Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty

BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication.Understanding the relationship between pain and opioid consumption following total hip arthroplasty(THA)is key to creating safe and effective opioid prescribing guidelines.AIM To evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.METHODS We retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale(VAS)pain and opioid medication questionnaires pre-and postoperatively.Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days.Survey results were divided into preoperative,postoperative days 1-7,postoperative days 8-14,and postoperative days 15-30 for analysis.Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’preoperative status using hierarchical Poisson and linear regressions,respectively.RESULTS There were 105 patients included.Mean VAS pain scores were the highest preoperatively 7.41±1.72.However,VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores:postoperative day 1-7(5.07±1.79;P<0.001),postoperative day 8-14(3.60±1.64;P<0.001),and postoperative day 15-30(3.15±1.63;P<0.001).Mean opioid pill consumption preoperatively was 0.68±1.29 pills.Compared to preoperative opioid consumption,opioid use was significantly greater between postoperative days 1-7(1.51±1.58;P=0.001)and postoperative days 8-14(1.00±1.27;P=0.043).Opioid consumption declined below preoperative levels between postoperative days 15-30(0.35±0.72;P=0.160)which correlates with a VAS pain score of 3.15.CONCLUSION All patients experienced significant benefit and pain relief from having undergone THA.Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30,which was associated with a VAS pain score of 3.15.These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.

Clinical therapeutic effect of self-prescribed Sanhanchushi Tongbi on lumbar disc herniation

BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a customized prescription.It disperses cold,relieves pain,removes cold from the meridians and viscera,and treats neuropathic pain.However,few studies have investigated its mechanism of pain relief.AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST.METHODS A total of 211 patients with LDH syndrome were divided into two groups:107 patients in the control group were treated with conventional massage combined with traction,and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST.The patients were treated for 4 wk.Indices of traditional Chinese medicine(TCM)syndrome score and serum inflammatory factor levels were measured.RESULTS After therapy,the TCM syndrome score in the observation group was significantly lower than that in the control group(P<0.05).The main symptoms,clinical signs,daily activities,and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy(P<0.05).The levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein were lower in the observation group than in the control group(P<0.05).In the observation group,superoxide dismutase levels were significantly higher,whereas malondialdehyde levels were significantly lower,compared with the control group(P<0.05).The overall efficacy rate in the observation group was 96.15%,which was substantially higher than that in the control group(88.79%;P<0.05).CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.

Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation

BACKGROUND Transarterial chemoembolization(TACE)combined with microwave ablation(MWA)is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis.However,it may cause severe postoperative pain and inflammatory responses.The paravertebral block(PVB)is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions.AIM To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.METHODS Sixty patients were randomly divided into PVB and control groups.The PVB group received ultrasound-guided PVB with 0.375%ropivacaine preoperatively,whereas the control group received intravenous analgesia with sufentanil.The primary outcome was the visual analog scale(VAS)score for pain at 6 h,12 h,24 h,and 48 h after the procedure.Secondary outcomes were the dose of sufentanil used,incidence of adverse events,and levels of inflammatory markers(white blood cell count,neutrophil percentage,C-reactive protein,and procalcitonin)before and after the procedure.RESULTS The PVB group had significantly lower VAS scores at 6 h,12 h,24 h,and 48 h after the procedure compared with the control group(P<0.05).The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea,vomiting,and respiratory depression than did the control group(P<0.05).Compared with the control group,the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure(P<0.05).CONCLUSION PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.

Effectiveness of treating menorrhagia using microwave endometrial ablation at a frequency of 2.45 GHz

BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment for menorrhagia.It has been covered by the national insurance in Japan since April 2012,and its demand has been increasing as the importance of women’s health has advanced in society.AIM To examine the efficacy of MEA as a treatment option for menorrhagia.METHODS In this study,we retrospectively analyzed 76 patients who underwent MEA between January 2016 and March 2020 in our department.MEA was performed in the lithotomy position,under general anesthesia,and with transabdominal ultrasound guidance,including the entire endometrial circumference while confirming endometrial coagulation.The Microtaze AFM-712 and the Sounding Applicator CSA-40CBL-1006200C were used for MEA,and the endometrium was ablated using a Microtaze output of 70 W and coagulation energization time of 50 s per cycle.The visual analog scale(VAS)was used to evaluate menorrhagia,menstrual pain,and treatment satisfaction.Additionally,the hemoglobin(Hb)levels before and after MEA and associated complications were investigated.RESULTS The average age of the patients was 44.8±4.0 years.While 14 patients had functional menorrhagia,62 had organic menorrhagia,of whom 14 had endometrial polyps,40 had uterine fibroids,and 8 had adenomyosis.The VAS score before MEA and 3 and 6 mo after the procedure were 10,1.3±1.3,and 1.3±1.3,respectively,for menorrhagia and 10,1.3±1.8,and 1.3±1.8,respectively,for menstrual pain,both showing improvements(P<0.001).The MEA Hb level significantly improved from 9.2±4.2 g/dL before MEA to 13.4±1.2 g/dL after MEA(P=0.003).Treatment satisfaction was high,with a VAS score of 9.6±0.7.Endometritis was observed in one patient after surgery and was treated with antibiotics.CONCLUSION MEA is a safe and effective treatment for menorrhagia.

Conscious Slower Breathing Predominates Parasympathetic Activity and Provides a Relaxing Effect, in Healthy Japanese Adult Women

Background: The optimal breathing pattern (BP) to effectively regulate autonomic nervous activity is yet to be determined. Objective: We aimed to clarify the effects of four BPs (BP-1, BP-2, BP-3, and BP-4) on autonomic nervous activity and mood changes. Methods: Eleven healthy adult female volunteers performed each BP in a sitting position for 5 min in a resting state. The time required for one breathing for BP-1 (30 breaths/min), BP-2 (20 breaths/min), BP-3 (15 breaths/min), and BP-4 (10 breaths/min) were 2 s, 3 s, 4 s, and 6 s, respectively. The inspiratory/expiratory time of one breathing was 1 s/1 s, 1 s/2 s, 2 s/2 s, and 2 s/4 s. The high-frequency component (HF) and low-frequency component (LF)/HF ratio during and before (control) performing a BP were calculated from heart rate variability data recorded using the wearable biometric information tracer M-BIT. Three mood changes, which are, “pleasure—unpleasure”, “relaxation—tension”, and “sleepiness—arousal”, in the subjects were assessed using the visual analog scale (VAS) before and after performing a BP. Results: Slower breathing induced an increase in HF power and a reduction in LF/HF ratio, indicating increased parasympathetic activity and decreased sympathetic dominance. Furthermore, VAS revealed that slower breathing increased the tendency to feel “pleasure”, “relaxation”, and “sleepiness”. Conclusion: Our results suggest that slower breathing predominates parasympathetic activity in the autonomic nervous system, resulting in a relaxing effect. This result may help lay the foundation for deriving breathing methods that efficiently regulate an individual’s autonomic activity.

Randomized, Double-Blind, Double-Masked, Parallel Group Clinical Study to Compare the Effectiveness of Diclofenac Potassium 150 mg, LP OD, vs Diclofenac Potassium 50 mg, TID, Three Times a Day, in Knee Osteoarthritis

Background: Osteoarthritis is a chronic disease associated with pain, inflammation, stiffness and synovial effusion, with progressive functional limitation, compromising quality of life. It progressively leads to loss or decrease in joint function. Pharmacological and non-pharmacological therapy seeks symptomatic management, complicated by a lack of adherence. After acetaminophen, non-steroidal anti-inflammatory drugs such as diclofenac are the most widely used medications. Objectives: The primary objective compared the analgesic effect of diclofenac 150 mg once daily vs. 50 mg three times daily in patients with knee osteoarthritis. The secondary objective assessed changes in quality of life. Method: One group received diclofenac 150 mg OD with placebo TTD. Another group received placebo OD and 50 mg active diclofenac (reference) TTD, both for 30 days. The evaluation of pain was carried out by a visual analog scale (VAS), at the beginning, 2, 3, 4, 15 and 30 days, quality of life (the WOMAC scale) and adverse effects, at 15 and 30 days. Results: Pain decreased significantly on days 15 and 30, compared to day 0, in both groups, without differences between groups. The total results in the WOMAC scale showed a very marked improvement at 15 and 30 days, without differences between groups. The most frequent adverse effects were constipation 6% in the reference group, and gastric discomfort 30.3% in the reference group vs 28.1%, in the Test group. Conclusions: Prolonged-release diclofenac 150 mg OD is as effective as diclofenac 50 mg TID for the treatment of patients with knee osteoarthritis.

Arabic Version of the Modified Constant Murley Score

Objectives: “Patient-reported outcome measures” has been used extensively, and it has shown the diseases’ impact on patient quality of life and has enabled the clinician to evaluate the clinical care efficacy. In the literature, there are more than 34 shoulder function assessment scoring instruments;the Modified Constant Murley Score (M-CMS) is one of the most popular scores. Although, the M-CMS had been translated and culturally adapted to Danish, Brazilian and Turkish versions, there is no Arabic version found in the literature. We aim to translate and culturally adapt M-CMS into the Arabic language. Method: The M-CMS was translated using previously published guidelines. The translation and cultural adaptation were done in five stages, initial translation by two bilingual translators then a synthesis of the translations after that, back translation by two native English speakers. Then an expert committee meeting approved the pre-final Arabic version. Finally, a pilot test was conducted on 41 patients to ensure its validity. Results: The M-CMS was successfully translated from the original English version to the Arabic version;no difficulties in the translation process were faced. Conclusion: A validated Arabic version of the M-CMS was produced and ready to be used for functional assessment of different shoulder pathologies in Arabic-speaking countries. Future study is needed for translation and cultural adaptation of the English standardized test protocol to assure the reproducibility of the Arabic version of the M-CMS.

Manipulation for degenerative lumbar spondylolisthesis:A systematic review of randomized controlled trials

Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.

Analgesic effects and hemodynamic mechanisms of perpendicular and transverse needling at Sanyinjiao(SP 6) in patients with primary dysmenorrhea: A randomized controlled trial

Objective: To explore the analgesic effects and uterine hemodynamics of perpendicular needling(PN)and transverse needling(TN) at SP 6 in patients with primary dysmenorrhea(PD).Methods: In this randomized controlled trial, patients with PD diagnosed with cold-dampness congealing pattern were randomly assigned in a ratio of 1:1 to receive PN or TN at bilateral SP 6 for 10 min.Acupuncture was performed when the menstrual pain score was over 40 mm on the first day of menstruation, as measured using the visual analog scale for pain(VAS-P). The primary outcome was average menstrual pain(VAS-P). Secondary outcomes included the pulsatility index(PI), resistance index(RI), and systolic-diastolic peaks ratio(S/D) in uterine arteries as measured using color Doppler ultrasonography;anxiety as assessed using the Hamilton Anxiety Rating Scale(HAMA), blood pressure(BP),and heart rate(HR).Results: Forty-eight patients completed the study. The TN group exhibited a significant reduction in VAS-P scores(-5.71 mm, 95% confidence interval(CI): -8.78, -2.63, P =.001), RI values(-0.05, 95% CI:-0.09, -0.01, P=.015), and HAMA values(-2.50, 95% CI: -4.78, -0.22, P=.032) when compared with the PN group. No significant differences in PI, S/D, BP, or HR values were observed between the two groups(P >.05).Conclusion: TN at SP 6 was superior to PN in alleviating menstrual pain and anxiety in patients with PD.This analgesic effect of TN may be due to its better ability to improve uterine arterial blood flow via decreases in RI values.

The Effects of Anma (Traditional Japanese Massage)—Randomised Trial

Background and Objective: Anma is a traditional Japanese bodywork therapy that has not been widely known and used in the West. There have been only a few Anma studies published in English journals. To study the effect of Anma (traditional Japanese massage) among participants who have neck and shoulder stiffness symptoms (so-called Katakori, in Japanese). Methods: The study participants consisted of seventy-seven (Study 1), thirteen (Study 2), and twenty (Study 3) adults with “Katakori” symptoms. The research design is as follows: (Study1) Randomized, Parallel-Group, Controlled Trial. (Study 2) Crossover Clinical Trial. (Study 3) Randomized, Parallel-Group, Controlled Trial. And we conducted Anma treatment for 45 minutes (Treatment) or rest in lying position for 45 minutes (Control). Results: In study 1, the symptom of “Katakori” was relieved after Anma treatment in Anma group (p d: 2.2). There was a significant interaction between the Anma group and the control group (p < 0.001). In study 2, MBV significantly increased following Anma treatment. There was a significant interaction between the Anma group and the control group (p = 0.022). In study 3, the symptom of “Katakori” was relieved after Anma treatment in the treatment group. There were no significant interactions between the groups in VAS and MBV values. Discussion and Conclusions: The study demonstrated that Anma therapy decreases “Katakori” symptoms while increasing MBV in the shoulder region.

changes in muscle activity in patients with primary chronic headache

Objective:According to the Global Burden of Disease Study,updated in 2018,headache disorders are the second leading cause in the world and impaired quality of life and lead to reduce daily activity and can be the cause of headache-related disability.So,we desperately need to develop new painless and minimally invasive methods to facilitate diagnosis to improve the quality of headache care.Methods:Our study involved 92 participants over 18 years of age with a diagnosis of primary chronic headache.Among those,36 were with chronic tension type headache,26 were with a chronic migraine,and 30 were healthy participants.All patients were selected according to the criteria of the International Headache Society.Clinical questionnaires,instrumental data,and characteristics of headache episodes were collected from all participants.We evaluated the muscle activity of the pericranial and cervical muscles in patients with chronic headache to compare with healthy participants using Surface electromyography to determine if there is an alteration in muscle activity.Results:Surface electromyography data showed that there was a statistically significant difference in results between the target group and the control group,where patients with primary chronic headache had high amplitude and velocity in the studied muscles on the electromyogram.Among the participants,there was a difference in the intensity of headache attacks on the visual analog scale chronic tension type headache 5.2±1.4,chronic migraine 7.7±1.3,control group 1.6±0.7 and in the frequency of headache attacks per month chronic tension type headache 14.4±1.9,chronic migraine 17.3±2.9,the control group of participants had headache attacks of≤1 per month.Conclusion:We concluded that the patients with primary chronic headaches there are changes in the muscle activity of the pericranial and cervical muscles.In contrast to patients without chronic headaches,which,in turn,the method of surface electromyography may encourage further research in this area.

Early Clinical Improvement of the Axial Pain after Sagittal Curve Restoration in Patients Who Underwent a Multiple Level Microdiscectomy with Fusion of the Cervical Spine Using Zero Profile Cages

A common pathology that causes axial and/or radicular pain is cervical degenerative spine. It has the potential to cause myelopathy. The majority of cases necessitate surgical decompression and sagittal balance correction;surgery may be performed at multiple levels of the cervical spine. Typically, during decompression, the degenerated discs are replaced and the spine is fused, and it has been recommended to restore the lordotic curve during the procedure to avoid any axial pain post-operatively. We followed our patients who had multiple level cervical spine decompression with fusion and monitored their axial pain after correction or in the absence of correction of the normal lordosis in the early post-operative period. When various levels of degenerative cervical spine are treated, it appears that axial pain does not improve in the immediate or early postoperative term.

Association between salivary α-amylase activity and pain relief scale scores in cancer patients with bone metastases treated with radiotherapy

Background Subjective assessment tools such as visual analog scales （VAS） or pain scores are commonly used to evaluate the intensity of chronic cancer-induced pain.However,their value is limited in some cases.We measured changes in VAS pain scores and salivary a-amylase （sAA） concentrations in cancer patients receiving radiotherapy for bone metastases to ascertain the correlation between these measures.Methods We enrolled 30 patients with bone metastases attending a single institution from June 2010 to March 2011.All patients with cancer-induced bone pain received radiation therapy （RT） at the same dose （30 Gy） and fractionation （3 Gy/ fraction,5 days/week） for palliative pain relief.We assessed heart rate （HR）,systolic and diastolic blood pressures （DBP/SBP） and VAS pain scores before （d0） and after five （d5） and ten fractions （d10） of irradiation,sAA and salivary cortisol （SC）concentrations were measured using a portable analyzer and automated chemiluminescence analyzer,respectively.Results Radiotherapy markedly decreased VAS scores from （82.93±9.29） to （31.43±t16.73） mm （P ＜0.001） and sAA concentrations from （109.40±26.38） to （36.03±19.40） U/ml （P ＜0.001）.Moreover,there was a significant correlation between these two indices （P ＜0.01,r=0.541）.HR decreased by 6.5％ after radiotherapy,but did not correlate with VAS scores （P ＞0.05）.SC concentrations and BP did not change significantly during the study （P ＞0.05）.Conclusions The significant correlation between sAA concentrations and VAS pain scores identified in these preliminary results suggests that this biomarker may be a valuable,noninvasive and sensitive index for the objective assessment of pain intensity in patients with cancer-induced bone pain.

Clinical effect of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia:a randomized parallel-controlled study

OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.

Effects of Shengmai Yin(生脉饮)on pulmonary and cardiac function in coronavirus disease 2019 convalescent patients with cardiopulmonary symptoms:a randomized,double blind,multicenter control trial

OBJECTIVE:To evaluate the efficacy and safety of Shengmai Yin(生脉饮,SMY)on visual analogue scale(VAS)for cardiopulmonary symptoms in coronavirus disease 2019(COVID-19)convalescent patients.METHODS:In this randomized,double blind and multicenter controlled trial,a total of 200 COVID-19 convalescent patients who with cardiopulmonary symptoms were enrolled from three medical centers in Hubei,China.These patients were randomized divided into trial group and the control group,100 patients in each one,SMY and its placebo were applied to respectively,for two weeks.VAS of clinical symptoms included shortness of breath,hidrosis,chest distress,palpitation,and dry cough was performed at 0,1,2 weeks.Decrease in VAS of 30%or more was defined as effective,and a reduction in VAS of 0 was defined as curative.RESULTS:A total of 192 completed the study.The VAS of TCM symptoms showed there was no difference in baseline between the two groups.The VAS in both groups was down-regulated,and there was no significant difference in VAS and cure rates at the first and second week between the two groups.There was no significant difference in breath,hidrosis,palpitation,and dry cough between the two groups but SMY treatment for two weeks has remarkable therapeutic effects in chest distress than placebo.CONCLUSIONS:SMY could effectively ameliorate the symptoms of chest distress,and improve the quality of life of the COVID-19 convalescent patients.

Efficacy of Hypnotherapy in the Management of Fibromyalgia:A Prospective Randomized Controlled Study

Objective:A multi-modal approach to fibromyalgia syndrome is necessary as it is affected by emotional,cognitive,and behavioral factors.In this context,hypnosis is one of the treatment methods used in fibromyalgia.However,studies on the use of hypnosis in fibromyalgia have mostly been conducted with short treatment durations of self-hypnosis.For this reason,we aimed to conduct this study in which the hypnosis sessions were face-to-face and the treatment duration was longer.Materials and Methods:Twenty-five patients who met the fibromyalgia diagnostic criteria published in the American College of Rheumatology(ACR)2016 and whose medical treatment was planned were included in the study.A total of 20 patients completed the study(10 hypnosis group and 10 control group).No additional treatment was applied to the control group other than medical treatment and exercise recommendations.In addition to medical treatment and exercise,patients in the hypnosis group received face-to-face hypnosis therapy once a week for 60 min,a total of 10 sessions.Evaluations of the patients before the treatment and in the 3^(rd)month after the treatment were made with the pain score and the fibromyalgia disease activity score.Results:Ages 18–65 years,with widespread pain for at least 3 months,according to ACR 2016 fibromyalgia diagnostic criteria;A total of 20 patients with fibromyalgia,10 in the hypnosis treatment group and 10 in the control treatment group completed the study.When the 3^(rd)month Visual Analog Scale(VAS)and Fibromyalgia Impact Questionnaire(FIQ)values of the group receiving hypnosis treatment were compared with the control group,a statistical difference was found(P<0.001).When the pre-treatment VAS and FIQ values of the group receiving hypnosis treatment were compared with the 3^(rd)month values,a statistically significant improvement was found(respectively;P=0.006,P=0.005).When the pretreatment and 3^(rd)month VAS and FIQ values of the control group were compared,no statistical difference was found(P=0.063).Conclusions:Hypnosis treatment is effective in reducing pain and increasing daily life activities in fibromyalgia patients,and no side effects were reported.It can be considered a complementary treatment within the multimodal approach in fibromyalgia patients.

Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae

OBJECTIVE: To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation(TCSOM) in treating chondromalacia patellae(CP).METHODS: Sixty cases of CP patients were randomly assigned to a TCSOM group and a Celecoxib group according to the random number table method. All patients in the TCSOM group were treated with a maximum of 10 spinal manipulations and rehabilitation training of quadriceps femoris. The symptoms before and after treatment were assessed with visual analog scale(VAS) and Kujala functional knee scoring system(KFKSS). A symptom improvement rate(SIR) was implemented in order to evaluate the effects of the treatments.RESULTS: The symptoms of 16 patients in the TC-SOM group quickly resolved after the first spinal manipulation and 8 cases were significantly improved. The VAS scores in the TCSOM group after 4weeks of treatment were significantly lower than those in the Celecoxib group. The KFKSS scores in the TCSOM group after 4 weeks of treatment were significantly higher than those in the Celecoxib group. Side effects of the treatment were not reported. Symptom improvement rate based on the VAS in the TCSOM group indicated more significant improvements than the Celecoxib group.CONCLUSION: TCSOM has greater efficacy than Celecoxib capsules for relief of the symptoms of CP.

Analysis of the Predictive Factors for the Recurrence of Deep Infiltrating Endometriosis:A 2-Year Prospective Study

Objective:To investigate factors that may be associated with the recurrence of deep infiltrating endometriosis(DIE)and DIE-related symptoms.Methods:Starting in September 2014,women with a confirmed diagnosis of DIE based on surgical and histological findings were included in the prospective study with a 2-year follow-up in our hospital.A total of 84 consecutive patients were included,all of whom underwent laparoscopic surgery.The data were obtained from the medical records of the patients.Follow-up data,including presence of pain as assessed using the visual analog scale(VAS)score and ultrasonography/magnetic resonance imaging findings,were obtained at 3,6,9,12,and 24 months postoperatively.Variables,such as age,body mass index,severity and duration of symptoms,size and location of the lesion,and pre-and postoperative medical treatment,were evaluated using univariate and multivariate analyses to identify factors correlated to recurrence.Results:A total of 11(13.1%)patients presented with recurrence,with a mean time to recurrence of 14.2 months.The univariate analysis showed that the longer duration of menstruation(7.4 vs.6.0,P=0.010),the more advanced revised American Fertility Society(rAFS)stage(Stages I and II vs.III and IV,χ^(2)=9.964,P=0.001),the higher VAS score for dysmenorrhea(9.4 vs.5.2,P=0.001),and the more severe pain during defecation(7.8 vs.4.8,P=0.016)were positively correlated to DIE recurrence.However,the multivariate analysis also revealed that a more severe dysmenorrhea and advanced rAFS stage were the independent factors associated with the recurrence of DIE,with an odds ratio of 1.895(confidence interval[CI]:1.061-3.385,P=0.031)and 4.310(CI:1.091-17.028,P=0.037),respectively.Conclusions:More than 10%of patients presented with recurrence of DIE 2 years after surgery.Recurrence of DIE was more common in patients who complained of more severe dysmenorrhea and had an advanced rAFS stage.

A Clinical Observation of Functional Abdominal Pain Syndrome in Patients Treated by Traditional Chinese Spinal Orthopedic Manipulation

Objective： To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation（TCSOM） in treating patients with functional abdominal pain syndrome（FAPS） in comparison with Pinaverium Bromide（Dicetel, PBD）, and to assess a possible cause for FAPS. Methods： Eighty patients with FAPS were randomly and equally assigned to the TCSOM group and PBD group according to the random number table. All patients in the TCSOM group were treated with a maximum of 5 times of spinal manipulations. Patients in the PBD group were instructed to take 50 mg 3 times a day, consistently for 2 weeks. The symptoms of pre-and post-treatment were assessed on a visual analog scale（VAS） pain score. A symptom improvement rating（SIR） was implemented to evaluate the effects of the treatments. Results： The symptoms of 27 cases of the TCSOM group were relieved soon after the first TCSOM treatment and 9 cases were significantly improved. The VAS pain scores in the TCSOM group were significantly lower than those in the PBD group after 2 weeks treatment. According to the SIR based on VAS, the TCSOM group included 30 cases with excellent results, 7 cases with good, and 3 cases with poor. Adverse events to the treatment were not reported. Based on VAS, the PBD group reported 8 cases with excellent results, 10 cases with good and 22 cases with poor. There was a significant difference between the two groups（P〈0.01）. Conclusions： The displacement of intervertebral discs and/or vertebra in the thoracic or lumbar region seems to be a contributing factor in the symptoms of FAPS. TCSOM is an effective treatment for FAPS.

Immediate analgesic effect of needling acupoints(bilateral De Qi vs unilateral De Qi)on primary dysmenorrhea:a multi-center,randomized,controlled trail

OBJECTIVE: To analyze the effect of needling acupoints(bilateral vs unilateral) with De Qi using data collected from 501 primary dysmenorrhea(PD) patients participating in multi-center, randomized,controlled trail.METHODS: De Qi was defined as at least one of the feelings in soreness, numbness, fullness or heaviness at the acupoints when stimulated with needles. The 501 patients were grouped in 3 groups in terms of De Qi or not De Qi in one side(unilateral)or both sides(bilateral) of the body: bilateral De Qi group, unilateral De Qi group, and non-De Qi group. The abdominal pains were measured using visual analog scale(VAS).RESULTS: In 501 patients, 472 acquired De Qi at unilateral acupoints, 24 De Qi at bilateral acupoint,and 5 had no De Qi at any acupoint. The data of non-De Qi group was excluded as the sample was less than 5% of that in the bilateral De Qi group.There was significant difference in the VAS before and after treatment between unilateral and bilateral De Qi group(P < 0.01). After stratified by acupoints, for the patients needled at Sanyinjiao(SP 6)and Xuanzhong(GB 39), VAS scores in the bilateral De Qi group were larger than those in the unilateral De Qi group(P < 0.05).CONCLUSION: Bilateral De Qi was possibly superior to unilateral De Qi in enhancing the immediate analgesic effect of needling the acupoints, but no statistical significance was observed on the pa-tients of needling at non acupoint, which preliminarily suggested this immediate analgesic effect was perhaps along meridians.