Ultrasound-guided genicular nerve block versus alcoholic neurolysis for treatment of advanced knee osteoarthritis patients

Aim of the workTo investigate the clinical efficacy of ultrasound (US)-guided genicular nerve block (GNB) with adjuvant corticosteroid versus alcoholic neurolysis on pain and function of knee osteoarthritis (KOA) patients.Patients and methodsThis study involved 46 advanced KOA patients divided into two groups; group 1 was treated with US-guided GNB with 1 ml triamcinolone + 6 ml bupivacaine divided into the superior medial (SM), superior lateral (SL) and inferior medial (IM) genicular nerves and group 2 was treated with US-guided genicular nerve ablation with 0.5–0.75 ml solution containing 50% alcohol in 0.25% bupivacaine for each nerve. Patients were assessed before and after 1 and 6 months from the injection using visual analogue scale (VAS), numerical rating scale (NRS) for knee pain on walking and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.ResultsPatients mean age was 57.15 ± 3.74 years, disease duration 9.5 ± 1.81, body mass index (BMI) was 35.46 ± 4.44 and were 27 females and 19 males (F:M 1.4:1). The age, disease duration, BMI and gender distribution were comparable between the two groups. VAS, NRS and WOMAC scores improved significantly after injection in group 2 up to 6 months while in group 1 improved for only 1 month. Adverse effects did not persist beyond two weeks and included local pain, hypoesthesia, swelling and bruise.ConclusionsGenicular nerve ablation with alcohol offers a new and seemingly safe modality to treat KOA and improves pain intensity and physical functioning with less cost, less logistic support and avoiding possible corticosteroids adverse effects.     

Assessing the impact of rheumatoid arthritis on quality of life in a group of patients attending a rheumatology clinic in Sri Lanka

BackgroundRheumatoid arthritis (RA) has a worldwide distribution affecting 0.5–3% of the population. We used Stanford Health Assessment Questionnaire (HAQ) to assess the quality of life (QOL) in a sample of patients with RA. Disability assessment component of the HAQ; the HAQ-DI, assesses a patient's level of functional ability and has been validated and used in clinical trials extensively.ObjectiveTo find the impact of illness on quality of life, in a sample of patients with RA using HAQ, and to calculate the HAQ-DI. Additionally, to find the age distribution and relationship of HAQ-DI with VAS, DAS28 and duration of illness.MethodologyA self administered questionnaire was used in a random sample of 100 patients attending a rheumatology clinic. Statistical analysis was done using the SPSS statistical package version 17 (SPSS Institute, Chicago).ResultsWe had a 100% female population with mild disease [HAQ-DI (0–<1)] in 62% of patients, while severe disease (≥2 and ≤3) was found in 5%. RA prevalence was highest in 41–50 years group (mean age ± SD = 50.8 ± 11.5 years). VAS had a positive correlation with HAQ-DI. Relationship of HAQ-DI and DAS28 was not statistically significant (p = 0.72), although there was a positive correlation between DAS28 and HAQ-DI in disease duration more than 5 years group (r = 0.19). Mean HAQ score was the highest in more than 10 years disease duration population (p = 0.006).ConclusionIn a busy clinic setting, simple parameters like disease duration and VAS give an indication about the functional effect of illness on a patient's quality of life.     

Topical nasal xylometazoline for flexible bronchoscopy (VAIN): A randomized,double-blind,placebo-controlled trial

BackgroundThe role of topical nasal vasoconstrictor administration during flexible bronchoscopy is unclear.MethodsConsecutive subjects undergoing flexible bronchoscopy were randomized to receive either topical xylometazoline (0.1%) or placebo (saline nasal spray, 0.74% w/v isotonic solution) before bronchoscopy. Background topical anesthesia included 2% nasal lignocaine gel, pharyngeal spray of 10% lignocaine, and 1% lignocaine solution for spray-as-you-go administration. The primary outcome was the operator rated ease of nasal negotiation of the bronchoscope on the visual analog scale (Negotiation VAS). Secondary objectives included assistant rated facial pain scale score, patient-rated nasal pain score (Pain VAS), time to reach the vocal cords after bronchoscope insertion, operator rated nasal mucosal trauma score (Trauma VAS), hemodynamic changes, and complications between the groups.ResultsIn all, 148 subjects were recruited and randomized to the placebo (73) and xylometazoline groups (75). Operator rated ease of nasal bronchoscope negotiation (Negotiation VAS) was similar in both the groups [Median (IQR), 1 (1–2) in both groups, p = 0.79]. There were no differences in the other outcomes including assistant rated score of facial pain [(Median (IQR), 2 (2–4) placebo and 2 (2–4) xylometazoline, p = 0.36], Pain VAS [Median (IQR), placebo 2 (1–2) and xylometazoline 2 (1–3), p = 0.28], Trauma VAS, [Median (IQR), placebo 1 (0–2) and xylometazoline 1 (0–1), p = 0.28], hemodynamic changes, or complications between the two groups.ConclusionThe findings of this study do not support the administration of topical nasal xylometazoline in flexible bronchoscopy.Trial registryTrial registered on Clinicaltrials.gov, www.clinicaltrials.gov NCT03424889, on January 02, 2018.     

Evaluation of factors associated with locomotive syndrome in Japanese elderly and younger patients with rheumatoid arthritis

Abstract

Objectives: We aimed to determine the prevalence of locomotive syndrome (LS) using the 25-question geriatric locomotive function scale (GLFS-25) and identify factors associated with LS in elderly and younger patients with rheumatoid arthritis (RA).

Methods: Overall, 390 patients with RA who underwent GLFS-25 measurement, bone mineral density determination, and bioelectrical impedance analysis were enrolled. Factors associated with LS were analyzed by comparing patients with and without LS among both elderly and younger patients with RA.

Results: The prevalence of LS was 41.5%, 47.7% and 32.3% in all patients, elderly patients, and younger patients with RA, respectively. Pain visual analog scale (VAS) and Health Assessment Questionnaire Disability Index (HAQ-DI) were associated with LS in both elderly and younger patients. Moreover, in younger patients with RA, disease activity score in 28 joints (DAS28), erythrocyte sedimentation rate (ESR), basal metabolic rate, and legs muscle mass were identified as being associated with LS.

Conclusion: This study demonstrated that to prevent LS, we should aim to control pain and maintain a low HAQ-DI in elderly and younger patients with RA, and improve disease activity and maintain a higher basal metabolic rate, and legs muscle mass in younger patients with RA.     

Electroacupuncture treatment for pancreatic cancer pain: A randomized controlled trial

BackgroundPancreatic cancer is often accompanied by severe abdominal or back pain. It's the first study to evaluate the analgesic effect of electroacupuncture on pancreatic cancer pain. A randomized controlled trial compared electroacupuncture with control acupuncture using the placebo needle.MethodsSixty patients with pancreatic cancer pain were randomly assigned to the electroacupuncture group (n = 30) and the placebo control group (n = 30). Patients were treated on Jiaji (Ex-B2) points T8–T12 bilaterally for 30 min once a day for 3 days. Pain intensity was assessed with numerical rated scales (NRS) before the treatment (Baseline), after 3 treatments, and 2 days follow-up.ResultsBaseline characteristics were similar in the two groups. After 3 treatment, pain intensity on NRS decreased compared with Baseline (?1.67, 95% confidence interval [CI] ?1.46 to ?1.87) in the electroacupuncture group; there was little change (?0.13, 95% CI 0.08 to ?0.35) in control group; the difference between two groups was statistically significant (P < 0.001). Follow-up also found a significant reduction in pain intensity in the electroacupuncture group compared with the control group (P < 0.001).ConclusionsElectroacupuncture was an effective treatment for relieving pancreatic cancer pain.     

Relationship between achievement of physical activity goal and characteristics of patients with rheumatoid arthritis

Objectives: We aimed to identify the relationship between achievement of a physical activity goal and the characteristics of patients with rheumatoid arthritis (RA).

Methods: Overall, 137 patients with RA who performed physical activity were enrolled. Statistical analysis was performed to examine relationship between patient characteristics and achievement of physical activity goal by univariate analysis, multivariate logistic regression analysis and the receiver operating characteristic method.

Results: The significant factors considered for univariate analysis performed to compare RA patients with and without achievement in physical activity goal were age, disease duration, BMI, global VAS, pain VAS, CRP, DAS28-CRP, and HAQ-DI. The significant related factors by multivariate logistic regression analysis were age (OR: 0.926), BMI (OR: 1.180), pain VAS (OR: 0.969), and HAQ-DI (OR: 0.229). The cutoff values were 62.0 years for age (sensitivity 72.5%, specificity 59.6%), 19.7 for BMI (sensitivity 91.2%, specificity 36.2%), 20.0 for pain VAS (sensitivity 63.7%, specificity 71.9%), and 0.30 for HAQ-DI (sensitivity 48.8%, specificity 89.5%).

Conclusion: We aim to preserve activities of daily living in patients with RA. To achieve physical activity goal, we should control pain VAS, and HAQ-DI. Further, the patients the value of HAQ-DI should be kept very low.     

Pantoprazole associated dyspepsia hypocalcemia and hyponatremia: A disproportionality analysis in FDA adverse event reporting system (FAERS) database

Background and study aimThe study was designed to detect novel Adverse Events (AEs) of pantoprazole by disproportionality analysis in the FDA (Food and Drug Administration) database of Adverse Event Reporting System (FAERS) using Data Mining Algorithms (DMAs). Pantoprazole, the most commonly over-utilized Over The Counter (OTC) medication, was selected to assess any short-term or long-term AEs. The study aimed to analyze the novel adverse events of pantoprazole using the FAERS database.Materials and methodsA retrospective case/non-case disproportionality analysis was performed in the FAERS database. This study was based on AEs reported to FAERS from 2006Q1-2021Q3. Openvigil 2.1 was used for data extraction. Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), and Information Component (IC) were applied to measure the disproportionality in reporting. A value of ROR-1.96SE > 1, PRR ≥ 2, and IC-2SD > 0 were considered as the threshold for a positive signal.ResultsA total of 1050 reports of dyspepsia, 7248 reports of hypocalcemia and 995 reports of hyponatremia were identified. A potential positive signal for dyspepsia (ROR-1.96SE = 2.231, PRR = 2.359, IC-2SD = 1.13), hypocalcemia (4.961, 5.45, 2.23) and hyponatremia (3.948, 4.179, 1.92) were identified for pantoprazole.ConclusionData mining in the FAERS database produced three potential signals associated with pantoprazole. As a result, further clinical surveillance is needed to quantify and validate potential hazards associated with pantoprazole-related adverse events.     

Pantoprazole associated dyspepsia hypocalcemia and hyponatremia: A disproportionality analysis in FDA adverse event reporting system (FAERS) database

Background and study aimThe study was designed to detect novel Adverse Events (AEs) of pantoprazole by disproportionality analysis in the FDA (Food and Drug Administration) database of Adverse Event Reporting System (FAERS) using Data Mining Algorithms (DMAs). Pantoprazole, the most commonly over-utilized Over The Counter (OTC) medication, was selected to assess any short-term or long-term AEs. The study aimed to analyze the novel adverse events of pantoprazole using the FAERS database.Materials and methodsA retrospective case/non-case disproportionality analysis was performed in the FAERS database. This study was based on AEs reported to FAERS from 2006Q1-2021Q3. Openvigil 2.1 was used for data extraction. Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), and Information Component (IC) were applied to measure the disproportionality in reporting. A value of ROR-1.96SE > 1, PRR ≥ 2, and IC-2SD > 0 were considered as the threshold for a positive signal.ResultsA total of 1050 reports of dyspepsia, 7248 reports of hypocalcemia and 995 reports of hyponatremia were identified. A potential positive signal for dyspepsia (ROR-1.96SE = 2.231, PRR = 2.359, IC-2SD = 1.13), hypocalcemia (4.961, 5.45, 2.23) and hyponatremia (3.948, 4.179, 1.92) were identified for pantoprazole.ConclusionData mining in the FAERS database produced three potential signals associated with pantoprazole. As a result, further clinical surveillance is needed to quantify and validate potential hazards associated with pantoprazole-related adverse events.     

Analgesic efficacy and safety of tramadol/ acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: a multicenter, outpatient, randomized, double blind, placebo controlled trial

OBJECTIVE: To evaluate the analgesic efficacy and safety of tramadol 37.5 mg/acetaminophen 325 mg (tramadol/APAP) combination tablets for treatment of chronic low back pain (LBP). METHODS: This 91 day, multicenter, outpatient, randomized, double blind, placebo controlled study enrolled 338 patients with chronic LBP requiring daily medication for > or = 3 months. Patients with at least moderate pain [pain visual analog scale (VAS) with scores > or = 40/100 mm] after washout were randomized to tramadol/APAP or placebo. After a 10 day titration, patients received 1 or 2 tablets QID. Primary outcome measure was final pain VAS score. Secondary measures included pain relief, quality of life and physical functioning, efficacy failure, and overall medication assessments. RESULTS: In total, 336 intent-to-treat patients received tramadol/APAP (n = 167) or placebo (n = 169). Mean baseline pain VAS score was 67.8. Intent-to-treat analysis showed significantly better mean final pain VAS scores (47.4 vs 62.9; p < 0.001) and mean final pain relief scores (1.8 vs 0.7; p < 0.001) for tramadol/APAP than for placebo. Roland Disability Questionnaire scores and physical-related subcategories of the McGill Pain Questionnaire and the Medical Outcome Study Short Form-36 Health Survey were significantly better for tramadol/APAP patients. More patients rated tramadol/APAP as "very good" or "good" than placebo (63.6 vs 25.2%; p < 0.001). Kaplan-Meier estimates of cumulative discontinuation rates due to efficacy failures were 22.9% (tramadol/APAP) vs 54.7% (placebo; p < 0.001). The most common treatment related adverse events with tramadol/APAP were nausea (12.0%), dizziness (10.8%), and constipation (10.2%). Average daily dose of tramadol/APAP was 4.2 tablets (tramadol 158 mg/APAP 1369 mg). CONCLUSION: Tramadol 37.5 mg/APAP 325 mg combination tablets show efficacy in pain reduction, in measures of physical functioning and quality of life, and in overall medication assessments, with a tolerability profile comparable with other opioids used for the treatment of chronic LBP.     

The efficacy of tramadol/acetaminophen combination tablets (Ultracet?) as add-on and maintenance therapy in knee osteoarthritis pain inadequately controlled by nonsteroidal anti-inflammatory drug (NSAID)

The purpose of this study is to compare the efficacy of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (tramadol/APAP) with that of nonsteroidal anti-inflammatory drugs (NSAIDs) as maintenance therapy following tramadol/APAP and NSAID combination therapy in knee osteoarthritis (OA) pain which was inadequately controlled by NSAIDs. Subjects with knee OA for over 1 year and moderate pain (numerical rating scale [NRS] ≥5) despite at least 4 weeks’ NSAID therapy (meloxicam 7.5 mg or 15 mg qd or aceclofenac 100 mg bid) received tramadol/APAP add-on (combination with NSAID) for 4 weeks. Thereafter, subjects with significant pain improvement (NRS <4) were randomized to receive either tramadol/APAP or NSAID for 8 weeks. On days 29 and 57, Western Ontario and McMaster Universities (WOMAC) OA index score was measured. Secondary measures included pain intensity (NRS), pain relief score, and subjects’ and investigators’ overall medication assessments. Of 143 subjects enrolled, 112 completed the 4-week tramadol/APAP and NSAID combination phase and 97 (67.8%) experienced significant pain improvement. Of the 97 subjects randomized, 36 in tramadol/APAP group and 47 in NSAID group completed the 8-week comparator study. On days 29 and 57, WOMAC scores and pain intensities did not increase in both groups compared to measurements immediately after the combination therapy. At these two time points, there were no significant differences in WOMAC scores, pain intensities, and other secondary measures between the two groups. Overall adverse event rates were similar in both groups. Tramadol/APAP add-on significantly improved knee OA pain which had been inadequately controlled by NSAIDs. In those subjects who showed favorable response to tramadol/APAP and NSAID combination therapy, both tramadol/APAP and NSAIDs were effective at maintaining the pain-reduced state and there was no significant difference in efficacy between tramadol/APAP and NSAIDs.     

Pain in women with knee and/or hip osteoarthritis is related to systemic inflammation and to adipose tissue dysfunction: Cross-sectional results of the KHOALA cohort

BackgroundConsidering the role of metabolic diseases in osteoarthritis (OA), we investigated whether biomarkers of adipose tissue dysfunction could be associated with OA-related pain.DesignWe cross-sectionally analyzed patients with knee and/or hip OA at inclusion in the KHOALA cohort. We used visual analogic scale (VAS) for pain, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) pain subscores. At inclusion, we measured ultra-sensitive CRP (usCRP), leptin and adiponectin for calculation of leptin:adiponectin ratio (LAR), a marker of adipose tissue dysfunction associated with central adiposity, high-molecular-weight adiponectin, visfatin and apolipoproteins. Univariate and multivariable analyses using stepwise linear regression models were performed to search for correlation between pain assessments and these biomarkers, with systematic adjustment on age.ResultsIn 596 women with hip and/or knee OA, multivariable analyses indicated that higher pain intensity was associated with higher LAR (VAS pain: β=0.49; p = 0.0001, OAKHQOL pain: β=-0.46; p = 0.0002, WOMAC pain: β=0.30; p = 0.001) in the whole group as well as in hip or knee OA patients considered separately. Pain intensity correlated also with usCRP level (VAS pain: β= 0.27; p = 0.02, OAKHQOL pain: β =-0.30; p = 0.01) and Kellgren-Lawrence score. In 267 men, no correlation between biomarkers and pain was found.ConclusionSerum LAR and usCRP level are associated with pain level, independently of radiographic structural severity in women with hip and/or knee OA, emphasizing the role of adipose tissue dysfunction and of meta-inflammation in pain experience in the female population.     

The assessment of neuropathic pain in patients with prediabetes

AimsNeuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes.MethodsOne hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity.ResultsTwenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001).ConclusionsNeuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.     

Potential role of brain biomarkers in primary knee osteoarthritis patients using magnetic resonance spectroscopy

BackgroundPain in osteoarthritis (OA) primarily results from tissue damage but its' intensity does not essentially parallel the extent of joint destruction or presence of active inflammation, thus suggesting the likely involvement of a central component. The mid-anterior cingulate cortex (mACC) has an important role in pain perception, intensity and progression. In OA, low mACC γ-aminobutyric acid (GABA) was associated with high pain suggesting a role of prefrontal disinhibition. Aim of the work: To investigate the role of mACC (GABA) levels in chronic knee OA (KOA) pain and determine if magnetic resonance spectroscopy (MRS) brain neurotransmitters can serve as potential biomarkers. Patients and methods: Forty-five patients with primary KOA (M/F:33/12; age:57 ± 6 years) along with 15 matched controls were recruited. Pain was assessed using Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS) and Western Ontario McMaster Osteoarthritis (WOMAC) questionnaire. mACC (GABA) was assessed and brain MRS neurotransmitters analysed including glutamate (Glx); N-acetylaspartate (NAA), total choline (tCho) and myo-inositol. Results: MRS analysis demonstrated no metabolite differences between controls and KOA patients in GABA, Glx, NAA and tCho. Myo-inositol:Glx ratio was significantly higher in patients (1.47 ± 0.37 vs 1.1 ± 0.29; p < 0.001). mACC (GABA) negatively correlated with VAS (r = −0.86, p < 0001), PCS (r = −0.94, p < 0001) and WOMAC (r = −0.96, p < 0001) in KOA patients. Myo-inositol:Glx significantly correlated with the age (r = 0.31, p < 0.038), disease duration (r = 0.61, p < 0.0001), VAS (r = 0.4, p < 0.02), PCS (r = 0.48, p < 0.001) and WOMAC (r = 0.53, p < 0.0001). Conclusions: This work confirms the importance of mACC in central sensitization of pain and highlights a promising role of the inflammatory neurotransmitter GABA and myo-inositol:Glx ratio as mechanistic biomarkers of chronic KOA pain.     

Pain neuroscience education versus transcutaneous vagal nerve stimulation in the management of patients with fibromyalgia

Aim of the workTo evaluate the effectiveness of pain neuroscience education (PNE) and transcutaneous vagal nerve stimulation (tVNS) for fibromyalgia (FM) patients, as one of the chronic pain treatment modalities.Patients and methodsThe study was conducted on 99 patients that were divided into 3 groups (n = 33 each): Patients in group A received 6 sessions of tVNS twice weekly (25 Hz for 30 min), group B received 6 sessions of tVNS twice weekly (25 Hz for 30 min) and 3 sessions of PNE once weekly (for 30 min) and group C received 3 sessions of PNE once weekly (for 30 min). The follow up done immediately after the end of the sessions by Visual Analogue Scale score, Fibromyalgia Impact Questionnaire (FIQ), Pain catastrophizing scale questionnaire (PCS-Q, Pain DETECT questionnaire (PD-Q) and state trait anxiety inventory (STAI Q) self-reported questionnaire.ResultsThe mean age of patients was 33.3 ± 8.2 years and they were 86 females and 13 males (F:M 6.6: 1) and the 3 groups were matched for age (p = 0.15) and gender (p = 0.13). During the procedures no side effects were encountered. The 3 groups showed significant improvement of FM symptoms assessed by VAS, FIQ, PCS-Q, PD-Q and STAI-Q (state and trait), but group B showed the best results percentage of improvement (60%, 34.4%, 54.2%, 40%, 51.1% and 52,2% respectively).ConclusionCombined tVNS and PNE are more effective than PNE alone or VNS alone in management of FM. Further studies with long term follow up to assess the long-term effect of tVNS or PNE.     

Evaluation of an effectiveness and safety of the electroacupuncture in the management of intractable neuropathic pain: A prospective,open-labeled,randomized, cross-over clinical trial

Background:There is no sufficient evidence on the effectiveness of acupuncture for neuropathic pain. This protocol describes a study that aims to evaluate the effectiveness and safety of electroacupuncture combined with conventional medicine for patients with intractable neuropathic pain, when compared with conventional medicine alone.Methods/design:This study is a prospective, open-labeled, randomized, cross-over clinical trial. A total of 40 patients with neuropathic pain who had a numeric rating scale (NRS) score of over 4 despite receiving conventional treatment for more than 3 months will be enrolled. Participants will receive conventional treatment for neuropathic pain (treatment C) or treatment C combined with 12 additional sessions of electroacupuncture treatment (treatment A) for 6 weeks. Participants will be randomly assigned to 1 of the 2 sequence groups (AC and CA group) with a 1:1 allocation. The differences of responder in the composite efficacy outcomes, which consist of the NRS, Brief Pain Inventory-Short Form (BPI-SF) pain subscale, and global assessment at 6 weeks after randomization will be examined as the primary outcome. Secondary outcomes include differences in the NRS, the Short-Form McGill Pain Questionnaire, BPI-SF, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Medical Outcomes Study Sleep Scale, global assessment, EQ-5D, and incremental cost-effective ratio at 6 and 15 weeks after randomization. Adverse events, vital signs, and physical examinations will be recorded to evaluate safety.Discussion:The study protocol for this trial will provide up-to-date evidence on the effectiveness and safety of electroacupuncture for patients with intractable neuropathic pain. The results will be disseminated through a peer-reviewed journal and conference presentations.Trial registration:Clinical Research Information Service, ID: KCT0003615. Registered on March 12, 2019. https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=13410& ltype=&rtype=     

Subjective easiness of pain assessment measures in older people

BackgroundChronic pain is a significant health problem in older people. Easy-to-use measures of pain help detection and assessment of pain in general practice.ObjectiveTo assess the subjective ease of use of self-report tools of pain among older home-dwelling people.MethodsIndependently living people aged 75, 80 and 85 years subject to communal preventive home visits with chronic pain were invited to a clinical pain examination. At the visit subjects were asked to assess their pain with 4 self-report tools; VAS (visual analog scale), NRS (numerical rating scale), PainDETECT and BPI (brief pain inventory), and at the end report the subjective ease of use for these measures.ResultsAltogether 106 subjects (28 males, 78 females) consented to participate in the clinical study. Musculoskeletal pain was the most common cause of chronic nociceptive pain, being present in 88 (83%) subjects. The most common manifestations were spinal disorders and osteoarthritis of the hip or knee. The multidimensional pain scales (PainDETECT and BPI) were rated easier to use than the unidimensional measures (VAS and NRS), although all the measures were assessed as “quite easy” to use in general. In comparison with the other measures, PainDETECT was significantly easier to use. Low MMSE explained the difficulty of using PainDETECT.ConclusionsThe VAS, NRS, PainDETECT and the BPI appear to be suitable pain measures to use for older community-dwelling people in general practice.     

Comparison of two growth hormone stimulation tests and their cut-off limits in healthy adults at an outpatient clinic

ObjectiveA peak GH less than 3 μg/L to insulin tolerance test (ITT) is commonly used as a threshold indicating severe adult GH deficiency (GHD). This cut-off is based on results obtained by polyclonal radioimmunoassays preferably under standard conditions at hospital. Our aim was to evaluate the validity of this cut-off limit using two currently used immunometric GH assays and to compare GH responses in the ITT and the GH releasing hormone + arginine (GHRH + ARG) test in healthy adults at our outpatient endocrine unit.DesignITT was performed on 73 subjects and the GHRH + ARG test on those 28 who showed insufficient response to the ITT.MethodsGH was measured by an immunofluorometric and immunochemiluminometric assay.ResultsGH peak above 3 μg/L was observed in 56% of the healthy volunteers with adequate hypoglycemia in the ITT. Among the 28 subjects with a peak GH below 3 μg/L, only two overweight men had a GH peak response below the commonly used cut-off limit of 9.1 μg/L in the GHRH + ARG test.ConclusionsLean healthy adults could erroneously be classified as GH deficient by the ITT while their results in the GHRH + ARG test were normal. The GH results are highly dependent on the immunoassay used, but false positive results in the ITT are often obtained even if lower cutoff limits determined on the basis on the calibration of the GH assay are used. Confounding factors seemed to blunt the GH response to the ITT more than to the GHRH + ARG test at our outpatient clinic.     

Subclinical entheseal involvement in patients with rheumatoid arthritis

BackgroundEnthesopathy is a common feature of Spondyloarthritis (SpA) but can also be found in rheumatoid Arthritis (RA). Recognizing enthesopathy could be challenging because of low sensitivity and specific clinical testing. To detect enthesopathy, The European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US).Aim of the workTo investigate the frequency and distribution of entheseal involvement in RA patients and its relation to disease activity.Patients and methods100 RA patients with any symptom in foot and ankle were enrolled. Disease activity score (DAS28), Visual analogue scale (VAS), Health assessment questionnaire-Disability index (HAQ-DI) and Glasgow Ultrasound Enthesitis Scoring System (GUESS) were assessed.ResultsThe mean age of patients was 44.1 ± 12.2 years, disease duration was 7 ± 5.8 years and 86% were females. The mean DAS28 score was 4.3 ± 1.2 and GUESS score was 7.2 ± 4.2; all patients had variable degrees of enthesitis: 30% of patients had mild enthesitis, 42% had moderate enthesitis and 28% had marked enthesitis. GUESS was significantly higher in patients with moderate (7.8 ± 4.9) and high (7.2 ± 3.2) disease activity than in patients with low disease activity (5.2 ± 3.9) and those in remission (6.5 ± 1.9) (p = 0.015). HAQ, Age and ESR significantly correlated with GUESS score (r = 0.19, p = 0.049; r = 0.23, p = 0.023; r = 0.33, p = 0.001 respectively).ConclusionSubclinical enthesitis is remarkable in RA patients. Quadriceps tendon enthesis was mostly affected. Enthesitis is significantly related to age, ESR and HAQ. The presence of enthesitis in RA may represent a potential marker for disease activity.     

Antofloxacin-based bismuth quadruple therapy is safe and effective in Helicobacter pylori eradication: A prospective,open-label,randomized trial

Background and study aimsThe present study was designed to evaluate the safety, efficacy, and tolerability of antofloxacin-based bismuth quadruple therapy in Chinese patients with Helicobacter pylori infection.Patients and methodsTotal 290 patients with H. pylori infection were randomly and equally divided into two groups as per different bismuth quadruple therapies for 14 d: colloidal bismuth pectin 200 mg thrice a day, lansoprazole 30 mg twice a day, amoxicillin 1 g twice a day, and antofloxacin 200 mg once a day (ACLA group) or levofloxacin 500 mg once a day (LCLA group). Eradication was assessed with ¹³C-urea breath test 6 wk after treatment completion; the primary endpoint was the eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses. The minimum inhibitory concentration was measured with the PDM epsilometer test to assess the susceptibility of H. pylori strains on gastric biopsy specimens to antofloxacin and levofloxacin.ResultsThe eradication rates of H. pylori in the ACLA group were 93.8% and 97.8% for the ITT and PP analysis, respectively; these rates were significantly higher than those in the LCLA group, at 86.2% and 92.6%, respectively (p = 0.031 and 0.041, respectively). The total incidence of adverse events during the eradication therapy did not significantly differ between the ACLA and LCLA groups (31.7% vs. 37.9%%, p = 0.267), and the two groups displayed similar severity of adverse events (p = 0.156) and compliance rate (100% by ACLA vs. 97.8% by LCLA, p = 0.080). The eradication rate with the antofloxacin susceptible strains in the ACLA group was significantly higher than that with the resistant strains (99.2% vs. 66.7%, p = 0.045). Moreover, the eradication rate with the levofloxacin susceptible strains in the LCLA group was significantly higher than that with the resistant strains (95.3% vs. 80.0%, p = 0.013).ConclusionAntofloxacin is safe and effective for H. pylori eradication. Antofloxacin-based bismuth quadruple therapy could be an alternative treatment for H. pylori eradication.     

Pain in individuals with idiopathic inflammatory myopathies,other systemic autoimmune rheumatic diseases,and without rheumatic diseases: A report from the COVAD study

Objectives

To compare pain intensity among individuals with idiopathic inflammatory myopathies (IIMs), other systemic autoimmune rheumatic diseases (AIRDs), and without rheumatic disease (wAIDs).

Methods

Data were collected from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an international cross-sectional online survey, from December 2020 to August 2021. Pain experienced in the preceding week was assessed using numeral rating scale (NRS). We performed a negative binomial regression analysis to assess pain in IIMs subtypes and whether demographics, disease activity, general health status, and physical function had an impact on pain scores.

Results

Of 6988 participants included, 15.1% had IIMs, 27.9% had other AIRDs, and 57.0% were wAIDs. The median pain NRS in patients with IIMs, other AIRDs, and wAIDs were 2.0 (interquartile range [IQR] = 1.0–5.0), 3.0 (IQR = 1.0–6.0), and 1.0 (IQR = 0–2.0), respectively (P < 0.001). Regression analysis adjusted for gender, age, and ethnicity revealed that overlap myositis and antisynthetase syndrome had the highest pain (NRS = 4.0, 95% CI = 3.5–4.5, and NRS = 3.6, 95% CI = 3.1–4.1, respectively). An additional association between pain and poor functional status was observed in all groups. Female gender was associated with higher pain scores in almost all scenarios. Increasing age was associated with higher pain NRS scores in some scenarios of disease activity, and Asian and Hispanic ethnicities had reduced pain scores in some functional status scenarios.

Conclusion

Patients with IIMs reported higher pain levels than wAIDs, but less than patients with other AIRDs. Pain is a disabling manifestation of IIMs and is associated with a poor functional status.