Actual Pain Research Articles

Brief Compassion-Focused Imagery Dampens Physiological Pain Responses

ObjectivesAffiliative processes are postulated to improve pain coping. Comparatively, compassion-focused imagery (CFI) also stimulates affiliate affect systems with a burgeoning behavioural, cognitive and physiological evidence base. Thus, the purpose of the present research was to investigate if engaging in brief CFI could improve pain coping.MethodsUtilising a randomised repeated measures crossover design, 37 participants were subjected to experimental pain (cold pressor) following counter-balanced engagement with CFI or control imagery, 1 week apart. Salivary alpha-amylase (sAA) and questionnaire measures of emotional responding were taken: at baseline, following introduction to the imagery condition (anticipation), and immediately after the cold pressor pain task (actual).ResultsParticipants exhibited increases in sAA levels in response to pain following control imagery but, no such changes were observed following CFI (i.e. there was a significant time-by-condition interaction). Pain tolerance (the length of time participants immersed their hands in the cold pressor) did not differ by imagery condition. However, sAA responses to actual pain predicted decreased pain tolerance in the CFI condition. Additionally, anticipatory sAA response predicted increased pain tolerance across both conditions. None of the emotional measures of well-being differed by imagery condition, nor by condition over time.ConclusionsThese data demonstrate that using CFI can curtail a physiological stress response to pain, as indicated by increases in sAA in the control imagery condition only, following pain; pain tolerance was not influenced by CFI. Compassion-based approaches may therefore help people cope with the stress associated with pain.

Impact of low back pain on fear of movement and functional activities

Fear is an uncomfortable feeling, which results from the proximity of actual threat or pain. A strong correlation exists between fear and pain. Kinesiophobia is the phobia of activity and physical movement, which results from a sensation of sensitivity to painful injury or reinjury. Low back pain (LBP) is among the frequent disorders of the musculoskeletal system. LBP is mainly due to bad postures and poor organisational ergonomics. Kinesiophobia has adverse effects on rehabilitation outcomes. So the systematic application of graded exposure to movements is recommended in patients with Kinesiophobia to prevent pain-related anxiety. We compared Kinesiophobia's impact on patients with both acute and chronic LBP. We aimed to find out the role of Kinesiophobia in patients having LBP. The survey-based research using Tampa scale of Kinesiophobia was conducted with cross-sectional design. It included participants of both genders,in the age group of 18-65 who were diagnosed with acute and chronic low back pain. Tampa Scale for Kinesiophobia, Evaluation Performa, NPRS and Goniometer were used as outcome measures for the study. The patients were thoroughly examined, and they were evaluated using the Tampa Scale. Scoring to 17-items Tampa Scale was performedin4-point Likert scale varying from “strongly disagree” to “strongly agree.” After the inversion of items 4, 8, 12, 16, the final score was determined. The total score ranges from a minimum of 17 to a maximum of 68. It was concluded that Kinesiophobia plays a crucial role in LBP, especially chronic LBP.

Pre-teens, Audio Analgesia and Dental Care: A Cross-Sectional Study

INTRODUCTION: Research has proven that music plays an important role in alleviating fear and anxiety among patients.AIM: To assess the effect of audio analgesia in pre-teen children aged 8-12 years undergoing dental restorations. MATERIALS AND METHOD: Data was collected using a pre-tested and pre-validated proforma filled by the child prior to start of the treatment by circling the number corresponding to the expected pain during the procedure [Ranged 0 (No pain) -10 (Maximum pain)]. Children who reported their expected pain above 5, were enrolled in group 1 (The ones receiving audio analgesia) while the remaining were assigned group 2 (controls). Children in group 1 were asked to put on their favourite song using noise cancellation headphones and the procedure was commenced. After completion of the treatment, the VAS scale was re-introduced and the children were asked to re-circle the actual pain experienced during the procedure. Data was analyzed using SPSS version 20.0 using the chi-squared test and Pearson’s correlation coefficient. A significant value was obtained when p was≤ 0.05. RESULTS: Of the total 80 children enrolled in the present study, there were an equal number of males and females (40 each). It was observed that 70.3% of children in group 1 had an increased pain tolerance as compared to only 37.2% of children in the control group(p=0.01). Pearson’s Correlation revealed a positive and linear association (r: +0.721) and a significant relationship (p = 0.03) between both groups. CONCLUSION: Audio analgesia has been proven to a promising alternative to distract the patient from the anxiety faced in the dental setting and is recommended for nervous and anxious patients.

High level of satisfaction among women who underwent oocyte retrieval without anesthesia

To assess the level of satisfaction of women undergoing transvaginal oocyte retrieval (TOR) without anesthesia as well as the comfort of the gynecologists. Single-center, prospective cohort study of women undergoing TOR from July 2017 to January2018. This study was conducted in an academic public hospital. Women with ≤15 follicles for retrieval were eligible. Women with body mass index > 35, difficult vaginal approach, endometrioma > 5 cm, or pelvic inflammatory disease were excluded. None. Our primary endpoint was patient satisfaction. Secondary endpoints were women's willingness to recommend or undergo the procedure again without anesthesia, anxiety levels before the procedure, expected level of pain, actual pain levels during the procedure, and gynecologist's level of difficulty or technical compromise. During the study period, 500 TORs were performed, of which 402 (80%) were screened for study eligibility. Overall, data were analyzed for 50 eligible women who had their first invitro fertilization cycle (participating in the study) without anesthesia. High rates of satisfaction were reported, and 90% would recommend the procedure without anesthesia to their friends. Physicians graded the difficulty of the procedure as very easy in 35 procedures; in only two procedures was difficulty reported. TOR without anesthesia is feasible, with a relatively high satisfaction rate from both patients and gynecologists, suggesting that it should be considered in selected women.

Factors influencing the prescribed dose of opioid analgesics in cancer patients.

The dose of opioids prescribed for cancer pain does not always correlate with the actual pain severity. However, there is little evidence to explain this observation. In the present study, we sought to determine factors that influence the dose of opioid analgesics. A total of 227 patients who were administered opioids between August 2012 and May 2016 and later expired within the Department of Palliative Care at Ashiya Municipal Hospital were included, and the following variables were examined: age, sex, type of cancer, Verbal Rating Scale before and after the administration of the maximum pre-scribed dose of opioids, type of opioids and route of administration, blood test results, pain severity, and use of adju-vants. Data were analyzed using step-wise multiple linear regression. Median of the maximum prescribed dose of opioids, expressed in oral morphine equivalent, was 68.6, 60.0, and 39.2 mg for patients aged <65, 65-74, and ≥75 years, respectively. Step-wise multiple linear regression analysis further demonstrated that an increase in age by 1 year decreased the maximum prescribed dose of opioids by 0.98-fold (p = 0.006). Other factors that influenced the maximum prescribed dose of opioids included the use of analgesic adjuvants (1.91-fold, p = 0.001), oral administration (0.54-fold, p = 0.016), and elevated level of bilirubin (0.95-fold by 0.1 mg/dL increase, p = 0.013). Opioids examined in the study are metabolized in the liver by cytochromes P450 or by glucuronidation. Thus, if reduced drug metabolism causes the reduction in the maximum prescribed dose of opioids, liver function may contribute to this effect. Based on our findings that old age is associated with a lower prescribed dose of opioids, future studies should examine additional variables included in laboratory tests in more detail and measure hepatic blood flow to determine the cause of this as-sociation.

Medically Unexplained Symptoms and Bodily Distress

Medically Unexplained Symptoms and Bodily Distress

"Please mind the gap": A secondary analysis of discomfort and comfort in intensive care.

To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. Secondary qualitative analysis of data from two previous exploratory studies. Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. Three themes, "Being deprived of a functioning body", "Being deprived of a functioning mind" and "Being deprived of integrity" characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients' needs and the nurses' achievements in fulfilling these needs. A gap exists between ICU patients' comfort needs and nurses' achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.

MP83-07 AFFECT ON EXPECTED AND PERCEIVED PAIN OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY IN ARABIC MEN GIVEN ARABIC MEDICAL INFORMATION

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety IV (MP83)1 Apr 2020MP83-07 AFFECT ON EXPECTED AND PERCEIVED PAIN OF TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY IN ARABIC MEN GIVEN ARABIC MEDICAL INFORMATION Brittany Milliner*, Joshua Palka, Nivedita Dhar, and Brian Allen Brittany Milliner*Brittany Milliner* More articles by this author , Joshua PalkaJoshua Palka More articles by this author , Nivedita DharNivedita Dhar More articles by this author , and Brian AllenBrian Allen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000975.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Healthcare providers in Metropolitan Detroit are seeing a growing number of Arabic-speaking migrants. Communication between Arabic-speaking patients and non-Arabic-speaking healthcare staff can be improved by using a professional interpreter and Arabic written medical information (AWMI). This study prospectively evaluated expected and actual pain levels before reading AWMI, after reading AWMI, and immediately after transrectal ultrasound guided (TRUS) prostate biopsy. METHODS: We prospectively analyzed records from 60 Arabic-only speaking/reading males aged 45-72 with elevated PSAwho underwent ambulatory TRUS prostate biopsy from a single urologist between January 2015 to December 2018. Pain was graded on an Arabic written Likert visual analog scale (Fig. 1) where 0 = no pain and 10 = excruciating pain. Patients completed the pain grading before and after reading the AWMI and after the prostate biopsy. The pain scores were evaluated for significance with the use of the Student t test and the Pearson correlation coefficient. RESULTS: The overall mean pain score was 4.74 ± 1.51 (range 2-9) before reading AWMI, 3.24 ± 1.57 (range 2- 8) after reading AWMI, and 2.18 ± 1.53 (range 1-7) after biopsy (P<.05) (Table 1). CONCLUSIONS: Muslim men have specific challenges in seeking healthcare based on Islamic teachings or social constructs. The use of AWMI in Arabic men may lower the amount of perceived pain of a prostate biopsy. Further research is needed to identify obstacles, improve access, and provide quality care for this population. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1258-e1258 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Milliner* More articles by this author Joshua Palka More articles by this author Nivedita Dhar More articles by this author Brian Allen More articles by this author Expand All Advertisement PDF downloadLoading ...

Patients help other patients: Qualitative study on a longstanding community cooperative to tackle leprosy in India.

BackgroundAlthough leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world’s newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India’s official declaration of ‘elimination’, which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds.Methods and findingsThis qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital’s sustainability. Open coding, axial coding and selective coding were conducted, and Glaser’s Six C’s model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients’ strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a ‘consumer-provider cooperative’, where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients’ occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study.ConclusionsThis study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.

Pain catastrophizing and medication overuse in patients with chronic migraine

Migraine is a frequent and debilitating primary headache. Pain catastrophizing is a negative set activated in response to anticipated or actual pain. The anticipatory fear of pain, one of its characteristics, has been associated with a greater prescription and use of analgesics. To explore the pain catastrophizing in relation to analgesic overuse and the headache impact on quality of life in patients with chronic migraine. An observational cross-sectional analytical study was performed. Patients older than 18 years with chronic migraine were included, who were given anonymously the Pain Catastrophizing Scale and the Head Impact Test-6. When comparing the incidence of analgesic overuse among patients with clinical pain catastrophizing levels and those without pain catastrophizing, the probability of analgesic overuse was 16 times higher in the first group (odds ratio = 16.06; 95% CI = 5.91-43.61; p < 0.0001). When comparing the presence of a severe migraine impact in patients with and without pain catastrophizing, the probability of a severe migraine impact is approximately eight times greater in the first group (odds ratio = 8.27; 95% CI = 3.19-21.42; p < 0.0001). Clinical levels of pain catastrophizing in patients with chronic migraine might be associated with a higher incidence of analgesic overuse and a greater headache impact on quality of life.

Research on Forecasting Technology of Single Base Tower Cost in Transmission Line Engineering

For a long time, the overhead transmission line project budget, completion settlement and financial final accounts are all valued according to the entire line. The project construction management and asset collection have not yet been refined. The management is not separately calculated according to the actual investment of different towers, and cannot be reflected in each base tower. The actual cost level and the accuracy of the cost need to be further improved. Therefore, this paper combines the actual pain points and difficulties of overhead line engineering cost management, and innovatively builds a pricing model based on a single base tower. When the company strengthens the construction drawing budget management, improves the project settlement level, accurately controls risks, and realizes high-quality management of cost management. The level of leanness is of great practical significance.

Harm-Benefit Analyses Can Be Harmful.

Harm-benefit analyses (HBAs) are becoming de rigueur with some governmental regulatory agencies and popular with local institutional animal care and use committees (or their equivalents), the latter due, in part, to the adoption of HBAs as an international accreditation standard. Such analyses are employed as an attempt to balance potential or actual pain or distress imposed on laboratory animals against scientists' justifications for those impositions. The outcomes of those analyses are then supposed to be included in an official assessment of whether a given animal protocol should be approved as proposed. While commendable in theory as a means to avoid or minimize animal suffering, HBAs come with a flawed premise. Establishing an accurate prediction of benefit, especially for so-called "basic" research (vs "applied" research, such as in vivo testing for product development or batch release), is often impossible given the uncertain nature of experimental outcomes and the eventual value of those results. That impossibility, in turn, risks disapproving a legitimate research proposal that might have yielded important new knowledge if it had been allowed to proceed. Separately, the anticipated harm to which the animal would be subjected should similarly be scrutinized with an aim to refine that harm regardless of purported benefits if the protocol is approved. The intentions of this essay are to reflect on the potential harm and benefit of the HBA itself, highlight how HBAs may be helpful in advancing refinements, and propose alternative approaches to both parts of the equation in the assessment process.

563 High Rate of Discordant Pain Levels Reported by Patients and Physicians During Gastrointestinal Endoscopy

INTRODUCTION: Procedural sedation is given to reduce patient anxiety, discomfort, pain and to improve outcomes in endoscopy. Data are limited regarding patient satisfaction with endoscopy. Our goal was to evaluate physician perceptions of patient pain and anxiety before and after endoscopy and factors associated with their correlation. METHODS: We performed a prospective study of 233 consecutive patients who received procedural sedation during endoscopy from August to November 2018 at the Portland VA Medical Center. Patients were given a pre-endoscopy survey to assess expectations and a post-endoscopy survey to assess procedural satisfaction, and physician were given a post-endoscopy survey only. Outcomes included expected and actual pain, anxiety, and sedation level during endoscopy and was reported on a scale from 0 to 5. RESULTS: Upper endoscopy, colonoscopy, and bi-directional endoscopy were performed in 30%, 60%, and 10% of cases, with an average procedural time of 19.1 minutes. Midazolam and fentanyl were most commonly used for sedation with an average dose of 4.0 ±0.1 mg and 102.5 ± 2.7 mcg, respectively. A minority of patients reported alcohol, marijuana, non-opiate pain medication, and opiate use (39%, 15%, 19%, and 16%, respectively). Pre-procedural anxiety and expected level of pain significantly improved with patient's post-procedural assessment (Tables 1 and 2). The average difference of anxiety and pain levels pre-endoscopy and post-endoscopy was 0.48 and 0.41, respectively. There was poor concordance between the physician's perceived patient pain and patient reported pain level during endoscopy (61%) with an overall Cohen's kappa of 0.258. Several factors associated with reduced patient and physician pain correlation included the presence of mental health disorders and use of benzodiazepines, SSRI, or SNRI (Table 3). Despite the discordance, the majority of patients reported satisfaction in pain control and would return for a repeat procedure (85% and 95%, respectively). CONCLUSION: Patients reported higher levels of pre-procedure anxiety and expected pain than actual anxiety and pain post-procedure. Physicians have poor concordance with patients with respect to pain levels, especially with more severe pain scores and in the presence of mental health disorders. Patients at high risk for discordance may benefit from more thorough pre-procedural counseling and a lower threshold for escalating doses of sedation during endoscopy.

Lesson Learned from Peer Volunteers in a Peer-Led Pain Management Program among Nursing Home Residents.

Background: Chronic pain is common among older adults and is associated with adverse physical and psychological outcomes. Given the burden of pain and limited healthcare resources, devising innovative and cost-effective ways of managing chronic pain is of high priority. The aim of this paper is to explore the experiences and perceptions of peer volunteers (PVs) in a peer-led pain management program among nursing home residents in Hong Kong. Methods: Forty-six PVs were recruited and trained to lead a pain management program (PAP). The PAP consisted of one 1 hour session per week for 12 weeks. It included 20 min of physical exercises performed under the supervision of PVs, followed by 30 min of pain management education, including information on pain situations, the impacts of pain, the use of drugs and non-drug strategies for pain management, demonstrations, and return demonstrations of various non-drug pain management techniques. Quantitative data were collected from questionnaires (demographics, pain situation, and pain knowledge) for all PVs. Qualitative data (PVs’ experiences in leading the PAP, their perceived benefits, barriers encountered, and recommendations for improving the PAP) were collected at week 12 (upon completion of the PAP). Data were analyzed using the Statistical Package for Social Sciences and content analysis for qualitative data. Results: A total of 46 PVs were recruited (34 females, 74%), with a mean ± SD age of 61.0 ± 5.1 years. Thirty-one of them reported having chronic pain. Before the training, their self-rated pain knowledge was 40.0 ± 20.5 (maximum 100 points) while their actual pain knowledge score was 86.1 ± 10.6 (maximum 100 points). The PVs reported an improvement in their knowledge and skills after leading PAPs. No PVs reported having received any negative comments about their role in leading the PAP but mentioned that they had received feedback on how to improve the program. Conclusions: This study provides further evidence that peer-led pain management programs are feasible and can lead to positive experiences for the PVs. Peer support models are coming into wide use because they show promise in helping patients to manage chronic conditions. Peer volunteers will become important resources in elderly care. The barriers that were identified may lead to improvements in the design and planning of future PAPs.

Experimental Characterization of the Chronic Constriction Injury-Induced Neuropathic Pain Model in Mice.

Number of ligations made in the chronic constriction injury (CCI) neuropathic pain model has raised serious concerns. We compared behavioural responses, nerve morphology and expression of pain marker, c-fos among CCI models developed with one, two, three and four ligations. The numbers of ligation(s) on sciatic nerve shows no significant difference in displaying mechanical and cold allodynia, and mechanical and thermal hyperalgesia throughout 84days. All groups underwent similar levels of nerve degeneration post-surgery. Similar c-fos level in brain cingulate cortex, parafascicular nuclei and amygdala were observed in all CCI models compared to sham-operated group. Therefore, number of ligations does not impact intensity of pain symptoms, pathogenesis and neuronal activation. A single ligation is sufficient to develop neuropathic pain, in contrast to the established model of four ligations. This study dissects and characterises the CCI model, ascertaining a more uniform animal model to surrogate actual neuropathic pain condition.

Relationship Between Postoperative Pain and Overall 30-Day Complications in a Broad Surgical Population: An Observational Study.

The aim of this study was to establish the relationship between postoperative pain and 30-day postoperative complications. Only scarce data are available on the association between postoperative pain and a broad range of postoperative complications in a large heterogeneous surgical population. Having postoperative pain was assessed in 2 ways: the movement-evoked pain score on the Numerical Rating Scale (NRS-MEP) and the patients' opinion whether the pain was acceptable or not. Outcome was the presence of a complication within 30 days after surgery. We used binary logistic regression for the total population and homogeneous subgroups to control for case complexity. Results for homogeneous subgroups were summarized in a meta-analysis using inverse variance weighting. In 1014 patients, 55% experienced moderate-to-severe pain on the first postoperative day. The overall complication rate was 34%. The proportion of patients experiencing postoperative complications increased from 0.25 [95% confidence interval (CI) = 0.21-0.31] for NRS-MEP = 0 to 0.45 (95% CI = 0.36-0.55) for NRS-MEP = 10. Patients who found their pain unacceptable had more complications (adjusted odds ratio = 2.17 (95% CI = 1.51-3.10; P < 0.001)). Summary effect sizes obtained with homogeneous groups were similar to those obtained from the total population who underwent very different types of surgery. Higher actual postoperative pain scores and unacceptable pain, even on the first postoperative day, are associated with more postoperative complications. Our findings provide important support for the centrality of personalized analgesia in modern perioperative care.

Reducing Opioid Prescriptions in Outpatient Pediatric Urological Surgery.

We assessed the impact of a 2-phase Plan-Do-Study-Act cycle to decrease opioid prescriptions following pediatric urological surgery. Parents of children undergoing outpatient urological procedures were given questionnaires to assess opioid dosing and pain scores using the Parents' Postoperative Pain Measure scale. Age, procedure and opioid prescription data were recorded, as well as volume of medication administered. During the first phase of data collection children received an opioid prescription for 10 doses. In the second phase opioid prescriptions were reduced by 50%. Nonparametric tests and Fisher exact test were used for analysis. Of 250 eligible children 98 (39%) with a median age of 3.0 years (IQR 7.0) participated. In the 81 patients prescribed opioids a median of 2 doses (IQR 3.6) were used in the preintervention and postintervention groups (p = 0.68). Using nonparametric statistical testing, no significant differences were found between pain scores in the 5-dose group (31 patients) and the 10-dose group (24 patients; p = 0.05 for day 1, p = 0.07 for day 2, p = 0.06 for day 3). There was no association between age and percent opioid used (p = 0.83). There were no significant differences in median pain scores or median doses among procedure types. In outpatient pediatric surgical practice opioid prescriptions can be decreased without increasing pain scores. Physician prescribing practices may contribute more to opioid consumption than actual pain patterns.

Efficacy of Chewing Gum to Reduce Orthodontic Pain Compared to Placebo: A Blinded, Parallel-Group, Preliminary Clinical Trial.

To quantify the pain experienced by orthodontic patients during the first 10 days of appliance placement, to determine whether chewing gum reduces orthodontic pain compared to placebo, and to examine patients' overall perceptions of the impact of orthodontic pain. Patients bonded with fixed appliances were randomly assigned to one of two groups (gum group [GG] or placebo group [PG]) and then followed for 10 days. The main outcome was a visual analog scale (VAS) pain score, and the secondary outcomes included patients' subjective assessments of overall pain level, the impact of pain on hygiene habits and treatment decision, and the frequency of analgesics consumption. Eighty kits (40 for GG and 40 for PG) were pre-randomized and concealed before patient enrollment using a computer-generated random sequence. Operators and patients were blinded. Data were analyzed using generalized linear models and Mann-Whitney U, chi-square, and Fisher exact tests. A total of 75 patients were allocated to intervention groups; 37 participated and completed diaries (20 in GG and 17 in PG). No statistically significant differences were detected between the GG and PG groups in any tested variable. Pain negatively affected some patients' oral hygiene practices. A mismatch existed between patient expectations and actual pain experiences. Female patients used analgesics more frequently than male patients (P = .046). Chewing gum three times per day does not seem to significantly reduce orthodontic pain compared to placebo. Orthodontists should manage their patients' pain expectations.

(252) The Role of Self-Other Comparisons in Race Differences in Pain Tolerance

Research has found race differences in pain sensitivity and tolerance. Evidence suggests how people compare themselves to similar others influences interpretations of their own health and well-being. We examined participants’ perceptions of their pain sensitivity compared to their perceptions of the pain sensitivity of “typical” members of their race (self-other comparison) and how these self-other comparisons related to race differences in actual pain tolerance. Black and White undergraduates (N=132; 48.5% Black) completed the Race/Ethnicity Expectations of Pain Questionnaire and a cold pressor task. First, we examined participants’ beliefs related to race differences in pain using a paired samples t-test to understand the perceived pain sensitivity of the comparison groups. Then, we examined how participants’ self-other comparison ratings for pain moderated the relationship between race and actual pain tolerance using a robust multiple-group moderation analysis. Results indicated participants rated the “typical” Black person as less pain sensitive than the “typical” White person (t(131)=-6.83, p

Does experienced pain affects local brain volumes? Insights from a clinical acute pain model

Background/Objective:To study pain-brain morphometry associations as a function of post-surgery stages (anesthesia, pain and analgesia) in an acute pain model. Method:Impacted mandible third molar were extracted. Before surgery, an anatomical T1 scan was obtained. Regional brain volumen and subcortical nuclei shapes were obtained. Statistical analyses were done using multiple regression, being pain scores the predictors and voxel volumes, subcortical nuclei volumes and subcortical nuclei shapes, the outcomes. Results:Pain was significantly larger at pain than at anesthesia and analgesia stages, and was higher during anesthesia than during analgesia. Pain intensity was related to grey matter in several cortical (Insula, Mid Frontal and Temporal Gyruses, Precuneus, Anterior Cingulate), and subcortical nuclei (Hippocampus, Thalamus, Putamen, Amygdala), depending of the post-surgical stage. A larger number of brain areas showed significance at pain that at anesthesia and analgesia stages. Conclusions:The relationships of regional brain volumes and subcortical nuclei shapes with pain scores seemed to be unsteady, as they changed with the patient's actual pain stage.