Pain Characteristics Research Articles

Do we really know if they are in pain? A cross-sectional study in hospitalised adult patients in Spain.

To describe the prevalence and characteristics of pain in adult hospitalised patients, as well as to analyse the concordance between patient-reported and recorded pain and its impact on analgesic management. A cross sectional study. The study was performed on a sample of 611 patients, from October to December 2017. Data were obtained from patient interviews, review of medical and nursing records and review of electronic prescribing. The prevalence of pain at the time of the interview was 36.7%. The median VAS score was 4. 90% of the patients had their pain assessed within the last 24 h; however, concordance between patient-reported pain and recorded pain in the nursing record was slight. Pain is still often documented inadequately. Despite the wide use of analgesics, half of the patients with moderate to severe pain do not have adequate pain management. A systematic assessment and recording of pain promotes appropriate analgesic prescription. The findings of our study provide insight into the main gaps in the correct management of pain in hospitalised patients. A systematic assessment and recording of the pain suffered by the patient facilitates its control and allows a better management of the analgesic prescription by the physician. This information could help hospital managers to develop training programmes on pain assessment and on the importance of doctor-nurse collaboration to improve pain management, increasing the quality of care and reducing hospital costs. The study has adhered to the relevant EQUATOR guidelines, according to The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Characteristics Of Temporomandibular Disorders And Orofacial Pain In Individuals With Rheumatoid Arthritis.

To compare characteristics of temporomandibular disorders (TMDs) in patients with rheumatoid arthritis (RA) to controls without RA. The sample included 80 subjects (aged 33 to 73 years; 88% women), 40 in each group. An international diagnostic protocol for TMD was followed. Arthralgia was the most prevalent TMD in the RA group. Orofacial pain was more common than in controls (42.5% vs 15%, P = .031), with higher chronic pain grade and pain intensity (P ≤ .005). Somatization and depression were also increased (P < .001). In multiple logistic regression analysis, arthralgia (OR: 6.4; 95% CI: 1.1 to 37.1; P = .038) and age ≥ 55 years were predictors of RA (OR 3.9; 95% CI: 1.4 to 10.8; P = .009) when controlling for the effects of gender and pain intensity. TMD was related to 7.4-times higher odds for presence of orofacial pain, while RA was related to 3.4-times higher odds for pain. RA patients experienced more orofacial pain and higher pain intensity, somatization, and depression compared to healthy individuals. Pain is more influenced by TMD than by RA.

Pain characteristics and sleep dysregulation in patients with rheumatoid arthritis and ankylosing spondylitis: relationships with pain intensity and disease activity

Background. Pain is a prominent manifestation in chronic immune-inflammatory rheumatic disorders, encompassing both nociceptive and non-nociceptive elements, the latter potentially resulting from central sensitization. The connection between inadequate sleep quality and the onset of central sensitization in individuals with chronic rheumatic diseases has been documented. Objectives. This study aimed to analyze the characteristics of pain, sleep quality, and their correlation with pain intensity and disease activity in adults with rheumatoid arthritis and ankylosing spondylitis. Methods. A prospective observational study was conducted, involving patients with RA, AS, and osteoarthritis. We evaluated pain intensity, pain characteristics, and sleep quality. Results. The study group included 152 patients. RA was primarily characterized by nociceptive pain, but AS exhibited a higher prevalence of neuropathic pain. Significant associations were found between PD-Q scores and disease activity in patients with RA, but no such correlations were identified in patients with AS. Individuals with AS showed a significant inverse correlation between PD-Q scores and pain intensity. The PSQI scores did not show any notable variations among the three groupings. The quality of sleep was found to be connected with disease activity in RA but not in AS. A substantial and noteworthy correlation was found between the overall PSQI score and the scores obtained from the PD-Q in both subgroups of RA and AS. Conclusion. Notable connections can be found between disease activity, pain characteristics, and sleep quality in chronic immune-inflammatory rheumatic diseases.

Treatment Delay in Patients Undergoing Headache Surgery (Nerve Decompression Surgery)

Although headache surgery has been shown to be an effective treatment option for refractory headache disorders, it has not been included as part of the headache disorder management algorithm by non-surgical providers. This study aims to evaluate the delay in surgical management of patients with headache disorders. In addition, a cost comparison analysis between conservative and operative treatment of headache disorders was performed, and the surgical outcomes of headache surgery were reported. Among 1112 patients who were screened, 271 (56%) patients underwent headache surgery. Data regarding the onset of headache disorder and pre- and postoperative pain characteristics were prospectively collected. To perform a cost comparison analysis, direct and indirect costs associated with the conservative treatment of headache disorders were calculated. The median duration between onset of headache disorder symptoms and headache surgery was 20 (8.2-32) years. The annual mean cost of conservative treatment of headache disorders was $49,463.78 ($30,933.87-$66,553.70) per patient. Over the 20-year time period before surgery, the mean cost was $989,275.65 ($618,677.31-$1,331,073.99). In comparison, the mean cost of headache surgery was $11,000. The median pain days per month decreased by 16 (0-25) (p<0.001), the median pain intensity reduced by 4 (2-7) (p<0.001), and the median pain duration decreased by 11 hours (0-22) (p<0.001). This study shows that patients experience symptoms of headache disorders for an average of 20 years prior to undergoing headache surgery. Surgical treatment not only significantly improves headache pain but also reduces healthcare costs and should be implemented in the management algorithm of headache disorders.

Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance.

This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.

Prevalence and characteristics of pain in moderate-to-severe obstructive sleep apnea patients and effect of CPAP treatment

Pain problems are common in patients with obstructive sleep apnea (OSA), but few studies have thoroughly evaluated pain in these patients. The objective of this study was to examine the prevalence and characteristics of pain in moderate-to-severe OSA patients and the effect of continuous positive airway pressure (CPAP) treatment. Moderate-to-severe OSA patients and healthy controls (HC) completed the Short Form McGill Pain Questionnaire (SF-MPQ) and a portion of the Brief Pain Inventory (BPI) Short Form to assess pain characteristics. The Epworth Sleepiness Scale (ESS), the Short Form-36 (SF-36), and the Hospital Anxiety and Depression Scale (HADS) were used to measure daytime sleepiness, health-related quality of life (HRQoL), and psychological status, respectively. The OSA patients with pain were divided into a CPAP-treated group and a CPAP-untreated group based on their adherence to CPAP. The subjects' pain intensity was reassessed after 3 months. The prevalence of pain was 57.5% in OSA versus 27.1% in HC (p < 0.001). Head (39.0%) accounted for the highest proportion of overall pain locations in subjects with OSA, with 28.8% of OSA patients experiencing headaches. Pain in OSA was associated with impaired HRQoL and psychological problems. Patients with very severe OSA had an increased risk for pain problems (OR: 7.000, p = 0.041). Associated factors for pain intensity in OSA included age, ESS ≥ 9.0, and lowest pulse oximetry (LSpO2) < 80.0%. Pain intensity in OSA decreased significantly after CPAP treatment (p < 0.001). Pain was prevalent among patients with moderate-to-severe OSA and was associated with depression, anxiety, and a lower HRQoL. Patients with very severe OSA had an increased risk for pain problems. The intensity of pain in OSA can be predicted by age, ESS ≥ 9.0, and LSpO2 < 80.0%, and it can be alleviated through CPAP treatment.

Clinical analysis of qualitative and quantitative pain characteristics in patients with acute and chronic vertebrogenic lumbosacral pain syndromes

Diverse approaches exist for diagnosing and treating patients afflicted with acute and chronic low back pain syndromes (LBP), thereby necessitating a comprehensive evaluation of the pain syndrome and a meticulous analysis of the neuropathic component to enhance our scholarly comprehension of the distinct differences in pain progression among these individuals. A total of 125 individuals (56 females and 69 males) diagnosed with vertebral lumbar pain syndromes (LBP), aged between 20 and 68 years (42.8 ± 11.1 years), underwent comprehensive evaluation. Stratification into two distinct groups was based on the duration of the pain syndrome: an acute pain group (pain lasting up to 3 months) and a chronic pain group (pain persisting beyond 3 months). Pain assessment, administered upon hospitalization, involved utilizing of well-established tools such as the Visual Analogue Scale (VAS), DN4 Questionnaire, and McGill Pain Questionnaire. The initial pain intensity, measured by VAS upon admission, was recorded as 7.15 ± 1.17 in the acute pain group and 6.08 ± 0.96 in the chronic pain group. Analysis of responses to the DN4 questionnaire revealed that patients with acute pain syndrome obtained an average score of 2.26 ± 1.01, whereas those in the chronic pain group scored 4.53 ± 1.02. The presence of a neuropathic component was identified in 38 % of patients with acute pain and 56 % of patients with chronic pain. Correlational analyses indicated a weak positive correlation (r = 0.12, p &lt; 0.05) between VAS scores and the assessment of neuropathic pain using the DN4 questionnaire in the acute pain group. However, the chronic pain group observed a moderate positive correlation (r = 0.41, p &lt; 0.001). Patients experiencing chronic LBP expressed their pain sensations in a more emotionally descriptive manner. Notably, the chronic pain group exhibited a statistically significant elevation in the number of selected descriptors according to the Index of Chosen Descriptors (ICD) on the sensory scale, as well as an increased Pain Rank Index (PRI) on both sensory and affective scales, compared to the acute pain group. To summarize, individuals with chronic LBP exhibit a more prevalence of the neuropathic component. Moreover, patients in the chronic pain group demonstrated higher scores indicative of sensory and psychosocial aspects of pain. Key words: acute pain, chronic pain, neuropathic component of pain, verbal descriptors, McGill Pain Questionnaire

Efficacy of a strength-based exercise program in patients with chronic tension type headache: a randomized controlled trial.

Strength-based exercise is widely used to treat tension-type headache, but the evidence of its benefit is unclear. This study aims to analyze the efficacy of a strength-based exercise program in patients with chronic tension-type headaches. A randomized controlled trial with a 12-week strength-based exercise program, with chronic tension-type headache. The headache characteristics (which were the primary outcomes: frequency, duration, and intensity), cervical muscle thickness at rest or contraction of multifidus and longus-colli muscle, cervical range of motion, pain pressure threshold of temporalis, upper trapezius, masseter, tibialis muscle and median nerve, and cervical craniocervical flexion test were assessed at baseline and 12-weeks of follow-up in the intervention group (n = 20) and the control group (n = 20) was performed on 40 patients (85% women, aged 37.0 ± 13.3 years). Between baseline and week-12 of follow-up the intervention group showed statistically significant differences compared to control group in the following primary outcomes: duration and intensity of headaches. In addition, the intervention group improved the thickness of deep cervical muscles, reduced the peripheral sensitization, and improved the strength of deep cervical flexors. A 12-week strength training of neck and shoulder region induced changes in pain intensity and duration, and physical-related factors in patients with TTH. Future interventions are needed to investigate if normalization of pain characteristics and physical factors can lead to an increase of headache-related impact.

Characteristics of Low Back Pain (LBP) in The Lumbosacral Examination in Radiological Installations: A Case of Tidore Island Hospital and Jailolo Hospital, Indonesia

The International Classification of Disease (ICD) shows that Low Back Pain (LBP) is a condition of pain and discomfort in a person below the corner of the last rib (costal margin) and above the lower gluteal fold, accompanied by pain in the legs. Low Back Pain (LBP) is not a disease or a diagnosis but instead triggers the term used for pain syndromes in which anatomical structures are affected in various ways by the duration of pain. Low Back Pain cases worldwide vary annually, reaching 15 to 45%. WHO shows that 33% of the population in developing countries experience persistent back pain. The prevalence of musculoskeletal disorders in Indonesia is 11.9% based on diagnosis by health workers, 24.7% based on diagnosis or incidence, and about 4.73% in North Maluku. Prevalence has increased significantly at the age of 35 to 55 years. The Lumbosacral Vertebrae examination technique is an initial examination to determine the presence of LBP abnormalities in the lumbosacral. The most frequently used radiological procedure in cases of LBP is a lumbosacral examination using anteroposterior (AP) and lateral projections. This research used a descriptive and retrospective approach. This research was conducted at the Radiology Installation of Tidore Islands Hospital and Jailolo Hospital for one year, January-December 2021. The results showed that the lumbosacral check in patients with clinical Low Back Pain (LBP) in the Radiology Installation of Tidore Islands Hospital and Jailolo Hospital was 64 at the Tidore Islands Hospital and 72 at the Jailolo Hospital. The people with the highest age in the two hospitals is the age range of 46-55 years, dominated by women (57.8%) at the Tidore Islands City Hospital and men (59.7%) at Jailolo Hospital. Also, the characteristics of Low Back Pain (LBP) based on the lumbosacral examination were lumbar spondylosis (43.8%) at the Tidore Islands Hospital and (41.7%) at the Jailolo Hospital.

Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States.

Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup. We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65-107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, "did you worry about falling down" and "did this worry ever limit your activities." Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry. Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12-1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12-3.75, p = .020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry. These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls.

Frequency of Non-Specific Cervical Pain Experienced by the Adult Population in Peshawar A Review Article

Non-specific cervical pain is a prevalent health concern affecting individuals across various age groups and populations. This study aims to investigate the frequency of non-specific cervical pain experienced by the adult population in Peshawar. A cross-sectional survey was conducted, gathering data from a diverse sample of adults residing in Peshawar. The results revealed valuable insights into the prevalence and characteristics of non-specific cervical pain in this region. The findings emphasize the need for public health interventions and awareness campaigns to address this issue effectively.

Prevalence of chronic pain and chronic widespread pain among subjects with heart failure in the general population: The HUNT study.

Pain in chronic heart failure (HF) is a significant but often unrecognized symptom. Characteristics of pain in subjects with HF are largely undescribed. The study aimed to address a knowledge gap in the relationship between HF and pain by investigating the prevalence of chronic pain and chronic widespread pain (CWP) among subjects with HF. Population data from the HUNT3 study in Norway (2006-2008, n = 50,802) was used. HF was measured by self-report. CWP was defined as having pain in both sides of the body, pain in the upper and lower limbs, and axial pain for at least 3 months in the last year. Associations between HF and CWP and HF and moderate to high pain intensity were analysed with logistic regression. Among subjects with HF in the general population, the prevalence of chronic pain was 67.8%, 20.7% had CWP, and 58.8% had moderate to high intensity pain. Compared to participants with cardiovascular disease but not HF, the odds of both CWP (OR = 1.6; 95% CI: 1.3-2.0) and moderate to high intensity pain (OR = 1.3; 95% CI: 1.3-1.8) were higher among participants with HF-controlled for age, sex, body mass index, and comorbidity. Our study confirmed the high prevalence of pain among HF subjects. This pain could not be explained by comorbidity or sociodemographic factors, which are relevant for clinical and research purposes. Pain management should not be restricted to cardiac-related pain but to chronic pain in general. This epidemiological study corroborates previous studies reporting a high prevalence of pain in the HF-population. We found that the relationship between HF, CWP, and pain intensity could not be explained by comorbidity or sociodemographic factors, illustrating the burden of chronic pain related to HF. Our results expand the understanding of pain in HF and highlight the need to identify and manage chronic pain among individuals with HF, as widespread pain adds to the symptom burden in individuals with HF.

Development of a binary classifier model from extended facial codes toward video-based pain recognition in cancer patients.

The Automatic Pain Assessment (APA) relies on the exploitation of objective methods to evaluate the severity of pain and other pain-related characteristics. Facial expressions are the most investigated pain behavior features for APA. We constructed a binary classifier model for discriminating between the absence and presence of pain through video analysis. A brief interview lasting approximately two-minute was conducted with cancer patients, and video recordings were taken during the session. The Delaware Pain Database and UNBC-McMaster Shoulder Pain dataset were used for training. A set of 17 Action Units (AUs) was adopted. For each image, the OpenFace toolkit was used to extract the considered AUs. The collected data were grouped and split into train and test sets: 80 % of the data was used as a training set and the remaining 20 % as the validation set. For continuous estimation, the entire patient video with frame prediction values of 0 (no pain) or 1 (pain), was imported into an annotator (ELAN 6.4). The developed Neural Network classifier consists of two dense layers. The first layer contains 17 nodes associated with the facial AUs extracted by OpenFace for each image. The output layer is a classification label of "pain" (1) or "no pain" (0). The classifier obtained an accuracy of ∼94 % after about 400 training epochs. The Area Under the ROC curve (AUROC) value was approximately 0.98. This study demonstrated that the use of a binary classifier model developed from selected AUs can be an effective tool for evaluating cancer pain. The implementation of an APA classifier can be useful for detecting potential pain fluctuations. In the context of APA research, further investigations are necessary to refine the process and particularly to combine this data with multi-parameter analyses such as speech analysis, text analysis, and data obtained from physiological parameters.

The Characteristics of Badminton-Related Pain in Pre-Adolescent and Adolescent Badminton Players.

Body pain, often considered as an early sign of injury in young players, warrants thorough study. This study aimed to examine the distribution of badminton-related pain and prevalence in pre-adolescent and adolescent badminton players. Profiles of badminton-related pain were surveyed using a questionnaire among 366 pre-adolescent and adolescent badminton players aged 7-12 years. The distribution of badminton-related pain was described, and the pain incidence was calculated. Proportions of pain per 1000-training-hour exposures were the main outcome measures. The analysis considered various age groups (7-8, 9-10, and 11-12 years) and years of badminton experience (≤2, 2-3, and > 3 years). In total, 554 cases of badminton-related pain were reported. The ankle was the most common site, followed by knee, plantar, shoulder, and lower back. The overall pain rate per 1000-training-hour exposure was 3.06. The 11-12-year-old group showed the highest pain rate, significantly greater than the 7-8-year-old group and the 9-10-year-old group. Additionally, the prevalence of pain exhibited an increasing trend with age. Finally, regardless of the age groups, participants with 2-3 years of badminton experience had the highest pain rate. These findings might help inform targeted interventions to reduce the high prevalence of pain in various body regions across pre-adolescent and adolescent badminton players.

Risk factors for opioid addiction in chronic non-cancer pain

Opioids are very effective pain medications, but they are not without complications. Its use in chronic cancer pain is clearly established, but not in chronic non-cancer pain. Opioid use has increased in recent years, but at the same time, it has been accompanied by an increase in side effects and related complications, including abuse, abuse and opioid addiction. If we look in the literature on the subject there is a global concern to make an adequate therapy with risk reduction, but the samples studied make it difficult to extrapolate results to the general population and even more so if we take into account factors such as psychiatric comorbidity. This leads us to consider the need to study our own population, its characteristics and see how it is being treated, to refine as much as possible on an appropriate prescription. The authors have carried out a cross-sectional study on patients with non-cancer chronic pain referred to psychiatry and the presence of opioid use disorder. We found risk factors related to the biopsychosocial characteristics of the patients and the characteristics of pain and its treatment. Knowing the risk factors, we can avoid yatrogeny, implement primary and secondary prevention and, ultimately, improve the quality of patient care.

Quantitative Assessment of Subjective Symptoms and Corneal Sensitivity in Chronic Orbital Pain Patients.

To objectively evaluate the subjective symptoms and characteristics of chronic orbital pain as well as to quantify sensitization of peripheral trigeminal nerves. In this prospective cohort study, patients who previously showed a response to peripheral trigeminal nerve blocks for unilateral, idiopathic chronic orbital pain and healthy subjects completed validated questionnaires assessing headaches, neuropathic signs and symptoms, photophobia, and pain qualities. Corneal sensitivity was measured in both eyes for all subjects with a Cochet-Bonnet aesthesiometer. For pain patients, the full assessment protocol was repeated 2-4 weeks after the study injection, and corneal sensitivity was also measured 30 minutes postinjection. Outcomes assessed were headache, neuropathic pain, and photophobia scores; pain qualities; and corneal sensitivity. Six female chronic orbital pain patients (mean age 48.2 years) and 11 female controls (mean age 47.5) were included. The mean headache, neuropathic pain, and photophobia questionnaire scores were significantly higher for pain patients than for controls (p < 0.001). On sensory testing, 5 pain patients (83.3%) endorsed allodynia, and all 6 (100%) had hyperalgesia in the ipsilateral frontal nerve dermatome. No controls had allodynia or hyperalgesia. Corneal sensitivity was similar between eyes in pain patients and between groups. Questionnaire scores and corneal sensitivity did not change significantly after the injection. Chronic orbital pain patients have a measurable reduction in quality of life due to headaches and photophobia. The supraorbital and supratrochlear nerves are sensitized, resulting in cutaneous hypersensitivity in the corresponding dermatome, but corneal nerves have normal sensitivity.

Comparison of thoracolumbar versus non-thoracolumbar osteoporotic vertebral compression fractures in risk factors, vertebral compression degree and pre-hospital back pain

BackgroundThoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF).MethodsOVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF.ResultsA total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was − 2.99 ± 1.11, − 3.24 ± 1.14, − 3.05 ± 1.40 in < 70, 70–80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior–posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1–2, and 2–4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1–2, 2–4, and > 4 weeks.ConclusionsThoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.

Characteristics of pain and their relationship to disease activity in UK patients with Behçet's syndrome: a prospective cohort study.

Behçet's syndrome (BS) is a rare multi-systemic vasculitis of unknown aetiology. Fibromyalgia syndrome (FMS) is more prevalent in rheumatological conditions such-as BS, than the general population. However, there is limited research into the aetiology and characteristics of pain in BS. To describe the pain characteristics and incidence of FMS in people with BS and investigate their relationship with BS disease activity. A cohort study of BS patients attending the Liverpool Behçet's Centre between February 2017 and March 2019. BS was defined using the International Study Group Criteria. BS severity was assessed using the Behçet's Disease Current Activity Form. FMS was determined from consultant diagnosis. Assessments of pain included: Pain Visual Analogue Scale (PVAS), Pain Mannequin, Brief Pain Inventory, EQ-5D-3L and Short Form McGill. Pain and FMS prevalence were compared between high and low disease activity. 90% reported moderate-severe pain with a median PVAS score of 68/100 [38, 81]. 35.6% of participants had FMS and 46.5% experienced generalized pain. 76% of participants with high disease activity reported severe pain, compared to 39.1% with low disease activity (p = .003). Pain was more generalised in high disease activity (72%) compared to low disease activity (37.7%) (p = .003). FMS was more prevalent in the high disease activity group (52%) than the low disease activity group (29%) (p = .04). This is the first study to explore pain in participants with BS in the United Kingdom. The majority of BS patients experience moderate-severe widespread pain. Severe widespread pain is more prevalent in those with high disease activity. We have demonstrated a relationship between high disease activity, worse pain intensity, and FMS. This paper contributes to the understanding of two conditions which remain to be fully understood, FMS and BS, and generates new hypotheses to describe the interplay between.

Pediatric inpatient interdisciplinary multimodal pain treatment in Germany

Severely disabling chronic pain affects approximately half amillion children in Germany. If there is a lack of response to unimodal treatment, an inpatient interdisciplinary multimodal pain treatment (IMPT) can be considered. This review article describes the supply situation of pediatric inpatient IMPT in Germany and presents the current evidence on the effectiveness. Based on asystematic literature search, studies addressing the effectiveness of pediatric inpatient IMPT in Germany were identified. In addition, further sources were used to extract information on pediatric IMPT treatment centers in Germany in order to describe the treatment approaches, the qualification of personnel and characteristics of patients. There are four pediatric pain centers in Germany that are specialized in inpatient IMPT for children and adolescents. Treatment duration ranges between 3 and 4weeks. The multimodal treatment is carried out by amultiprofessional team and is generally available for patients up to 18years. The majority of patients are female. The effectiveness of pediatric IMPT in Germany was investigated up to 4years after treatment. Positive effects were shown for pain characteristics and also for the emotional burden. Additional treatment modules can facilitate further optimization of treatment effects. Further research on the effectiveness of IMPT in Germany is important in order to refine and optimize the available treatment programs.

Coexistence of neuropathic corneal pain, corneal nerve abnormalities, depression, and low quality of life.

To evaluate the quality of life (QoL), mental health conditions and corneal morphology in neuropathic corneal pain (NCP) subjects without a significant ocular surface disease. A composite questionnaire was administered to 228 consecutive subjects, assessing the pain intensity, duration, and quality using a modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Pain Detect (PD) questionnaires. Subjects diagnosed with possible central NCP and two sub-groups of patients diagnosed with peripheral ocular pain completed an additional battery of mental health questionnaires and were examined by In Vivo Confocal Microscopy (IVCM). Of the 76 subjects that reported chronic ocular pain (duration >1 month), 53 were classified with probable NCP. Nine subjects without signs that justify the pain and non-responding to topical anaesthesia, were considered affected by central NCP. In these patients, a significant negative correlation was found between the presence pain and the mental component of the QoL (R2 = 0.733), and a positive correlation between the severity of pain the presence post-traumatic stress disorder (R2 = 0.83) and depression (R2 = 0.93). Although neuromas and sprouting had higher frequency in the central NCP group compared the control groups, these differences was not statistically different. The assessment of ocular pain characteristics using multiple questionnaires and IVCM may help to recognize differences between nociceptive and neuropathic pain. An association between pain intensity and mental health condition may guide the therapeutical choices.