical resection of the patient's stricturing terminal ileal disease, histopathological examination demonstrated active chronic inflammation with endometriosis. Small bowel endometriosis should be considered as an unusual differential diagnosis in women who may present with obscure gastrointestinal bleeding from the small bowel or recurrent bowel obstruction.

Relato de caso de lombalgia inflamatória com extenso comprometimento anatômico-funcional: a importância de uma adequada abordagem da dor lombar na Atenção Primária à Saúde / Case report of inflammatory low back pain with extensive anatomical-functional impairment: The importance of an adequate approach to low back pain in Primary Care / Presentación de un caso de lumbalgia inflamatoria con afectación anatómico-funcional extensa: La importancia de un abordaje adecuado de la lumbalgia en Atención Primaria de Salud

Introdução: A lombalgia é uma condição prevalente e que apresenta importante impacto na capacidade funcional e na qualidade de vida, sendo a sua correta abordagem na Atenção Primária à Saúde fundamental para a identificação e o estabelecimento de um diagnóstico etiológico precoce de possíveis patologias que possam estar relacionadas a desfechos mórbidos e a graves limitações funcionais. Apresentação do caso: Paciente de 56 anos, sexo masculino, hipertenso, foi encaminhado para serviço especializado de reumatologia com histórico de lombalgia havia mais de 20 anos. Ao exame físico foi constatada presença de deformidades da coluna vertebral e extensa limitação de movimentos. Exames radiográficos mostravam esclerose de articulações sacroilíacas, osteopenia difusa e coluna vertebral em aspecto de "bambu". Conclusões: Constata-se a importância de que na abordagem das lombalgias na atenção primária se busque o reconhecimento de possíveis etiologias graves e potencialmente incapacitantes que possam estar subjacentes à queixa de dor lombar. Com esse objetivo, é fundamental o reconhecimento das chamadas red flags relacionadas às lombalgias, além de sua caracterização como mecânica ou inflamatória. Perante a atuação da atenção primária no oferecimento de um cuidado pautado na integralidade e na prevenção de agravos, reafirma-se a importância de uma avaliação clínica pormenorizada das lombalgias nesse nível de atenção à saúde.

Introduction: Low back pain is a prevalent condition that has an important impact on functional capacity and quality of life, and its correct approach in Primary Care is fundamental to the identification and establishment of an early etiological diagnosis of possible pathologies that may be related to outcomes morbid conditions and serious functional limitations. Case presentation: 56-year-old male patient, hypertensive, referred to a specialized rheumatology service with a history of low back pain for over 20 years. Physical examination revealed the presence of spinal deformities and extensive movement limitations. Radiographic examinations showing sclerosis of the sacro-iliac joints, diffuse osteopenia and a "bamboo" appearance of the spine. Conclusions: It is important that in the approach of low back pain in Primary Care, we seek to recognize possible serious and potentially disabling etiologies that may underlie the complaint of low back pain. For that, it is essential to recognize the so-called "red flags" related to low back pain, in addition to its characterization as mechanical or inflammatory. Given the role of Primary Care in offering care based on integrality and in the prevention of injuries, the importance of a detailed clinical assessment of low back pain at this level of health care is reaffirmed.

Introducción: La lumbalgia es una patología prevalente que tiene un impacto importante en la capacidad funcional y la calidad de vida, y su correcto abordaje en Atención Primaria de Salud es fundamental para la identificación y establecimiento de un diagnóstico etiológico precoz de posibles patologías que puedan estar relacionadas con los resultados, condiciones morbosas y limitaciones funcionales graves. Presentación del caso: Paciente masculino de 56 años, hipertenso, remitido a servicio especializado de reumatología con antecedentes de dolor lumbar de más de 20 años. El examen físico reveló la presencia de deformidades de la columna y amplias limitaciones de movimiento. Los exámenes radiológicos muestran esclerosis de las articulaciones sacroilíacas, osteopenia difusa y una apariencia de "bambú" de la columna. Conclusiones: Es importante que al abordar la lumbalgia en Atención Primaria de Salud busquemos reconocer las posibles etiologías graves y potencialmente incapacitantes que pueden subyacer a la queja de lumbalgia. Con este objetivo, es fundamental reconocer las llamadas "banderas rojas" relacionadas con la lumbalgia, además de su caracterización como mecánica o inflamatoria. Dado el papel de Atención Primaria de Salud a la hora de ofrecer una atención basada en la integralidad y prevención de enfermedades, se reafirma la importancia de una evaluación clínica detallada de la lumbalgia en este nivel de atención sanitaria.

Fenómeno de Raynaud en el pezón durante la lactancia: serie de casos / Fenómeno de Raynaud en el pezón durante la lactancia: serie de casos

El fenómeno de Raynaud consiste en la contracción excesiva de los vasos sanguíneos en respuesta a diversos estímulos y, si bien suele comprometer las extremidades, existen otras localizaciones menos frecuentemente afectadas. Este trabajo se enfoca en describir las características de una serie de mujeres con fenómeno de Raynaud en el pezón. Mediante revisión de historias clínicas y comunicación directa con las pacientes, se recopilaron y analizaron los datos de 12 mujeres con Raynaud del pezón entre 2016 y 2023. Se evaluaron variables como edad, síntomas, desencadenantes, tratamientos y duración de los síntomas. En esta serie de casos, el fenómeno de Raynaud del pezón en mujeres lactantes se manifestó con mayor frecuencia en primigestas alrededor del décimo día posparto; el dolor fue intenso, en la mayoría mejoró con tratamientos locales y/o farmacológicos, y no limitó la duración de la lactancia materna.

Raynaud's phenomenon consists of excessive contraction of the blood vessels in response to various stimuli; although it usually affects the extremities, other locations are less frequently involved. This study focused on describing the characteristics of a series of women with Raynaud's phenomenon of the nipple. Through medical record review and direct communication with patients, data from 12 women diagnosed with Raynaud's phenomenon of the nipple between 2016 and 2023 were collected and analyzed. The following variables were assessed: age, symptoms, triggering factors, treatment, and duration of symptoms. In this case series, Raynaud's phenomenon of the nipple in breastfeeding women was more common among primiparous women around 10 days after delivery; pain was severe and, in most cases, improved with local and/or drug treatment, and did not limit the duration of breastfeeding.

Prevalence and risk factors of low back pain in military personnel: a systematic review.

Purpose: Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories. Methods: For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8. Results: Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494-2.89), history of LBP (OR = 2.2-8.91), and sedentary position (OR = 0.55-3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively. Conclusions: Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.

The relationship between changes in pain intensity and functional disability in persistent disabling low back pain during a course of cognitive functional therapy.

OBJECTIVES: Pain relief and reduced disability are both common treatment targets for persistent disabling low back pain (LBP). Cross-sectional studies show a moderate relationship between functional disability and pain intensity, but little is known about the relationship between changes in pain intensity and functional disability over multiple time points. The objective of this study was to investigate the associations between changes in functional disability and pain intensity and whether changes occurred simultaneously or differentially during a course of cognitive functional therapy for people with persistent disabling LBP. METHODS: Self-reported measures of pain intensity and patient-specific functional disability were collected prior to each treatment session from 40 participants during a 12-week intervention period. Linear mixed modeling was used to assess simultaneous and lagged associations between pain intensity and functional disability over time. Sensitivity analysis using nonparametric subject-specific methods (simulation modeling analysis) was also performed. RESULTS: Thirty-five participants had sufficient data for analysis. Using the linear mixed-model approach, there was evidence of a moderate and simultaneous association between pain intensity and functional disability over time (regression coefficient = 0.56, 95% confidence interval: 0.44-0.68, p < 0.001). Simulation modeling analysis supported weak to mostly strong associations and supported for simultaneous change in pain and disability for the majority of participants (22 of 35, 64%). CONCLUSION: Changes in pain intensity and functional disability were moderately related across the intervention. Visual inspection of graphs indicated a very close relationship in some individuals and a decoupling of pain intensity and functional disability in others. The changes in pain intensity and functional disability seem to occur simultaneously in most individuals.

Venipuncture in pediatric emergency department by using koala attachment distraction method: Randomized clinical trial.

OBJECTIVE: To assess, compare and relate the toddler's pain and anxiety during venipuncture by using either the Koala Attachment Distraction method or the physical restraint method and to evaluate the level of anxiety perceived by the companions in both groups. METHOD: Randomised, single-blind, controlled clinical trial in two arms (control and intervention group) conducted in the paediatric emergency department of a tertiary university hospital. The study variables were pain and stress of the child and anxiety perceived by the accompanying persons in both groups at the time before and during the technique. The pain rating scale Face, Leg, Activity, Cry, Consolability; the Groningen stress scale and the STAI questionnaire were used. RESULTS: A total of 113 participants aged 3 to 4 years participated in the trial (n = 113). 50 % (55) were girls, mean total age 3.83 ± 0.59 years and accompanying persons 37.17 ± 6.96. During the technique the mean pain in control and intervention groups was 5.64 ± 3.30 and 3.87 ± 3.01; stress, 3.25 ± 1.22 and 2.67 ± 1.24, respectively. No statistically significant differences were found in the assessment of anxiety between the groups. CONCLUSIONS: Patients who underwent the Koala Attachment Distraction method venipuncture show a lower level of pain and anxiety than those who received physical restraint, and the anxiety perceived by the companion is similar in both groups.

Microneedles containing Cucumaria frondosa polysaccharides and 3-acetylaconitine exert analgesic, anti-inflammatory and chondroprotective activity for knee osteoarthritis.

3-Acetylaconitine (AAC) is a commercially analgesic drug for arthritis, however, due to its narrow safety range, its clinical application is limited. The objective of the study was to investigate the combined effect of Cucumaria frondosa polysaccharide (CFP) and AAC in microneedles on knee osteoarthritis (KOA). The characterization of microneedles was conducted and a rat model of monosodium iodoacetate (MIA)-induced KOA was established to evaluate the anti-inflammatory and analgesic activity in this study. The inhibitory effects on cartilage degradation and synovial inflammation were determined by morphological observation of the knee joint, pathological and imaging results. The von Frey pain threshold and hind limb weight bearing test were used to evaluate the effect of microneedles on pain relief. The results showed that microneedles had the mechanical strength to penetrate the skin and dissolved well in the skin for drug delivery within 30 min after patch administration. Furthermore, AAC-MN and CFP-AAC-MN both played roles in relieving pain, reducing cartilage degeneration and inhibiting synovial inflammation in KOA. In summary, CFP combined with AAC loading into microneedles exhibited higher skin penetration and more advantages in inhibiting cartilage damage and inflammation compared to AAC alone.

Analgesic effect of dance movement therapy: an fNIRS study.

OBJECTIVE: This study aims to explores the physiological and psychological mechanisms of exercise-induced hypoalgesia (EIH) by combining the behavioral results with neuroimaging data on changes oxy-hemoglobin (HbO) in prefrontal cortex (PFC). METHODS: A total of 97 healthy participants were recruited and randomly divided into three groups: a single dance movement therapy (DMT) group, a double DMT group, and control group. Evaluation indicators included the pressure pain threshold (PPT) test, the color-word stroop task (CWST) for wearing functional near-infrared spectroscopy (fNIRS), and the self-assessment manikin (SAM). The testing time is before intervention, after intervention, and one hour of sit rest after intervention. RESULTS: 1) Repeated measures ANOVA revealed that, there is a time * group effect on the PPT values of the three groups of participants at three time points. After 30 minutes of acute dance intervention, an increase in the PPT values of 10 test points occurred in the entire body of the participants in the experimental group with a significant difference than the control group. 2) In terms of fNIRS signals, bilateral DLPFC and left VLPFC channels were significantly activated in the experimental group. 3) DMT significantly awakened participants and brought about pleasant emotions, but cognitive improvement was insignificant. 4) Mediation effect analysis found that the change in HbO concentration in DLPFC may be a mediator in predicting the degree of improvement in pressure pain threshold through dance intervention (total effect ß = 0.7140). CONCLUSION: In healthy adults, DMT can produce a diffuse EIH effect on improving pressure pain threshold, emotional experience but only showing an improvement trend in cognitive performance. Dance intervention significantly activates the left ventrolateral and bilateral dorsolateral prefrontal cortex. This study explores the central nervous system mechanism of EIH from a physiological and psychological perspective.

Comparison of staggered and conventional posterior single-door laminoplasty.

OBJECTIVE: This study aimed to delineate the clinical and radiological outcomes between two different single-door laminoplasty techniques, the staggered approach and the conventional one-sided approach, in treating cervical spondylotic myelopathy (CSM). METHODS: This is a retrospective chart review that involved 67 patients who had CSM with symptoms lasting for ≥3 months, and underwent staggered laminoplasty (Group A, n=35) or conventional laminoplasty (Group B, n=32). Outcomes measures included intraoperative parameters, the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) for pain, cervical curvature, cervical range of motion (ROM), and radiographic parameters that reflected the level of post-operative muscle atrophy. Follow-up assessments were available at 3-, 6-, and 12-months post-operation. RESULTS: The mean ages in Group A and Group B were 57.11 (SD, 8.02) and 55.28 (SD, 8.47) years, respectively, with a gender distribution of 40.00% female in Group A and 40.63% in Group B (P>0.05). The average operative times were 130.86 (SD, 11.80) and 129.84 (SD, 10.51) minutes, respectively (P>0.05). However, intraoperative blood loss in milliliters was significantly higher in Group A (196.06; SD, 32.69) compared to Group B (155.03; SD, 37.80) (P<0.001). JOA scores revealed no significant post-operative differences between the two groups. Nevertheless, Group A exhibited less VAS pain, reduced post-operative ROM loss at 6 and 12 months, and less alteration in cervical curvature and decreased severity in muscle atrophy at 3-, 6-, and 12-months post-surgery. CONCLUSION: Patients who underwent staggered single-door laminoplasty experienced more favorable outcomes in some metrics than those who received the conventional technique.

Postoperative Pain Comparison Between Alcohol-Assisted and Transepithelial Photorefractive Keratectomy Using Nepafenac Treatment: A Novel Study.

INTRODUCTION: The study aimed to compare postoperative pain between alcohol-assisted and transepithelial photorefractive keratectomy in patients who received the novel analgesic preoperative nepafenac treatment 2 days preoperatively and 3 days postoperatively. Pain, stinging, tearing, light sensitivity, and stress levels were evaluated. METHODS: The study included a retrospective analysis of 55 patients divided into two groups: bilateral alcohol-assisted photorefractive keratectomy (aa-PRK) and transepithelial photorefractive keratectomy (transepithelial-PRK). Nepafenac was administered for pain control for all patients, with patients receiving four drops for 2 days before the surgery and 3 days postoperatively per clinical instructions. Patients completed questionnaires on the day of the surgery and for the first 5 days postoperatively. Statistical analysis was performed using XLSTAT (version 2023.1.2). t-Test was used to analyze and compare pain and symptom levels and Fisher's exact test for categorical data. p-Values less than 0.05 were considered statistically significant. RESULTS: The study examined 55 patients (49% female) with a mean age of 25.11 ± 6.81 years who had undergone bilateral surface refractive surgery to correct myopic errors. The mean baseline standard error (SE) was -3.16 ± 2.20 D. Among these patients, 27 patients underwent aa-PRK and 28 patients underwent transepithelial-PRK. Higher levels of pain were significant in the aa-PRK group (p = 0.003). However, there was no significant difference between the groups in the average levels of stinging, tearing, or light sensation. Additionally, stress levels decreased over time in both groups, with levels becoming almost equal after 5 days, and there was no significant difference in the average stress levels between the two groups. CONCLUSIONS: The study found that patients who underwent the transepithelial-PRK procedure had significantly lower pain levels compared with those who underwent aa-PRK after being treated with nepafenac per protocol. However, there was no significant difference between the two groups in terms of stinging, tearing, light sensation, and stress levels.

Opioid Misuse by Adults with Chronic Pain: The Impact of Illness and Medication Beliefs.

BACKGROUND: Why do some adults with chronic pain misuse their prescription opioids when others do not? Based on the extended Common-Sense Model, the study evaluated whether adults' beliefs about their pain have an indirect effect on risk of opioid misuse through beliefs about opioids when controlling for depression. METHODS: The sample included 297 adult participants in the U.S. recruited from Prolific, an online crowdsourcing website. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R; protective and threat-related illness beliefs about chronic pain), the Beliefs about Medicines Questionnaire-Specific subscale (BMQ-Specific; concern and necessity medication beliefs about prescription opioids), and the Current Opioid Misuse Measure (COMM; risk of current opioid misuse). This cross-sectional parallel mediation analysis was conducted using MPlus. RESULTS: After controlling for depression, the indirect effect of protective illness beliefs on opioid misuse risk through concern medication beliefs (b = -0.01, 95% CI (-0. 038, -0.001), and the indirect effect of threat-related illness beliefs on opioid misuse risk through necessity medication beliefs (b = 0.02, 95% CI (0.004, 0.036) were significant. The full model explained 35% of the variance of opioid misuse risk. CONCLUSIONS: Adults with chronic pain with stronger protective beliefs about pain were less likely to have concerns about their opioids and were at lower risk for opioid misuse, while those with greater threat-related beliefs about pain were more likely to believe that their opioids were necessary and be at greater risk for opioid misuse. Results have implications for medical and mental health providers and future research.

Endogenous pain modulation after sleep restriction in migraine: a blinded crossover study.

BACKGROUND: Patients with migraine are vulnerable to insufficient sleep, but the impact of sleep restriction is largely unknown. In addition, the importance of sleep may be different in patients with migraine who mostly have attack onsets during sleep, so called sleep-related migraine, compared to patients with non-sleep-related migraine. In this study we investigate the effect of sleep restriction on endogenous pain modulation in patients with migraine and healthy controls. We also compared the effect of sleep restriction in sleep-related and in non-sleep-related migraine. METHODS: Measurements were conducted in 39 patients with migraine between attacks and 31 controls, once after habitual sleep and once after two consecutive nights of partial sleep restriction. There were 29 and 10 patients with non-sleep-related and sleep-related migraine respectively. Test stimulus was 2-min tonic noxious heat to the left volar forearm. Temporal summation was calculated as the regression coefficient for rated pain in the late part of this 2-min stimulation. Conditioning stimulus was right hand-immersion in 7 °C water. Conditioned pain modulation was defined as the difference in rated pain with and without the conditioning stimulus and was calculated for temporal summation and mean rated pain for the test stimulus. The effect of sleep restriction on temporal summation and conditioned pain modulation was compared in migraine subjects and controls using two-level models with recordings nested in subjects. RESULTS: Conditioned pain modulation for temporal summation of heat pain tended to be reduced after sleep restriction in patients with migraine compared to controls (p = 0.060) and, in an exploratory analysis, was reduced more after sleep restriction in sleep-related than in non-sleep-related migraine (p = 0.017). No other differences between groups after sleep restriction were found for temporal summation or conditioned pain modulation. CONCLUSION: Patients with migraine may have a subtly altered endogenous pain modulation system. Sleep restriction may have an increased pronociceptive effect on this system, suggesting a mechanism for vulnerability to insufficient sleep in migraine. This effect seems to be larger in sleep-related migraine than in non-sleep-related migraine.

'Pain free if I ever will be': lived experience of workers seeking care for pain attributed to musculoskeletal disorders.

BACKGROUND: Pain attributed to musculoskeletal disorders are a significant hinderance to work ability and economic growth, especially in developing countries. Quality of life and lived experience of workers with musculoskeletal disorders have not been explored enough to determine whether person-centred care is provided. There is a wealth of evidence for using the biomedical approach in the management of workers with musculoskeletal disorders, which has proved ineffective in reducing absenteeism and symptoms experienced by workers. The purpose of this study was to explore the lived experience of workers seeking care for musculoskeletal disorders and how their pain attitudes and beliefs influenced their experience. METHODS: A qualitative approach with thematic analysis was used. Purposive sampling was used to recruit six participants for semi-structured interviews. All participants were either experiencing pain attributed to a musculoskeletal disorder or had received care for a musculoskeletal disorder. RESULTS: Pain attitudes and beliefs of workers with a musculoskeletal disorder and healthcare professionals greatly influenced the care and recovery process of musculoskeletal disorders. There is a primary biomedical lens informing care of workers with musculoskeletal disorders received. Workers expect healthcare professionals to explore their concerns further, but the focus of care for most participants was their presenting complaint. There is also a need for the autonomy of workers to be preserved, and communication between healthcare professionals and workers with musculoskeletal disorders needs to improve. CONCLUSIONS: Many stakeholders are involved in the recovery process from musculoskeletal disorders. There is a need for a biopsychosocial informed practice to improve return-to-work (RTW) in workers with musculoskeletal disorders. Change is needed at all healthcare system levels to reduce the negative experiences of workers and maladaptive pain beliefs that is associated with persisting symptoms and extended absenteeism.

A comparative effectiveness study of usual care, simple Chuna manual therapy, and complex Chuna manual therapy for the treatment of pelvic biomechanical lesions in patients with non-acute low back pain: a protocol for multicenter, randomized controlled trial.

BACKGROUND: Chuna manual therapy (CMT), a Korean manual therapy technique predominantly used for treating low back pain (LBP) and related disorders, lacks well-conceived research focusing on its comparative effectiveness, safety, and economic evaluation, particularly with respect to complex CMT with established CMT diagnostic algorithms. This study aims to illustrate a protocol for a randomized clinical study for comparative effectiveness and cost-effectiveness of complex CMT with simple CMT and usual care. METHODS: This is a protocol for a three-armed, multicenter, assessor-blinded, pragmatic, randomized controlled trial study. A total of 81 patients suffering from non-acute LBP with pelvic biomechanical lesions (PBL), characterized by a pain duration of at least two weeks and a Numeric Rating Scale (NRS) score of 5 or higher, will be recruited from two Korean medicine hospitals. These participants will be randomly assigned to one of three groups: complex CMT plus usual care (UC; n = 27), simple CMT plus UC (n = 27), or UC groups (n = 27). They will undergo treatment for 4 weeks, and follow-up assessments will be performed 8 weeks after treatment completion. The primary outcome will be the NRS score of LBP, and secondary outcomes will include the Oswestry Disability Index, Patient Global Impression of Change, credibility and expectancy questionnaire, three-dimensional posture analysis indicators, quality of life assessment, economic evaluation, and safety assessments. DISCUSSION: This will be the first study to assess the comparative effectiveness, safety, and cost-effectiveness of complex CMT compared to UC and simple/complex CMT in patients with LBP and PBL. We will also analyze useful diagnostic methods to help in clinical practice for CMT diagnosis. TRIAL REGISTRATION: Clinical Research Information Service (CRIS), KCT0009210. Registered on February 28, 2024.

Screening of Sensorial and Inflammatory Changes in Patients Submitted to Orthognathic Surgery.

BACKGROUND: Despite the high levels of success after orthognathic surgery, the immediate postoperative pain and edema, besides the neurosensorial deficits, are common complications. OBJECTIVE: This study aimed to evaluate the pattern of sensory and inflammatory responses in patients undergoing orthognathic surgery. METHODS: This prospective observational study included 20 patients undergoing bimaxillary orthognathic surgery, who were evaluated in the preoperative period and on Days 1, 2, 3, 4, 5, 6, 7, and 30 after surgery, using a battery of tests to assess sensorial and inflammatory changes. RESULTS: Subjective and objective evaluations of edema indicated a trend toward edema resolution within 30 days, with a significant decrease in mouth opening on days 1, 7, and 30 after surgery. Regarding nasal obstruction, a significant increase in Nasal Obstruction Symptom Evaluation (NOSE) scores was demonstrated on the first, second, and third days, returning to preoperative levels after 30 days. There was a significant increase in visual analogic scale (VAS) scores from the first to the seventh day after surgery, with a reduction within 30 days. For mechanical and thermal sensitivity tests, the lower lip and chin regions had poorer results, without recovery after 30 days. Positive correlations were observed between painful and inflammatory parameters, as well as between subjective and objective evaluations. Analysis of saliva biomarkers did not show significant differences for pre- and postoperative CCL3 or CCL4 levels. CONCLUSION: Data provide new evidence about the early inflammatory and sensorial complications after orthognathic surgery.

Disparities in pain management among transgender patients presenting to the emergency department for abdominal pain.

OBJECTIVE: Transgender and gender-diverse (TGD) individuals have a gender identity or expression that differs from the sex assigned to them at birth. They are an underserved population who experience health care inequities. Our primary objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bisexual/queer (LGBQ) or heterosexual individuals presenting with abdominal pain to the emergency department (ED). METHODS: Retrospective observational cohort study of patients ≥12 years of age presenting to 21 EDs within a health care system with a chief complaint of abdominal pain between 2018 and 2022. TGD patients were matched 1:1:1:1 to cisgender LGBQ women and men and cisgender heterosexual women and men, respectively. Propensity score matching covariates included age, ED site, mental health history, and gastrointestinal history. The primary outcome was pain assessment within 60 min of arrival. The secondary outcome was analgesics administered in the ED. RESULTS: We identified 300 TGD patients, of whom 300 TGD patients were successfully matched for a total cohort of 1300 patients. The median (IQR) age was 25 (20-32) years and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 min of arrival (59.0% TGD vs. 63.2% non TGD, p = 0.19). There were no differences in the number of times pain was assessed (median [IQR] 2 [1-3] vs. 2 [1-4], p = 0.31) or the severity of pain between groups (5.5 [4-7] vs. 6 [4-7], p = 0.11). TGD patients were more likely to receive nonsteroidal anti-inflammatory drugs (32.0% vs. 24.9%, p = 0.015) and less likely to receive opioids than non-TGD patients (24.7% vs. 36.9%, p = <0.001). TGD and nonbinary patients, along with LGBQ cisgender women (24.7%) and heterosexual cisgender women (34%), were less likely to receive opioids than LGBQ cisgender men (54%) and heterosexual cisgender men (42.3%, p < 0.01). CONCLUSION: There was no difference in frequency of pain assessment, regardless of gender identity or sexual orientation. More cisgender men, compared to TGD and cisgender women, received opioids for their pain.

Psychometric evaluation of the Danish version of the Pain Self-Efficacy Questionnaire in patients with subacute and chronic low back pain.

OBJECTIVE: The Pain Self-Efficacy Questionnaire (PSEQ) is a widely used patient-reported outcome measure designed to assess the level of pain self-efficacy in patients with low back pain (LBP). Although the PSEQ has been translated into Danish, its measurement properties remain unknown in patients with subacute and chronic LBP in Danish outpatient clinics. The aim of this study was to investigate the construct validity, internal consistency, test-retest reliability, and measurement error of the Danish version of the PSEQ in a group of Danish patients with subacute and chronic LBP in a hospital outpatient setting. METHODS: Patients with LBP referred to two Danish outpatient clinics were recruited for this study. Two days after the consultation, the participants were emailed a link to a survey that included the following outcome measures: the PSEQ, the Oswestry Disability Index, the Numeric Pain Rating Scale, and the Tampa Scale of Kinesiophobia. Five days after completion of the survey, a new survey that included the PSEQ was sent to the participants. RESULTS: In total, 109 participants were included for the analysis of construct validity and internal consistency, with 94 participants included for the analysis of test-retest reliability and measurement error. Construct validity was found to be high and internal consistency was acceptable, with Cronbach's alpha = 0.93 (95% confidence interval [CI] = 0.91-0.93). Test-retest reliability was found to be good, with an intraclass correlation coefficient (ICC2.1) of 0.89 (95% CI = 0.82-0.92). The standard error of measurement was calculated to be 4.52 and the smallest detectable change was 12.5 points. CONCLUSIONS: The Danish version of the PSEQ showed acceptable measurement properties in terms of construct validity, internal consistency, and test-retest reliability in a group of patients with subacute and chronic LBP. However, further studies are needed to investigate other aspects of the measurement properties.