Actual Pain Research Articles

Should Placebo Treatment Be Used in the Clinical Setting for Pain Management? A Commentary

A placebo should not be used in clinical settings for pain management because it is associated with ethical dilemmas and also has detrimental health effects. It is illegal and immoral to fabricate, suppress and misrepresent information to the client, because concealing information has a considerable outcome on the patient-doctor relationship. The use of a placebo has a substantial negative impact on clients’ health when they are actually in pain. However, a placebo has an impact on patients’ expectations by activating a series of endogenous opioids that modify the experience of pain. While it is true that a placebo helps in reducing pain in some circumstances, we cannot just assume that a placebo always works effectively for all patients. The use of a placebo can compromise the patient’s safety or underrate the potential risk associated with disregarding the patient’s actual pain. The use of a placebo is ethically problematic as it falls under the concept of deception, and it is also injurious to misunderstand the actual pain that may lead to serious health consequences.

Reliability of clinical examination methods for postoperative pain after primary root canal treatment

Background/purposeClinical test results may have lower reliability due to the varying range of test stimulation or patient subjectiveness. This study aimed to verify a reliable clinical test method by comparing pain intensity levels of a tooth at rest, during function, and after the clinical tests of percussion and chewing. Materials and methodsA total of 36 asymptomatic necrotic teeth that required root canal treatment, one in each patient, were included. All treatment procedures were performed in a single visit by an experienced endodontist. Patients were asked to mark their pain levels on a vertical visual analog scale (VAS) while the relevant tooth was at rest and during function 24 h after the treatment. In addition, patients marked their pain levels after the clinical tests of percussion and chewing. Finally, the pain levels were compared using Pearson's correlation for the reliability of the test methods at a significance level of 95%. ResultsThe postoperative pain levels measured during the clinical tests and functions were significantly higher than the pain levels at rest (P < 0.05). The pain levels after percussion tests were significantly higher than that during the function and chewing tests (P < 0.05). Pain intensity during the function was simulated with a higher correlation when using the chewing strip method rather than the percussion method. ConclusionThe bite test using the chewing strips as a pain intensity assessment can mimic the actual postoperative pain experience, whereas the percussion test fails to provide the accuracy of this pain experience.

The Neuromatrix Theory of Pain and Transactional Theory of Stress and Coping: Improving Understanding of Pain Catastrophizing in Individuals With ACL Reconstruction and Knee Osteoarthritis

Individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms commonly exhibit psychological impairments, such as pain catastrophizing. Pain catastrophizing is a negative cognitive–affective response to anticipated or actual pain and has been linked to greater pain intensity and decreased function in this population. However, an examination of the neuromatrix theory of pain and the transactional theory of stress and coping may help to explain the development and consequences of pain catastrophizing in individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms. Exploration of these theoretical models will help clinicians better understand the impact of pain catastrophizing on post-injury outcomes, as well as help to identify intervention strategies to address maladaptive psychological responses and improve outcomes for individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms.

Correlating the Patient Reported Outcomes Measurement Information System (PROMIS) to the Foot and Ankle Outcome Score and Patient Functional Testing in Total Ankle Arthroplasty Patients

Category: Ankle Arthritis; Other Introduction/ Purpose: The orthopaedic field, including foot and ankle surgery, continues to rely on patient reported outcome measures (PROMs) as the cornerstone of research studies. Various questionnaires exist, each with their advantages and disadvantages. The Patient-Reported Outcomes Measurement Information System (PROMIS) has become increasingly popular due to its reliability, validity, and efficiency. This system has been tested against the Foot and Ankle Outcome Score (FAOS) for foot and ankle conditions, however little is known about its validity for patients with ankle arthritis undergoing total ankle arthroplasty (TAA). Additionally, its relationship to functional tests is unknown, which could reveal whether it could be used in lieu of these resource-intensive assessments. Therefore, we aimed to validate PROMIS against the FAOS and functional tests in TAA patients. Methods: This prospective cohort study included 102 patients (mean age: 63.5 years) who were diagnosed with ankle arthritis and underwent subsequent TAA. Preoperative PROMIS scores, FAOS, and functional tests including the 4 square test (4SST), timed up and go (TUG), and sit-to-stand (STS) were gathered and analyzed preoperatively. PROMIS physical function and pain interference domains were tested for reliability using Rasch partial credit models. Convergent validity between PROMIS physical function and pain interference, and FAOS function, daily living was evaluated using Spearman’s correlation coefficient. In addition, the relationship between the functional tests and all 6 PROMIS domains were evaluated using Spearman’s correlation coefficient. Results: Infit and outfit mean squares (MSQs) for PROMIS physical function ranged from 0.61 – 0.78, indicating a good fit in the Rasch model. Similarly, infit and outfit MSQs for PROMIS pain interference ranged from 0.77 – 0.8, also indicating a good fit. Separation reliability was 0.89 for physical function and 0.85 for pain interference, indicating good reliability to actual patient function and pain levels. PROMIS physical function demonstrated a moderate positive correlation with FAOS function, daily living (r=0.52) while pain interference demonstrated a moderate negative correlation (r=-0.52). PROMIS physical function demonstrated statistically significant weak negative correlations for all 3 functional tests (r=-0.19 for 4SST, r=-0.27 for TUG, r=-0.2 for STS) [Figure 1]. Conclusion: Our study revealed good reliability of PROMIS physical function and pain interference domains, with a moderate correlation to FAOS function, daily living. Additionally, we found weak correlations between PROMIS physical function and functional tests and no significant correlations between pain interference and functional tests. This indicates acceptable convergent validity to the FAOS but not to functional tests. Therefore, while PROMIS provides reliable and valid measures, it does not replace the need for functional tests, which should be pursued in conjunction to deliver a complete assessment of TAA patients.

Content Analysis for a Statewide Substance Use Disorder and Pain Management Curriculum for Health Professional Students (ALAHOPE).

Alabama's health professions schools have many common goals when it comes to educating their students about substance use disorder (SUD) and pain, but a statewide consistent SUD and pain management curriculum does not exist in Alabama. The ALAbama Health professionals' Opioid and Pain management Education (ALAHOPE) project set out to create an interprofessional curriculum around SUD and pain management that all Alabama health professions schools can use to promote consistent evidence-based teaching and a patient-centered approach around these two topics. An adapted form of the Kern model of curriculum development was used to guide the project. The first dimension of this model is problem identification, which requires identifying the desired future state. One of many assessments performed to identify the desired future state was an analysis of six external curricula. The purpose of this assessment was to critically document and analyze existing SUD and pain management curricula to inform the ALAHOPE curriculum content. The learning objectives and detailed content topics of each curriculum were documented and categorized into content topics. These broad topics were used as one piece of a cross-thematic analysis of several future state assessments that led to the development of broad curriculum goals for the ALAHOPE curriculum project. Common trends found in the analyzed curricula included learning objectives not being all-inclusive or not matching the actual curricula content, combining SUD and pain management content, and including the risks of treating pain with controlled substances in content solely created for pain management. These results can be used to help inform other SUD and pain management educational content.

Can Patients Accurately Recall their Preoperative Pain and Functional Scores Following Rotator Cuff Repair and Total Shoulder Arthroplasty?

Accurate analysis of preoperative shoulder pain and function is important for understanding treatment efficacy and producing high-quality research. Oftentimes, preoperative patient-reported outcomes (PROs) are missing. Therefore the accuracy of recalled preoperative PROs may be important. We investigate the ability of patients who underwent rotator cuff repair (RCR) or shoulder arthroplasty (TSA) to recall their preoperative PROs. We identified 145 patients who underwent either RCR or TSA and had preoperative PROs. All patients completed the ASES, SANE, SST, and VAS surveys within 3 months prior to surgery. Patients were contacted between one and four years after surgery and asked to recall their baseline pain and shoulder function prior to surgery. The mean difference was calculated by determining the difference between the mean recalled score and the mean actual score. Intraobserver reliability analysis was performed, comparing recall and actual score for each using the 2-way mixed-effects intraclass correlation coefficient (ICC) model. The ICC values > 0.75 were considered excellent, values between 0.4 and 0.75 were considered moderate, and values of < 0.4 demonstrated a weak agreement. For patients who underwent RCR, the mean differences between actual and recalled ASES, SANE, SST and VAS pain were 6.3 (P=0.004), 2.0 (P=0.155), -0.04 (P=0.625) and - 1.0 (P<0.001), respectively. In patients who underwent TSA, the mean differences between actual and recalled ASES, SANE, SST and VAS pain were 4.5 (P =0.038), -3.9 (P=0.262), -1.2 (P=0.001) and -1.5 (P<0.001), respectively. ASES, SST, and VAS show moderate reliability, and SANE reliability was weak in both RCR and TSA populations. Patients had a tendency to recall higher pain scores than actual preoperative pain scores. In patients who underwent RCR or TSA, there was too much variability between individual patient's ability to accurately recall preoperative pain and function to reliably use recall data for research purposes.

Prediction of individual trigeminal pain sensitivity from gray matter structure within the sensorimotor network.

To determine whether multivariate pattern regression analysis based on gray matter (GM) images constrained to the sensorimotor network could accurately predict trigeminal heat pain sensitivity in healthy individuals. Prediction of individual pain sensitivity is of clinical relevance as high pain sensitivity is associated with increased risks of postoperative pain, pain chronification, and a poor treatment response. However, as pain is a subjective experience accurate identification of such individuals can be difficult. GM structure of sensorimotor regions have been shown to vary with pain sensitivity. It is unclear whether GM structure within these regions can be used to predict pain sensitivity. In this cross-sectional study, structural magnetic resonance images and pain thresholds in response to contact heat stimulation of the left supraorbital area were obtained from 79 healthy participants. Voxel-based morphometry was used to extract segmented and normalized GM images. These were then constrained to a mask encompassing the functionally defined resting-state sensorimotor network. The masked images and pain thresholds entered a multivariate relevance vector regression analysis for quantitative prediction of the individual pain thresholds. The correspondence between predicted and actual pain thresholds was indexed by the Pearson correlation coefficient (r) and the mean squared error (MSE). The generalizability of the model was assessed by 10-fold and 5-fold cross-validation. Non-parametric permutation tests were used to estimate significance levels. Trigeminal heat pain sensitivity could be predicted from GM structure within the sensorimotor network with significant accuracy (10-fold: r=0.53, p < 0.001, MSE=10.32, p=0.001; 5-fold: r=0.46, p=0.001, MSE=10.54, p < 0.001). The resulting multivariate weight maps revealed that accurate prediction relied on multiple widespread regions within the sensorimotor network. A multivariate pattern of GM structure within the sensorimotor network could be used to make accurate predictions about trigeminal heat pain sensitivity at the individual level in healthy participants. Widespread regions within the sensorimotor network contributed to the predictive model.

Development of a score map to guide interpretation of WOMAC Pain scores prior to knee arthroplasty

BackgroundScores from patient reported outcome measures (PROMs) are challenging to interpret for both clinicians and patients. PROMs obtained prior to knee arthroplasty (KA) could be used to inform important decisions related to KA made by both patients and clinicians. The purpose of this study was to develop a “score map” to allow for efficient and meaningful use of PROMs scores for patients considering KA. MethodsKnee arthroplasty data obtained between one day and twelve months preoperatively from two multicenter studies were combined and used to develop and test the accuracy of a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale score map. To develop the score map, individual item scores were used to determine the most probable responses to items for the entire range of possible WOMAC Pain scores. Predicted WOMAC Pain scores, using the most probable response for each possible score on the score map, were compared to actual presurgical WOMAC Pain scores using Weighted Kappa (Κw) agreement coefficients. The score map is an easy-to-use graphical display of the entire range of WOMAC Pain scores from no pain to extreme pain for each item comprising the WOMAC Pain scale. ResultsData from 780 patients were used in the analyses. The score map predicted WOMAC Pain scores and showed substantial agreement with actual WOMAC Pain scores Κw = 0.68 (95 %CI = 0.58, 0.77) to Κw = 0.77 (95 % CI = 0.75, 0.79). Perfect prediction of actual scores occurred between 55.1 % and 62.5 % of the time for all WOMAC Pain items. ConclusionThe WOMAC Pain score map has potential for facilitating a variety of important clinical decisions and discussions between patients and practitioners during healthcare encounters related to KA candidacy. For example, by comparing a patents’ scores to literature-based estimates, patients may better understand how their WOMAC Pain scores compare to other persons who underwent KA, how much a score may change, on average, after surgery and whether this change might be acceptable to them.

Evaluation of Effectiveness of Graphics Interchange Format and Wong–Baker FACES Pain Rating Scale as Pain Assessment Tool in Children

The objective of this preliminary study was to evaluate the validity and reliability of the graphics interchange format (GIF) as a self-reporting pain assessment tool in children. In this in vivo observational study, pain assessment of 42 children aged 7-13 years with a chief complaint of dental pain reporting the first time to the Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India, were included. Informed consent was obtained from the parents or guardians. All the responses were obtained by a single practitioner, after showing the respective self-reporting pain scale, that is, Wong-Baker FACES Pain Rating Scale (WBFPRS) and GIF pain scale. A questionnaire study was performed at the end of the study. The data were recorded, and then statistical analyses were performed. Both scales showed significant differences (p = 0.001*) when scales were individually compared to the actual pain intensity experienced by the patient. Both WBFPRS and GIF pain scales have shown non-significant differences (p = 0.155). The GIF pain scale has shown very strong relationship (r = 0.936, p = 0.001*), while WBFPRS showed strong relationship (r = 0.725, p = 0.001*). The GIF pain scale has shown almost perfect agreement (k = 0.911) whereas WBFPRS has shown substantial agreement (k = 0.710) with actual pain intensity. In the questionnaire study, most children strongly agreed that the GIF pain scale is easier to understand than WBFPRS. The GIF pain scale is a very promising self-report pain assessment tool for children. Further research on improving the GIF pain scale is very important. The newly devised GIF pain scale seems to be a very promising self-report pain scale for effective determination of pain experienced by the patient.

The relation between children's attention bias to pain and children's pain-related memory biases is moderated by parental narrative style

Children's heightened attention to pain and parental narrative style have been linked to the development of negatively-biased pain memories in children (i.e., recalling higher levels of pain and fear than initially reported, which robustly predicts maladaptive pain outcomes). However, the interplay between child attention bias and parental narrative style remains to be assessed. This study aims to fill this gap using enhanced paradigms assessing children's cognitive biases for cues signaling actual pain. Healthy school children (N = 63; 9–15 years old) received painful heat stimuli while performing a spatial cueing task measuring attention bias to cues signaling actual pain. Parent-child interaction upon completion of the painful task, was coded for parental narrative style (i.e., elaboration, repetition and evaluation). Children's pain-related memories were elicited two weeks later. Findings indicated that children showed an attention bias to cues signaling pain. Furthermore, children who were hypervigilant to pain cues benefitted from parents elaborating more about the pain experience, while children who avoided pain cues developed more negatively-biased pain memories if parents had a more elaborative style compared to a more evaluative parental style. In conclusion, this study suggests that optimal ways to talk about children's pain depend upon child characteristics (i.e., children's attention bias to pain).

Procedural Aspects of Epidural Catheter Placement: A Prospective Observational Study of 173 Epidural Catheter Insertions

The risks and benefits of epidural analgesia have been studied extensively, but information regarding many other aspects of epidural catheter insertion is limited. The authors aimed to add information regarding procedural pain, procedure duration, failure rates, and the effect of experience to the ongoing discussion on this procedure. A prospective observational study. A Danish tertiary hospital. Patients scheduled to undergo video-assisted thoracic surgery. Epidural catheter insertion in 173 patients undergoing video-assisted thoracic surgery for lung cancer. The authors recorded the time required for the epidural insertion procedure, the attempts used, insertion level, access use, patient position, placement technique used, and the designation of the physician placing the catheter. Furthermore, the authors asked the patients to evaluate the expected procedural pain, and after the procedure the authors asked them to evaluate the actual level of pain experienced. Six and 24 months after discharge, the authors examined persistent sequelae by using questionnaire assessments. The median procedure duration was 13 minutes, with 75% of the catheters placed within 22 minutes. Actual procedure-related pain (mean score [M]=3.5, SD=2.0) was significantly (p < 0.0001) less than that expected before the procedure (M=4.9, SD=2.0). The patients' expected pain, attempts required for successful catheter placement, and approach used to access the epidural space significantly affected the actual procedure-related pain (p=0.001, p ≤ 0.003, and p=0.023, respectively). Persistent pain and sensory disturbances were observed in 11% and 4% of the patients, respectively, after 6 months and in 6% and 4% of the patients, respectively, after 2 years. In this study, the authors examined several lesser-known aspects of epidural procedures. The use of epidural analgesia as part of the pain management plan after surgery requires a more complex evaluation instead of merely discussing the possibility of procedural infections, hematomas, or neurologic injuries. The procedure time, patients' expected and experienced pain related to the procedure, and the potential long-term side effects should be a part of the decision-making process.

Prospective analysis of pain expectancy and experience during MR-fusion prostate biopsy: does reality match patients’ expectancy?

PurposeMultiparametric magnetic resonance imaging fusion targeted prostate biopsy (MR-TB) has emerged to the biopsy technique of choice for evaluation of patients with suspected prostate cancer (PCA). The study aimed to determine expected and experienced pain during MR-TB depending on patients’ psychological state.MethodsWe prospectively enrolled 108 men with suspicion of PCA who underwent MR-TB. All patients completed self-reported validated questionnaires assessing pain, stress, self-efficacy, anxiety and study-specific questionnaires on expected and experienced pain before, during and after MR-TB. Patient characteristics and survey scores were obtained.ResultsOverall, pain levels during MR-TB were low (mean 2.8/10 ± 2.5 Numerical Rating Scale, NRS). 10/86 (11.6%) participants reported severe pain (≥ 7/10 NRS). Pain correlated significantly with anxiety (r = 0.42), stress (r = 0.22) and pain expectancy (r = 0.58). High self-efficacy did not show increased pain resilience. Participants anticipated more pain than experienced during each step of MR-TB with significant differences concerning local anesthesia and core sampling (both p < 0.001), among others. Expectancy and actual pain did not match regarding severity and impact of the total amount of cores taken (p < 0.05). Independent predictors of increased pain at biopsy were prostate volume > 50 ml (p = 0.0179) and expected pain during rectal manipulation (p < 0.001).ConclusionPain during MR-TB can be positively influenced by reducing men’s anxiety, stress and pain expectancy. To meet the needs of the audience, clinicians should address concrete pain levels of each procedural step and consider special treatment for patients with prostate volume > 50 ml and men reporting on increased rectal sensitivity.

The Effect of a Pain Educational Video Upon Child Pain-Related Memory and the Moderating Role of Parental Pain- and Non-Pain-Attending Verbalizations: An Experimental Lab-Based Study.

Early memories of pain contribute to fear and may underlie the maintenance and development of chronic pain into adulthood. Accordingly, understanding determinants that may impact children's pain memory development is key. This study examined (a) the effect of a brief engaging pain educational video in healthy children before undergoing an experimental pain task upon children's recalled pain intensity and pain-related fear and (b) the moderating role of parental pain- and non-pain-attending verbalizations before and after the pain task. Seventy-seven children (8-15 years old) participated in an experimental heat pain task, including actual heat pain stimuli delivered through a thermode on their forearm. Children were randomized to the experimental group (i.e., watching a pain educational video) or the control group (i.e., no video). Children's recalled pain intensity and pain-related fear were elicited 2 weeks later. Findings showed that recalled pain intensity (but not recalled pain-related fear) of children who watched the pain educational video was significantly lower compared to the control group (p = .028). Further, parental pain-attending verbalizations before the pain task moderated the impact of the video upon children's recalled pain intensity (p = .038). Specifically, children in the control group, but not the experimental group, whose parents used less pain-attending verbalizations recalled higher pain intensity, whereas children whose parents used more pain-attending verbalizations recalled lower pain intensity. As children's pain memories have important implications for pain assessment, treatment, and health across the lifespan, these findings might have important implications for the prevention of development or maintenance of maladaptive pain-related outcomes.

Predicted and actual 2-year structural and pain progression in the IMI-APPROACH knee osteoarthritis cohort.

The IMI-APPROACH knee osteoarthritis study used machine learning (ML) to predict structural and/or pain progression, expressed by a structural (S) and pain (P) predicted-progression score, to select patients from existing cohorts. This study evaluates the actual 2-year progression within the IMI-APPROACH, in relation to the predicted-progression scores. Actual structural progression was measured using minimum joint space width (minJSW). Actual pain (progression) was evaluated using the Knee injury and Osteoarthritis Outcomes Score (KOOS) pain questionnaire. Progression was presented as actual change (Δ) after 2 years, and as progression over 2 years based on a per patient fitted regression line using 0, 0.5, 1 and 2-year values. Differences in predicted-progression scores between actual progressors and non-progressors were evaluated. Receiver operating characteristic (ROC) curves were constructed and corresponding area under the curve (AUC) reported. Using Youden's index, optimal cut-offs were chosen to enable evaluation of both predicted-progression scores to identify actual progressors. Actual structural progressors were initially assigned higher S predicted-progression scores compared with structural non-progressors. Likewise, actual pain progressors were assigned higher P predicted-progression scores compared with pain non-progressors. The AUC-ROC for the S predicted-progression score to identify actual structural progressors was poor (0.612 and 0.599 for Δ and regression minJSW, respectively). The AUC-ROC for the P predicted-progression score to identify actual pain progressors were good (0.817 and 0.830 for Δ and regression KOOS pain, respectively). The S and P predicted-progression scores as provided by the ML models developed and used for the selection of IMI-APPROACH patients were to some degree able to distinguish between actual progressors and non-progressors. ClinicalTrials.gov, https://clinicaltrials.gov, NCT03883568.

The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study.

BackgroundIntravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children.ObjectiveThe main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan.MethodsWe applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test.ResultsA total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=–3.551, P<.001 and Z=–3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=–2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=–3.643, P<.001).ConclusionsThe intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

Trauma and pain sensitization in youth with chronic pain.

Chronic pain (pain lasting ≥3 months) co-occurs with internalizing mental health issues, such as posttraumatic stress symptoms (PTSS), at high rates in youth. The mechanisms underlying these relationships remain unclear. Posttraumatic stress symptoms, including re-experiencing (eg, intrusive memories), alterations in cognition and mood, hyperarousal, and avoidance could lead to altered neuronal processing, pain sensitization, and greater reports of pain. However, the relationships between PTSS and pain sensitization in youth with chronic pain are not known. Youth (n = 165) aged 10 to 18 years were recruited from outpatient multidisciplinary chronic pain programs. Symptoms of PTSS were assessed using psychometrically sound questionnaires. Youth also underwent a cold-pressor task, the most commonly used experimental pain induction technique. During this task, they reported on their expected pain, actual pain intensity, and pre- and post-state pain catastrophizing. Their pain threshold was recorded. A multivariate general linear model was used to examine the relationships between PTSS, ratings of pain intensity, state pain catastrophizing, and pain threshold, controlling for age, gender, ethnicity, anxiety, and depressive symptoms. Higher PTSS were associated with greater pain thresholds (P = 0.03) and higher pre- and post-state pain catastrophizing (P ≤ 0.05). Individuals with higher PTSS may avoid or dissociate from pain-inducing stimuli, thus leading to higher pain thresholds. However, individuals with higher PTSS also tend to catastrophize prior to and following exposure to pain. Avoidant and pain catastrophizing behaviors may serve to perpetuate chronic pain conditions. Future research is needed to determine how PTSS are related to pain sensitization prior to the development of chronic pain in at-risk youth.

A Comparative Analysis of Patients’ Perceived Pain Versus Actual Pain Pre- and Post-Intracavernosal Injection for Treatment of Erectile Dysfunction

A Comparative Analysis of Patients’ Perceived Pain Versus Actual Pain Pre- and Post-Intracavernosal Injection for Treatment of Erectile Dysfunction

Ефективність препарату Артрида® при болю в нижній частині спини

Стаття присвячена лікуванню пацієнтів із хронічним рецидивуючим болем у нижній частині спини. Наведено дані дослідження клінічної ефективності та безпеки препарату Артрида®, застосування якого в комплексній терапії в момент загострення і наявності актуального больового синдрому дозволяло скорочувати терміни прийому і дози нестероїдних протизапальних препаратів, а також сприяло поліпшенню біомеханічних показників і функціональної здатності пацієнтів.

Needle phobia and pain among electrodiagnostic subjects: Preliminary survey

Needle phobia, otherwise known as trypanophobia, is seen in at least 10% of the general population. We evaluated the effect of needle phobia on the perceived and actual pain during electrodiagnostic procedures in this study.

Patient's perspectives of injection‐site pain in intracavernosal therapy

AbstractIn this article, we report on patient's self‐reported anticipated and actual experiences of injection‐site pain while learning intracavernosal therapy. This is significant because anticipated pain has a strong bearing on the willingness of patients to pursue this form of treatment. We looked at 25 men undergoing teaching for intracavernosal injections for erectile dysfunction of mixed aetiology to assess their anticipated pain levels against actual pain levels experienced while injecting. Patients used a standard 0–10 pain score to indicate the level of pain they expected to experience while injecting prior to giving themselves an injection. They were subsequently asked to indicate how painful they actually found the injection. We found that, despite the fact that the majority of patients surveyed expected to experience moderate to severe levels of pain, post‐injection they reported either no pain or mild pain. Men undergoing teaching for penile self‐injection tend to overestimate the injection‐site pain caused by such treatment. Being able to reassure prospective patients of the ease of injection therapy may improve uptake.