Baseline Pain Intensity Research Articles

A comparative study of the efficacy and safety of thiocolchicoside and chlorzoxazone in patients with acute musculoskeletal pain

Background: Thiocolchicoside and chlorzoxazone are commonly used muscle relaxants for the management of acute musculoskeletal pain. However, there is limited evidence comparing their efficacy and safety. Aims and Objectives: The aim of the study was to compare the efficacy and safety of thiocolchicoside and chlorzoxazone in patients with acute musculoskeletal pain. Materials and Methods: This was a randomized, open-label, parallel-group study conducted in a tertiary care hospital. A total of 50 patients with acute musculoskeletal pain were randomized to receive either thiocolchicoside (8 mg) or chlorzoxazone (500 mg) thrice daily for 7 days. The primary outcome measure was the change in pain intensity from baseline to Day 7, assessed using a visual analog scale (VAS). The secondary outcome measures were the percentage reduction in pain intensity and the incidence of adverse events. Results: The baseline characteristics of the patients were similar in both groups. The mean baseline pain intensity was 7.2±1.3 in the thiocolchicoside group and 7.1±1.2 in the chlorzoxazone group. After 7 days of treatment, both drugs significantly reduced pain intensity from baseline. The mean pain intensity at Day 7 was 2.9±1.1 in the thiocolchicoside group and 3.1±1.2 in the chlorzoxazone group. The percentage reduction in pain intensity was 59.7%±12.3% in the thiocolchicoside group and 56.3%±11.5% in the chlorzoxazone group. However, there was no statistically significant difference between the groups in terms of pain intensity reduction (P=0.453). Conclusion: The results of this study suggest that thiocolchicoside and chlorzoxazone are equally effective and safe in the management of acute musculoskeletal pain. The choice of drug may depend on the patient’s individual characteristics and risk factors.

Baseline Factors Associated with Pain Intensity, Pain Catastrophizing, and Pain Interference in Intensive Interdisciplinary Pain Treatment for Youth.

Background: More could be known about baseline factors related to desirable Intensive Interdisciplinary Pain Treatment (IIPT) outcomes. This study examined how baseline characteristics (age, gender, child pain catastrophizing (PCS-C), pain interference, pain intensity, anxiety, depression, paediatric health-related quality of life (PedsQLTM), and parent catastrophizing (PCS-P)) were associated with discharge and 3-month follow-up scores of PCS-C, pain intensity, and pain interference. Methods: PCS-C, pain intensity, and pain interference T-scores were acquired in 45 IIPT patients aged 12-18 at intake (baseline), discharge, and 3-month follow-up. Using available and imputed data, linear mixed models were developed to explore associations between PCS-C, pain intensity, and pain interference aggregated scores at discharge and follow-up with baseline demographics and a priori selected baseline measures of pain, depression, anxiety, and PCS-C/P. Results: PCS-C and pain interference scores decreased over time compared to baseline. Pain intensity did not change significantly. Baseline PCS-C, pain interference, anxiety, depression, and PedsQLTM were associated with discharge/follow-up PCS-C (available and imputed data) and pain interference scores (available data). Only baseline pain intensity was significantly associated with itself at discharge/follow-up. Conclusions: Participants who completed the IIPT program presented with reduced PCS-C and pain interference over time. Interventions that target pre-treatment anxiety and depression may optimize IIPT outcomes.

The relationships between pain-associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study.

The presence of pain-associated psychological distress (PAPD) in musculoskeletal disorders, including negative mood, fear-avoidance, and lack of positive affect/coping, is associated with prolonged disability. The importance of considering psychological influence on pain is well known, but practical ways of addressing it are not as straightforward. Identifying relationships between PAPD and pain intensity, patient expectations, and physical function may guide the development of future studies that assess causality and inform clinical practice. To assess the relationship between PAPD measured by the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag tool, and baseline pain intensity, expectations of treatment effectiveness, and self-reported physical function at discharge. Retrospective cohort study. Hospital-based outpatient physical therapy. Patients 18 to 90 years old with spinal pain or lower extremity osteoarthritis. Pain intensity and patient expectations of treatment effectiveness at intake, and self-reported physical function at discharge. A total of 534 patients, 56.2% female, median (interquartile range [IQR]) age 61 (21) years with an episode of care between November 2019 and January 2021 were included. A multiple linear regression showed a significant association between PAPD and pain intensity with 6.4% (p < .001) of the variance explained. PAPD explained 3.3% (p < .001) of the variance in patient expectations. One additional yellow flag present resulted in a 0.17-point increase in pain intensity and 1.3% decrease in patient expectations. PAPD was also associated with physical function with 3.2% (p < .001) of the variance explained. PAPD explained 9.1% (p < .001) of the variance in physical function at discharge in the low back pain cohort only when assessed independently by body region. These findings support the theory that the pain experience is complex and multiple factors should be considered when evaluating a patient with musculoskeletal pain. Clinicians who have identified PAPD may consider these relationships when planning or modifying interventions and pursuing multidisciplinary collaboration.

Factors associated with self-reported pain and hand function following dorsal wrist ganglion excision.

This study aimed to analyse which factors contribute to pain and limited hand function after dorsal wrist ganglion excision. We included 308 patients who underwent surgery between September 2017 and August 2021. Patients completed baseline questionnaires and the patient-rated wrist/hand evaluation questionnaire at baseline and 3 months postoperatively. We observed an improvement in postoperative pain and hand function, but individual outcomes were highly variable. We performed stepwise linear regression analyses to examine which patient characteristics, disease characteristics and psychological factors were associated with postoperative pain and hand function. Higher postoperative pain intensity was associated with recurrence following previous surgery, treatment of the dominant hand, higher baseline pain intensity, lower credibility the patient attributes to the treatment and longer symptom duration. Worse hand function was associated with recurrence following prior surgery, worse baseline hand function and lower treatment credibility. Clinicians should take these findings into account during patient counselling and expectation management.Level of evidence: II.

Interaction analyses: Enhancing understanding of chronic low back pain

BackgroundChronic low back pain (CLBP) is complex. Statistical examination of influences of exposures (e.g. characteristics) upon outcomes (e.g. pain) facilitates understanding of complexity and personalized care. Psychological factors may be associated with higher disability following exercise in CLBP. Examining interactions of psychological variables with exercise on disability might further understanding of CLBP. ObjectivesSecondary analysis of data from a CLBP cohort evaluating interactions between psychological variables and exercise on disability. DesignLongitudinal cohort study. MethodVariables from a published prognostic model for disability: disability (baseline/one-year follow-up), psychological principal component scores (principal component score two (PC2) – Fear-avoidance beliefs, pain catastrophizing, pain self-efficacy; principal component score three (PC3) - thought suppression, behavioral endurance), exercise (during follow-up), forward-bending time, punishing significant other responses. Differences between exercisers and non-exercisers were assessed using Chi-Squared/Mann-Whitney tests. Multivariable linear regression models for follow-up disability included a term examining interaction between principal component scores and exercise. ResultsExercisers had significantly different scores for PC2 (p = .02) and PC3 (p = .03), lower baseline (p = .005) and follow-up pain intensity (p < .001), follow-up disability (p < .001) and faster forward-bend times (p = .014). There was no significant interaction between exercise and PC2 (p = .92) or PC3 (p = .75). ConclusionsThis study showed no interaction between psychological factors and exercise on disability at follow-up. These findings suggest that the disability outcome of people with CLBP who undertake exercise as an intervention does not differ from those who do not undertake exercise, irrespective of their baseline psychological status.

Effect of low-frequency dorsal root ganglion stimulation in the treatment of chronic pain

BackgroundThe role of stimulation parameters, especially stimulation frequency is not well understood in dorsal root ganglion stimulation. Previous studies documented higher effectiveness for frequencies as low as 20 Hz, but there is evidence that even lower values could lead to better outcomes. In this study, we investigate the influence of low-frequency DRG-S.MethodThis is a randomized double-blind clinical trial with a crossover design. Patients with an already implanted DRG-S system were included and randomly tested with 4 Hz, 20 Hz, 60 Hz, and sham stimulation. Amplitude was adjusted to subthreshold values for each frequency. Each frequency was tested for 5 days, followed by a 2-day washout period. Patients were assessed using VAS, McGill Pain Questionnaire, EQ-5D-5L, and Beck Depression Inventory.ResultsSeventeen patients were in included. Time between inclusion in this study and primary implant was 32.8 months. Baseline stimulation frequency was 20 Hz in all patients. Mean baseline pain intensity was VAS 3.2 (SD 2.2). With 4-Hz stimulation, VAS was 3.8 (SD 1.9), with 20 Hz VAS 4.2 (SD 2.0) and with 60 Hz VAS 4.6 (SD 2.7). Worst pain control was seen with sham stimulation with a VAS of 5.3 (SD 3.0). Stimulation with 4 Hz achieved lower VAS scores, but this was only statistically significant when compared to sham (p = 0.001). A similar trend favoring 4-Hz stimulation was seen using the Beck Depression Inventory, but in this case no statistical significance was found. Outcomes of McGill Pain Questionnaire and EQ-5D-5L favored 20 Hz stimulation, but again without statistical significance.ConclusionsLow-frequency stimulation was not significantly better than classic 20-Hz stimulation in relieving pain intensity; the study might however be underpowered. Longer washout and observational periods might also be necessary to show clear differences in frequency response.

Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study.

Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.

Association between Prior Pain Intensity, Back Function and The Characteristics of Episodes in Patients with Low Back Pain

There is little information about causes of recurrence and why low back pain (LBP) transit to recurrent LBP. The aim of this study was to identfy the recurrence proportion of LBP, and the relation between baseline pain intensity, back function and the number, duration and mean pain intensity of subsequent episodes in patients with recurrent LBP. Four hundred and sixty-four patients were included in this study. The mean age of the participants was 38.70 ± 13.10 (ranges from 20 to 65 years). Demographic data were recorded. Prior pain intensity (VAS), back function (FBPS) and subsequent pain episodes (pain diary) were assessed at baseline and over 6 months. Recurrence proportion of LBP was 39.2% during 6-month follow-up. Baseline pain intensity and back function were significantly different in patients with recurrent LBP compared to patients without recurrent LBP ( p

Curcuma longa and Boswellia serrata extract combination for hand osteoarthritis: an open-label pre-post trial

Context Osteoarthritis (OA) of the hand is a common painful musculoskeletal disorder with no cure. There is a need for an efficient and safe treatment to relieve OA pain. Objective To investigate the effects of a Curcuma longa and Boswellia serrata food supplement in addition to standard care on hand pain. Materials and methods This open-label, non-controlled, post-observational study was based on 232 patients suffering from hand pain with or without joint deformity. Patients received a medical prescription for a three-month treatment with a food supplement containing 89 mg of C. longa dry extract, 120 mg of B. serrata resin, and 1.8 µg vitamin D. Pain was evaluated on a 10-point visual analog scale (VAS). The number of painful hand joints, patient satisfaction, nonsteroidal anti-inflammatory drugs intake, and side effects were also recorded. Results Baseline pain intensity (regression coefficient ± SE: −0.19 ± 0.01, p < 0.0001) and the number of painful joints (regression coefficient ± SE: −0.022 ± 0.0029, p < 0.0001) decreased significantly throughout the 3 months treatment period. NSAIDs intake and topical drug application were significantly decreased by 64% (p < 0.0001) and 79% (p < 0.0001) after 12 weeks, respectively. Only 3/239 (1.3%) patients reported side effects probably related to the product. 80.3% were satisfied with the treatment and 75.5% wished to continue treatment. Conclusion This is the first clinical trial showing that C. longa and B. serrata resin can relieve symptoms in patients with hand osteoarthritis. The study provides useful information for the design of a clinical trial including a broader population.

Can Internet-Delivered Pain Management Programs Reduce Psychological Distress in Chronic Pain? Exploring Relationships Between Anxiety and Depression, Pain Intensity, and Disability.

Adults with chronic pain who also report high pain intensity and disability are more likely to experience depression and anxiety symptoms. The present study examined changes in anxiety and depression symptoms after an Internet-delivered pain management program based on baseline pain intensity and disability severity categories. We conducted a secondary analysis of data from four randomized controlled trials (N = 1,333). Greater pain intensity and disability were associated with increased odds of elevated anxiety or depression symptoms at baseline. Treatment led to greater reductions in anxiety and depression symptoms compared with a waitlist control, and these improvements occurred irrespective of baseline pain intensity or disability severity. Those individuals who reported ≥30% improvements in pain intensity or disability after treatment were more likely to also report ≥30% improvements in psychological symptoms. Importantly, most participants who achieved ≥30% improvements in depression and anxiety had not experienced such improvements in pain intensity or disability. These findings suggest that emerging Internet-delivered pain management programs can lead to reductions in psychological distress even when pain intensity and disability are severe or do not improve with treatment. This indicates the value of such treatments in treating distress and improving mental health in people with chronic pain.

Effectiveness of an 8-week hatha yoga intervention to improve lower back pain in university office workers: A mixed-methods pilot exploratory study.

Hatha yoga programs have been shown to be effective at improving low back pain among a variety of populations; however, methods to decrease low back pain of university office employees have not been studied. To examine the impact of an 8-week hatha yoga intervention on measures of health among university office employees. Seven participants completed the 8-week yoga intervention. All measures, including anthropometric measures and online questionnaires, were completed at baseline and post-intervention. Baseline pain intensity (6.6±3.1) and pain interference (15.6±4.7) reflected a moderate level of back pain and moderate to severe interference. Pain intensity showed a non-significant improvement with medium-to-large effect size [p = 0.07, (d = 0.7)]. There was a significant improvement with a large effect size [p = 0.002, (d = 2.4)] in pain interference. Baseline anxiety (7.4±3.6) reflected a borderline abnormal symptom level, but anxiety significantly reduced to normal levels at post-intervention with a medium effect size [p = 0.002 (d = 0.5)]. Focus group themes were improvements in health and development of a sense of community. Hatha yoga may be an effective mode of low-impact physical activity to decrease pain and improve mental health while facilitating a sense of community for office workers employed by a university. This study demonstrates promising results with large effect sizes; however, more research with larger sample size and randomized treatment and control groups are needed for future study efforts.

The influence of exercise on clinical pain and pain mechanisms in patients with subacromial pain syndrome.

BackgroundFew studies have investigated the underlying mechanisms for unilateral subacromial pain syndrome (SAPS). Therefore, this study examined (1) if 8‐weeks of exercise could modulate clinical pain or temporal summation of pain (TSP), conditioned pain modulation (CPM), and exercise‐induced hypoalgesia (EIH) and (2) if any of these parameters could predict the effect of 8‐weeks of exercise in patients with unilateral SAPS.MethodsThirty‐seven patients completed a progressive abduction exercise program every other day for 8‐weeks. Worst shoulder pain in full abduction was rated on a numeric rating scale (NRS). Pain pressure thresholds (PPTs), TSP, CPM, EIH, Shoulder Pain and Disability Index (SPADI), Pain Catastrophizing Scale (PCS), PainDETECT questionnaire (PD‐Q), Pain Self‐Efficacy Questionnaire (PSE‐Q) and Pittsburgh Sleep Quality Index (PSQI) were assessed before and after intervention.ResultsThe intervention improved worst pain intensity (p < 0.001), increased the CPM (p < 0.001), improved the sleep scores (p < 0.005) and reduced the PainDETECT ratings (p < 0.001). No changes were observed in PPT, TSP, EIH, SPADI, PCS and PSE‐Q (all p > 0.05). In a linear regression, the combination of all baseline parameters predicted 23.2% variance in absolute change in pain after 8 weeks. Applying backwards elimination to the linear regression yielded that baseline pain intensity combined with TSP predicted 33.8% variance.ConclusionThis explorative study suggested reduction in pain, improved sleep quality and increased CPM after 8‐weeks of exercise. Furthermore, the results suggests that low pain intensity and high TSP scores (indicative for pain sensitisation) may predict a lack of pain improvement after exercise.

Mediation Analysis in Manual Therapy Research

ObjectiveThe purpose of this study was to illustrate the applicability of mediation analysis in the manual therapy field by assessing whether pain intensity, duration of pain, or the change in systolic blood pressure mediated the heart rate variability (HRV) of patients with musculoskeletal pain who received manual therapy. MethodsA secondary data analysis from a 3-arm, parallel, randomized, placebo-controlled, assessor-blinded, superiority trial was performed. Participants were randomized into spinal manipulation, myofascial manipulation, or placebo groups. Cardiovascular autonomic control was inferred from resting HRV variables (low-high frequency power ratio; LF/HF) and blood pressure responsiveness to a sympathoexcitatory stimulus (cold pressor test). Pain intensity and duration were assessed. Mediation models analyzed whether pain intensity, duration, or blood pressure independently affected the improvement of the cardiovascular autonomic control of patients with musculoskeletal pain after intervention. ResultsThe first assumption of mediation was met for LF/HF with statistical evidence of a total effect of spinal manipulation, as compared with placebo on HRV outcomes (β = 0.77 [0.17-1.30]); second and third assumptions showed no statistical evidence of a relationship between the intervention and pain intensity (β = –5.30 [–39.48 to 28.87]), pain intensity, and LF/HF (β = 0.00 [–0.01 to 0.01]). ConclusionIn this study of causal mediation analysis, the baseline pain intensity, duration of pain, and responsiveness of the systolic blood pressure to a sympathoexcitatory stimulus did not mediate the effects of the spinal manipulation on the cardiovascular autonomic control of patients with musculoskeletal pain. Accordingly, the immediate effect of spinal manipulation on the cardiac vagal modulation of patients with musculoskeletal pain may more likely be related to the intervention rather than the mediators investigated.

Health-related quality of life, psychological distress, and fatigue in metastatic castration-resistant prostate cancer patients treated with radium-223 therapy

BackgroundRadium-223 is a registered treatment option for symptomatic bone metastatic castration-resistant prostate cancer (mCRPC). Aim of this multicenter, prospective observational cohort study was to evaluate health-related quality of life (HR-QoL), psychological distress and fatigue in mCRPC patients treated with radium-223.MethodsPrimary endpoint was cancer-specific and bone metastases-related HR-QoL, as measured by the EORTC QLQ-C30 and BM-22 questionnaires. Secondary endpoints were psychological distress and fatigue, evaluated by the HADS and CIS-Fatigue questionnaires. Outcomes were analyzed for the total cohort and between subgroups (1-3 versus 4-5 versus 6 radium-223 injections). A trajectory analysis was performed to explore HR-QoL patterns over time.ResultsIn total, 122 patients were included for analysis. Baseline HR-QoL, pain intensity, psychological distress and fatigue were worse in patients who did not complete radium-223 therapy. In patients who completed therapy, stabilization of HR-QoL was perceived and psychological distress and fatigue remained stable, whereas clinically meaningful and statistically significant deterioration of HR-QoL, psychological distress and fatigue over time was observed in patients who discontinued radium-223 therapy. Trajectory analysis revealed that HR-QoL deterioration over time was more likely in patients with baseline opioid use, low hemoglobin and high alkaline phosphatase levels.ConclusionsPatients who discontinued radium-223 therapy showed worse HR-QoL, psychological distress and fatigue at baseline and more frequent deterioration of HR-QoL, psychological distress and fatigue over time when compared to patients who completed therapy. Specific attention with regard to HR-QoL during follow-up is indicated in patients with opioid use, low hemoglobin and high alkaline phosphatase levels before radium-223 therapy initiation.Clinical trial registration numberNCT04995614.

Cortical function and sensorimotor plasticity are prognostic factors associated with future low back pain after an acute episode: the Understanding persistent Pain Where it ResiDes prospective cohort study.

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N = 120) participated in a prospective cohort study with 6-month follow-up. Candidate predictors were selected from the neurobiological (eg, sensorimotor cortical excitability assessed by sensory and motor-evoked potentials and brain-derived neurotrophic factor genotype), psychological (eg, depression and anxiety), symptom-related (eg, LBP history), and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with the presence of LBP at 6 months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress, and pain catastrophizing were the strongest predictors ( R2 = 0.47) of pain intensity at 6 months. Older age and higher pain catastrophizing were the strongest predictors ( R2 = 0.30) of disability at 6 months. When the LBP outcome was dichotomised, sensory cortex and corticomotor excitability, brain-derived neurotrophic factor genotype, depression and anxiety, LBP history and baseline pain intensity, discriminated between those who did and did not report LBP at 6 months (C-statistic 0.91). This study identifies novel risk factors for the development of future LBP. Neurobiological risk factors, when added to a multivariable linear regression model, explained a further 15% of the variance in the 6-month pain intensity.

No Difference in Patient Reported Outcome Measures for Patients with High Grit Scores

Background:The importance of grit on maintaining overall wellness is well described, but less is known about how grit impacts surgical outcomes, specifically among pediatric patients. The pediatric-validated 5-item Grit Scale measures trait-level perseverance and passion for long-term goals.Purpose/Hypothesis:The purpose of this study was to identify whether Grit scores were associated with baseline PROMIS Pain Interference and Pain Intensity scores. The investigators hypothesized that higher Grit would be associated with lower PROMIS Pain Interference and Pain Intensity scores.Methods:Pediatric and adolescent patients who underwent lower extremity sports or trauma surgery between 2018-2020 at a single orthopaedic hospital preoperatively completed the Grit scale along with PROMIS Pain Interference and Pain Intensity questionnaires. Patients were excluded if they underwent multiple surgeries (with the exception of implant removal). Patients were divided into five groups based on their Grit quintile (<20th, 20-40, 40-60, 60-80, >80th). Statistical analysis was run on IBM SPSS version 22.Results:A total of 103 patients were included in analysis with a median preoperative Grit Score of 4.0. Spearman correlation between Grit cohort and PROMIS Pain Interference and Pain Intensity scores demonstrated no associations between higher Grit scores and higher PROMIS baseline Pain Interference and Pain Intensity scores (p = 0.612, 0.981, respectively).Conclusion:This study did not find associations between baseline Grit and PROMIS Pain Interference and Pain Intensity questionnaires. Therefore, Grit may be an independent construct that is not measured in the existing outcome scales and should be further investigated. Although not associated with baseline pain, its associations with postoperative pain improvement should be further studied.Figure 1.Baseline PROMIS Scores based on GRIT score quintile. Blue represented Pain Interference Score. Orange represents Pain Intensity Score

Long-term effectiveness and safety of medical cannabis administered through the metered-dose Syqe Inhaler.

Preliminary clinical studies on medical cannabis (MC) treatment using the Syqe Inhaler showed short-term effectiveness and safety at very low and precise doses of MC. Here, we retrospectively analyzed "real-life" long-term data collected in real time on the potential effectiveness and safety of MC administered with this device. Patients were monitored by Syqe's patient support program. (-)-Δ9-trans-Tetrahydrocannabinol (Δ9-THC) served as a dosage marker for full-spectrum MC. Pain intensity was evaluated using a numeric pain scale (NPS) from baseline to 120 days after treatment initiation. The change in quality of life (QoL) from baseline was evaluated. Adverse events (AEs) were followed up continuously for 15 months. Of the 143 patients (mean age 62 ± 17 years; 54% males) included in the analysis, most (72%) were diagnosed with chronic neuropathic pain. The stable daily dose, after a mean 26 ± 10 days of titration was 1,500 ± 688 μg aerosolized Δ9-THC. Significant pain reduction, ranging from 22.8% in the intent-to-treat population to 28.4% in the population that reported baseline pain intensity ≥8 points on the NPS (P < 0.001), was observed. Ninety-two percent of patients reported improved QoL. Adverse events were reported mostly during the titration phase (34% of patients) and declined to ≤4% at 3 to 15 months. Only 7% of patients reported psychoactive AEs (anxiety and restlessness). Medical cannabis treatment with the Syqe Inhaler demonstrated overall long-term pain reduction, QoL improvement, and a superior AE profile compared with administration of MC by conventional routes. Additional follow-up in a larger population is warranted.

Pain trajectories and well-being in children and young people with cerebral palsy: A cohort study.

To identify 5-week pain intensity trajectories and their association with physical and psychological well-being in children/young people with cerebral palsy (CP). A cohort study was conducted with 101 Canadian children/young people with CP, of whom 49 were female, with an overall mean age of 12 years 11 months (SD 3 years 1 month), range of 8 to 18 years, and classified in any Gross Motor Function Classification System level. Self-reported pain intensity (Faces Pain Scale - Revised) was collected weekly for 5 weeks and physical and psychological well-being (KIDSCREEN-27) at baseline and 5 weeks. Statistical analyses included latent class growth and general linear models. All Gross Motor Function Classification System levels were represented (I=40.6%; II=15.8%; III=20.8%; IV=13.9%; V=8.9%). Five pain intensity trajectories were identified. Three trajectories had very low (35.4%), low (32.4%), or high (4.9%) mean stable pain. Two trajectories had moderate changing pain (16.8%) and high pain decreasing to moderate levels (10.5%) respectively. Trajectory participants with stable high pain had the lowest physical well-being (adjusted β=-10.01; 95% confidence interval [CI]=-19.37 to -0.66). Those in the three trajectories with the highest mean baseline pain intensity (>3 out of 10) had the lowest psychological well-being (adjusted β=-8.27, 95% CI=-14.84 to -1.70; β=-6.74, 95% CI=-12.43 to -1.05; β=-5.82, 95% CI=-15.34 to 3.71). Almost one-third of participants had moderate-to-high pain intensity trajectories. Membership in the higher pain intensity trajectories was associated with lower physical and psychological well-being. Five distinct 5-week pain intensity trajectories were identified in children/young people with cerebral palsy. Thirty-two per cent of participants had moderate-to-high pain intensity trajectories. Participants in the trajectories with higher pain intensity reported lower physical and psychological well-being.

Bidirectional Relationship Between Body Pain and Depressive Symptoms: A Pooled Analysis of Two National Aging Cohort Studies.

AimsTo investigate the bidirectional longitudinal association between pain and depressive symptoms and explore whether gender modifies the association.MethodsThis study used data of 17,577 participants without depressive symptoms and 15,775 without pain at baseline from waves 1–8 (2002/2003 to 2016/2017) of the English Longitudinal Study of Aging (ELSA) and waves 1 to 3 [2011–2015] of the China Health Retirement Longitudinal Study (CHARLS). Cox regression models were performed at the cohort level to evaluate the potential longitudinal associations, and then random-effect meta-analyses were conducted to pool the results. The potential modifying effect was detected by Z-test.ResultsDuring 103,512 person-years of follow-up in participants without depressive symptoms, baseline pain intensity was associated with incident depressive symptoms. Compared with individuals who reported no pain at baseline, the pooled adjusted hazard ratio (HR) of incident depressive symptoms for participants with mild to moderate pain and for those with severe pain was 1.37 (95% CI: 1.22–1.55, p < 0.001) and 1.52 (95% CI: 1.34–1.73, p < 0.001), respectively. During 81,958 person-years of follow-up in participants without pain, baseline depressive symptoms were associated with a significantly higher incidence of pain, and the pooled adjusted HR of incident pain was 1.71 (95% CI: 1.60–1.82, p < 0.001). These associations were not modified by gender.ConclusionsA bidirectional longitudinal association between pain and depressive symptoms was demonstrated, not modified by gender. Family doctors should be aware of the bidirectional association and advice individuals with pain or depressive symptoms to be screened for both kinds of symptoms.

Sensitivity to Pain Traumatization and Its Relationship to the Anxiety-Pain Connection in Youth with Chronic Pain: Implications for Treatment.

The bidirectional relationship between anxiety and chronic pain in youth is well-known, but how anxiety contributes to the maintenance of pediatric chronic pain needs to be elucidated. Sensitivity to pain traumatization (SPT), an individual’s propensity to develop responses to pain that resemble a traumatic stress response, may contribute to the mutual maintenance of anxiety and pediatric chronic pain. A clinical sample of youth (aged 10–18 years) with chronic pain completed a measure of SPT at baseline and rated their anxiety and pain characteristics for seven consecutive days at baseline and at three-month follow-up. Multiple linear regression analyses were conducted to model whether SPT moderated the relationship between baseline anxiety and pain intensity, unpleasantness, and interference three months later. SPT significantly moderated the relationship between anxiety and pain intensity. High anxiety youth with high SPT reported increased pain intensity three months later, while high anxiety youth with low SPT did not. High anxiety youth who experience pain as potentially traumatizing are more likely to report higher pain intensity three months later than high-anxiety youth who do not. Future research should examine whether children’s propensity to become traumatized by their pain predicts the development of chronic pain and response to intervention.