This study aimed to explore the central mechanism of classical trigeminal neuralgia (CTN) by analyzing the static amplitude of low-frequency fluctuation (sALFF) and dynamic amplitude of low-frequency fluctuation (dALFF) in patients with CTN before and after a single-trigger pain.This study included 48 patients  with CTN. All participants underwent 3D-T1WI and three times resting-state functional magnetic resonance imaging. The images were taken before stimulating the trigger zone (baseline), within 5 s after stimulating the trigger zone (triggering-5 s), and in the 30th minute after stimulating the trigger zone (triggering-30 min). The differences between the three measurements were analyzed using a repeated-measures analysis of variance.The sALFF values of the bilateral middle occipital gyrus and right cuneus gradually increased, and the values of the left posterior cingulum gyrus and bilateral superior frontal gyrus gradually decreased in triggering-5 s and triggering-30 min. The values of the right middle temporal gyrus and right thalamus decreased in triggering-5 s and subsequently increased in triggering-30 min. The sALFF values of the left superior temporal gyrus increased in triggering-5 s and then decreased in triggering-30 min. The dALFF values of the right fusiform gyrus, bilateral lingual gyrus, left middle temporal gyrus, and right cuneus gyrus gradually increased in both triggering-5 s and triggering-30 min.The sALFF and dALFF values changed differently in multiple brain regions in triggering-5 s and triggering-30 min of CTN patients after a single trigger of pain, and dALFF is complementary to sALFF. The results might help explore the therapeutic targets for relieving pain and improving the quality of life of patients with CTN.The online version contains supplementary material available at 10.1186/s10194-022-01488-8. Trigeminal neuralgia (TN) is a severe chronic neurogenic pain, with predominantly right-sided onset  and an aNeurovascular compression (NVC) is considered to be the main cause of CTN , and demNeuroimaging has the advantages of being noninvasive and convenient, and the resting-state function magnetic resonance imaging (rs-fMRI) captures the neural activity in the brain of participants at rest, more closely mirroring the physiological state . It has The static amplitude of low-frequency fluctuation (sALFF) is one of the commonly used data analysis methods for fMRI, it is a reliable and sensitive technique . sALFF iThe dynamic ALFF (dALFF) uses the amplitude of low-frequency fluctuation (ALFF) with sliding window approaches . It is aIn our study, we reconstructed the pain status of patients with CTN having harmless daily activities and performed multi-time rs-fMRI. We hypothesized that sALFF and dALFF in multiple brain regions of patients with CTN changed differently after triggering pain. We used this to locate the brain regions associated with the development of CTN, thus providing a basis for studying the central mechanism of CTN.All the participants provided written informed consent. This prospective study was approved by the local ethics committee of the Hangzhou First People's Hospital, Zhejiang University School of Medicine (IRB# NO.202107002). It was carried out following the Declaration of Helsinki.Eighty-five patients with CTN were recruited prospectively from the Department of Radiology at Hangzhou First People's Hospital, Zhejiang University School of Medicine, between July 2021 and March 2022.The inclusion criteria for patients with CTN were as follows: 1) patients diagnosed with CTN according to the third edition of the International Classification of Headache Disorders (ICHD-3), and demonstration on MRI of NVC (not simply contact), with morphological changes (atrophy or dislocation) in the trigeminal nerve root ; 2) unilThe exclusion criteria were as follows: 1) patients with CTN who had undergone surgical treatment before; 2) headaches and other paroxysmal or chronic pain conditions; 3) a family history of headache or other pain in first-degree relatives; 4) other somatic or psychiatric conditions; 5) left handedness, and  contrainPatients on analgesic medications were asked to discontinue their medications 12 h before their scheduled scanning sessions. Before the MRI scan, a medical history was taken to determine which zone triggered more pain in daily life, and stimulated the trigger zone within 5 s before the second rs-fMRI scan. The trigger zone was stimulated by the doctors, which was gentle touch by long cotton swab . The foaIf the patients experienced the stimulated pain, the pain would be assessed using the Visual Analogue Scale (VAS) after the scan. The researchers guided patients in rating their pain on a scale of 0–10. A higher score indicated greater pain intensity. A rating of “0” represented no pain, and a rating of “10” meant intolerable pain.2; voxel size = 1 × 1 × 1 mm3; turning angle = 9 degrees), and 240 functional images . Each scanning process lasted 15 min.All patients underwent MRI using a 3.0 T MRI scanner  and an eight-channel phased-array head coil. All participants were instructed to close their eyes, stay awake, and breathe quietly until the scan was completed. The 3D damage-gradient echo sequence functional data were collected and used. The parameters were as follows: 176 structural images , (3) normalization of the structural images (T1-weighted images) to the Montreal Neurological Institute (MNI) and re-sampling of the resulting data to obtain 3 × 3 × 3 mm3 voxel size, (4) spatial smoothing with an isotropic Gaussian kernel of 6-mm full-width at half-maximum, which aimed to reduce the incomplete effect of registration and improve the image signal-to-noise ratio, (5) removal of linear trend of the time course of the blood oxygenation level-dependent (BOLD) signal, and (6) a noise removal process, including the regression of Friston-24 head motion parameters, cerebrospinal fluid signals, and white matter signals. If the head motion exceeded the 3-mm maximum displacement and the rotation exceeded 3° or the framewise displacement (FD) exceeded 0.5, 4 patients were excluded and the remaining 48 patients with CTN were selected for analysis.Rs-fMRI data preprocessing was conducted using the Data Processing and Analysis of Brain Imaging (DPABI) and Sales Process Management 12 (SPM12) toolbox based on the MATLAB platform . The preprocessing pipeline included the following steps: (1) discarding the first 10 volumes of each session to ensure that the MRI signal reached a steady state, (2) slice-timing and head motion correction of the remaining images  for multiple comparison correction. The Spearman correlation analysis was used to assess the association between the average sALFF and dALFF values of significant clusters and pain characteristics.In the Data Processing & Analysis of Brain Imaging (DPABI) software, we compared the sALFF and dALFF values of regional brain activity, which were measured three times for patients with TN using repeated-measures analysis of variance (ANOVA) to examine the differences between groups. Based on Gauss random field theory  and right cuneus gradually increased in triggering-5 s and triggering-30 min, the values for the left posterior cingulum gyrus (PCC) and bilateral superior frontal gyrus (SFG) gradually decreased in triggering-5 s and triggering-30 min, the values of the right middle temporal gyrus (MTG) and right thalamus decreased in triggering-5 s and subsequently increased in triggering-30 min, and the sALFF values of the left superior temporal gyrus (STG) increased in triggering-5 s and then decreased in triggering-30 min Table . The resThe bilateral SFG and right cuneus were significantly correlated with VAS at baseline, the left PCC was significantly associated with VAS at baseline and triggering-5 s Table .Table 3TCompared with the baseline, the dAFLL values of the right fusiform gyrus, bilateral lingual gyrus, left MTG, and right cuneus gyrus gradually increased in triggering-5 s and triggering-30 min Table . The resThe right cuneus was significantly correlated with VAS at baseline Table .Table 5TOur study found that the sALFF and dALFF values changed differently in multiple brain regions during two time points after triggering pain. The sALFF and dALFF values changed in different brain regions, and they also overlapped with each other. The sALFF values demonstrated the steady intensity of activity in brain regions, while the dALFF values reflected the plasticity and flexibility of spontaneous brain activity through the variability of energy expenditure . Both weWith the deepening of research on CTN, increasing evidence indicates that the central mechanism is involved in its occurrence and development , 30. MosThe STG is located in the temporal lobe. In our study, compared with the baseline, the sALFF values of the left STG increased in triggering-5 s and then decreased in triggering-30 min, but they did not return to the baseline. This finding indicated that the STG not only participated in the process of CTN but also failed to return to the baseline level within half an hour. CTN is a special type of chronic neuropathic pain, and the STG is involved in forming pain memory. Studies have shown that individuals who exaggerate pain show increased activity in the STG during pain stimulation . Mayr etThe MTG is part of the default mode network (DMN), which is the most stable resting-state network. The DMN is usually active when it is not in contact with any external environment, and the signal is suppressed when it is subjected to painful stimulation. In our study, the changing pattern of sALFF values in the right MTG during the three different times indicated that it was not only involved in the process of CTN pain but also was part of a trend of recovery in a short time. Yuan et al.  found thThe thalamus is located on both sides of the third ventricle, and the left and right thalamus are connected by a mass of gray matter. This connection participates in the formation of the limbic system and is considered as a "pain matrix". In our study, the signal changes in the thalamus were similar to those in the MTG after triggering the pain, which decreased in triggering-5 s and increased in triggering-30 min. It indicated that the low-frequency oscillations of spontaneous brain activity from the thalamus were interrupted in a short time after triggering pain, and then either recovered or even increased. This further elucidated the important role of the thalamus in the processing of pain. Zhang et al.  found byCompared with the baseline, the sALFF value in PCC gradually decreased in triggering-5 s and triggering-30 min, with no recovery trend. This indicated that PCC not only participated in the pain process of CTN but also acted for a long time, and the PCC was negatively corrected with VAS at baseline and triggering-5 s. PCC is associated with pain and memory, and it can combine bottom-up attention with information from memory and perception. Borsook et al.  found diThe SFG is located in the upper part of the prefrontal cortex. In this study, the signal change patterns of the bilateral SFG were similar to those of the left PCC, and the SFG was positively corrected with VAS at baseline. The SFG is involved in socially oriented thinking and is also associated with the expectation of impending pain . Mayr etBoth the MOG and the cuneus are located in the occipital lobe. The occipital lobe contains most of the anatomical areas of the visual cortex, facilitates visual information processing and communication with the cerebral cortex, and plays a role in the perception of facial emotions. Besides visual information processing, it also integrates somatosensory information with other sensory stimuli and cognitive processes, including attention, learning, and memory. In our study, compared with the baseline, the sALFF values in bilateral MOG and right cuneus gradually increased in triggering-5 s and triggering-30 min. Xiang et al.  found thIn our study, the sALFF and dALFF signals of the right cuneus changed and gradually increased after triggering pain, which were both negatively corrected with VAS at baseline. No changes were found in sALFF and dALFF values in other brain regions, indicating that dALFF was complementary to sALFF and provided more information for the study of the pathophysiological process of CTN.Compared with the baseline, the dALFF values of the bilateral lingual gyrus, right fusiform gyrus, and left MTG decreased at different times after stimulating the trigger zone, and the left MTG was positively corrected with average duration of attack at baseline. The lingual gyrus is located in the occipital lobe and below the talate sulcus, which is a part of the primary visual cortex and associated with visual memory and attention deficits. Russo et al.  found byThe fusiform gyrus is located on the basal surface of the temporal and occipital lobes, and is involved in sensory integration and cognitive processing. This region is also an important part of the limbic system and is closely associated with mental abilities such as emotion, behavior, learning, and memory. The fusiform gyrus plays an important role in the anticipation and perception of pain regulation . Xiang eThis study had several limitations. Firstly, the central mechanism of CTN was studied by imitating or reproducing the pain state of patients with CTN, but it was only prolonged for 30 min after triggering the pain. The results indicated that it was necessary to prolong the time before scanning so as to better understand the changes in brain function in patients with CTN after an episode of pain. Secondly, we did not conduct the classification studies according to the average duration of attack, and in the future we will study CTN patients depending on the average duration of attack. Thirdly, we only studied the imaging data of patients with CTN before and after pain, and we did not carry out the correlation analysis with clinical parameters.Our study was conducted by simulating or reproducing a single pain trigger in patients with CTN. We found that compared with the baseline, the sALFF and dALFF values changed differently in multiple brain regions at different times after a single trigger of pain, and dALFF was complementary to sALFF. The findings provided a basis for exploring the central mechanism of CTN and the therapeutic targets to help patients relieve pain and improve their quality of life.Additional file 1: Supplementary file 1. Regions with dynamical amplitude of low-frequency fluctuations in CTN patients with the step size of 5 TRs (10 s).


Three patients (20%) reported clinical success at 3 months. Three patients experienced minor complications after embolization  and two patients had moderate complications (transient skin ischemia). Conclusion: MSK embolization with microspheres for treatment of refractory chronic shoulder pain showed moderate results in terms of clinical success and safety.Purpose: Musculoskeletal (MSK) embolization is emerging in tendinopathy treatment. The objective of this study was to assess the efficacy and safety of MSK embolization with microspheres in the treatment of chronic shoulder pain. Patients and methods: This retrospective monocentric study included patients with chronic shoulder pain resistant to 6 months or more of conventional therapies who were treated with MSK embolization between 2017 and 2021. Embolization was performed using calibrated 100–250 µm microspheres. Clinical success was defined as pain reduction, i.e., a decrease in the visual analogue scale (VAS) pain score of ≥50% at 3 months after MSK embolization as compared to baseline. Adverse events were collected. Results: Fifteen patients  were included, with a median age of 50.3 years (IQR: 46.7–54.5). The median duration of symptoms was 26.6 months (20.6–39.8). The median VAS pain scores were 7.0 (7.0–8.0) at baseline, 6.0 (3.5–7.0) at 1 month, 5.0 (4.5–6.5) and 5.0 (3.0–7.4) at 3 months and 6 months ( Chronic shoulder pain is a global burden affecting between 4.7% and 46.7% of the adult population each year  and reprRecent studies have focused on destruction of the pathological loops of inflammation. Inflammation is at the origin of the development of neovascularization, feeding nerve growth and inducing chronic disabling pain ,10. ThesBased on this theory, musculoskeletal (MSK) embolization is emerging as one of the new analgesic therapeutic strategies for treating tendinopathies. It was recently reported in patients with tendinopathies, enthesopathies and retractile capsulitis of the shoulder with good safety and good clinical results ,15,16,17The major embolic agent reported in the literature for MSK embolization is an antibiotic solution, imipenem–cilastatin, administered in emulsion with contrast media, with temporary embolic properties after microcrystallization ,19,20. ANon-resorbable agents, such as microspheres, are used in daily practice in a wide range of embolization procedures, such as uterine fibroids , benign Our retrospective monocentric study was approved by a national institutional review board (CRM-2110-208). Before data collection, patients were informed about the study and could, in accordance with the local regulation for retrospective studies, oppose the use of their anonymized data for this research. Embolization was proposed for compassionate purposes to patients aged 18 years or older suffering from chronic inflammatory shoulder pain with restriction of movement and refractory to all conventional treatments  for at least 6 months, after validation in a multidisciplinary meeting with an orthopedist, an algologist and a radiologist. All consecutive patients who underwent MSK embolization between June 2017 and September 2021 were included in the study. Patients were not included in the study if they had a complete rotator cuff tear, if they presented arthropathy secondary to chronic inflammatory rheumatism  or microcrystalline rheumatism or had chronic renal insufficiency or hemostasis disorders. Pregnant women were not included. Patients who had MSK embolization for chronic shoulder pain with other embolization agents were also excluded.For all patients included, the procedures were performed by one interventional radiologist (JG) with 6 years of experience. The procedures were scheduled on an outpatient basis in an angiographic room . Under local anesthesia and ultrasound guidance, percutaneous arterial radial access was performed using a 4 F introducer sheath . Digital subtraction angiography from the subclavian artery was performed with a 4 F angiographic catheter  to locate the arteries feeding the shoulder joint. The selective catheterization was performed with a 2.0 F microcatheter  to look at neovessels, i.e., abnormal vessels characterized on imaging as a tumor blush, as at arterial phase, with occasional early venous drainage.®, Boston Scientific Corporation, Malborough, MA, USA) diluted to the eightieth. The solution was loaded in a 1 ml syringe and injected 0.1 mL per 0.1 mL. A maximum volume of 4 mL of diluted particles  solution was injected to limit off-targeted ischemic complications. Cutaneous collaterals were protected using an icepack on the skin. The patient related during the procedure whether the selective injection of iodine contrast reproduced the usual shoulder pain, thus reinforcing the operator to perform embolization in this area. The therapeutic strategy consisted in embolization of the neovessels, whilst carefully maintaining the larger vascular supply to off-target structures, such as the skin and bones. The disappearance of neovessels, i.e., the reduction of the tumor blush with a “dead tree” appearance, described in the literature [When neovessels were detected, embolization was carried out using calibrated microspheres of 100–250 µm , as compared to pain measured at baseline . The patThe secondary objectives were to evaluate the technical success and safety of the MSK embolization procedure using non-resorbable microspheres to evaluate the minimum clinically important difference (MCID) of the procedure and to assess the evolution of MRI inflammatory signals before and after the procedure. Technical success was defined as embolization achieved for one or more arteries supplying neovessels, confirmed by angiography after the procedure. All complications related to MSK embolization that occurred between the MSK embolization procedure and the last patient follow-up consultation 6 months after the procedure were collected according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) criteria . The MCI® (version 16.49) and using GraphPad Prism software (version 9.3).Standard descriptive statistics were used for continuous quantitative variables presented as medians and interquartile ranges and for qualitative variables presented as numbers and percentages. A Wilcoxon signed-rank test was performed to compare pain VAS score before and after embolization. Fisher’s exact test was used to compare pain scores at baseline and 3 months for the MCID analysis. The level of statistical significance was set at 0.05 for all comparison tests. Analyses were performed on ExcelThere were 15 patients retrospectively included in the study. They were referred to our academic center and benefited from MSK embolization for chronic shoulder pain. Demographic data are summarized in The technical success was 100%, as MSK embolization by selective catheterization of at least one feeder artery with reduction of the vascular blush in angiography was achieved in all 15 patients . The prep = 0.002). Among the patients who had initial nocturnal pain (n = 13/15), 10 reported an improvement (77%), whereas 3 patients did not report any difference (23%). Concerning range of motion, six patients (40%) reported an improved mobility 3 months after the procedure. No patient reported increased pain or decreased range of motion 3 months after the procedure. Concerning the MCID, three months after the procedure, four patients (27%) reported pain improvement and were satisfied with the procedure (p = 0.099).Clinical success, i.e., pain decrease ≥ 50% (VAS), was reported at 3 months in three patients (20%) . Among tn = 2 (13.3%)) and transient osteo-medullary edema (n = 1 (7.7%)) , was reported in eight patients 53%, . Two pat (7.7%)) .Enhanced MR images before embolization were available for 13 patients (87%) and 1 patient had a non-enhanced MRI (including T2-weighted sequences) . AngiogrThis study showed the moderate efficacy of MSK embolization with non-resorbable microspheres for treating chronic shoulder pain. Besides a technical success of 100%, moderate adverse events were reported with off-target embolization.p = 0.002). This effectiveness should be toned down by its clinical relevance: indeed, only 3 patients (20%) reported MSK embolization clinical success in terms of pain reduction, one of whom experienced symptom recurrence only 6 months after embolization. This is far less effective than MSK embolization for shoulder pain with imipenem–cilastatin, as reported by Okuno et al. [Our results showed a statistically significant reduction in pain, with a median VAS of 5.03 months after MSK embolization compared to 7.0 at baseline , much longer than those of cohorts in previously published studies  suffered a significant post-embolization syndrome  that required analgesics. This was not reported in previous studies using imipenem–cilastatin. In genicular artery embolization with microbeads , it was The systematic use of enhanced MRI  may generate interesting data and possible correlations with angiographic serigraphs and thus increase the attention paid to tumor-like blushes during patient management. Some patients had angiographic blushes without contrast on pre-embolization MRI; however, T2-weighted hypersignals showing inflammation were often well correlated with the angiographic blushes.Patients included in this study had symptoms lasting longer than 6 months and had failed standard treatments, including corticosteroid injections. Other approaches are currently being evaluated, although they are mostly oriented towards early damage for PRP injection  or do noOur study has several limitations, one of which is its retrospective character. It was also monocentric, with a small sample, as it was a first experience in this indication, which limits the weight of our results. However, we believe that our safety results for MSK embolization with microspheres for chronic shoulder pain need to be reported, as it is currently performed in genicular arteries with very acceptable safety results, as described by early published reports ,27,33,39MSK embolization with non-resorbable microspheres for chronic shoulder pain refractory to conventional therapies is feasible but associated with significant adverse events. Its efficiency seems to be lower than that of embolization with imipenem–cilastatin emulsion.


Temporomandibular joint disorders (TMDs) are ailments affecting the jaws and allied structures, resulting in many pathologies . Pain, clicking or crepitus, restricted range of motion, deranged jaw function, and deflected or deviated mouth opening and closing are the commonly observed manifestations in TMDs. Internal derangement refers to an aberrant relation of the articular disc to the condyle and fossa, respectively. Conventional therapies highlight the role of non-invasive conservative treatment strategies, namely joint unloading, anti-inflammatory drugs, and physiotherapy. Current literature has emphasized the use of corticosteroids and platelet-rich plasma (PRP) as treatment strategies in TMDs. This study aimed to evaluate whether intra-articular injection of PRP after normal saline lavage in TMJ minimizes the symptoms of TMDs, as compared to injection of normal saline. Thirty patients with TMD according to research diagnostic criteria (RDC) were selected. One group received arthrocentesis with normal saline, and the other group received arthrocentesis with PRP injection. The patients were assessed for pain, maximum inter-incisal mouth opening, bite force, and TMJ sounds. TMDs treated by PRP injection had slightly better results. More studies are required to substantiate the outcome. Injections of PRP were more effective in reducing the symptoms than arthrocentesis with normal saline. Chronic facial pain is a common cause of disability in patients' daily activities. Management of pain requires medical and surgical procedures by health professionals. This raises the need for multidisciplinary treatment due to the complex character of complaints. Temporomandibular joint pain occurs in the movement of the mandible when chewing and speaking, increasing the pain even further –4.Temporomandibular disorders (TMD) can be divided into muscle and articular categories. However, differences between the two are sometimes difficult to differentiate because muscle disorders may often camouflage articular disorders, or they may stay together. Myogenic complications include myalgia , myospasm, isolation, and fibrosis/contracture. Articular problems include synovitis/capsulitis, inflammation of the joints, trauma/fractures, arthritis, and neoplasm .Modification of cartilage structure and the subchondral bone due to collagen reaction, extracellular matrix, macromolecules, and proteoglycans usually occurs in TMDs , 7. InteAdvice and medications recommended for TMDs include educating patients on behavior modification and reducing stress, jaw relaxation exercises, soft foods, non-steroidal anti-inflammatory drugs (NSAIDs), splints, and physiotherapy. If surgical intervention is required, management includes arthrocentesis, disc repositioning, or discectomy for TMD patients , 9.This study aimed to compare the results of arthrocentesis with normal saline and arthrocentesis with normal saline and platelet-rich plasma (PRP) by evaluating mouth opening, pain, and bite force as prognostic criteria.This study included 30 patients, with 15 patients randomly selected in group A and 15 patients in group B. All patients were selected from the Outpatient Department (OPD) of Oral and Maxillofacial Surgery, Jamia Millia Islamia, New Delhi, for 24 months (June 2018 to 2020). All patients were selected according to the research and diagnostic criteria (RDC). Arthrocentesis using normal saline was used for Group A, and arthrocentesis using normal saline and PRP was used in Group B (15 patients) .Inclusion criteria: diagnosis by the Research and Diagnostic Criteria and age more than 18 and less than 60.Exclusion criteria: include age less than 18 and above 60, poor overall health of the patient, and diagnosis of connective tissue diseases. Contraindications of using platelet-rich plasma include platelet function disorders, fibrinogen deficiency, and anticoagulation treatment.Bite force assessment;Pain assessment using Visual Analog Scale (VAS);Minimum incisal opening;TMJ sounds;Operating time;Patient compliance.5 ml of blood was withdrawn from the patient. Then, the blood was poured into a test tube with sodium citrate anticoagulant (0.5 ml) and centrifuged at an average of 2100 rpm for 15 minutes. After that, the plasma of the first crop was separated using centrifugation at 3500 rpm for 10 minutes to collect the pellet. For each TMJ, 0.8 ml of PRP was injected into 2 ml syringes,The temporomandibular region was prepared with an antiseptic solution. The injection point was marked 10 mm forward from the tragus and 2 mm below the trago-canthal line. After blocking the auriculotemporal nerve, the joint was washed with 200 ml of normal saline in group A. In group B, 200 ml of normal saline was injected, and after irrigation with normal saline, platelet-rich plasma was injected. During the procedure, the patient's mouth was wide open. After the injection, the patient was asked to make temporomandibular joint movements slowly.Postoperatively, the same treatment modality was applied in both groups to all patients after intra-articular injections. Three days after the injection, patients were advised to open their mouths as slowly as possible. Starting with the fourth day onwards, they were asked to open their mouths until reaching the threshold of pain.Mouth opening was measured using a scale from the incisal edge of the mandibular incisors to the incisal edges of maxillary incisors. Bite force was measured using a bite force measuring device. The bite was measured between upper and lower right maxillary first molars. Three readings were taken, and the mean was calculated for all three readings. Pain measurement was performed using the VAS scale. The observation was made by the same doctor before and after the procedure.The average range of mouth opening  before treatment in groups A and B was 20±1.5 mm. The average interincisal mouth opening before treatment in groups A and B was 16–35 mm. Patients in groups A and B improved mouth opening after 3 months. The average interincisal mouth opening after one month in group A was 25±1.6 mm. After one month, the average incisal opening in group B was 24.2 mm. The average mouth opening after 3 months was 35 in the case of PRP, and in group A it was 30.5. Results pointed out that average mouth opening in group A was similar to mouth opening in group B in the first month, but as time passed, mouth opening in group B improved more than in group A.Pain evaluation was done in both groups three months after the follow-up. Both groups had a reduction in pain intensity. At the 3-months follow-up, out of 15 patients who underwent PRP therapy, 14 patients had a reduction in pain at their examination. However, of the 15 patients who underwent arthrocentesis with normal saline only, 12 reported a reduction in pain. After treatment, pain relief was significantly more pronounced in group B (treated with PRP). In group A , after 3 months of follow-up, 8 cases were pain-free, and the other 5 cases had reduced pain intensity. In group B, 9 cases were pain-free, and 5 had reduced pain. Significantly, in the first month after lavage, patients in group B experienced more pain than group A.According to the VAS scale, both groups experienced pain initially. On the first day after surgery, the pain increased in all patients due to the intervention, but it improved from the second day onwards . Also, mThe time consumed in the first group was significantly less than in the second group, as the second group required withdrawal of blood and PRP preparation, but compliance in group A was slightly better.Comparing PRP combined with arthrocentesis to arthrocentesis alone elicited more promising and coherent results. Reports by Kilic et al. revealed superior masticatory efficiency in patients treated with PRP injections, and cone-beam computed tomography (CBCT) evaluation also validated two-fold improved reparative remodeling in osteoarthritis patients . HoweverAccording to Mustafa et al. , there wAccording to the VAS scale, all patients experienced pain in both groups initially. On the first day after surgery, the pain increased and mouth opening reduced because of the intervention, but it improved from the second day  and 2. A


Sciatica is a pain disorder often caused by the herniated disk compressing the lumbosacral nerve roots. Neuroimaging studies have identified functional abnormalities in patients with chronic sciatica (CS). However, few studies have investigated the neural marker of CS using brain structure and the classification value of multidimensional neuroimaging features in CS patients is unclear.Here, structural and resting-state functional magnetic resonance imaging (fMRI) was acquired for 34 CS patients and 36 matched healthy controls (HCs). We analyzed cortical surface area, cortical thickness, amplitude of low-frequency fluctuation (ALFF), regional homogeneity (REHO), between-regions functional connectivity (FC), and assessed the correlation between neuroimaging measures and clinical scores. Finally, the multimodal neuroimaging features were used to differentiate the CS patients and HC individuals by support vector machine (SVM) algorithm.Compared to HC, CS patients had a larger cortical surface area in the right banks of the superior temporal sulcus and rostral anterior cingulate; higher ALFF value in the left inferior frontal gyrus; enhanced FCs between somatomotor and ventral attention network. Three FCs values were associated with clinical pain scores. Furthermore, the three multimodal neuroimaging features with significant differences between groups and the SVM algorithm could classify CS patients and HC with an accuracy of 90.00%.Together, our findings revealed extensive reorganization of local functional properties, surface area, and network metrics in CS patients. The success of patient identification highlights the potential of using artificial intelligence and multimodal neuroimaging markers in chronic pain research. Sciatica is a pain disorder often caused by the herniated disk compressing the lumbosacral nerve roots, usually presenting as pain radiating from the low back down to the leg below the knee . About aPrevious neuroimaging studies have shown greater regional homogeneity (REHO) of the posterior cingulate  and loweGiven these neuroimaging findings on chronic pain, we speculated that patients with CS may also have abnormal changes in structural properties or between-regions FC. In addition, previous studies have applied machine learning techniques to distinguish patients with post-herpetic neuralgia (PHN) and HC using the amplitude of low-frequency fluctuation (ALFF) values . HoweverTherefore, this study aimed to investigate the underlying neurobiological mechanisms of CS using surface-based morphometry, local functional metric, and network FC analyses in patients with CS using structural and functional magnetic resonance imaging (fMRI) data. Besides, the relationships between neuroimaging measures and clinical symptom scale scores were examined. Furthermore, the diagnosability of the neuroimaging properties was evaluated utilizing a support vector machine (SVM) of machine learning techniques and neuroimaging features with significant differences between CS patients and HC.This study included 34 CS patients who meet the diagnostic criteria of sciatica  and 38 HThe key inclusion criteria of CS people were: (1) 35–65 years old; (2) having unilateral radiating leg pain below the knee for more than 3 months, accompanied by a positive straight-leg raise test or corresponding neurological deficit  with magnetic resonance imaging (MRI) or computed tomography (CT) confirmed disk herniation, (3) leg pain intensity on the visual analog scale (VAS) (0–100 mm) of 40 mm or higher , (4) rigThis study has been approved by the Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (No. 2020BZYLL0803), and it was part of a study registered in Chinese Clinical Trial Registry (ChiCTR2100044585). All participants provided written informed consent according to the Declaration of Helsinki after study procedures were explained to them thoroughly. We collected MRI data from all participants.After recruitment, the following clinical measurements were evaluated by CS patients within the day before the MRI scanning. VAS was performed to rate the extent of pain in the leg and low back. Oswestry Disability Index (ODI)  was condMagnetic resonance imaging images were obtained at a Siemens 3.0 T MRI scanner  using a standard head coil at the Department of Radiology for Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University. The high-resolution T1 structural MRI (sMRI) was acquired using a gradient echo sequence with the following parameters: repetition time (TR) = 2,530 ms, echo time (TE) = 2.98 ms, flip angle (FA) = 7°, inversion time = 1,100 ms, field of view (FOV) = 240 mm × 240 mm, number of slices = 192, voxel size = 1 mm × 1 mm × 1 mm, and in-plane resolution = 256 × 256. And resting-state functional MRI (rs-fMRI) was scanned using echo-planar imaging (EPI) sequence with the following parameters: whole brain, TR = 2,000 ms, TE = 30 ms, FOV = 224 mm × 224 mm, FA = 90°, slice thickness/gap = 3.5/0.6 mm, voxel size = 3.5 mm × 3.5 mm × 3.5 mm, axial slices = 32, in-plane resolution = 64 × 64, and 240 volumes. The scan duration was 5 min for the T1-weighted image and 8 min for EPI scans for blood oxygen-level dependent (BOLD)-based functional neuroimaging. We used comfortable foam pads to minimize head motion and earplugs to reduce noise interference. Before starting scanning, we instructed participants to keep their eyes closed, stay awake, avoid engaging in any specific thoughts and keep still.U of non-parametric test result showed that there is no significant difference in head motion among the three groups .Visually checking image quality by a neuroradiologist (QR) to make sure there were no apparent structural abnormalities or artifacts present, and the images with head movement greater than 2 mm in any direction or head rotation greater than 1° were excluded. Two HCs were excluded from the study on account of excessive head motion (>2 mm in translation or >2.0° in rotation) during the rs-fMRI scanning. The two excluded participants were female, their ages were 48 and 54 years. As a result, 34 patients with CS and 36 HCs were included in further statistical analyses. Furthermore, we also extracted the mean framewise displacement (FD)  for each1 was used to pre-process T1-weighted images, the key steps including motion correction, non-uniform intensity normalization, talairach transform computation, skull removal, volumetric segmentation, cortical surface reconstruction and so on. Mean cortical thickness and surface area were calculated for each of the 68 cortical regions of the Desikan-Killiany Atlas (34 per hemisphere). Cortical thickness was estimated for each participant using the distance from the white matter boundary to the corresponding pial surface  surface . The cer2  (version 6.1)2 . For eacIt should be noted that ALFF was calculated without filtering during the pre-processing process, and REHO was not smoothed during the pre-processing but smoothed after it was calculated, to allow the data to be normalized, which would be conducive to statistical analysis and indicator standardization. ALFF and REHO values were calculated using the DPBAI toolbox. ALFF is used to detect the regional intensity of spontaneous fluctuations in the BOLD signal, REHO calculates the temporal homogeneity of the BOLD signal between a given voxel with neighboring voxels. These measures were selected to pinpoint the spontaneous neural activity of specific regions and physiological states of the brain. The ALFF measures the gross power of oscillations within a certain frequency range, using the DPBAI software and regions of interest (ROIs) defined by the Anatomical Automatic Labeling (AAL) ROI library. The calculation procedure: (1) Fast Fourier Transform (FFT) was used to convert all voxels from the time domain to the frequency domain; (2) the ALFF of every voxel was calculated by averaging the square root of the power spectrum across 0. REHO was computed based on Kendall’s coefficient of concordance (KCC) of the time series of the voxel with its nearest 26 neighboring voxels. The REHO was computed for all brain voxels.z-values. We grouped significant nodes according to a well-defined seven-network atlas derived from 1,000 healthy participants by We used the software MATLAB 2017 and the DPABI (version 6.1) to extract time courses of 160 ROIs in the Dosenbach 160 atlas . Each ROp < 0.05.Demographic data collected from either group includes age, gender, educational level, and occupation. Participants were asked to indicate the physical activity level of the work they do most of the time, the nature of occupation was defined as manual work and mental work. We used Statistical Package for Social Sciences (SPSS) V21 software to conduct statistical analyses. Before statistical analyses, we checked the normality of each metric. Education in each group and age of the HC group were non-normally distributed, we used Kolmogorov–Smirnov non-parametric tests. As for categorical variables , we used the Chi-Square test to evaluate the differences between groups. The significance level was set at t-tests were used to compare the regional-wise differences between the two groups if the measurements were normally distributed , and if the data distribution is not normal, we used non-parametric tests of Mann–Whitney U. Effect sizes are depicted as Cohen’s d. The effect size was computed at https://www.psychometrica.de/effect_size.html.The cortical surface area and cortical thickness of CS patients and HC were extracted. Then, we used SPSS V21 software to conduct statistical analyses. Two-sample independent t-tests were performed to compare the results between the two groups, Gaussian Random Field theory (GRF) correction, voxel-level p < 0.001, and cluster-level p < 0.05. We extracted the values of ALFF and REHO results and calculated effect sizes using Cohen’s d.For ALFF and REHO maps, voxel-wise two-sample independent t-tests with FDR corrected (p < 0.05) in DPABINet . The figures were distributed in DPABINet and BrainNet Viewer.3 Finally, we extracted the values and showed them in the tables. Cohen’ s d was used as the effect size measure.For FC analyses, we also used two-sample independent p < 0.05).We extracted metrics  with significant group differences and investigated their relationships with clinical variables. VAS score for leg pain, VAS score for back pain, ODI score, SF-36 for physical, SF-36 for mental, SFBI for frequency, and SFBI for bothersomeness were investigated. For non-normally distributed variables , we used Spearman’s correlation analyses. For the other normally distributed variables, Pearson correlation was used to analyze the correlation. The above statistical analyses were implemented using SPSS V21  framework. First, the C regularization parameter and the linear kernel function were optimized by performing 5-fold cross-validation on the n-1  training data. Once the optimal SVM model was obtained, it was applied to classify the left-out individual as CS or HC.The performances of a classifier were quantified using accuracy, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC). Note that the specificity represented the proportion of the HC individuals correctly predicted, while the sensitivity represented the proportion of the CS individuals correctly predicted. Specifically, accuracy is calculated as (TP + TN)/(TP + TN + FN + FP), sensitivity is defined as TP/(TP + FN) and specificity is defined as TN/(FP + TN), where TN is the number of true negatives , TP is the number of true positives , FN is the number of false negatives , and FP is the number of false positives . In addition, the AUC is an evaluation measure based on the ROC curve, which illustrates the performance of the classifier. The ROC curve is delineated by plotting 1-specificity and sensitivity at different thresholds, and the thresholds of each ROC curve underwent stepwise variation from 0 to 1 in each 0.1 interval. Last, the model’s performance was evaluated by computation of the Matthews Correlation Coefficient (MCC). The calculation formula  is as fop = 0.449), gender (Chi-square test: p = 0.497), years of education (p = 0.381), and occupation (Chi-square test: p = 0.204) between the CS and HC groups   and right rostral anterior cingulate (rACC)  , the FC between left basal ganglia and left precentral gyrus had a negative correlation with the VAS for leg pain score , and the FC between mFC and left precentral gyrus had a negative correlation with the VAS for leg pain score . The correlation results were shown in For FC analysis, there were 15 connections between SMN and VAN that exhibited higher connection strength in the CS group than in the HC group, with a few connections among other networks. In addition, there were 10 lower connections among six networks  in cLBP patients, and the FCs could discriminate cLBP patients from HCs with 91% accuracy . Our stuThe SMN including the primary and secondary sensorimotor cortex, which receives and processes sensory information from the periphery, is thought to be the main brain network responsible for pain perception . AbnormaOur study also showed the abnormal FCs within FPN and with the other networks, and previous studies have shown positively associated with pain rating changes . The froIn recent years, SVM techniques combined with neuroimaging metrics have been applied to differentiate pain patients from HCs and to predict the outcome of certain interventions . The patHowever, chronic pain could affect multiple brain systems and cause extensive reorganization of brain structure and function, and the results of these studies were often derived from a few modalities, ignoring the combination of multiple modalities, which may affect the performance of the machine learning classifiers. In our study, SVM was applied to combined MRI imaging features , which distinguished CS patients from HC with higher accuracy of 90.00%. The finding implies that multimodal data analysis gives better results and exhibits the best model’s performance (MCC = 0.800) than unimodal analysis. The multimodal analysis could combine the advantages of multiple imaging techniques to improve both spatial and temporal resolution and target disease neurobiomarkers with high specificity and sensitivity and provide many new opportunities to improve brain research. The identification of distinguishable or predictive neuroimaging biomarkers is needed as it can aid in diagnosis and prognosis, as well as be helpful in clinical decision-making. To date, one of the few factors that independently predict poor outcomes in sciatica is the duration of leg pain , the appWe acknowledge that our research has several limitations. First, the present study was based on 34 CS patients and 36 HCs, it is necessary to expand the sample size to confirm the results. Brain metrics and clinical variables correlation analysis were conducted with two-sided significance levels  without corrections for multiple comparisons due to the small sample size and the exploratory nature of the study. Second, the study covered a range of ages from 35 to 65 years, restricting the generalization of the present results to other populations. Future studies with the younger or older age range are needed to increase external validity. Third, it might be a lack of a dataset of patients with other chronic pain disorders, we could not verify the specificity of the multimodal markers. Future studies with more datasets of pain-related disease will help clarify which specific chronic pain diseases  are associated with functional impairment in different brain domains. Fourth, perhaps even more importantly, clinical measurements were evaluated at a single time point (1 day before MRI scanning) which does not necessarily reflect the long-term status of an individual, other time-dependent variables on multiple time points may provide more information on the chronic pain status. Fifth, the results of the brain’s functional network are affected by different parcelation strategies. Other brain atlases are needed to further assess the reliability of the differentiation of CS individuals. Last, we acknowledged that we only recruited sciatica patients with diagnosed disk herniated disks, and it cannot distinguish if the results are due to pain, or due to the specific nature of the origins of the pain in the patient group, so our results should not be exaggerated.Our findings provide new insights into the pathophysiologic mechanisms of CS and highlight the potential of multimodal features as markers in the research of neural mechanisms of chronic pain.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (No. 2020BZYLL0803). The patients/participants provided their written informed consent to participate in this study.XYW: formal analysis, visualization, and writing – original draft and review and editing. XW: conceptualization, methodology, supervision, visualization, and writing – review and editing. GS: supervision, writing – review and editing, and investigation. LW and JT: supervision and funding acquisition. FY: data curation. CL, MR, and HZ: data curation and investigation. NL: supervision, data curation, and investigation. C-ZL: conceptualization, funding acquisition, and supervision. All authors contributed to the article and approved the submitted version.


Latent and active myofascial trigger points (MTrPs) in knee-associated muscles may play a key role in pain management among patients with knee osteoarthritis (KOA). The aim of this study was to investigate the effect of dry needling treatment on pain intensity, disability, and range of motion (ROM) in patients with KOA.This randomized, single-blinded, clinical trial was carried out for 6 weeks of treatment and 6-month follow-up. A total of 98 patients met the entry criteria and were randomly assigned to the dry needling latent and active myofascial trigger point (MTrPs) with the stretching group or the oral diclofenacwith the stretching group. Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM were statistically analyzed before and after treatment and at the 6-month follow-up.A total of 42 patients in the dry needling group (DNG) and 35 patients in the diclofenac group (DG), respectively, completed the study, and there was no significant difference in the general data between the two groups. After treatments, both the groups showed a good effect in knee pain, function, and ROM, However, the DNG showed a significantly better result than the DG. Especially in the results of the 6-month follow-up, the DNG showed much better results than the DG.Dry needling on latent and active MTrPs combined with stretching and oral diclofenac combined with stretching can effectively relieve pain, improve function, and restore knee ROM affected by KOA. However, the effects of dry needling and stretching are better and longer lasting than those of oral diclofenac and stretching for at least 6 months.www.chictr.org.cn) in 17/11/2017 with the following code: ChiCTR-INR-17013432.Registered in the Chinese Clinical Trial Registry ( Osteoarthritis of the knee is a chronic degenerative articular disease that often affects the elderly . The patThere are currently no disease-modifying therapies, and therefore, the goal of treatment is to treat KOA-related symptoms, including pain and stiffness, with the goal of minimizing dysfunction and improving the quality of life. Some solutions for treating this disease include lifestyle changes, medications, physical therapy, and finally surgical interventions . Among tThe pain of KOA may not be just arthrogenic; it may result from other factors. Myofascial trigger points (MTrPs) are considered hyperirritable spots in a taut band of skeletal muscle, which may produce pain, muscle weakness, and decreased ROM symptoms, depending on their relationship with symptoms . It is cThis study aimed at determining the clinical effects of dry needling on latent and active MTrPs with stretching exercise for KOA and compared with the effect of oral diclofenac with stretching exercise over a 6-week treatment course. We hypothesized that dry needling on latent and active MTrPs combined with stretching can better improve the symptoms and functional abilities of patients with KOA.A single-blind trial with 6-month of follow-up with parallel groups was carried out from November 2017 to June 2019. All of the procedures were reviewed and approved by the research ethics committee of Shanghai University of Sport Institute , and this study was carried out in accordance with the World Medical Association’s Declaration of Helsinki (1964). This randomized controlled trial (RCT) has been registered at the Primary Registry of International Clinical Trial Registry Platform World Health Organization “Chinese Clinical Trial Registry” [ChiCTR-INR-17013432], It should be noted that a small change was made after registration. The inclusion of WOMAC is the result of evaluating knee symptoms and functions.There are no previous studies on the trigger point compared with oral diclofenac for KOA. For this reason, we did not use data from the literature to calculate the sample size. Based on previous pilot trials, the primary outcome measures Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to estimate the sample size, assuming an effect size of 0.4, using G Power 3.1.9.4, assuming a two-tailed test, an alpha level (α) of 0.05, and a desired power (β) of 90%. The estimated desired sample size was calculated to be at least 34 subjects per group. To compensate for a 20% drop-out rate, the sample size was increased to 41 patients in each group.A total of 166 participants were assessed for eligibility. Among them, 98 patients with KOA confirmed by radiographic analysis were recruited from the Rehabilitation Department in Shangti Injury Orthopedic and Department of Pain Management, Huadong Hospital affiliated to Fudan University, All of the patients refused to undergo any surgery and signed the informed consent forms. The CONSORT flow diagram for the RCT to study the effects of dry needling on MTrPs versus oral diclofenac in patients with KOA is illustrated in Fig. To be eligible, participants had to satisfy the following clinical criteria:The inclusion criteria were participants aged 55 years or older with knee pain and uni- or bilateral dysfunction, primary KOA fulfilling the American College of Rheumatology criteria for clinical and Kellgren-Lawrence grades II, III, and IV upon radiographic classification , 20. An A total of 98 patients who fulfilled the inclusion criteria were randomly assigned (1:1 ratio) to the two dry needling group (DNG) or the control group (diclofenac group) by an independent researcher using Microsoft Excel 2010 via computerized random numbers . An indeOutcome measures were assessed at baseline, 6 weeks,and 6 months by the same research assistants who had previously been blinded to intervention allocation. Demographic variables were gender, age, height, weight, body mass index (BMI), Duration of pain, Kellgren-Lawrence OA grade and Prevalence of active and latent MTrPs.The NPRS was used to measure knee pain intensity. Patients were asked to indicate the average intensity of knee pain over the past 24 h. using an 11-point scale ranging from 0 (“no pain”) to 10 (“worst pain imaginable”) at baseline, 2 weeks, 6 weeks, and 6 months following the initial treatment session. The NPRS is a reliable and valid instrument to assess pain intensity .Active range of motion (ROM) of knee flexion was recorded using a long-arm goniometer. The participant was placed in the prone position and was asked to bring the heel of the tested leg as close as possible to the buttock with the contralateral lower limb in extension. The goniometer’s pivot tip was placed on the femur’s lateral epicondyle of the tested knee with one arm in line with the lateral malleolus and the other arm in line with the greater trochanter, The fully extended knee was considered to be the zero position, and the degree of maximum flexion was recorded. The degree of maximum flexion recorded has been shown to be a reliable and valid measure in clinical practice .The WOMAC is the most widely used instrument to evaluate the symptomatology and function in KOA. It contains 24 questions: 5 questions about pain (0–20 points), 2 questions about stiffness (0–8 points), and 17 questions about physical function difficulty (0–68 points), which can be completed in less than 5 min. Higher WOMAC scores  indicate a greater degree of deterioration , 26.The diagnosis of active and latent MTrPs followed the criteria described by the International Delphi Panel , 27. 1, After the skin was locally sterilized, the MTrPs were transcutaneously punctured through the marks with a 0.30 mm × 40 mm or 0.30 mm × 75 mm sterilized disposable stainless-steel acupuncture needle. During dry needling, the left thumb or two fingers pressed or held the taut band. The right hand was used to quickly insert the needle into the entire layer of the skin to avoid skin tingling. The needle tip was then punctured back and forth into the taut band in different directions until a local twitch response was elicited. Once the first local twitch response was obtained, the needle was moved up and down  at approximately 1 Hz until no more local twitch responses were elicited; if the patient's tolerance was poor, 1 or 2 local twitch responses were sufficient. The depth of needle insertion ranged from 15 to 65 mm and it depended on the depth of the muscles selected and the thickness of the fat. After pulling out the needle, ischemic compression with a finger was applied for 10 − 30 s. Dry needling treatment was administered once a week and dry needling treatments were terminated once VAS score was less than 3. For the trigger point marked by the surgical marker, if there is only a taut band but no hypersensitive spot, and no palpation with the reproduction of the patient’s symptoms at the next examination, the treatment of the trigger point will be terminated. In addition, the patients were taught to perform self-stretching exercises of knee flexors and extensors at home.Knee flexor self-stretching involved the standing hamstring stretch or the sitting toe touch stretch. For the standing hamstring stretch, participants stood with the involved leg elevated on a chair or stool. While standing tall, maintaining the neutral spine posture, and keeping the involved knee in full extension, subjects were instructed to lean forward hinging at the hips until moderate stretch discomfort was felt in the hamstrings . For theThe stretching of the patient depended on the muscle with the trigger point, that is, when a certain muscle had a trigger point, the corresponding muscle stretch was performed.The above static stretching was maintained for 1 min and repeated three times per day. The extent of stretching is suitable for tightness, if there was discomfort such as numbness or pain, the patient needed to reduce the extent and time of stretching. Even after terminating the dry needling or oral medicine therapies, all patients would continually conduct it.Diclofenac sodium double-release enteric-coated capsules , each containing 75 mg of diclofenac sodium, were taken orally 75 mg a day before a meal without chewing, together with a glass of water every time and once a day for 6 weeks as a treatment course combined with self-stretching at home (same as that in the DNG).p < 0.05).All data were analyzed using the Statistical Package for Social Sciences (SPSS) V.22.0. The mean and SD for each quantitative variable were calculated after confirming normal distribution of the data using the Shapiro–Wilk test. The independent t-test was used to compare the differences in the underlying data of the subjects included. Two-way repeated measures analysis of variancewith a post-hoc Bonferroni correction was used, and the level of significance was set at 5% . The NPRS score in the DG showed a significant decrease after the 3 week and the 6-month follow-ups compared with that at the pre-treatment timepoint (p < 0.05). However, there was a significant increase in the NPRS score at the 6-month follow-up compared with that at the 6-week timepoint (p > 0.05). Comparison between groups showed that there was no significant difference between the DNG and the DG before treatment (p > 0.05), and the DNG showed significantly lower scores than the DG after 6 weeks and 6 months of follow-up (p < 0.05).The results for treatment effects on symptom outcomes are shown in Table P < 0.05). However, in the DG, there was a significant increase in the WOMAC  score at the 6-month follow-up compared with that at the 6-week timepoint (p > 0.05). Comparison between groups showed that there was no significant difference between the DNG and the DG before treatment (p > 0.05), and the DNG showed significantly lower scores than the DG after 6 weeks and 6 months of follow-up (p < 0.05).The WOMAC  scores in the DNG and DG were significantly decreased at the 6-week and 6-month follow-ups compared to those at the pre-treatment time point (P < 0.05). Comparison between groups showed that there was no significant difference between the DNG and the DG before treatment (p > 0.05), and the DNG showed a significantly increased ROM than the DG after 6 weeks of treatment (p < 0.05).With respect to active ROM of knee flexion, there was a significant increase in the DNG and DG at 6 weeks of treatment compared to that at the pre-treatment time point (n = 2) and abdominal pain (n = 1), and no serious adverse drug reactions were found in this clinical trial.Common dry needling treatment-related adverse events include subcutaneous hematoma, continuous post-dry needling pain, and dizziness caused by hypoglycemia. Common adverse events related to oral diclofenac sodium are gastrointestinal adverse events, renal-function adverse events, and hepatic-function and cardiovascular adverse events. According to the previous literature, all of these adverse drug reactions are predictable. During the 6 weeks’ treatment period, two patients in the DNG dropped out of the trial because of continuous post-dry needling pain, three patients dropped out of the trial because of indigestion , as the early lesion of OA, often achieves positive effects by needling the active trigger point of the quadriceps femoris , 41. How(1). Quadriceps tightness can lead to an increased compression force of the patellofemoral joint , 48, or (2). The tensor the fascia lata is connected to the patellofemoral through the iliotibial band (ITB) and the sateral patellar retinaculum. The increased tension of the tensor fascia lata increases thepatellar lateral translation and tilt and increases thelateral cartilage pressure , 51.(3). The hamstrings, apart frombeing the primary mechanism of knee flexion, also protect the knee from eccentric contraction during the support phase. These both function to cushion the joint and to generate limb deceleration during gait . In addi(4). Inanopen-chain, the gastrocnemius muscle can bend the knee joint and ankle plantar flexion, and the soleus muscle can also bend the ankle plantar flexion. However, inaclosed-chain, the gastrocnemius muscle and soleus muscle pull the lower end of the femur and the lower leg backward to straighten the knee joint . In fact(5). The gluteus medius is theprimary abductor of the hip. During walking, weak hip abductors of the stance limb produce a pelvic drop on the swing limb and stance knee varus angulation that shifts the line of gravity (LOG) away from the stance knee. This LOG shift increases the knee adduction moment and the medial joint compressive forces, leading to progressive degeneration. The hip adductor muscles may eccentrically counteract the varus angulation of the knee and consequently might unload the medial tibiofemoral joint . A syste(6). Hip external rotation (the posterior fibers of the gluteus medius and maximus muscles) act eccentrically to control the movements of hip medial rotation during activities with body weight support.The weakness of hip external rotation leads to the internal rotation of the femur, and this contributes to increased lateral forces acting on the patella and greater stress on the lateral patellofemoral joint , 62.The effects of the included muscles on joint mechanics are as follows:Previous studies have reported that ROM of the knee joint is decreased gradually in individuals with KOA . It is eTraditionally, clinicians have relied heavily on the use of NSAIDs, including diclofenac sodium to treat the symptoms of KOA, such as inflammatory pain and joint stiffness. Diclofenac is a proven, commonly prescribed nonsteroidal anti-inflammatory drug (NSAID) that has analgesic, anti-inflammatory, and antipyretic properties and has been shown to be effective in treating a variety of acute and chronic pain and inflammatory conditions.Despite its side effects, diclofenac sodium still remains the drug of choice . ClinicaThis experiment has certain limitations,one of which is the lack of supervision of the patient’s self-stretching. To cover the ethical and feasibility considerations, this study compared two treatment groups, but no placebo group was used in this experiment. Because current studies have shown no correlation between pain and osteoarthritis classification, this experiment did not analyze and statistics according to the classification of osteoarthritis. Most of our follow-ups were conducted by telephone because the patient was too old and has limited physical mobility. Therefore, no ROM was measured. However, the patient may not have completed the recommended exercise. Finally, previous studies primarily focused on active trigger points, that is, inactivate active trigger points to latent trigger points. However, how to evaluate the effect of dry needling on latent trigger points requires further research to investigate this important issue. The pressure pain threshold (PPT) may have important value for the evaluation of latent trigger points; however, there was no record due to a lack of appropriate instruments.Compared with the diclofenac group, the dry needling group manifested persisting superiority and clinically relevant benefits for at least 6 months in patients with KOA. The benefits included a decreased pain intensity and disability as well as knee ROM.


To evaluate the usefulness of surgical neurolysis for neuropathic pain relief in patients with posttraumatic brachial plexus injury (BPI). T-test was performed, and in order to determine the magnitude of these changes, an effect size was measured. α = 0.05.  A prospective, longitudinal, nonrandomized, self-controlled before and after study was performed to evaluate the pain changes according to their intensity using the Visual Analogue Scale (VAS), and the sensory recovery after surgery using the British Medical Research Council (BMRC) scale for sensory recovery. To establish significant changes, a paired p = 0.005, Δ = 1.572), added to a mean sensory improvement (25%) from 2.8 ± 1.62 to 3.5 ± 0.97 after surgery according to BMRC, without statistically significant changes (p=0.062), showing a moderate effect size (Δ = 0.413). Almost all patients showed improvement in the continuous and paroxysmal pattern of pain. No postoperative complications were observed. Discussion. These results suggest that in cases of BPI that originates from a compressive syndrome secondary to the posttraumatic fibrosis that surrounds the nerve structures causing strangulation and inducing hypernociception, the use of surgical neurolysis is an appropriate alternative for patients with medically refractory neuropathic pain. Ten patients were included with an average follow-up of 61.9 ± 53.62 months. The main mechanism of injury was vehicular trauma (70%). A significant decrease in pain after the surgical intervention was observed resulting from an average preoperative state according to VAS of 8.4 ± 1.58, to a postoperative state of 3.4 ± 3.27 (59.52%,  Neuropathic pain caused by a lesion or disease of the somatosensory nervous system can result from nerve compression in posttraumatic brachial plexus injuries (BPI) produced by the connective tissue (fibrosis) that surrounds the nerve structures, generating a compressive phenomenon that causes strangulation of the nerve, inducing hypernociception mediated by inflammatory mediators . TherefoSurgical neurolysis is a technique that began to be used in World War by exploration of the wound and debridement of the affected nerve. There are two types of surgical neurolysis, both with the purpose of decompressing the affected nerve structure; the internal neurolysis consists of making multiple longitudinal cuts along the epineural area of the affected nerve structure, and the external neurolysis, which consists of dissecting the connective tissue that surrounds the injured nerve structures, lysing the adhesions formed in the compartment. The dissection is usually careful and slow to protect the underlying structures and preserve the continuity of the nerve . In 1996A prospective, longitudinal, nonrandomized, self-controlled before and after study was performed according to Consolidated Standards of Reporting Trials (CONSORT) 2010 statement for reporting nonrandomized studies , to evalThe data extraction was focused on collecting information on the demographic aspects , etiology, anatomical location of the injury, affected side, interval injury-surgery, and average follow-up . The clinical evaluation of the patients was focused on collecting data corresponding to the preoperative and postoperative state of two clinical components (pain and sensory). It was decided to assess pain according to its intensity using the Visual Analogue Scale (VAS), the most validated measurement method , and theplatysma aponeurosis was lifted, taking care of the underlying external jugular vein (ligating it on occasions to avoid a nearby injury). Subsequently, the omohyoid muscle (guiding point of the approach) was delimited, moving it with a surgical rubber band without the need to section it. Under the thickness of the adipose tissue, the transverse cervical artery was identified, which was ligated and sectioned. Subsequently, a dissection of the anterior interscalene triangle aponeurosis was performed . In some cases, the ascending cervical artery could be seen parallel to the phrenic nerve, whose integrity was always preserved. Thereafter, the exposure of the upper trunk (C5–C6) was performed, which was surrounded with a surgical band for manipulation and cranial displacement for the exposure of the middle (C7) and lower trunks (C8-T1). All the trunks of the brachial plexus were explored deeply, no muscles were sectioned, and all surgical corridors  were used to perform the procedure. External surgical neurolysis was realized; it consisted in releasing the tight fascia, muscle, and tendon that are compressing the nerve and cutting out the scar tissue around the nervous structures, to avoid the compressive phenomena caused by the scar tissue that was adjacent to the injury. The extent of neurolysis was determined by the compression sites observed at the time of surgery. All the procedures were carried out by the corresponding author.Approaches located in the supraclavicular fossa were performed, through a “V-shaped” incision following the posterior border of the sternocleidomastoid and the inferior border of the clavicle, the T-test and a Wilcoxon signed-rank test were performed to establish the relationship between the preoperative and postoperative changes. In order to determine the magnitude of these changes, an effect size of postoperative outcomes in pain and sensory components was measured, the effect size was calculated using the Cohen's d, and recalculated considering the correction coefficient for small sample sizes to avoid overestimating the effect measure. A sample size calculation was carried out  and procedural factors , as well as frequencies to describe the other characteristics .The clinical changes were also represented as median and maximum and minimum ranges, due to the nonparametric distribution of the sample. However, it was decided to perform the representation with means and standard deviations because it is usually the most frequent form as reported in the literature. To establish significant changes after surgery in pain and sensory outcomes, a paired A total of 10 patients met the inclusion criteria for the analysis. According to gender, the percentage of males predominated . The average age of the population at the time of the injury was 34 ± 16.85 years old. The main mechanism of injury was vehicular trauma  in 7 cases, followed by industrial trauma, stab injury, and hit by a vehicle (10% each). Roots injuries from C5 to T1 were present in only 3 patients. Radiologic features in MRI represented the compromise evolution of traumatic BPI in the included patients and are shown in p=0.005), which showed a large effect determined by Cohen's D (Δ = 1.572). With the aim of evaluating if the pain outcomes were secondary to an impact on the sensory component, it was decided to evaluate the sensory state before and after surgery, showing that the mean preoperative state according to the BMRC was 2.8 ± 1.62, changing to a postoperative state of 3.5 ± 0.97, resulting in a trend towards improvement in postoperative sensory component, without these changes being statistically significant (p=0.062), showing a moderate effect determined by Cohen's D (Δ = 0.413). Therefore, it was assumed that the surgery did not have a negative impact on the sensory component. All patients included before surgery were under pharmacological management  for their original neuropathic pain control, only 3 patients after surgery received pharmacological management: patient number 2 received tramadol and acetaminophen , patient number 3 received gabapentin (250 mg/day), and patient number 7 received tramadol and acetaminophen . Seventy percent of the patients did not require after surgery pharmacological treatment. Regarding the surgical intervention, almost 9 patients showed improvement in the continuous and paroxysmal pattern of neuropathic pain after surgery without predominance of one component over another. No postoperative complications were observed. Surgery did not affect motor function, even the patients presented an improvement in strength after the intervention (the discussion of these results is the objective of another study).The results of the surgical intervention in the motor and sensory components are shown in p = 0.005), and an important clinically significant improvement (∆ = 1.572) after surgical neurolysis. Without showing an impact on the sensory component, there was an improvement of 25% without statistically significant changes (p = 0.062) but with a moderate effect size (∆ = 0.413). On the other hand, an aspect to highlight about patient number 6 (the only patient who worsened after the intervention This study showed that 9 patients (90%) had a decrease in pain , where four patients (40%) presented a complete pain intensity reduction at the last follow-up (VAS = 0), with an overall decrease of 59.52%, statistically significant changes  refractory to medical treatment, associated with a compressive syndrome secondary to a traumatic process; observations explained because the trauma conditions a local inflammatory process that leads to the development of fibrosis through the activation of fibroblasts, resulting in increased collagen synthesis and accumulation of thin and disorganized collagen fibers . This fiEarly evaluations to establish a temporary relationship between surgery and symptom improvement have the limitation of not being able to define the effect; this is because patients over-/under-estimate their symptom relief while they are healing during the first few days/weeks after surgery . For thiThe neuropathic pain of the included patients consisted of the presence of pricking, tingling, electric shocks, burning sensations, and pain evoked by touching. The study focused on analyzing the decrease in pain intensity since it is the one most associated with an impact on quality of life. Pain after BPI is generally characterized by 2 main different components: paroxysmal  pain, and continuous (burning) pain ,21. The One of the great advantages of the study is that the patients studied were a highly homogeneous group (trauma patients) with strict inclusion criteria. In addition, an adequate calculation of the sample size was made (Supplemental An exhaustive search has been made in the literature on the subject, in order to establish the previous antecedents published about the usefulness of surgical neurolysis for the relief of neuropathic pain in patients with BPI. An advanced search in PubMed was performed using the MeSH terms, “Brachial plexus neuropathies,” “Surgery,” and “ Pain,” obtaining a total of 108 results from 1951 to 2021. The selected articles were those clinical studies written in English that mentioned the outcome of pain after the surgical management with neurolysis in patients with BPI. A total of 4 articles published between 1977 and 2020 were selected for the analysis. Data extraction was focused on determining the preoperative and postoperative state of pain according to VAS, the existence of statistically significant changes, as well as the percentage of improvement of the patients in terms of pain by calculating the delta of the pre- and post-operative pain state. The results of the literature review are shown in Surgical neurolysis shows an important relief of severe neuropathic pain in those patients with BPI who manifest a compressive syndrome of traumatic origin; these findings force us to think if we are adequately perceiving the effectiveness of surgical neurolysis in contemporary times, which years ago seemed to be a technique comparable to spontaneous recovery, a clear misconception. It is necessary to perform a complete clinical trial with a well-randomized, well-controlled, and well-powered design, in order to evaluate the benefits of this technique even in other clinical components such as motor recovery. Nevertheless, this study is a relevant precedent to reveal the possible indications for pain relief that surgical neurolysis has in the management of posttraumatic BPI, a surgical technique displaced and forgotten over the years.


Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction.This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair.This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021.A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument . Mean patient-reported pain  was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples.Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal. Inguinal hernias can be repaired through open procedures or laparoscopic procedures. Currently, the laparoscopic approach can be transabdominal extraperitoneal (TEP) or transabdominal preperitoneal (TAPP), both of which use mesh and are widely performed.Both are minimally invasive and can be performed easily and with smaller incisions. In addition, they allow improvements in quality of life, combined with a faster recovery period, reduction of postoperative pain, and morbidity.Pain is common postoperatively; however, it is expected to occur in the first few days and to respond well to analgesics with progressive improvement, ceasing completely in a few weeks. Nevertheless, persistence of pain for a period longer than 3 months can be characterized as chronic pain. Postoperative pain is an important index, as it has direct implications on morbidity, healthcare-associated costs, and quality of life. It is, therefore, relevant to be evaluated in the surgical practice.Given the improvement of minimally invasive surgery techniques with lower complication rates, surgical outcomes are increasingly dictated by patient-reported postoperative satisfaction and their perception of how they feel when performing daily activities. This type of postoperative quality-of-life assessment using a variety of tools has become the main way of measuring parameters of therapeutic successThe aim of this study was to compare laparoscopic techniques of inguinal hernia repair, considering the two most used methods , with respect to quality of life and prevalence of chronic pain in the late postoperative period. Secondary objectives include evaluation of epidemiological data on patients with inguinal hernias and occurrence of early postoperative complications.This is a retrospective cross-sectional study, approved by the Institutional Review Board of the Pequeno Príncipe Faculty . This study consisted in the evaluation of medical records of 167 patients who underwent unilateral or bilateral laparoscopic inguinal hernia repair between January 2017 and February 2021. Subsequently, patients included in the study were contacted to respond to the survey tool for quality of life (SF-36) and for chronic pain . Consent was obtained.All study participants were at least 3 months postoperatively at the time of data collection. Study participants were operated on by the same team of general surgeons and gastrointestinal surgeons. All surgical procedures were performed under general anesthesia. In patients undergoing TAPP, pneumoperitoneum was performed, followed by placement of three trocars for optic access and two for laparoscopic forceps. The preperitoneal space was accessed by opening the parietal peritoneum of the affected inguinal region, followed by dissection and identification of the local anatomy. The hernia was localized, its contents and sac were reduced. Afterward, a 15´15 cm polypropylene mesh was positioned covering the entire region of the myopectineal space and secured with 4–5 endostapler staples. The parietal peritoneum was closed with continuous suture with long-lasting absorbable suture and the abdomen was deflated. Skin was closed with nonabsorbable suture.For patients undergoing TEP, the suprapubic preperitoneal space was punctured with a Veress needle and then three trocars were positioned, one for optics and two for laparoscopic forceps. The preperitoneal space was dissected and the local anatomy was identified. The hernia was localized, its contents and sac were reduced, and a 15´15 cm polypropylene mesh was positioned covering the entire region of the myopectineal space and secured with 4–5 endostapler staples. The preperitoneal space was deflated and the skin was closed with nonabsorbable suture.The clinical variables analyzed in patient’s medical records were age, sex, time from surgery, comorbidities, surgical technique for repair (TEP or TAPP), and recent postoperative complications. The postoperative complications evaluated for this study were hematoma, seroma, surgical site infection, and ischemic orchitis..The Charlson Comorbidity Index (CCI) was used to assess comorbidities, analyzing 19 clinical conditions, including cardiovascular disease, diabetes mellitus, liver disease, and lung disease. This index aims to predict risk of death related to having comorbiditiesPatients excluded from this study included patients under 18 years of age, time from surgery less than 3 months, open approach to hernia repair, repair of recurrent hernias or femoral hernias, and those for whom the repair was indicated in urgent or emergency situations ..The SF-36 questionnaire was used in eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health.The tool utilized to assess postoperative pain in this study was the VAS. The VAS is a visual, simple, and effective validated tool for pain assessment. It consists of a line with ends numbered from 0 to 10, in which the patient assigns a score to their pain, with 0 being no pain and 10 being the worst pain imaginableFinally, patients who filled out the questionnaire incorrectly, those who could not be contacted (via phone or email), or those who declined to participate in the study were excluded from the analysis.Data collected from the two groups (TAP and TEP) were analyzed using mean and standard deviation for continuous variables and absolute and relative frequencies for categorical and ordinal variables. Shapiro-Wilk test and histogram generation were used for sample distribution analysis. Student’s t-test for normal continuous dependent variables, Mann-Whitney test for non-normal continuous dependent variables, and chi-square test for categorical dependent variables were also used. A significance level of 5% was used for this study.A total of 167 patients who underwent laparoscopic inguinal hernia repair were included in the study. Data on patient demographics and early postoperative complications were analyzed. Subsequently, the patients were contacted and only 40 responded to the survey tool composed of SF-36 and VAS (18 patients in the TAPP group and 22 in the TEP group).Among the 167 medical records that were analyzed, only 12 (7.19%) patients were female. The mean age of the study participants was 55.19 years, with the oldest patient being 86 years old and the youngest being 22 years old. There was no statistically significant difference between the TAPP and TEP groups in terms of age (p=0.33). In all 46 (27.54%) patients had medical history notable for hypertension, 24 (14.37%) for dyslipidemia, 19 (11.38%) for diabetes, 9 (5.39%) for benign prostatic hyperplasia, 3 (1.80%) had a previous myocardial infarction, and 4 (2.40%) had a previous stroke.The groups were statistically balanced regarding comorbidities according to the CCI (p=0.61). Mean CCI was 1.21±0.16 for the TAPP group and 1.33±0.15 for the TEP group.Among the early postoperative complications, seroma was the most prevalent, which was present in 16 (9.58%) patients. This was followed by hematoma in 8 (4.79%) cases, and ischemic orchitis and pain, both of which occurred in 3 (1.80%) patients. After statistical analysis, seroma was found to be significantly more commonly diagnosed in TAPP patients as compared to TEP (p=0.04), while the other complications showed no significant difference between groups (p>0.05) .Analysis of the results of the SF-36 survey, responded by 40 patients, revealed no significant difference between the evaluated domains: mental health, limitations due to emotional and social aspects, vitality, overall health state, pain, limitation due to physical factors, and functional capacity .The lowest averages were seen in the vitality domain, in which questions were based on whether patients felt vigorous, with will, strength, energy, and whether there was presence of exhaustion and/or fatigue. Meanwhile, the highest averages were seen in the functional capacity domain, in which the questions were related to basic daily activities, such as lifting heavy objects, carrying groceries, climbing stairs, kneeling, walking a few blocks, showering, and getting dressed.When analyzing the results of the VAS, 17 (42.50%) patients answered the survey and reported zero pain intensity, 23 patients reported some pain, but only 3 patients had pain intensity greater than 5 . No stat, who carried out with 2246 patients (p<0.001).Regarding postoperative complications, the incidence of seroma was significantly higher in the TAPP group . These r. In their systematic review and meta-analysis, 9 studies with a total of 54,138 patients were evaluated, and results suggested that the open, TAPP, and TEP techniques are comparable in terms of postoperative hematoma, seroma, recurrence, infectious complications, urinary retention, and length of hospital stay.There was no significant difference between TEP and TAPP techniques with regard to the incidence of postoperative hematoma, postoperative pain, and ischemic orchitis . This is. Results for the TAPP and TEP groups were similar in all domains of the scale, showing no significant difference between the techniques  from 0  to 100 chniques . with 314 patients showed that both TAPP and TEP techniques improved patients’ quality of life, from comparing preoperative to 3 months postoperatively. The TEP group showed significant improvement in all domains . The TAPP group showed significant improvement in all domains, except those of vitality and social functions. However, both groups were comparable postoperatively in terms of quality of life.The prospective randomized controlled study carried out by Bansal et al. compared quality of life using the SF-36 survey between preoperative and postoperative periods (3 month postoperative), after open hernia repair. A significant improvement was observed in the domains of physical aspect and pain, and significant differences were seen in the domains of functional capacity, mental health, social aspects, and emotional aspects. Only the domains of overall health and vitality did not demonstrate a statistically significant improvement (p>0.05). A similar result was found in our study in the late postoperative period of TEP and TAPP, in which the lowest means were obtained in the domains of vitality, mental health, and overall health state, while the highest mean was also in the domain of functional capacity  was shorter than in TAPP . However, there was no significant difference in the presence of chronic pain between the TAPP and TEP techniques (p=0.772).Donovan et al.It is worth mentioning that due to the SARS-CoV-2 pandemic, social distancing, and scarcity of human resources and medical supplies, the number of elective surgeries performed in 2020 was significantly lower than in previous years. In addition, getting in contact with patients to carry out this study was done exclusively via telephone, so the insecurity of sharing information and experiences at a distance were factors that could have limited the number of patients participating in the study. The complexity of the SF-36 questionnaire could have also led to a smaller number of participants. In addition, limitations of this study are also related to data being acquired retrospectively and from patients operated in a single center.Despite these limitations, this study stands out for being one of the first to present national data comparing quality of life and chronic postoperative pain between the two main laparoscopic surgical techniques for inguinal hernia repair.Patients undergoing TAPP inguinal hernia repair in this study had higher incidence of postoperative seroma as compared to those undergoing TEP repair. However, the techniques are comparable in terms of incidence of other early postoperative complications. In addition, no significant difference was seen between TEP and TAPP in quality of life and chronic pain in the late postoperative period.It is important to emphasize that further research is needed to establish whether there are any significant differences between the techniques, given that our sample is limited and consists of patients operated on in a single institution. Therefore, the choice of technique should take into consideration the surgeon’s experience and the patient’s overall clinical status and presentation.