Superior-Labrum Anterior-Posterior Return to Sport Index (SLAP-RSI) Score to Quantify Psychological Readiness to Return to Play (223)

Objectives: Superior-labrum anterior-posterior (SLAP) tears are common among athletic populations and may require surgical treatment. Return to play post-operatively may be complicated by a number of factors, including psychological readiness to return. The purpose of this study was to evaluate the use of the SLAP Return to Sport Index (SLAP-RSI) score to quantify psychological readiness to return to play following operative management of SLAP tears. Methods: A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 12-month follow-up was performed. Patients were evaluated for their psychological readiness to return to sport using the SLAP-RSI score. The SLAP-RSI score was created by adapting the terms in the Anterior (ACL-RSI score) with terms related to SLAP tears. A SLAP-RSI score > 56 is considered a passing score for being psychologically ready to return to play. Results: The study included 174 athletes who underwent operative management of SLAP tears. Overall, 73.5% percent of patients were able to return to play, and the mean SLAP-RSI score in this cohort was 74.1±20.9, as compared to 46.7±27.7 in those who were unable to return (p<0.0001). Of those who returned, 82.1% passed the SLAP-RSI benchmark of 56, while of those who did not return, 33.3% passed the SLAP-RSI benchmark of 56. Additionally, a significant difference was found in each component of the SLAP-RSI score between the two cohorts (p<0.05). No individual component of the SLAP-RSI score was below 56 in patients who were able to return to play, while none was above 56 in those who were unable to return. Among patients who were unable to return, ones who cited lifestyle reasons had a higher SLAP-RSI score (77.4 ± 21.8) than those who cited residual pain (28.2 ± 15.1) or fear of re-injury (42.6 ± 23.6) (p<0.0001). Conclusions: Following the operative management of SLAP repair, patients that are unable to return to play exhibit poor psychological readiness to return which may be due to residual pain or fear of re-injury.

Residual Pain in the Context of Selecting and Switching Biologic Therapy in Inflammatory Rheumatic Diseases

For many years, inflammatory rheumatic diseases (IRDs) represented a source of disappointment in medical care caused by the mediocre efficacy of the available treatments. Some of these diseases, like Rheumatoid Arthritis (RA) or Ankylosing Spondylitis (AS), caused fear in the general population, especially due to associated joint deformities and subsequent disabilities. However, in the last 20 years, a new successful class of antirheumatic drugs has become available: biologic Disease-Modifying Antirheumatic Drugs (bDMARDs). Due to this innovative treatment, the days are over when joint and spine deformities defined the condition of a person with RA or AS. Nonetheless, expectations are higher today, and other clinical problems, (not entirely solved by bDMARDs), seem to drive the drug selection during the span of rheumatic diseases. Most of these issues are covered by the term “unmet needs.” One of the most intriguing of such needs is the residual pain (RP) in patients that are otherwise in the biological remission of the disease. Present in a significant proportion of the patients that enter remission status, RP is poorly understood and managed. In recent years, new data has become available in this area and new conceptual clarifications have occurred. In this review, we explain the various nature of RP and the necessity of treatment diversification in such situations. All in all, we believe this condition is far more complex than simple pain and includes other clinical aspects, too (like fatigue or mood changes) so the terms Post-Remission Syndrome (PRS), and PRS pain might be more appropriate.

Factors and Strategies for Post-Vertebroplasty Residual Pain from Thoracolumbar Osteoporotic Vertebral Compression Fractures (OVCF): a systematic review.

Purpose Insignificant pain relief (IPR) in short period after vertebroplasty is common, which often disturb doctors and affect patients Therefore, we reviewed systematically relative articles and attempted to get meaningful evidence on factors and strategies for IPR.Methods PubMed, Web of Science, Embase, CNKI, WanFang, and VIP were searched for literatures treating the osteoporotic vertebral compression fractures (OVCFs) with vertebroplasty and assessing the clinical efficacy.Results 817 references were electronically retrieved, 81 full-text papers were screened and 41 studies were included. Twenty-two trials presented factors on IPR, mainly including bone cement related, operation related and patient-related factors. Nineteen studies showed strategies on residual pain, including improving osteoporosis, reforming surgical operation and add other therapies. 16 prospective, 20 retrospective and 5 meta-analyses consisted the systematic review. The date from included studies point to different results, with less risk of bias, were needed to clarify the factors and strategies for residual pain.Conclusions Bone cement distribution and operation error are highly related to the post-vertebroplasty residual pain. Many therapeutic methods could improve pain and rehabilitate function but lacking more high-level evidence due to the insufficient trails.

Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

Effects of Scrambler Therapy in Patients with Failed Back Surgery Syndromes and Factors Associated with Depression Affecting Pain before and after the Therapy

Objectives. To report the effects of scrambler therapy in patients diagnosed with failed back surgery syndromes and to analyze the factors affecting pain before and after the therapy. Methods. This study included 26 patients (12 males and 14 females). The Oswestry Disability Index (ODI) and Brief Pain Inventory (BPI) before and after scrambler therapy, Beck Depression Inventory (BDI) score before therapy, and residual pain after therapy were assessed. The changes in the ODI, BPI, and residual pain before and after the therapy were analyzed using the Wilcoxon signed rank test. Spearman correlation analysis and Fisher’s exact test were used to confirm the correlation between BDI and other factors. Multiple regression analysis was used to identify independent factors predicting residual pain, posttherapy ODI, and posttherapy BPI. Results. The ODI changed from 25.69 ± 7.98 to 21.80 ± 9.41 (p<0.05), and the BPI changed from 68.96 ± 18.00 to 61.62 ± 20.27 after scrambler therapy (p<0.05). In addition, residual pain changed from 100 to 76.15 (p<0.05). The BDI was negatively correlated with the duration of scrambler therapy and positively correlated with the initial OPD and BPI. In multiple regression analysis, residual pain was significantly correlated with the BDI (p<0.05). Conclusion. Scrambler therapy can be used to change the total scores of the ODI and BPI after 5 sessions of treatment. Also, residual pain was significantly related to the BDI. Clinical significance of depression severity on pain should be further investigated via prospective studies.

FRI0335 THE EFFECT OF TOFACITINIB ON RESIDUAL PAIN IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:Current treatments for PsA have proven effective in reducing patient (pt)-reported pain;1,2however, residual pain often remains. Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA.Objectives:This descriptive analysis evaluated the effect of tofacitinib, adalimumab and placebo on residual pain in pts with PsA whose inflammation was attenuated after 3 months of therapy.Methods:Data were included from OPAL Broaden (NCT01877668), a randomised, double-blind, placebo-controlled Phase 3 trial of 12 months’ duration in pts with PsA.3Pts were randomised to receive tofacitinib 5 mg twice daily (BID), tofacitinib 10 mg BID, adalimumab 40 mg subcutaneous injection once every 2 weeks or placebo. This analysis assessed pts with ‘residual pain’ at Month (M)3. Residual pain was considered as pain in pts with complete attenuation of inflammation at M3, defined by a swollen joint count (SJC) of 0 and CRP levels <6 mg/L. Pain was measured by a visual analogue scale (VAS; 0 [“no pain”] – 100 mm [“most severe pain”]). Changes in pain from baseline to M3 and residual pain (VAS pain reported at M3) were assessed.Results:Demographics and baseline disease characteristics have previously been reported in the primary study, and were generally similar between treatment groups.3At M3, 100/422 (23.7%) pts with PsA had achieved SJC of 0 and CRP <6 mg/L. At M3, more tofacitinib-treated (tofacitinib 5 mg BID, n=23/107 [21.5%]; tofacitinib 10 mg BID, n=33/104 [31.7%]) and adalimumab-treated pts (n=31/106 [29.2%]) achieved SJC of 0 and CRP <6 mg/L vs placebo (PsA: n=13/105 [12.4%]). Baseline pain appeared numerically higher in tofacitinib-treated pts (tofacitinib 5 mg BID, 54.7 mm; tofacitinib 10 mg BID, 58.4 mm) vs adalimumab-treated pts (47.7 mm) and placebo (50.4 mm). In pts who achieved SJC of 0 and CRP <6 mg/L at M3, improvements in pain from baseline to M3 appeared numerically greater in pts receiving tofacitinib vs those receiving placebo (Figure 1a). When considering absolute (residual) pain at M3, mean residual pain was similar across treatment groups (ranging from 22.7–29.2 mm; Figure 1b), despite a higher baseline pain in tofacitinib treatment groups.Conclusion:Changes from baseline in pain and absolute pain at M3 suggest that in pts with PsA whose inflammation has been completely attenuated, tofacitinib might have an effect on residual pain not obviously attributable to inflammation. However, the sample population was small, and there were large standard deviations. To confirm these results and to understand the mechanisms by which tofacitinib may improve residual pain, a meta-analysis will be performed using individual participant data from pts with rheumatic disease who have participated in tofacitinib randomised controlled trials.References:[1]Gladman et al. Ann Rheum Dis 2007;66:163-68.[2]Gladman et al. Arthritis Care Res 2014;66:1085-92.[3]Mease et al. NEJM 2017;377:1537-50.Acknowledgments:Study sponsored by Pfizer Inc. Medical writing support was provided by Mark Bennett of CMC Connect and funded by Pfizer Inc.Disclosure of Interests:Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Clifton Bingham Grant/research support from: Bristol-Myers Squibb, Consultant of: Bristol-Myers Squibb, Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, Lara Fallon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, John Woolcott Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Yves Brault Shareholder of: Pfizer France, Employee of: Pfizer France, Lisy Wang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Meriem Kessouri Shareholder of: Pfizer France, Employee of: Pfizer France

Synovitis after Total Knee Arthroplasty: Possible Cause of Residual Postoperative Pain (Preliminary Study)

Purpose: The cause of residual pain after total knee arthroplasty (TKA) was unknown. Little attention has been given to postoperative synovitis as a cause of unexplained residual pain after TKA. Here we preliminarily investigated the relationship between synovitis after TKA and pain with ultrasonography. Methods: This study was conducted using convenient outpatient samples followed for TKA. Synovitis was accessed with ultrasonography. We originally made synovitis scores, which are a summation of the synovitis grade in the entire knee. Pain assessments including rest, moving pain visual analog scale (VAS) and WOMAC score and its subscale were evaluated. Correlations between synovitis scores or the maximum grade and pain assessments were analyzed. Pressure pain thresholds (PPTs) on synovitis were evaluated. Results: 46 knees in 37 patients (34 female, 3 male) were evaluated. Synovitis scores correlated with rest and moving VAS (r = 0.439; 0.355, p = 0.002, 0.016). PPTs on positive synovitis significantly decreased compared with grade zero (average PPTs (SD) on grade zero, one, two = 484(21), 255(13), 268(20) kPa; p < 0.001). Conclusion: Synovitis after TKA was associated with residual unexplained pain. Ultrasonography and synovitis scores should be available to evaluate synovitis after TKA.