Acute Pain Intensity Research Articles

Acute postoperative pain is correlated with the early onset of postpartum depression after cesarean section: a retrospective cohort study.

The primary purpose of this study was to evaluate the correlation between the intensity of acute postoperative pain and development of postpartum depression (PPD) after cesarean section (CS). The secondary purpose was to investigate perioperative risk factors for PPD detected in the postoperative period after CS. We retrospectively reviewed 615 women who had undergone CS between January 2017 and October 2019 in our hospital. The incidence of PPD was 22.7% on postoperative day (POD) 5 in the 247 women whose numerical rating scale (NRS) scores on POD3 were available. The severity of acute postoperative pain evaluated by NRS was higher in women with than in those without PPD on POD3 (P < 0.02). The independent risk factors for the onset of PPD on POD5 were being a primipara [adjusted odds ratio (aOR), 2.08; 95% confidence interval (CI), 1.03-4.20, P < 0.05], preoperative presence of chronic pain (OR, 4.44; 95% CI 1.82-10.81, P < 0.001), and NRS ≥ 2 on POD3 (aOR, 4.90; 95% CI 1.06-22.61, P < 0.05). Our findings suggest that assessing both acute postoperative pain and presence of PPD can inform the introduction of interventions in the early phase to prevent development of PPD after CS.

Pengaruh Pemberian Natrium Bikarbonat terhadap Kelelahan dan Nyeri Otot setelah Melakukan Treadmill

Treadmill is a physical exercise that caused a metabolic transition from aerobic into anaerobic. The aim of this study was to determine the effect of sodium bicarbonate to reduce fatigue and muscle pain after treadmill. This study used a time-series design with 20 selected samples from undergraduate student population of the Faculty of Medicine, Jember University. Samples consumed 100mg/kgBW NaCl (placebo) and NaHCO3 300mg/kgBW then perform a treadmil protocol until it reached maximum muscle fatigue. The results showed that the average treadmill of the treatment group (778,1±121,21 seconds) was longer than control group (717,7±93,02 seconds). The intensity of acute pain as measured by VAS (Visual Analog Scale) treatment group was lower (44,7±22,47 units) than control (55,4±19,97 units). So this study inferred that NaHCO3 can reduce fatigue and acute pain intensity after treadmill.

Musculoskeletal pain management in the Emergency Department

Introduction: The intensity of acute musculoskeletal pain is underestimated by health providers. Analgesia in adults that receive treatment for acute musculoskeletal pain varies from 11-29%. The timely and effective treatment of pain should become priority for the adequate pain management.Aim: The aim of the present study was to explore musculoskeletal pain management in the emergency department (ED).Material and Method: This is a descriptive study. The studied sample consisted of 82 patients, who admitted in the ED of Athen’s general hospital, due to acute musculoskeletal pain. For data collection, a special designed registration form was used. Related measurements were completed at two time points; the first time point was during patients’ admission to ED and the second one, 30 minutes post treatment or post ED discharge.Results: Patients average pain score was 7.25 ± 1.85 (first time point) and 3.76 ± 2.66 (second time point). Analgesia was provided to 51.2% of the sample and non-invasive methods were used in 51.2%. As for the frequency of the administrated drugs, analgesics were mostly preferred (29.3%), nonsteroidal anti-inflammatory drugs (NSAIDs) at 25.6% and opioids were used only at 9.8%. The mean time to first anministrated analgesic therapy was 16.56 ± 32.89 min.Conclusions: In spite of the extensive research and international guidelines for pain management, the fulfillment of the patients’ expectations for adequate and timely relief remains a challenge. The key for successful pain management lies to further education of medical stuff.

Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial.

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies.

Uso de morfina como tratamiento del dolor agudo en el Servicio de Emergencia del Hospital General Ambato

Introducción: El dolor es el principal síntoma por el cual los pacientes acuden al servicio de emergencia de nuestro hospital, representando hasta un 80% de las consultas médicas y un 10% refieren tener dolor agudo.&#x0D; Objetivo: Evaluar si el uso de morfina como primera elección terapéutica es adecuado para disminuir la intensidad del dolor agudo en pacientes que acuden al servicio de emergencia.&#x0D; Metodología: Se realizó un estudio descriptivo retrospectivo en pacientes atendidos durante el año 2018 en el Servicio de Emergencia del Hospital General Ambato, en los cuales se utilizó morfina como primera elección para tratamiento de dolor agudo con escala de dolor de EVA 7 a 10 puntos.&#x0D; Resultados: Durante el periodo 2018 en el servicio de Emergencia del Hospital Iess Ambato se utilizó como primera elección para el tratamiento del dolor agudo analgésicos tipo morfina en 370 pacientes, con gran disminución en su intensidad en poco tiempo de la administración.&#x0D; Conclusiones: Se debe considerar la utilización de morfina como primera línea de tratamiento para dolor agudo por su rápida acción y disminución de la sintomatología en pacientes que acuden al servicio de emergencia con EVA &gt;7/10.

Risk and protective factors for chronic pain following inguinal hernia repair: a retrospective study.

A large proportion of patients experience chronic post-surgical pain (CPSP) following inguinal hernia repair surgery. The aim of this study was to investigate the predictive risk factors and protective factors for CPSP following inguinal hernia surgery. After institutional ethics approval was obtained, we conducted a retrospective observational case-control study including a total of 236 adult patients undergoing electiveinguinal hernia repair at a single tertiary medical center from 2014 to 2015. Preoperative and postoperative variables were collected from electronic medical records. Binary logistic analysis was used to determine the association between CPSP and clinical factors and built a CPSP risk model. The incidence of CPSP was 14.4%. Bilateral inguinal hernia repair (OR 4.44; 95% CI 1.62 to 12.17; p = 0.004), preoperative pain (OR 2.57; 95% CI 1.14 to 5.79; p = 0.023), preoperative anxiety (OR 1.05; 95% CI 1.01 to 1.09; p = 0.018), and relatively high intensity of acute pain at 1week after the surgery (OR 1.40; 95% CI 1.03 to 1.91; p = 0.031) were the risk factors for CPSP while low-dose ketamine at anesthesia induction (OR 0.42; 95% CI 0.18 to 0.98; p = 0.044) was the protective factor for CPSP in patients undergoing inguinal hernia repair. These results indicated that bilateral inguinal hernia repair, preoperative pain, preoperative anxiety, and acute pain at 1week after the surgery were the independent risk factors for CPSP while low-dose ketamine was the protective factor. These findings may assist with primary prevention by allowing clinicians to screen for individuals with the risk of CPSP.

Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial.

BackgroundTranscutaneous electrical nerve stimulation (TENS) is a noninvasive modality which may be used to reduce acute postoperative pain. Intense perioperative pain within the first few days after hip fracture surgery is common and is related to negative consequences such as restricted and delayed ambulation.ObjectiveThe objective of the present study was to examine the effect of incorporating TENS treatment on pain intensity, and mobility, with standard rehabilitation care during the acute post-operative phase following Gamma-nail surgical fixation of extracapsular hip fractures.Materials and methodsForty-one patients were randomly assigned to a supplement of 30 mins of active TENS or sham TENS. The standard rehabilitation care included five daily 30 mins physical therapy treatments beginning 24 hrs after surgery. Outcome measures were: pain intensity at rest, at night and during ambulation (assessed with the Numeric Rating Scale; Functional Ambulation Classification instrument; time to complete five sit-to-stand tests; and two-minute walk test). Data were analyzed with Wilcoxon score rank tests. Significance was set at p≤0.05.ResultsSignificantly greater pain reduction during walking was noted in the active TENS group compared to sham TENS group (differences between the fifth and the second days: 2.55±1.37 vs 1.06± 1.11, respectively; p=0.0011). Additionally, advantage of active TENS was demonstrated in greater increase in walking distance on the fifth day and higher level of mobility compared to the sham TENS group. No additional effects of active TENS were noted on pain intensity at rest and at night and on five times sit-to-stand performance.ConclusionAddition of TENS to the standard care of elderly patients in the early days following Gamma nail surgical fixation of extracapsular hip fracture is recommended for pain management while walking and functional gait recovery. The effect of TENS on long-term functional outcomes should be explored in future studies.Trial registrationThe trial was registered at the ISRCTN registry: ID ISRCTN32476360.

Association between treatment-related early changes in psychological factors and development of postherpetic neuralgia.

To examine the association between catastrophizing and pain intensity with acute herpes zoster, and the association of treatment-related early changes in depressive symptoms, anxiety, and catastrophizing with postherpetic neuralgia (PHN) development, independent of acute pain intensity. We analyzed 44 outpatient participants with acute herpes zoster who completed a 6-month follow-up. Participants completed a self-reported questionnaire with a Visual Analog Scale (VAS), the Pain Catastrophizing Scale (PCS), and the Hospital Anxiety and Depression Scale (HADS) at first visit, and 3 and 6months, thereafter. We assessed associations between acute pain intensity and analyzed factors using univariate regression analyses. Univariate and bivariate logistic regression models were constructed to assess associations of variables at the first visit and early changes in psychological factors with PHN development. Sex, severe skin rash at first visit, PCS, and HADS depression were associated with acute pain intensity {standardized regression coefficient, 0.46 [95% confidence interval (CI) 0.12-0.74], 0.36 (95% CI 0.07-0.65), 0.33 (95% CI 0.03-0.62), 0.47 (95% CI 0.19-0.74), respectively}. Acute pain intensity and early change in pain intensity were associated with PHN development [odds ratio (OR) 1.08 (95% CI 1.02-1.14) OR 2.38 (95% CI 1.10-5.16), respectively]. Decreased PCS was associated with decreased risk of PHN development, independent of acute pain intensity [OR 0.31 (95% CI: 0.12-0.80)]. Catastrophizing was associated with acute pain intensity, and lower pain-related catastrophizing among patients with acute herpes zoster was associated with less risk of PHN development, independent of acute pain intensity.

The Effects of Ultrasound-Guided Transversus Abdominis Plane Block on Acute and Chronic Postsurgical Pain After Robotic Partial Nephrectomy: A Prospective Randomized Clinical Trial.

Use of a locoregional analgesia technique, such as the ultrasound-guided transversus abdominis plane block (TAPb), can improve postoperative pain management. We investigated the role of TAPb in robotic partial nephrectomy, a surgery burdened by severe postoperative pain. In this prospective trial, patients with American Society of Anesthesiologists class I-III physical status undergoing robotic partial nephrectomy were randomly assigned to standard general anesthetic plus ultrasound-guided TAPb (TAP group) or sole standard general anesthetic (NO-TAP group). The primary end point was morphine consumption 24 hours after surgery. Secondary outcomes were postoperative nausea and vomiting in the first 24 hours, sensitivity, and acute and chronic pain, as measured by multiple indicators. A total of 96 patients were evaluated: 48 patients in the TAP group and 48 in the NO-TAP group. Median morphine consumption after 24 hours was higher in the NO-TAP group compared with the TAP group (14.1 ± 4.5 mg vs 10.6 ± 4.6, P < 0.008). The intensity of acute somatic pain and the presence of chronic pain at three and six months were higher in the NO-TAP group. Our results show that TAPb can significantly reduce morphine consumption and somatic pain, but not visceral pain. TAPb reduced the incidence of chronic pain.

Parecoxib Shortens the Duration of Acute Postoperative Pain After Laparoscopic-Assisted Vaginal Hysterectomy.

The effect of parecoxib sodium on the duration and severity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy has been inadequately studied. This randomized, controlled trial compared the effects of parecoxib, methylprednisolone, and placebo on the duration of acute postoperative pain after elective laparoscopic-assisted vaginal hysterectomy. Ninety-four eligible patients were randomized to three groups [parecoxib sodium 40 mg (Group P), methylprednisolone 1 mg/kg (Group M), and saline (Group S)]. The duration of pain during coughing [median (interquartile range)] was significantly lower in Group P than in Group M or Group S [26.0 (5.8–48.0) vs. 48.0 (30.0–55.5) vs. 48.0 (36.0–58.5) h; p = 0.025]. The duration of pain during rest was also significantly lower in Group P than in Group M or Group S [5.5 (3.8–21.0) vs. 24.0 (6.0–28.0) vs. 22.0 (5.8–36.0) h; p = 0.009]. Compared with those in Group M and Group S, the patients in Group P reported less intense visceral pain during coughing at 12 (p = 0.050) and 24 h (p = 0.009) as well as at rest at 12 h (p = 0.008). Compared with those in Group P and Group S, the patients in Group M showed lower serum C-reactive protein levels and higher blood glucose levels after surgery. No differences were noted in nausea, vomiting, length of hospital stay, wound infection, and delayed wound healing among the groups. Thus, parecoxib sodium reduces the duration and intensity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy.

P030: Acute pain resolution after an emergency department visit: a 14-day trajectory analysis

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

Totally extraperitoneal inguinal hernia repair with or without fixation leads to similar results. Outcome of randomized prospective trial.

IntroductionThe use of implants in inguinal hernia repair has reduced its recurrence rate. However, postoperative groin pain still remains an unresolved problem. There are suggestions that in totally extraperitoneal inguinal hernia repair (TEP-IHR) two of the likely factors responsible for pain are use of fixation and the type of fixation used.AimTo evaluate the impact of mesh fixation on the incidence of postoperative pain, restriction of physical activities, hernia recurrence risk, return to normal activities and demand for analgesics in patients after unilateral TEP-IHR.Material and methodsUnilateral TEP-IHR was performed in 139 male patients randomized to three groups: self-gripping mesh (SG), lightweight mesh (L) and lightweight mesh with fixation (LF). Full study-inclusion criteria were met by 110 patients; 43, 18 and 49 in groups SG, L and LF respectively. Follow-up occurred on the 1st, 2nd, and 7th day and 3, 6, 12 months postoperatively. The numeric rating scale (NRS) was used to assess pain and the EuraHS-QoL (European Registry for Abdominal Wall Hernias Quality of Life Score) questionnaire to compare quality of life (QoL) prior to surgery and one year later.ResultsNo statistically significant differences were observed between study groups with regard to the incidence rate and intensity of acute post-operative pain, chronic pain, analgesic demand, return to normal activity, hernia recurrence rate and post-operative QoL.ConclusionsLack of fixation in TEP-IHR does not increase the risk of hernia recurrence, and its presence does not significantly worsen the treatment results; especially it does not increase the incidence of chronic pain.

Pain in individuals with RASopathies: Prevalence and clinical characterization in a sample of 80 affected patients.

Pain in individuals with RASopathies is a neglected topic in literature. In this article, we assessed prevalence and profile of pain in a sample of 80 individuals affected by RASopathies. The study sample included individuals with Noonan syndrome (N = 42), Costello syndrome (N = 17), and cardio-facio-cutaneous syndrome (N = 21). A set of standardized questionnaires and scales were administered (VAS/numeric scale, r-FLACC, Wang-Baker scale, NPSI, BPI, NCCPC-R) to detect and characterize acute and chronic pain and to study the influence of pain on quality of life (PEDs-QL, SF-36) and sleeping patterns (SDSC); revision of past medical history and multisystemic evaluation was provided. Available clinical data were correlated to the presence of pain. High prevalence of acute (44%) and chronic (61%) pain was documented in the examined sample. Due to age and intellectual disability, acute pain was localized in 18/35 individuals and chronic pain in 33/49. Muscle-skeletal and abdominal pain was more frequently reported. The intensity of acute and chronic pain interfered with daily activities in 1/3 of the sample. Pain negatively impacted on QoL and sleeping patterns. This work documents that pain is highly prevalent in RASopathies. Future studies including subjective and objective measures of pain are required to discriminate a somatosensory abnormality from an abnormal elaboration of painful stimuli at a central level.

Sleep Shortage Is Associated With Postherpetic Neuralgia Development Through Hyperesthesia and Acute Pain Intensity: A Community-Based Prospective Cohort Study.

There have been no community-based studies investigating the association between sleep duration and postherpetic neuralgia (PHN) development. The aim of the current study was to examine the association of sleep with herpes zoster (HZ) incidence and PHN. In total, 12,329 residents (ages 50 to 103years) of Shozu County, Japan, participated in our study from December 2009 to November 2010 and were followed up for 3years. At baseline, the participants completed self-administered health questionnaires, including those on usual sleep duration. Three dermatologists diagnosed HZ on the basis of clinical symptoms and virus identification testing by polymerase chain reaction and serological tests, and evaluated pain using a modified Zoster Brief Pain Inventory survey form via telephone. We used a Cox proportional hazard regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HZ and PHN. We also performed mediation analysis to examine whether hyperesthesia and acute pain intensity mediated the association between sleep shortage and chronic pain intensity. During follow-up, 400 cases of HZ were identified. Of these, 55 participants developed PHN. Sleep duration was not associated with HZ incidence. Sleep shortage increased the risk for PHN (HR 2.02 [95% CI: 1.06 to 3.85]). Hyperesthesia and acute pain intensity mediated the association between sleep shortage and chronic pain intensity (indirect/total effect ratio=50% mediation). Sleep shortage was associated with increased risk for PHN, and hyperesthesia and acute pain intensity appeared to mediate this association. Sleep shortage may be a novel risk factor for PHN.

Acute Pain Resolution After an Emergency Department Visit: A 14-Day Trajectory Analysis

The objective of the study is to evaluate the acute pain intensity evolution in emergency department (ED) discharged patients, using group-based trajectory modeling. This method identifies patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. This was a prospective cohort study of ED patients aged 18 years or older, with an acute pain condition (≤2 weeks), and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (numeric rating scale of 0 to 10) and pain medication use. Among the 372 included patients, 6 distinct post-ED pain intensity trajectories were identified. Two started with severe levels of pain; one remained with severe pain intensity (12.6% of the sample) and the other ended with a moderate pain intensity level (26.3%). Two other trajectories had severe initial pain; one decreased to mild pain (21.7%) and the other to no pain (13.8%). Another trajectory had moderate initial pain that decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day period (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and opioid consumption. Acute pain resolution after an ED visit seems to progress through 6 different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

Perioperative use of gabapentinoids for the management of postoperative acute pain: protocol of a systematic review and meta-analysis

BackgroundOpioids are commonly used for the management of postoperative pain, but their use is limited by important adverse events, such as respiratory depression and the potential for addiction. Multimodal opioid-sparing analgesia regimens can be effectively employed to manage postoperative pain and reduce exposure to opioids. Gabapentinoids (pregabalin and gabapentin) represent an attractive class of drugs for use in multimodal regimens. The American Pain Society recommends the use of gabapentinoids during the perioperative period; however, evidence to inform such a recommendation is unclear.MethodsWe will conduct a systematic review and meta-analysis of randomized clinical trials evaluating the use of systemic gabapentinoids, in comparison to other analgesic regimens or placebo in adult patients undergoing surgery. We will search MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and ClinicalTrials.gov databases for relevant citations. Our primary outcome will be intensity of postoperative acute pain (12 h). Our secondary outcomes will be postoperative pain intensity at 6, 24, 48 h, and 72 h, cumulative dose of opioids administered within 24, 48, and 72 h following surgery, the length of stay, chronic pain, and adverse events. Two investigators will independently select trials and extract data. We will evaluate the risk of bias of included trials using the Cochrane risk of bias tools. We will represent pooled continuous data as weighted mean differences and pooled dichotomous data as risk ratios with a 95% confidence interval. We will use random effect models and assess statistical heterogeneity with the I2 index.DiscussionOur study will provide the best level of evidence to inform the effect of gabapentinoids in the management of postoperative acute pain.Systematic review registrationPROSPERO CRD42017067029

Anchoring the Numeric Pain Scale Changes Pain Intensity Reports in Patients With Chronic But Not With Acute Pain.

Despite enormous differences between acute and chronic pain, the numeric pain scale (NRS) is commonly used in pain research and clinical practice for assessing the intensity of both acute and chronic pain. The use of this scale has been challenged as it may fail to accurately reflect the pure intensity of chronic pain. To compare the effect of anchoring the NRS on the intensity of pain reported by patients with acute vs. chronic pain. Patients with acute postoperative or chronic pain (n=100/group) were requested to rate their: current clinical pain intensity on an NRS from 0 to 100; the intensity of an anchoring pain event on the same scale; and subsequently to rate again their current pain intensity while making reference to the reported intensity of the pain event. The magnitude of correction was compared between the 2 groups. The anchoring pain was rated identically between the groups. However, following anchoring, patients with chronic pain made a significantly larger correction of their pain intensity than did those with acute pain (mean±standard deviation=9±9, median [interquartile range]=10 [0 to 10] vs. 3±7, 0 [0 to 5], respectively; P<0.0001). More patients in the chronic pain group corrected their pain intensity. Logistic regression showed that chronic pain and female gender significantly increased the likelihood of making the correction (chronic pain: odds ratio 7.2, 95% confidence interval 3.5 to 15.1, P<0.0001; female gender: odds ratio 2.8, 95% confidence interval 1.4 to 5.5, P<0.0001). The results suggest that anchoring the NRS can potentially improve the accuracy of reported chronic pain intensity.

In-hospital opioid consumption, but not pain intensity scores, predicts 6-month levels of pain catastrophizing following hepatic resection: A trajectory analysis.

The study aims were to model acute pain intensity and opioid consumption trajectories up to 72hr after open hepatic resection, identify predictors of trajectory membership and examine the association between trajectory memberships and 6-month pain and psychological outcomes. This is a long-term analysis of a published randomized controlled trial on the impact of medial open transversus abdominis plane catheters on post-operative outcomes. A total of 152 patients (89 males; mean age 63.0 [range: 54-72]) completed questionnaires on pain and related characteristics pre-operatively and 6months post-operatively. Total opioid use was recorded several times over a 72-hr period while self-reported pain intensity scores were collected multiple times until hospital discharge. Analyses were carried out using growth mixture modelling, logistic regression and general linear models. Both pain intensity and opioid consumption showed that a four-trajectory model best fits the data. Patients in the lowest opioid consumption trajectory were more likely to be classified in the constant mild pain intensity trajectory. Age and baseline levels of anxiety significantly predicted opioid trajectory membership while baseline depressive symptoms significantly predicted pain intensity trajectory membership. Patients in the two highest opioid consumption trajectories reported significantly higher levels of pain catastrophizing at 6months compared to patients in the other 3 trajectories (all p<0.05). High consumption of opioids after surgery is associated with higher levels of pain catastrophizing 6months later. Identification of patients within these trajectories may lead to the development of early interventions targeted to high risk individuals. Differences in initial levels of opioid consumption and rates of change in opioid consumption shortly after surgery can help predict long-term psychological responses to pain. Identifying key characteristics associated with initial opioid consumption can lead to the development of cost-effective early interventions targeted to high risk individuals.

Prediction of Acute Postoperative Pain from Assessment of Pain Associated With Venous Cannulation.

It has previously been reported that venous cannulation-induced pain (VCP) can be used to predict acute postoperative pain after laparoscopic cholecystectomy. Patients rating VCP at ≥2.0 VAS units had 3.4 times higher risk for moderate or severe pain. The purpose of this study was to evaluate if VCP scores of ≥2.0 VAS units are associated with higher risk for acute postoperative pain after various common surgical procedures. In a prospective clinical observational study, 600 male and female 18- to 80-year-old patients scheduled for elective surgery were included. The primary outcome measure was the difference in maximum postoperative pain intensity between low responders (VCP < 2.0) and high responders (VCP ≥ 2.0) to VCP. Secondary outcome measures were the difference in proportion of patients with moderate or severe postoperative pain between low and high responders, and potential influence of age, gender, and preoperative habitual pain. Patients scoring VCP ≥2.0 VAS units reported higher acute postoperative pain intensity levels than those scoring VCP <2.0 VAS units (median 3.0 [interquartile range 0.0 to 5.0] vs. 0.2 [interquartile range 0.0 to 4.0], P = 0.001), and also had 1.7 times higher risk for moderate or severe postoperative pain (P = 0.005). Moderate or severe postoperative pain was reported by 38% of patients with VCP scores of ≥2.0 VAS units and by 26% with VCP scores of <2.0 VAS units (P = 0.005). Scoring of VCP intensity before surgery, requiring no specific equipment or training, is useful to predict individual risks for moderate or severe postoperative pain, regardless of patient age or gender, in a setting involving different kinds of surgery.

Assessment of musculoskeletal pain in autoimmune diseases

Correct diagnosis and right assessment are cornerstones of clinical success in the practice of pain management. Due to constant pressure on the clinician to prove his/ her efficiency, the core elements in assessment of pain are often overlooked. The pain has been considered as the ‘fifth vital sign’. A variety of pain assessment scales are available for evaluating the intensity of acute and chronic pain. Under or over-assessment of pain often lead to errors in pain management. This is mainly due to proceeding with the treatment plan without a proper clinical history collection and clinical examination. This compromises the patient’s opportunity to obtain optimum pain relief. The current review provides an overview on the pain assessment tools used in musculoskeletal pain assessment, and to assist clinicians and researchers in selecting the pain assessment methods best suited to serve their purposes.