Tag: statistics

Nutrition. 2026 May 5;150:113264. doi: 10.1016/j.nut.2026.113264. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze differences in taste preferences and dietary characteristics in early childhood according to genetic polymorphisms in taste receptor genes.

METHODS: This study is a secondary analysis of a randomized clinical trial (ReBEC: RBR-229SCM; U1111-1226-9516) that enrolled infants at 5.5 mo of age and allocated them to different complementary feeding methods in Porto Alegre, Brazil. At 12 mo old, the Food Preferences Questionnaire (FPQ) was applied, and data on dietary characteristics were obtained. Between 12 and 35 mo of age, the Taste Acceptance Test (TAT) was conducted, and oral mucosa samples were collected for the analysis of polymorphisms in sweet and bitter taste receptor genes. Pearson’s chi-square test, Fisher’s exact test, and Kruskal-Wallis test were used in data analysis.

RESULTS: A total of 96 infants with available data for exposures and outcomes were included in the analysis. The duration of exclusive breastfeeding was associated with TAS1R3(rs35744813) (P = 0.039), TAS1R2(rs9701796) (P = 0.022), and the number of sweet taste-related polymorphisms (P = 0.013). In the FPQ, TAS1R3(rs35744813) was associated with a preference for sour-tasting foods (P = 0.040), and TAS2R16(rs846672) with a preference for umami-flavored foods (P = 0.042). In the TAT, bitter taste reactions were associated with TAS1R2(rs9701796) (P = 0.021), TAS1R3(rs307355) (P = 0.008), and the number of sweet taste-related polymorphisms (P = 0.037). In contrast, sour taste reactions were associated with the number of bitter taste-related polymorphisms (P = 0.048).

CONCLUSIONS: The study found that genetic polymorphisms were associated with infant food acceptance, leading to differences in food preferences. Future longitudinal and experimental studies are needed to elucidate the mechanisms by which genetic polymorphisms influence infant food acceptance.

PMID:42263342 | DOI:10.1016/j.nut.2026.113264

Am J Emerg Med. 2026 Jun 2;108:26-34. doi: 10.1016/j.ajem.2026.06.002. Online ahead of print.

ABSTRACT

INTRODUCTION: The need for alternative analgesia to opioids in the emergency department (ED) has become increasingly urgent due to the opioid epidemic. Ketamine, traditionally used for sedation, has emerged as a promising alternative for pain control in the acute care setting. This scoping review evaluates the use of intranasal (IN) ketamine compared with intravenous (IV) opioids for analgesic efficacy in treating acute pain in the ED.

METHODS: A search of PubMed, CINAHL and PRIMO databases was conducted for randomized controlled trials (RCTs) published between 2015 and 2025. A total of 561 records were identified, and 8 RCTs evaluating analgesic efficacy as the primary outcome were included in this review. This review was conducted in accordance with the PRISMA-ScR reporting guidelines.

RESULTS: Eight RCTs including 846 patients were included (2016-2025), all conducted in Iran, Israel, or Thailand. IN ketamine (0.3-1.5 mg/kg) was most commonly compared with IV morphine (0.1 mg/kg). Across studies, IN ketamine demonstrated comparable reductions in pain scores to IV morphine, with several trials reporting no statistically significant differences at measured time points, although IV morphine was generally associated with faster onset of analgesia. In one study, IV fentanyl produced greater pain reduction than IN ketamine. Adverse effects were generally mild and transient with IN ketamine associated with fewer adverse events compared to IV morphine.

CONCLUSION: IN ketamine may be useful for acute pain management in the ED. However, further research is needed to determine optimal dosing, compare its efficacy with more potent opioids, and evaluate long-term outcomes associated with its use.

PMID:42263334 | DOI:10.1016/j.ajem.2026.06.002

Foot (Edinb). 2026 Jun 4;68:102268. doi: 10.1016/j.foot.2026.102268. Online ahead of print.

ABSTRACT

BACKGROUND: Falls in older adults remain a major clinical concern. Although the Enhanced Paper Grip Test (EPGT), provides an objective measure of lower limb strength and has shown promise in controlled settings, its use in routine podiatric practice has not been described.

AIM: To audit the implementation of the EPGT in routine private podiatric practice and to explore whether EPGT measures are associated with self-reported recent falls in older adults.

METHODS: The EPGT was introduced on a trial basis in three independent private UK podiatry clinics for six months. People (aged ≥60 y) were tested when the treating podiatrist considered the assessment clinically appropriate. Anonymised routine clinical data were extracted retrospectively at the end of the audit period, including EPGT outcomes, age, sex, and self-reported history of an unexplained fall in the previous twelve months.

RESULTS: Seventy-eight participants (mean age 72 ± 7 years) were assessed; 17 reported a fall. Median EPGT force was statistically significantly lower in fallers (11.9 N) than in non-fallers (21.4 N), U= 283,z = -3.554,p < .0005. Differences remained significant after adjustment for age and sex and were robust to outlier exclusion. Hallux-related pathology was not associated with EPGT outcomes.

CONCLUSIONS: In this pragmatic private practice audit, the EPGT could be incorporated into routine podiatric assessment and lower EPGT values were associated with self-reported recent falls. These findings support the EPGT as a potentially useful adjunct to falls risk screening that could be offered as part of routine podiatry care. Prospective studies are needed before predictive use or clinical thresholds can be established.

PMID:42263330 | DOI:10.1016/j.foot.2026.102268

Pain Physician. 2026 May;29(3):281-287.

ABSTRACT

BACKGROUND: Trans-sacral canalplasty (TSCP) is a minimally invasive epidural adhesiolysis technique positioned between conventional block therapy and open surgery. However, the relationship among MRI-defined levels of stenosis, epidurographic block patterns, and clinical effectiveness remains unclear.

OBJECTIVES: To investigate the clinical significance of mismatch between MRI-defined levels of stenosis and epidurographic block as well as to evaluate the short-term outcomes and feasibility of adhesiolysis in patients undergoing TSCP.

STUDY DESIGN: A retrospective observational study.

SETTING: A university hospital in Japan and an affiliated institution.

METHODS: We reviewed all patients who underwent TSCP between October 2024 and August 2025. Baseline characteristics, diagnosis, surgical history, and minimum dural sac area at L3/4, L4/5, and L5/S (measured on MRI using ImageJ2) were assessed. Epidurography was performed to identify block levels, and cases were categorized as concordant (MRI-defined level of stenosis = block level) or discordant (mismatch). Discordant cases were subclassified into a “tail-stop” type (in which contrast stopped in a position caudal to the MRI-defined level of stenosis) and a “pass-through” type (in which these levels differed). Clinical effectiveness was defined as an improvement in low back pain or leg pain at one week after the procedure. Feasibility of adhesiolysis was also evaluated.

RESULTS: Twenty-eight patients underwent TSCP during the study period. Nine (32.1%) showed concordance between MRI-defined levels of stenosis and epidurographic block sites, and 19 patients (67.9%) showed discordance (tail-stop, n = 11; pass-through, n = 8). Overall, 23 patients (82.1%) experienced clinical improvement. The effectiveness rate was 66.7% (6/9) in the concordance group and 89.5% (17/19) in the discordance group; however, the difference was not statistically significant (P = 0.290). In the discordance group, there was a significant difference in gender distribution between subgroups, with men predominating in the tail-stop subtype and women in the pass-through subtype (P = 0.024), but not in age, diagnosis, surgical history, or minimum dural sac area. Epidural dissection was successful in 21 patients (75.0%), with no significant difference between the effective and noneffective groups (73.9% vs 80.0%, P > 0.999).

LIMITATIONS: A single-center retrospective design, small sample size, and short-term follow-up of only one week.

CONCLUSIONS: TSCP demonstrated favorable short-term clinical effectiveness, even in cases with mismatches between MRI and epidurographic findings. The feasibility of adhesiolysis may contribute to the clinical success of TSCP. Epidurographic mismatch should not be considered a contraindication for TSCP, and our findings support its role as a minimally invasive option for patients with degenerative disorders of the lumbar spine who are unsuitable for open surgery.

PMID:42263314

Pain Physician. 2026 May;29(3):269-279.

ABSTRACT

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) affects approximately 50% of patients who receive chemotherapy. CIPN often results in dose reductions, therapy discontinuation, and long-term neurological impairment. Despite existing studies, identifying high-risk populations remains challenging, particularly in patients with diabetes, diabetic neuropathy, and those undergoing corticosteroid therapy.

OBJECTIVES: We sought to evaluate the key risk factors associated with CIPN by analyzing patient demographics, comorbidities, and chemotherapy regimens, with a specific focus on diabetes-related variables in order to inform early identification and prevention strategies.

STUDY DESIGN: Retrospective, single-center, observational cohort study.

SETTING: Academic tertiary care cancer center.

METHODS: Adult patients who received chemotherapy between January 2016 and December 2023 were identified through electronic medical records. Patients with CIPN were defined by the International Classification of Disease, Tenth Revision G62.0 diagnosis code (drug-induced polyneuropathy) and an associated diagnosis of “painful peripheral neuropathy.” Extracted data included demographics (age, body mass index [kg/m2], race/ethnicity), clinical variables (alcohol use, corticosteroid use, diabetes-related factors), and chemotherapy regimen details. Descriptive statistics, Wilcoxon rank sum, c2/Fisher’s exact tests, and multivariable logistic regression were performed. Institutional review board (IRB) approval was obtained (IRB exemption #2024-0139).

RESULTS: Among 36,949 patients, significant CIPN risk factors included older age (40-80 years, P < 0.0001), women (odds ratio [OR] 1.89; P < 0.0001), non-Hispanic/non-Latino ethnicity (OR 1.29; P < 0.0001), and corticosteroid use (OR 2.01; P < 0.0001). African American patients had lower odds of CIPN than White patients (OR 0.78; P < 0.0001). Diabetic neuropathy was strongly associated with increased CIPN risk (OR 5.35; P < 0.0001). Alcohol use was inversely associated with CIPN (OR 0.75; P < 0.0001). Several chemotherapy agents also showed significant associations.

LIMITATIONS: Our study is limited by its retrospective design, potential misclassification bias in CIPN diagnosis, and reliance on electronic medical records. Alcohol use data were frequently missing or unspecified, limiting interpretation.

CONCLUSIONS: Key CIPN risk factors include age, race/ethnicity, corticosteroid use, and diabetic neuropathy. Alcohol use appeared inversely associated with CIPN, though causality remains unclear. Individualized patient assessments and proactive management strategies may help reduce CIPN incidence and improve outcomes in patients with cancer who are receiving chemotherapy.

PMID:42263313

Pain Physician. 2026 May;29(3):E217-E227.

ABSTRACT

BACKGROUND: Degenerative disc disease is a leading cause of low back pain. Conservative treatments like pain medication and exercise therapy have shown mixed results, while procedures like fusion surgery carry risks such as adjacent segment disorder and surgical morbidity. Therefore, there is a critical need for treatments that bridge the gap between conservative care and surgery.

OBJECTIVE: To assess the efficacy of intradiscal hydrogel implantation compared with sham treatment of intradiscal injection of saline in patients with chronic discogenic low back pain.

STUDY DESIGN: Prospective, double-blind, randomized, controlled, multicenter trial.

SETTING: Two tertiary interventional pain care centers in Switzerland and in the Netherlands.

METHODS: Forty-nine patients with chronic discogenic low back pain unresponsive to conservative treatment were randomized to receive either intradiscal hydrogel implantation or a sham treatment. Control Group patients could cross over to hydrogel treatment after 6 months. The primary outcome was pain improvement at 6 months. Secondary outcomes included disability, quality of life, employment status, Patient Global Impression of Change score, analgesic use, disc space height, and disc degeneration. Adverse events were continually assessed.

RESULTS: At 6 months postprocedure, the Hydrogel Group patients had improved pain scores compared to Control Group patients, though not statistically significant (P = 0.070). Six out of 24 patients in the Hydrogel Group reported much improvement on their Patient Global Impression of Change scores, compared to 0 out of 25 in the Control Group (P = 0.008). Within-group disability improvements were statistically significant in the Hydrogel Group but not in the Control Group. No significant differences were found between groups in disability, quality of life, or employment status. Only one serious adverse event was reported-a patient from the Hydrogel Group was hospitalized due to a possible exacerbation of low back pain 6 days postprocedure.

LIMITATIONS: This trial’s limitations include strict eligibility criteria and questions about the validity of intradiscal saline as a placebo.

CONCLUSIONS: This trial suggests that percutaneous intradiscal hydrogel implantation may reduce chronic discogenic pain and disability, with significant Patient Global Impression of Change improvements, though larger trials are needed to confirm efficacy.

PMID:42263312

Pain Physician. 2026 May;29(3):E209-E216.

ABSTRACT

BACKGROUND: A transversus abdominis plane block provides reliable abdominal wall analgesia, but which adjuvants best sustain its effect remains debated. By facilitating diffusion of local anesthetics, hyaluronidase may improve block quality.

OBJECTIVES: This study evaluated the safety and efficacy of 2 hyaluronidase doses added to bupivacaine for bilateral transversus abdominis plane blocks in patients having a cesarean delivery.

STUDY DESIGN: A prospective, randomized, double-blind, controlled clinical trial.

SETTING: Benha University Hospital, Arab Republic of Egypt, from May 2023 through February 2024.

METHODS: A double-blind, controlled randomized trial was performed with 114 patients having elective cesarean delivery. The patients were allocated equally into 3 arms: Group I (bupivacaine alone), Group II (bupivacaine plus 750 IU hyaluronidase), and Group III (bupivacaine plus 1500 IU hyaluronidase). The time to first rescue analgesia served as the primary outcome. Secondary outcomes encompassed 24-hour morphine requirements, Visual Analog Scale pain score at rest and on coughing, patient satisfaction, hemodynamics, and adverse events. Analyses employed the appropriate statistical tests (parametric or nonparametric), with subsequent post hoc comparisons for significant findings.

RESULTS: Both hyaluronidase groups had significant prolonged analgesia (median 8.1 hours and 9.6 hours) compared to the control group (5.8 hours) (P < 0.001). Morphine requirements over the first postprocedure 24 hours diminished significantly (P < 0.001); Groups II and III had lower pain scores at rest and on coughing between postprocedure hours 2 and 12 (all P < 0.05). Patient satisfaction increased with hyaluronidase (P = 0.0039). No group differences were observed for adverse events, including postoperative nausea and vomiting or local anesthetic toxicity.

LIMITATIONS: This single-center trial with 24-hour follow-up may restrict generalizability and long-term safety assessment; also only 2 hyaluronidase doses were examined.

CONCLUSIONS: Adding hyaluronidase to bupivacaine for transversus abdominis plane block enhances analgesic duration and quality without compromising safety in patients having cesarean delivery. Both high and low doses appear equally effective, suggesting that even lower doses are sufficient for optimal effect.

PMID:42263311

Pain Physician. 2026 May;29(3):251-257.

ABSTRACT

BACKGROUND: The transforaminal epidural steroid injection (TFESI) is a widely used interventional procedure for managing radicular pain. Although TFESI is well established as a safe and effective treatment, patients frequently seek detailed explanations regarding its procedural steps, expected outcomes, and potential risks. Artificial intelligence (AI)-based platforms, particularly large language models (LLMs) such as ChatGPT, have emerged as accessible sources of periprocedural medical information. However, the accuracy, readability, and empathy of AI-generated responses in the context of interventional pain management remain uncertain.

OBJECTIVES: To compare the accuracy and readability of responses generated by ChatGPT and fellowship-trained pain medicine physicians to common patient questions about TFESIs and to assess the potential utility of AI in patient education and periprocedural guidance.

STUDY DESIGN: A cross-sectional comparative study.

METHODS: Twenty frequently asked patient questions about TFESIs were retrospectively identified from pain clinic consultations and submitted individually to ChatGPT-4o and to fellowship-level physicians. Two interventional pain specialists independently evaluated all responses for accuracy and empathy using a 5-point Likert scale; discrepancies were resolved by a third reviewer. Readability was analyzed using the Readable® tool kit across 7 indices: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGRL), Gunning Fog Index, SMOG Index, Coleman-Liau Index, average word and sentence length, and estimated overall reach.

RESULTS: Both sources delivered highly accurate responses. However, ChatGPT’s answers had significantly lower FRES scores, reflecting reduced reading ease, and higher scores across all other readability indices, indicating greater linguistic complexity and lower accessibility. These responses required a higher level of education to understand. Although empathy scores for ChatGPT were lower than the physicians’, the difference was not statistically significant.

LIMITATIONS: This study assessed a single AI platform (ChatGPT-4o). Accuracy and empathy ratings were performed subjectively by 2 pain specialists, which might have limited generalizability. Additionally, AI-generated responses can vary with software updates, reducing reproducibility across time.

CONCLUSION: ChatGPT provides accurate information regarding TFESIs but demonstrates lower readability and a less empathetic tone than answers given by fellowship-trained physicians. With targeted improvements in clarity and patient-centered communication, AI holds potential as a useful adjunct in patient education and clinical support.

PMID:42263306

Pain Physician. 2026 May;29(3):E139-E149.

ABSTRACT

BACKGROUND: Opioid-free anesthesia (OFA) is becoming increasingly common, yet its effects on early postoperative recovery remain unclear.

OBJECTIVE: Our study assessed the effect of OFA on postoperative recovery compared to opioid-based anesthesia (OBA).

STUDY DESIGN: Systematic review and meta-analysis.

METHODS: We searched MEDLINE, the Cochrane Library, Embase, BIOSIS, and Web of Science concluding on December 19, 2024, for randomized controlled trials comparing OFA and OBA in adults (≥ 18 years). Data were extracted, and risk of bias was assessed using the Cochrane RoB 2.0 tool (The Nordic Cochrane Centre for The Cochrane Collaboration). The primary outcome was recovery quality at postoperative 24 hours. Random-effects meta-analyses were conducted. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Our meta-analysis was registered with PROSPERO (ID CRD42024621490).

RESULTS: Sixteen trials with a total of 1,968 patients were included in our meta-analysis. OFA was statistically significance associatedwith an improved Quality of Recovery (QoR)-40 score (mean difference 6.33; 95% CI, 3.48-9.17; very low certainty) and QoR-15 score at postoperative 24 hours (mean difference 10; 95% CI, 2.25-17.74; low certainty) compared to OBA. OFA was a statistical significance associated with a reduced risk of postoperative nausea and vomiting, as well as a shorter stay in the postanesthesia care unit. OFA did not reduce postoperative pain and extubation time.

LIMITATIONS: Our meta-analysis has high heterogeneity, with a predominance of women and middle-aged populations in the included studies. Additionally, side effects related to OFA were not analyzed.

CONCLUSIONS: Our systematic review and meta-analysis concluded that it is uncertain whether OFA is superior to OBA in improving postoperative recovery quality. However, OFA leads to a statistically significant reduction in the incidence of postoperative nausea and vomiting. The evidence was primarily drawn from small trials involving elective surgeries. While our results support using OFA, larger and high-quality studies are needed to validate its effect on postoperative recovery quality.

PMID:42263301

Cancer Nurs. 2026 May 4. doi: 10.1097/NCC.0000000000001584. Online ahead of print.

ABSTRACT

BACKGROUND: Yoga-based breathing exercises (pranayama) can be effective in improving symptoms such as pain, fatigue, and insomnia, and increasing self-efficacy after colorectal cancer surgery.

OBJECTIVE: To evaluate the effects of pranayama on pain, fatigue, insomnia, and self-efficacy after colorectal cancer surgery.

METHODS: This study was a randomized controlled trial comparing a yoga-based breathing intervention to a usual care control group. Participants who were taking the same type and dosage of postsurgical pain medication and not taking sleeping pills were randomly assigned to groups. This study was conducted with 80 adult patients with a recent diagnosis of colorectal cancer who were scheduled for surgical resection. The intervention group performed pranayama twice a day in the evening before surgery and for 7 days after surgery.

RESULTS: In the intervention group, fatigue decreased (P = .012, η2 = 0.055) and sleep quality improved more (P = .033, η2 = 0.043) compared with the control group. Although pain levels decreased over time in the intervention group compared with the control group, this change was not statistically significant (P = .185, η2 = 0.021). Similarly, self-efficacy showed an upward trend in the intervention group; however, this increase was not statistically significant (P = .126, η2 = 0.026).

CONCLUSIONS: Pranayama may be effective in reducing postsurgical fatigue and insomnia and improving self-efficacy.

IMPLICATIONS FOR PRACTICE: These findings support the integration of pranayama into holistic perioperative care as a complementary approach to managing postsurgical symptoms such as fatigue and insomnia.

PMID:42263273 | DOI:10.1097/NCC.0000000000001584