Changes In Pain Severity Research Articles

Impact Of Oral Surgery On Quality Of Life In Elderly Patients

Objectives: To evaluate the effectiveness of oral surgery on the quality of life in the aging population, with emphasis on pain relief, functional changes, and patient satisfaction. The study also examines recovery modulators affecting outcomes. Study Design: A Prospective Cohort Study. Place and Duration of Study: From June 2024 to November 2024 at Oral & Maxillofacial Surgery Department, Bolan Medical Complex Hospital Quetta. Methodology: A prospective cohort study of 120 elderly patients (≥60 years) who had oral surgeries including tooth extractions, dental implants and periodontal surgeries. Pain, chewing ability, social interaction, self-esteem, and overall satisfaction were assessed by pre- and post-operative surveys. Paired t-tests, ANOVA, p-values, and standard deviations were performed on qualitative factors to assess significant change in quality of life. Results: The study group consisted of 120 elderly patients (age 60–85 years, mean 71.3 years (SD=5.2)). No significant change in pain severity (23572; ppercent (40%) (45335; p<0.05) change was seen in social interaction. Subgroup analysis indicated that patients who had comorbid conditions including diabetes and CV disease had prolonged time to recovery, averaging 2 weeks delay. However, QoL improvements were still significant in each subgroup (p<0.05). Conclusion: With its additional benefits of pain reduction, chewing function improvement and socializing, oral surgery plays an important role in enhancing the quality of life for older patients (5). However, recovery times differ greatly, particularly in people with comorbidities such as diabetes or cardiovascular diseases. These results highlight the need for personalized treatment and follow-up to improve recovery and results after oral surgical procedures performed on older patients. Keywords: Elderly, Oral Surgery, Quality of Life, Recovery

A multisite validation of brain white matter pathways of resilience to chronic back pain.

Chronic back pain (CBP) is a global health concern with significant societal and economic burden. While various predictors of back pain chronicity have been proposed, including demographic and psychosocial factors, neuroimaging studies have pointed to brain characteristics as predictors of CBP. However, large-scale, multisite validation of these predictors is currently lacking. In two independent longitudinal studies, we examined white matter diffusion imaging data and pain characteristics in patients with subacute back pain (SBP) over 6- and 12-month periods. Diffusion data from individuals with CBP and healthy controls (HC) were analyzed for comparison. Whole-brain tract-based spatial statistics analyses revealed that a cluster in the right superior longitudinal fasciculus (SLF) tract had larger fractional anisotropy (FA) values in patients who recovered (SBPr) compared to those with persistent pain (SBPp), and predicted changes in pain severity. The SLF FA values accurately classified patients at baseline and follow-up in a third publicly available dataset (Area under the Receiver Operating Curve ~0.70). Notably, patients who recovered had FA values larger than those of HC suggesting a potential role of SLF integrity in resilience to CBP. Structural connectivity-based models also classified SBPp and SBPr patients from the three data sets (validation accuracy 67%). Our results validate the right SLF as a robust predictor of CBP development, with potential for clinical translation. Cognitive and behavioral processes dependent on the right SLF, such as proprioception and visuospatial attention, should be analyzed in subacute stages as they could prove important for back pain chronicity.

A multisite validation of brain white matter pathways of resilience to chronic back pain

Chronic back pain (CBP) is a global health concern with significant societal and economic burden. While various predictors of back pain chronicity have been proposed, including demographic and psychosocial factors, neuroimaging studies have pointed to brain characteristics as predictors of CBP. However, large-scale, multisite validation of these predictors is currently lacking. In two independent longitudinal studies, we examined white matter diffusion imaging data and pain characteristics in patients with subacute back pain (SBP) over 6- and 12-month periods. Diffusion data from individuals with CBP and healthy controls (HC) were analyzed for comparison. Whole-brain tract-based spatial statistics analyses revealed that a cluster in the right superior longitudinal fasciculus (SLF) tract had larger fractional anisotropy (FA) values in patients who recovered (SBPr) compared to those with persistent pain (SBPp), and predicted changes in pain severity. The SLF FA values accurately classified patients at baseline and follow-up in a third publicly available dataset (Area under the Receiver Operating Curve ~0.70). Notably, patients who recovered had FA values larger than those of HC suggesting a potential role of SLF integrity in resilience to CBP. Structural connectivity-based models also classified SBPp and SBPr patients from the three data sets (validation accuracy 67%). Our results validate the right SLF as a robust predictor of CBP development, with potential for clinical translation. Cognitive and behavioral processes dependent on the right SLF, such as proprioception and visuospatial attention, should be analyzed in subacute stages as they could prove important for back pain chronicity.

Long-Term Efficacy of Combined Focused and Radial Extracorporeal Shockwave Therapy for Gluteus Medius Tendon Pathology: A Pilot Study.

Background: Gluteus medius tendinopathy is amongst the most prevalent lower limb tendinopathies and is now recognized as the primary cause of insidious lateral hip pain. Typically affecting middle-aged women, this condition causes disability and reduced quality of life as it negatively impacts most daily life activities. Several studies demonstrate that extracorporeal shockwave therapy is effective in reducing pain and promoting functional recovery in several musculoskeletal disorders including tendinopathies. However, most published data are limited to evaluating focal or radial shockwaves as single interventions. Contrariwise, there is little evidence reporting the use of combined ESWT treatment and outcomes for managing tendon pathologies, and no data are reported on combined ESWT for gluteus medius tendinopathy. Objectives: The aim of this study was to evaluate the clinical outcomes of combined ESWT in gluteus medius tendinopathy. Methods: Medical charts of 11 consecutive patients with gluteal tendinopathy confirmed by ultrasound who underwent a combined ESWT protocol were reviewed. Changes in pain severity and lower limb function were evaluated using the numerical rating scale, the Victorian Institute of Sports Assessment for Gluteal tendinopathy questionnaire, and the Roles and Maudsley score. Clinical outcome measurements were collected at baseline (T0), 2 months after combined ESWT (T1), and at long-term follow-up (T2), at least 10 months post-treatment (mean 26 months). Results: The mean age of the sample was 62.55 ± 3.17 years. A marked prevalence of females was recorded (nine subjects, 81.8%). A significant improvement was observed in all outcome criteria both at short- and long-term follow-up after combined ESWT compared to baseline (p < 0.05). Treatment success rates were 90.9% and 81.8% at T1 and T2, respectively. Conclusions: Combined ESWT is effective and safe for patients with gluteal tendinopathy, with good long-term results in terms of pain relief and improved functional impairment.

The Association of the Changes in Pain Severity and Cervical Cobb Angle before Versus After Anterior Cervical Discectomy With Fusion Surgery

Background and Aim: Axial neck pain due to degenerative cervical myelopathy can be improved after repairing anterior cervical discectomy with fusion (ACDF) surgery. However, whether changes in postoperative pain can be associated with improvement in the Cobb angle following surgery is still controversial. This study aims to assess the trends of the changes in pain severity and also Cobb angle and then test the relationship between the changes in two parameters. Methods and Materials/Patients: This longitudinal study was performed on 60 consecutive patients who were scheduled to undergo ACDF surgery due to neck disc or degenerative cervical myelopathy (DCM) and had axial neck pain before the operation. Before operation as well as 2 weeks, 2 months and 6 months after surgery, the pain score and value of Cobb angle were measured. Results: Before surgery, the patients suffered from significant axial neck pain with a mean pain score of 7.47±2.02, but after surgery, patients experienced a downward trend of changes in pain score as the mean pain score of 0.92±1.46 at two weeks, 1.31±1.63 at two months and 1.32±1.64 at six months after operation. The repeated measure analysis of variance (ANOVA) test showed a significant reduction in pain scores within follow-up time (P&lt;0.001). A significant improvement was also revealed in the Cobb angle after the operation and the mean value of this angle was significantly lower at two weeks, two months, and six months after surgery than before surgery. Using the multivariate linear regression modeling with the presence of baseline parameters, the relationship between pain score and Cobb angle remained insignificant (P=0.387). Conclusion: Following ACDF surgery, the improvement in axial neck pain and Cobb angle is predictable, but the relationship between these two indicators will not necessarily be significant.

Interventions to reduce opioid use for patients with chronic non-cancer pain in primary care settings: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings. In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from inception to December 28th 2021, and updated on Dec 14th 2023 for randomized controlled trials (RCTs) and cohort studies with no restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool for RCTs and Newcastle Ottawa Scale for cohort studies. Primary outcomes included mean reduction in morphine equivalent daily dose (reported as mean differences [MDs] mg/day; 95% confidence intervals [95%CIs]) and/or opioid cessation proportion. Secondary outcomes were mean changes in pain severity (reported as standardized mean difference [SMDs]; 95%CIs) and (serious) adverse events. Meta-analyses were performed using random-effects models. We identified 3,826 records, of which five RCTs (953 participants) and five cohort studies (901 participants) were included. Overall, opioid dosage was significantly reduced in intervention groups compared to controls (MD: -28.63 mg/day, 95%CI: -39.77 to -17.49; I2 = 31.25%; eight studies). Subgroup analyses revealed significant opioid dose reductions with mindfulness (MD: -29.36 mg/day 95%CI: -40.55 to -18.17; I2 = 0.00%; two trials) and CBT-based multimodalities (MD: -41.68 mg/day; 95%CI: -58.47 to -24.89; I2 = 0.00%; two cohort studies), respectively, compared to usual care. No significant differences were observed in opioid cessation (Odds ratio: 1.10, 95%CI: -0.48 to 2.67, I2 = 58.59%; two trials) or pain severity (SMD: -0.13, 95%CI: -0.37 to 0.11; I2 = 33.51%; three trials). Adverse events were infrequently examined, with withdrawal symptoms commonly reported. The studied interventions were effective in reducing opioid dosage for people with CNCP in primary care. They highlighted the importance of multidisciplinary collaboration. Large-scale RCTs measuring the long-term effects and cost of these interventions are needed before their implementation.

Brain white matter pathways of resilience to chronic back pain: a multisite validation.

Chronic back pain (CBP) is a global health concern with significant societal and economic burden. While various predictors of back pain chronicity have been proposed, including demographic and psychosocial factors, neuroimaging studies have pointed to brain characteristics as predictors of CBP. However, large-scale, multisite validation of these predictors is currently lacking. In two independent longitudinal studies, we examined white matter diffusion imaging data and pain characteristics in patients with subacute back pain (SBP) over six- and 12-month periods. Diffusion data from individuals with CBP and healthy controls (HC) were analyzed for comparison. Whole-brain tract-based spatial statistics analyses revealed that a cluster in the right superior longitudinal fasciculus (SLF) tract had larger fractional anisotropy (FA) values in patients who recovered (SBPr) compared to those with persistent pain (SBPp), and predicted changes in pain severity. The SLF FA values accurately classified patients at baseline and follow-up in a third publicly available dataset (Area under the Receiver Operating Curve ~ 0.70). Notably, patients who recovered had FA values larger than those of HC suggesting a potential role of SLF integrity in resilience to CBP. Structural connectivity-based models also classified SBPp and SBPr patients from the three data sets (validation accuracy 67%). Our results validate the right SLF as a robust predictor of CBP development, with potential for clinical translation. Cognitive and behavioral processes dependent on the right SLF, such as proprioception and visuospatial attention, should be analyzed in subacute stages as they could prove important for back pain chronicity.

Боль в спине. Результаты неинтервенционного исследования применения препарата Амбениум® парентерал в условиях реальной клинической практики

Aim: to estimate efficacy, tolerability, and safety of Ambenium® parenteral [phenylbutazone sodium 400 mg and lidocaine hydrochloride 4 mg] used for treatment of patients with low back pain. Methods. A total of 100 patients with low back pain (LBP), who received a single intramuscular injection of Ambenium® parenteral, were included in the study. The follow-up period was 3 days. The change in pain severity on VAS (mm) was selected as a primary outcome measure for efficacy. The pain syndrome severity was estimated before administration of the drug (visit 1) and 4, 6, 8 and 12 h after the drug administration, as well as during visits 2 (day 2) and 3 (day 4). The McGill Pain Questionnaire, muscle syndrome index (MSI), Roland-Morris Disability Questionnaire pain estimates were used as the secondary diagnostic criteria. The percentage of patients with the positive response relative to baseline (the decrease in pain severity on VAS by more than 50%) was also determined. Results. The dynamics of the primary efficacy measure (pain severity on VAS) was as follows: 7.4 ± 0.92 cm (mean ± standard deviation) during visit 1, 5.6 ± 1.49 cm after 2 h, 4.6 ± 1.74 cm after 4 h, 3.0 ± 1.79 cm after 8 h; the VAS score was 2.3 ± 1.70 cm after 12 h (р&lt;0.001). The share of patients who responded to therapy (with the decrease in pain severity on VAS by more than 50% relative to baseline) was 84% [95% CI: 75.0 – 91.0] 24 h after the first administration, 94% during visit 3 [95% CI: 87.0 – 98.0], р&lt;0.001. The secondary efficacy criteria (muscle syndrome index and McGill Pain Questionnaire score) showed significant positive dynamics (р&lt;0.001). No systemic adverse events were reported. Conclusion. The study showed that a single intramuscular injection of Ambenium® parenteral was an efficient, well-tolerated and safe treatment option for low back pain. Administration of a single drug dose makes it possible to ensure a significant clinical effect reflected in the pain severity decrease and restoration of the patient’s motor activity.

Using Haptic Technology for Pain Reduction and Functional Improvement

Advancements to reduce pain severity and improve functionality are generally lacking. Chronic or recurrent pain is the most common reason patients consult primary care clinicians. Adverse events associated with existing pharmacological pain treatments have incentivized researchers to identify effective pain treatment strategies that have limited side effects, including non-invasive and non-pharmacologic options. Research has shown that a clearer understanding of the pain neuromatrix may assist in identifying alternative approaches and improving patient outcomes. A network consisting of neuronal pathways and circuits responding to sensory (nociceptive) stimulation makes up the neuromatrix of pain. Research provides strong support that these pathways and areas of the brain have elicited change in response to external stimuli. Advancements in the understanding of how external tactile stimuli, specifically “haptic vibrotactile trigger technology (VTT)” disrupts the neuromatrix of pain, has led to the development of technology that shows promise in targeting the nociceptive pathways. Through ongoing research, the technology has been incorporated into non-invasive, non-pharmacological topical patches and other routes of delivery to evaluate response as it relates to different health concerns and conditions. The purpose of this IRB-approved, minimal risk, randomized, and blinded study was to evaluate patients’ experiences and/or perceptions and patient response for those who received a haptic vibrotactile trigger technology (VTT) embedded non-pharmacologic, non-invasive, over-the-counter pain patch (FREEDOM Super Patch with VTT; Srysty Holding CO, Toronto, Canada) and those who received a placebo patch without the embedded technology. This final outcome data from the HARMONI Study adds to previously published interim data. Methods: Baseline, 7- and 14-day data were recorded in one hundred sixty-eight (168) adult subjects (107 females and 61 males) in a Treatment Group (n=148) or Control Group (n=20) with a mean age of 53 years who presented with mild, moderate and even severe musculoskeletal, arthritic and neurological pain. The study evaluated changes in overall severity and interference scores via a validated scale (Brief Pain Inventory (BPI)), changes in the use of prescription and OTC medications, patient satisfaction, and any side effects reported while using an active or placebo patch. Results: For the Treatment Group, results showed statistically significant decreases in mean BPI severity and interference scores after using the VTT embedded pain patch. After 14 days, the vast majority of patients reported “less” or “a lot less” usage of oral medications and were very/extremely satisfied with the patch. Results also showed statistically significant and positive outcomes in all measured Quality of Life (QoL) components with improvements in general activity, mood, relations with other people, sleep, normal work, walking ability, and enjoyment of life. In the Control Group, there were no significant changes in pain severity, interference levels, usage of medications, and patient satisfaction was poor during the 14 day study period. Conclusions: Study results indicate that this non-pharmacologic, non-invasive, haptic vibrotactile trigger technology (VTT) embedded topical patch reduces pain severity and interference scores and may reduce the use of concurrent medications, including prescribed anti-inflammatory and other oral medication for adult patients with arthritic, neuropathic, and musculoskeletal pain. Results reported suggest that the non-pharmacological topical pain patch should be added to the current arsenal of noninvasive and nonpharmacological pain therapies.

Testing Biological and Psychological Pathways of Emotion Regulation as a Primary Mechanism of Action in Yoga Interventions for Chronic Low Back Pain: Protocol for a Randomized Controlled Trial.

Interventions that promote adaptive emotion regulation (ER) skills reduce pain in patients with chronic pain; however, whether the effects of yoga practice on chronic low back pain (CLBP) are due to improvements in ER remains to be examined. This study will test whether the effects of yoga on CLBP (improved pain severity and interference) are mediated by improved ER, the extent to which effects are related to specific aspects of ER, and the role of pain sensitization as a mediator or moderator of effects. In this study, pain sensitization will be assessed by quantitative sensory testing and gene expression profiles to examine whether pain sensitization moderates yoga's effects on pain or whether yoga and ER abilities reduce pain sensitization, leading to decreased pain severity and interference. For this 2-arm parallel group blinded randomized controlled trial, we will enroll 204 adults with CLBP who will be randomized to receive the yoga (n=102) or a control stretching and strengthening (n=102) intervention, which are delivered via web-based synchronous biweekly 75-minute sessions over 12 weeks. Participants are encouraged to practice postures or exercises for 25 minutes on other days using accessible prerecorded practice videos that are sent to participants digitally. Participants will be assessed at 5 time points: baseline, midintervention (6 weeks), postintervention (12 weeks), and 3- and 6-month follow-ups. Assessments of ER, pain severity and interference, pain sensitivity including somatosensory and gene expression profiles, and physical strength and flexibility will be conducted at each visit. The fidelity of the interventions is assessed using a manualized checklist to evaluate recorded group sessions to ensure consistent instructor delivery. The primary outcome will be the mean change in pain severity as measured by the Brief Pain Inventory-Short Form at 12 weeks. The primary mechanism of action is ER measured by change in the Difficulties in Emotion Regulation Scale total score. Secondary outcomes include pain sensitivity, physical strength and flexibility, pain interference, and quality of life. A mediation path analysis and series of moderated mediation path analyses will be conducted to test the study hypotheses. As of January 2024, we have enrolled 138 participants. We expect the study to be completed by May 2025. The study will provide important data for evaluating whether improvements in ER are responsible for reduced pain perception and pain sensitivity as well as increased quality of life in the context of chronic pain. The study findings have important implications for determining the mechanism of action for yoga and possibly other mind-body interventions as nonpharmacological therapies for pain management. The results of the study will inform the content, delivery, and measures for intervention trials involving yoga as a modality for relieving pain and improving function. ClinicalTrials.gov NCT04678297; https://clinicaltrials.gov/study/NCT04678297. DERR1-10.2196/56016.

A new neuromodulation method in chronic migraine; non-ınvasive pulsed radiofrequency, a single-blinded, randomised, controlled trial.

Non-invasive pulsed radiofrequency (NipRF) therapy, a neuromodulation method for peripheral nerves, is a new treatment modality for pain. We aimed to show the changes in pain severity and frequency per month in chronic migraine with NipRF treatment. We treated patients diagnosed with chronic migraine according to the International Classification of Headache Disorders III beta diagnostic criteria. In half of the patients, we applied pulsed radiofrequency (pRF) treatment with transcutaneous electrodes to the greater occipital nerve (GON) trace. In the other half, we applied the GON block under ultrasound guidance. The Migraine Disability Assessment Scale (MIDAS) was administered to the participants, and those with scores > 2 were included in the study. Pain intensity and frequency were evaluated using the visual analog scale (VAS) and a headache diary completed before and 4weeks after treatment. When both groups were compared, the pre- and post-treatment VAS scores and headache frequencies were similar. Comparing the pre-treatment and post-treatment values within the groups, VAS scores and headache frequency decreased significantly after treatment in both groups (p < 0.001). In this study, we observed that NipRF treatment is safe and effective for treating chronic migraine. Pain intensity and frequency decreased with NipRF treatment, similar to that in the GON block group. NCT05499689, Date: 08/11/2022.

Accelerated Brain Aging Mediates the Association Between Psychological Profiles and Clinical Pain in Knee Osteoarthritis

Chronic pain is driven by factors across the biopsychosocial spectrum. Previously, we demonstrated that magnetic resonance images (MRI)-based brain-predicted age differences (brain-PAD: brain-predicted age minus chronological age) were significantly associated with pain severity in individuals with chronic knee pain. We also previously identified four distinct, replicable, multidimensional psychological profiles significantly associated with clinical pain. The brain aging-psychological characteristics interface in persons with chronic pain promises elucidating factors contributing to their poor health outcomes, yet this relationship is barely understood. That is why we examined the interplay between the psychological profiles in participants having chronic knee pain impacting function, brain-PAD, and clinical pain severity. Controlling for demographics and MRI scanner, we compared the brain-PAD among psychological profiles at baseline (n = 164) and over two years (n = 90). We also explored whether profile-related differences in pain severity were mediated by brain-PAD. Brain-PAD differed significantly between profiles (ANOVA's omnibus test, P = .039). Specifically, participants in the profile 3 group (high negative/low positive emotions) had an average brain-PAD ∼4 years higher than those in profile- (low somatic reactivity), with P = .047, Bonferroni-corrected, and than those in profile 2 (high coping), with P = .027, uncorrected. Repeated measures ANOVA revealed no significant change in profile-related brain-PAD differences over time, but there was a significant decrease in brain-PAD for profile 4 (high optimism/high positive affect), with P = .045. Moreover, profile-related differences in pain severity at baseline were partly explained by brain-PAD differences between profile 3 and 1, or 2; but brain-PAD did not significantly mediate the influence of variations in profiles on changes in pain severity over time. PerspectiveAccelerated brain aging could underlie the psychological-pain relationship, and psychological characteristics may predispose individuals with chronic knee pain to worse health outcomes via neuropsychological processes.

The ceramic coated implant (CCI). Evolution total ankle replacements: a retrospective analysis of 40 ankles with 8 years follow-up.

Diminutive data is available on the outcome of several previously used total ankle replacement implants. The purpose of this study was to investigate the medium-term functional and radiological outcome and implant survival of the CCI Evolution implant. Consecutive series of 40 ankles operated in our hospital with primary TAR using the CCI Evolution implant in 2010-2013 were available for follow-up. The prospective clinical and radiographic data including the Kofoed score, subjective satisfaction and standard radiographs were collected preoperatively and at fixed time-points postoperatively. A CT was obtained in cases where osteolysis or loosening were suspected. The improvement of the Kofoed score and subjective satisfaction were statistically significant (p<0.0001). The implant survival was 97% (95% confidence interval (CI) 81%-100 %) at 5 years, and 81 % (95% confidence interval (CI) 60 %-92%) at 8 years. There were altogether 25 (64%) complications. Overall revision rate was 28% and failure rate 13%. The CCI implant outcome was not acceptable. The malposition of prosthetic components, subsidence, and peri-implant osteolysis were recorded often. Although the patient reported outcome measures improved, mostly due to positive changes in pain severity, overall revision and failure rates were high and comparable with previous findings of the CCI implant.

Back pain and radicular pain after lumbar microdiscectomy

PurposeIt is generally expected that lumbar microdiscectomy affects radicular leg pain, but not so much local back pain. The primary objective was to evaluate if the trajectories of changes in pain severity follow similar patterns for back and radicular leg pain after lumbar microdiscectomy. The secondary objective was to investigate the associations between some preoperative parameters and the patterns of these trajectories.MethodsRegister-based retrospective study of 353 patients undergoing microdiscectomy in the lumbar spine. Linear mixed modelling was applied.ResultsThe average age of the participants was 46 years and 44% were women. The developmental trajectories were similar for both back and leg pain. Pain level decrease during the first year after the surgery, slightly worsening later. No statistically significant interactions were detected of preoperative pain duration or severity, sex or age on the shapes of the trajectories. For every analyzed grouping factor, the 95% confidence intervals overlapped at every postoperative time point with one exception – worse preoperative back pain was statistically significantly associated with worse pain at three months and at the end of the two-year follow-up.ConclusionAfter microsurgical discectomy, developmental curves for both back and radicular leg pain demonstrated similar patterns. Pain intensity decreased during the first year after the surgery. and slightly increased after that remaining, however, below the preoperative level. Age, sex, preoperative pain duration or preoperative intensity of leg pain were not associated with significant differences in the trajectories of pain severity after the surgery. In this study, severe preoperative back pain was the only factor, which was significantly associated with worse postoperative trajectory of pain intensity.

Emotion-Focused Psychodynamic Interview for People with Chronic Musculoskeletal Pain and Childhood Adversity: A Randomized Controlled Trial

Childhood adversity and emotional conflicts are associated with the presence and severity of chronic musculoskeletal pain (CMP), yet common treatments for CMP do not address such risk factors. We developed a single session, emotion-focused psychodynamic interview, based on Emotional Awareness and Expression Therapy and Intensive Short-term Psychodynamic Therapy, and we tested the interview’s effects on pain-related outcomes and potential psychological mediators in a randomized, controlled trial. Adults (N = 91; ages 21–70, M = 44.64; 87.9% women) reporting CMP and at least 3 adverse childhood experiences completed measures at baseline and 6-week follow-up. Participants were randomized to immediate interview or waitlist control conditions. The 90-minute interview was conducted via videoconference, and the interviewer elicited disclosure of adversities and conflicts, linked these with pain, and encouraged the experience and expression of adaptive emotions. Analyses indicated that conditions did not differ significantly on change in pain severity; however, compared to control, the interview led to a significantly greater reduction in pain interference (P = .016, ηp2 = .05) and a similar trend for anxiety (P = .058, ηp2 = .04). The interview also significantly changed several potential mediators: pain-related anxiety (P = .008, ηp2 = .06), pain controllability (P = .016, ηp2 = .06), and psychological (P < .001, ηp2 = .15) and brain attributions (P = .022, ηp2 = .05) for pain. Participants viewed the interview as very valuable. We conclude that addressing childhood adversities and conflicts in a psychodynamic interview is beneficial for people with CMP. PerspectiveThis study found that, compared to waitlist control, a 90-minute, remotely-administered, emotion-focused, psychodynamic interview improved pain interference, and anxiety among adults with chronic musculoskeletal pain and childhood adversity. Intensive emotional work can be done in a single session to the benefit of patients with chronic musculoskeletal pain.

The role of frailty on quality of life in older adults during the COVID-19 pandemic.

The impact of frailty, a physiological state characterized by reduced reserve for stressors and related to worse outcomes, on older adults during the pandemic is unclear. Our aim was to identify the effects of frailty among older adults during the COVID-19 pandemic. A total of 197 older adults who were not exposed to COVID-19 were assessed with an online survey one year after the pandemic began in Turkey. Frailty, quality of life, and fear of COVID-19 were assessed with the Tilburg Frailty Indicator, the Nottingham Health Profile, and the Fear of COVID-19 Scale, respectively. Since March 2020, changes in pain severity and localization, fatigue, and fear of falling were assessed. Multiple linear regression analyses were conducted. In this study, 62.5% of the participants were frail. The prevalence of pain was significantly increased during the COVID-19 pandemic, but only among the frail. The increases in pain severity, fear of falling, and fatigue were significantly higher for the frail than the non-frail. The model including physical and psychological components of frailty and pain severity explained 49% of the variation in quality of life (R = 0.696; R2 = 0.485; p < 0.001). The physical component of frailty had the highest impact on quality of life (B = 20.591; β = 0.334). This study focused on negative outcomes that were experienced more by frail older adults compared to non-frail older adults when they were locked down at home for an extended period of time during the COVID-19 pandemic. It is necessary to quickly improve and maintain the health of these affected individuals.

Economic analysis of patient-related effects of an interdisciplinary pain self-management program.

Active Day Patient Treatment (ADAPT) is a well-established 3 week intensive cognitive-behavioural, interdisciplinary pain management program for patients with disabling chronic pain. The aim of this analysis was to conduct an economic analysis of patient-related effects of ADAPT using hospital administrative data, specifically, to compare the costs and health outcomes for patients 1 month after participating in the program, with the preprogram period when they were receiving standard care. This retrospective cohort study included 230 patients who completed ADAPT (including follow-ups) between 2014 and 17 at the Pain Management and Research Centre at the Royal North Shore Hospital in Sydney, Australia. Data on pain-related healthcare utilization and costs before and after the program were assessed. Primary outcome measures were labour force participation for patients' average weekly earnings and cost per clinically meaningful change in Pain Self-efficacy Questionnaire, Brief Pain Inventory (BPI) Severity, and BPI interference scores (n = 224). We estimated patients, on average, earned $59 more each week at 1 month follow-up compared with baseline. The cost per clinically meaningful change in pain severity and interference score based on the BPI severity and BPI interference were AU$9452.32 (95% CI: $7031.76-$12,930.40) and AU$3446.62 (95% CI: $2851.67-$4126.46), respectively. The cost per point improvement and per clinically meaningful change in the Pain Self-efficacy Questionnaire were $483 (95% CI: $411.289-$568.606) and $3381.02, respectively. Our analysis showed a better health outcome, reduced healthcare services' cost, and reduced number of medications taken 1 month after participating in ADAPT.

Overall prognosis of acute and chronic musculoskeletal, widespread, and neuropathic pain in children and adolescents

Objectives This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: We aim to describe the overall prognosis (focusing on the pain course) and the negative impact(s) of acute and chronic musculoskeletal, widespread, and neuropathic pain in children (aged six to 12 years) and adolescents (aged 13 to 18 years) by evaluating: incidence of pain recovery at three and 12 months after reporting acute or chronic pain; change in pain severity at three and 12 months after reporting acute or chronic pain; and negative impact(s) of pain at three and 12 months after reporting chronic pain.

Efficacy of botulinum toxin type A injection for Raynaud's phenomenon and digital ulcers in patients with systemic sclerosis.

Systemic sclerosis (SSc) is an autoimmune, connective tissue disorder of unknown etiology which causes vasculopathy and fibrosis. Raynaud's phenomenon (RP) is a common complication of SSc, which leads to ischemia and gangrenes. Treatment of RP is a clinical problem and often remains insufficient.This study aimed to evaluate the therapeutic efficacy of local injections of botulinum toxin type A (BTX-A) in improving the symptoms of Raynaud's phenomenon (RP) secondary to scleroderma. This parallel single-blinded, placebo-controlled clinical trial enrolled 29 patients with scleroderma. Participants received BTX-A in the first, 2nd, 3rd, and 4th dorsal web spaces and the base of the thumb and small finger of the non-dominant hand and 2.5 ml of sterile normal saline in the opposite hand. Pre-injection measurements and post-injection follow-up evaluations at months 1 and 4 were performed. We compared the outcomes using the paired Student's t-test. The change in pain severity between pre-injection and month 1 follow-up was significantly larger in the BTX-A group (p-value = 0.04). Between pre-injection and month 1 and month 4, the changes in the Raynaud's condition score (RCS) (p-value = 0.02, 0.004, respectively) and the number of Raynaud's attacks (p-value = 0.006, 0.001, respectively) were significantly greater in the BTX-A group. No significant difference was found in terms of paresthesia, skin thickening, upper extremity function, ulcer diameter, number of ulcers, or Raynaud's attack duration between the two groups (p-value > 0.05). In time, the decrease in pain severity, paresthesia, RCS, number of ulcers, and ulcer diameter, and the increase in upper extremity function were significantly greater in the BTX-A group as compared to the placebo group (p < 0.05). Our study showed that local injection of BTX-A is safe and has beneficial therapeutic effects on RP and RP-related digital ulcers in SSc patients.

Infraslow Neurofeedback Training Alters Effective Connectivity in Individuals with Chronic Low Back Pain: A Secondary Analysis of a Pilot Randomized Placebo-Controlled Study.

This study explored the effect of electroencephalographic infraslow neurofeedback (EEG ISF-NF) training on effective connectivity and tested whether such effective connectivity changes are correlated with changes in pain and disability in people with chronic low back pain. This involved secondary analysis of a pilot double-blinded randomised placebo-controlled study. Participants (n = 60) were randomised to receive ISF-NF targeting either the pregenual anterior cingulate cortex (pgACC), dorsal anterior cingulate and somatosensory cortex (dACC + S1), ratio of pgACC*2/dACC + S1, or Sham-NF. Resting-state EEG and clinical outcomes were assessed at baseline, immediately after intervention, and at one-week and one-month follow-up. Kruskal-Wallis tests demonstrated significant between-group differences in effective connectivity from pgACC to S1L at one-month follow up and marginal significant changes from S1L to pgACC at one-week and one-month follow up. Mann-Whitney U tests demonstrated significant increases in effective connectivity in the ISF-NF up-training pgACC group when compared to the Sham-NF group (pgACC to S1L at one-month (p = 0.013), and S1L to pgACC at one-week (p = 0.008) and one-month follow up (p = 0.016)). Correlational analyses demonstrated a significant negative correlation (ρ = -0.630, p = 0.038) between effective connectivity changes from pgACC to S1L and changes in pain severity at one-month follow-up. The ISF-NF training pgACC can reduce pain via influencing effective connectivity between pgACC and S1L.