https://bjpain.org/index.php/bjpain/issue/feedBangladesh Journal of Pain2024-09-29T21:31:52+00:00Professor Kazi Mesbahuddin Iqbal bjp@bjpain.orgOpen Journal Systems<p>Bangladesh Journal of Pain (BJPain) is an official journal of the Bangladesh Society for Study of Pain (BSSP). This open-access journal is dedicated to publishing high-quality research in areas of biomedical science particularly focusing on pain and its related disorders. The journal publishes various types of research articles eg. Original contributions, reviews, case-reports/case-series, and correspondence biannually. This single-blind peer-reviewed journal is acknowledged by the Bangladesh Society for Study of Pain (BSSP). </p>https://bjpain.org/index.php/bjpain/article/view/96Experience of Avascular Necrosis of Hip Joint due to Unjustified Use of Steroid: A Case Series Study2024-09-29T20:15:37+00:00Md. Mosharaf Hossaindr.mhpalash47@gmail.comMd Mostafa Kamalbjp@bjpain.orgEasmin Akterbjp@bjpain.orgMd. Rasheduzzaman Bhuiyanbjp@bjpain.orgMd Zunaidbjp@bjpain.orgA K M Akhtaruzzamanbjp@bjpain.org<p>The use of steroids, whether in herbal or synthetic form, for purposes such as weight gain, appetite enhancement, and pain relief is a prevalent practice in Bangladesh. Lacking adherence to pharmacological guidelines, such as those outlined by the American College of Rheumatology (ACR) poses a significant health risk. Steroid-induced osteonecrosis is one in many adverse effects that consuming OTC steroid causes. AVN is characterized by the death of bone tissue due to the prolonged use or high-dose administration of corticosteroids. Commonly affected areas include the hip joints, knees, and shoulders. However, this seemingly innocuous trend has prompted concern, particularly at the Dhaka Specialized Pain Management and Research Centre, where a notable pattern has emerged. From July 2022 to June 2023, a total of six reported cases highlighted a worrisome trend of individuals encountering health issues due to the misuse or prolonged use of over-the-counter (OTC) steroids. The majority of the reported cases were male, predominantly in their 2nd to 3rd decade of life. The common thread among these cases was the history of oral steroid ingestion, either in the form of herbal or synthetic compounds. The patients presented with complaints of pain in the hip and groin area, particularly during walking. Diagnostic imaging, including X-ray and MRI of the hip joints, consistently revealed a classical picture of Avascular Necrosis (AVN), underlining the potential association between steroid use and this debilitating condition. The cases reported at the Dhaka Specialized Pain Management and Research Centre serve as a stark reminder of the potential consequences, such as AVN, that can arise from the uninformed or unsupervised use of steroids.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Painhttps://bjpain.org/index.php/bjpain/article/view/93Analgesic Efficacy of Suprainguinal Fascia Iliaca Compartment Block (SFICB) vs Combined Pericapsular Nerve Group (PENG) Block with Lateral Femoral Cutaneous Nerve Block (LFCN) in Hip Surgery2024-09-29T18:45:27+00:00Md. Aftab Uddinbjp@bjpain.orgSalah Uddin Al Azadbjp@bjpain.orgNahida Parveen Nimmibjp@bjpain.orgShyama Prasad Mitrabjp@bjpain.orgLutful Azizlutful.aziz@evercarebd.com<p><strong>Background</strong>: Pain management for hip fracture is challenging due to complex anatomical variations and patient positioning during surgery. Though various modalities of regional techniques are being used for pain management, none of them has proven superiority. Recently fascia iliaca compartment block and pericapsular nerve group block have drawn lots of attention due to simplicity and superior pain control. In this study suprainguinal fascia iliaca compartment block (SFICB) was compared with pericapsular nerve group (PENG) block in combination with lateral femoral cutaneous nerve (LFCN) block to evaluate the analgesic efficacy and utility in fracture neck femur patients.<br><strong>Methods</strong>: This prospective study was conducted from January 2022 to December 2022. Total 40 patients were allocated in two groups, suprainguinal fascia iliaca compartment block (Gr-F) or PENG with LFCN block (Gr-P) group. 30 minutes after performing the block, pain was assessed with NPRS scale during positioning for combined epidural anaesthesia. Then pain assessment was done 2 hour for first 12 hours followed by 4 hour in following 12 hours. Haemodynamic profile, duration of analgesia and requirement of rescue analgesics were recorded.<br><strong>Results</strong>: During positioning of the patient for central neuraxial block, NPRS was (2.5 ± 0.3) for Gr-P and (4.5 ± 0.6) for Gr-F with p = 0.039. For Gr-F, 20% patient required Dexmedetomidine infusion during positioning. The onset of analgesia in Gr-P was (10.56 ± 3.46) minutes and in Gr-F was (15.86 ± 3.3) minutes with p < 0.05. Duration of analgesia during active movement was 14.6 (±1.09) hours for Gr-P and 10.2 (±2.06) hours for Gr-F with p value < 0.05.<br><strong>Conclusion</strong>: Combination of PENG with LFCN block provides a superior analgesia characterised by early onset action, less pain score at rest and on movement during positioning of the patient and prolong duration of action on active movement postoperatively.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Painhttps://bjpain.org/index.php/bjpain/article/view/94Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Pain Management after Total Abdominal Hysterectomy2024-09-29T19:05:45+00:00Nazem Ahmednazemahmed2017@gmail.comNazmul Ahsan Siddiqi Rubelbjp@bjpain.orgMansura Akter Pannabjp@bjpain.orgMir Masud Royhanbjp@bjpain.orgMir Shahadat Hossainbjp@bjpain.orgAfshana Rahmanbjp@bjpain.orgMd Mostafa Kamalbjp@bjpain.org<p><strong>Background</strong>: Post-operative analgesia is of vital importance to prevent various undesirable side effects such as respiratory complications, venous thromboembolism, and increased hospital stay. The transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. Therefore, this randomized, prospective study was conducted to compare the post-operative analgesic efficacy of QL block and TAP block in patients undergoing abdominal hysterectomy.<br /><strong>Methods</strong>: This study was carried out in the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Patients of ASA status I and II, planned for total abdominal hysterectomy under spinal anaesthesia were selected and randomly allocated into two groups (Group A – TAP Block and Group B – QL Block). Hemodynamic status, time of onset of sensory block, mean duration of postoperative analgesia, the amount of rescue analgesic requirements as well as intensity of post-operative pain were assessed at different point of time. Visual analog scale (VAS) was used to assess the postoperative pain. Total morphine consumption in 24 hours and time required for 1st postoperative analgesic were recorded.<br /><strong>Results</strong>: A total of 60 patients were included in this study. The onset of sensory block was faster in Group B than A (22.6±6.5 min & 16.3±5.2 min). VAS score was higher among group A at 10th hours and 18th hours. In case of group B, VAS score was more at 14th hour. Post operatively 1st demand of analgesia was earlier in Group-A (10.4±1.5 vs 14.1±1.7) (p< 0.001). Total analgesic requirement was higher in Group- A than Group B (18.7±4.6 vs11.2±3.8) (p< 0.001).<br /><strong>Conclusion</strong>: Quadratus Lumborum Block produces longer duration of analgesia, provides optimum post-operative pain control and maintain an excellent hemodynamics than TAP block in patients undergoing abdominal hysterectomy.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Painhttps://bjpain.org/index.php/bjpain/article/view/95Safety and Efficacy of Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia2024-09-29T19:59:55+00:00Chandra Shekhar Karmakarbjp@bjpain.orgMohammad Abdul Hannanbjp@bjpain.orgRajat Shuvra Dasbjp@bjpain.orgSaiful Mahmud Tuserbjp@bjpain.orgKazi Mahzabin Arinbjp@bjpain.orgAyesha Sultanabjp@bjpain.orgA K M Akhtaruzzamanbjp@bjpain.org<p><strong>Background</strong>: Trigeminal neuralgia (TN) is characterized by intractable pain in one or more division of trigeminal nerve. Pharmacologic management is first line treatment for TN, when it fails interventional treatment options are considered like percutaneous procedures or micro vascular decompression. Radio frequency thermoscoagulation is an effective option for medically refractory cases to control pain.<br /><strong>Objective</strong>: To evaluate the safety and efficacy of Radiofrequency thermocoagulation of the gasserian ganglion for the treatment of trigeminal neuralgia.<br /><strong>Methods</strong>: Total 44 patients were included in this prospective obsarvational study who were already diagnosed with trigeminal neuralgia and refractory to medical management. All patients were treated by radiofrequency thermocoagulation after confirming the position of needle tip by sensory and motor stimuli. Three lesions were created at 60-70oC for 90 second each. Patients were assessed for pain relief, corneal reflex, numbness and masticatory muscle weakness at immediate post procedural stage, 1 week, 1 month and at 6 months.<br /><strong>Results</strong>: Twenty eight patients had pain over both mandibular (V3) and maxillary (V2) division, 12 patients had mandibular (V3) and 4 patients had only maxillary (V2) division involvement. Excellent pain relief was archived in 38 (86.36%) patients, 4 patients (9.09%) have good pain control and 2 (4.54%) patient developed poor pain control with development of Anesthesia dolorosa in 1 patient. None of them develop complete facial numbness, 41 patients developed tolerable numbness and 2 patients develop somewhat bothersome, Facial numbness. Three patients developed unilateral masseter muscle weakness however no patients developed corneal ulcers, blindness or other complications.<br /><strong>Conclusion</strong>: Temperature controlled thermocoagulation is a safe and effective treatment options for trigeminal neuralgia.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Painhttps://bjpain.org/index.php/bjpain/article/view/97Role of Ultrasound Guided Platelet Rich Plasma Therapy for Isolated Supraspinatus Tendinopathy2024-09-29T20:53:06+00:00Sudheer Darabjp@bjpain.orgMinal Chandrachandra.minal.minal@gmail.comSrilatha PuliBJP@BJPAIN.ORGChetana ChetanBJP@BJPAIN.ORG<p><strong>Background</strong>: Rotator cuff (RC) injuries are not so uncommon a cause of disability among the population. The RC stabilizes the shoulder, a highly unstable joint owing to great mobility. Supraspinatus (SS) is one of the RC tendons undergoing damage ranging from mild tendinosis to complete tear due to degeneration, trauma, or other causes. Supraspinatus tears (STs) have been classically treated conservatively with physical and pharmacotherapy and later on with the help of surgical repair. Non-surgical treatment with biologics like platelet-rich plasma (PRP) therapy has been tried with positive results but with limited data. We aim to identify the role of PRP therapy in patients with symptomatic supraspinatus tendinopathy (STP) for improving the range of motion as well as reducing the pain and physical disability.<br /><strong>Methods</strong>: This study was done on fifty symptomatic STP patients who failed medical and physical therapy for at least three months. The improvement in the pain score following two sittings of PRP therapy was evaluated with numerical rating scale (NRS). The improvement of the function of shoulder joint movements for daily activities was assessed with the modified University of California-Los Angeles (UCLA) shoulder score. Moreover, NRS, tear size (TS, assessed with ultrasound), Constant Shoulder Score (CSS), and modified UCLA shoulder score were recorded at baseline, and subsequently at 1-month, 3-months, and 6-months following the second sitting of the PRP therapy.<br /><strong>Results</strong>: At baseline, the CSS was 36.42±5.12, and was 61.58±6.35, 81.22±6.23, and 87±3.9 at 1-month, 3-months, and 6-months follow-up, respectively. The NRS was 8.18±0.96 before the procedure and 4.26±0.8, 2.02±0.62, 1.84±0.51 at 1-month, 3-months, and 6-months follow-up, respectively. The mean TS pre-procedure was 3.12±0.89, and a significant decrease in TS was seen at 1-month (2.87±0.88), 3-months (2.44±0.79), and 6-months (2.17±0.76). Modified UCLA score was 16.86±3.49 at baseline which improved to 24.66±3.17 at 1-month, 31.64±2.69 at 3-months, and 32.5±1.67 at 6-months.<br /><strong>Conclusion</strong>: PRP results in healing of the torn SS tendon. It also reduces pain score, improve range of motion and quality of life of the patients.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Painhttps://bjpain.org/index.php/bjpain/article/view/92Prevalence of prescription drug abuse among patients with chronic pain attending in a pain clinic of a tertiary hospital2024-09-29T18:23:30+00:00Md Mostafa Kamalbjp@bjpain.orgMonira Parveenbjp@bjpain.orgDilip Kumar Bhowmickbjp@bjpain.orgMd Shafiqul Islambjp@bjpain.orgA K M Akhtaruzzamanakm.akhtaruzzaman@bsmmu.edu.bd<p><strong>Background</strong>: Chronic pain and prescription drug abuse are extremely prevalent worldwide. Non-medical use of prescription drugs like opioids, central nervous system depressants and stimulants can lead to addiction, abuse or misuse, and diversion. It is not known what proportion of patients have already been exposed to prescription drug abuse presenting for chronic pain management. The main objective of the study was to assess the prevalence of prescription drug abuse among the patients presenting for chronic pain management.<br><strong>Method</strong>: The study was conducted at the out patient’s settings in the Pain Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka. Study population included patients suffering from chronic pain of at least 2 years duration and patients over 18 years of age. Both quantitative and qualitative methods of investigation were followed. The quantitative data was collected by face-to-face interview, clinical evaluation and recording of reports. Based on the patient information recorded 30 patients ( one-tenth of quantitative sample) were selected to find out the qualitative details through in-depth investigation of extent, trends, patterns and consequences of prescription drug abuse or misuse characteristics.<br><strong>Results</strong>: Quantitative data was collected from 305 patients. The average age of patients was 39.92 ± 9.61 years and male to female ratio was 2.2:1. Most of the patients were living in rural area 195 (64%). Chronic musculoskeletal pain was more prevalent among chronic pain patients 31% [95% CI: (26-36)]. The mean (±SD) duration of pain was 6.82 ± 3.45 years. Most commonly prescribed medications were NSAID 81% [95% CI: (76-85)], muscle relaxants 50% [95% CI: (45-56)] and opioids 41% [95% CI: (35-46)]. The prevalence of drug abuse was 64% [95% CI: (59-70)]. The specified ways of drug abuse revealed that 49% [95% CI: (42-56)] patients used medication without legal prescriptions, 21% [95% CI: (16-27)] used more than the prescribed dose and 30% [95% CI: (23-36)] used more than the prescribed duration for relieving pain. NSAID was the most common drug taken without legal prescription 72% [95% CI: (63-81)] and used more than the prescribed dose 57% [95% CI: (42-72)]. The most common cause of taking drugs more than prescribed dose and duration were initially relief of pain but gradually higher dose needed 79% [95% CI: (66-91)] and painful condition worsened after stopping medication 76% [95% CI: (65-87)], respectively. The common problems/complications<br>related to drug abuse were mental disturbance 78 (26%), sleeplessness 69 (23%) and loss of memory 64 (21%).<br><strong>Conclusion</strong>: The prevalence of prescription drug abuse is high among chronic pain patients. Many patients suffer from abuse-related complications, which is a major concern for the healthcare system.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Painhttps://bjpain.org/index.php/bjpain/article/view/91Research Initiative in SARPS Countries: Fostering Pathways for Sustainable Development2024-09-29T17:52:19+00:00Gauhar Afshangauhar.afshan@aku.edu<p>The South Asian Regional Pain Society (SARPS), founded in 2003, attained the official status of a Federation-in-formation of the International Association for the Study of Pain (IASP) in 2020. It encompasses five member countries from the South Asian Association for Regional Cooperation (SAARC) region; Bangladesh, India, Pakistan, Sri Lanka, and Nepal. The Primary objective of SARPS is to supports its member countries in providing effective, accessible, affordable, and ethical care to individual suffering from pain conditions while also enhancing research collaboration across the region. Although there are many similarities, there are also variations within SARPS countries regarding the barriers they face in research. Addressing these challenges requires a concerted effort through SARPS to raise awareness about the importance of pain research. It is essential to establish clear priorities for pain treatment and research, improve higher education and governance systems, and invest in healthcare and research infrastructure.</p>2023-12-30T00:00:00+00:00Copyright (c) 2023 Bangladesh Journal of Pain