Current Pain Intensity Research Articles

Clinical and cost-effectiveness of ultrasound-guided intra-articular corticosteroid and local anaesthetic injection for hip osteoarthritis: a randomised controlled trial (HIT)

Purpose: Evidence of the effectiveness of intra-articular corticosteroid injection for hip osteoarthritis (OA) is limited. The HIT trial compared the clinical and cost-effectiveness of an ultrasound-guided intra-articular hip injection (USGI) of 40mg triamcinolone acetonide and 4ml 1% lidocaine hydrochloride combined with best current treatment (BCT) with (i) BCT alone (primary objective) and (ii) an USGI of 5ml 1% lidocaine only combined with BCT (EudraCT: 2014-003412-37). Methods: This was a pragmatic, three-parallel group, single-blind, randomised controlled trial in adults with moderate to severe painful hip OA recruited from community musculoskeletal services and primary care. Participants were randomised equally to: (1) BCT alone, (2) BCT plus USGI triamcinolone/lidocaine, or (3) BCT plus USGI lidocaine only. BCT comprised written information and individualised advice regarding weight loss, exercise, footwear, walking aids and analgesia. Outcomes were collected postally at 2 weeks, 2, 4 and 6 months. The primary outcome was self-reported current hip pain intensity (0-10 numeric rating scale (NRS)) over 6 months (repeated measures analysis). A wide range of secondary outcomes were measured at each follow-up point including pain and physical function (Western Ontario and McMaster University Arthritis Index, WOMAC), pain self-efficacy, participant’s global impression of change, general health (EQ-5D-5L) and healthcare utilisation. Participants and clinicians were not blind to allocation to BCT alone or injection, however participants randomised to either injection arm were blind to the nature of injection. The research nurse involved in data collection and study statistician were blind to treatment allocation. 204 participants were required to detect a minimum difference of 1 point in mean pain NRS score between arms (1) and (2) with 80% power (5% two-tailed significance level, 15% loss to follow-up). Analysis was by intention-to-treat. To determine the cost-effectiveness of BCT plus USGI triamcinolone/lidocaine compared with BCT alone, a cost-utility analysis was conducted, adopting an NHS perspective. QALYs were calculated over a period of 6 months using the area under the curve approach. Results: 199 participants were recruited (43% male, mean age 63 years), 67 to arm (1) and 66 each to arms (2) and (3). Primary outcome completion rates were 95% at 2 weeks, 94% at 2 months, 90% at 4 months, and 89% at 6 months. Greater mean improvement in hip pain intensity (0-10 NRS) over 6 months was seen with BCT plus USGI triamcinolone/lidocaine compared with BCT alone: -1.43 (95% CI -2.15, -0.72). Greater mean improvement in pain intensity was seen at 2 weeks (-3.17; -4.06, -2.28,) and 2 months (-1.81; -2.71, -0.92,), but not at 4 months (-0.86; -1.78, 0.05) or 6 months (0.12; -0.80, 1.04). Participants treated with BCT plus USGI triamcinolone/lidocaine compared with BCT alone had greater mean improvement in function (WOMAC-F -5.47; (-9.41, -1.53)) and pain self-efficacy (5.87; 2.30, 9.45) over 6 months. More participants reported being completely recovered/much better at 2 months with BCT plus USGI triamcinolone/lidocaine than with BCT alone (45.4% v 6.9%; relative risk=6.7; 2.5, 17.9). There was no statistically significant difference in hip pain intensity over 6 months between BCT plus USGI triamcinolone/lidocaine compared with BCT plus USGI lidocaine only (-0.52; -1.21, 0.18). However, a statistically significant difference was seen in favour of the group receiving USGI triamcinolone/lidocaine in comparison to USGI lidocaine alone for a range of secondary outcome measures, over 6 months (e.g. pain self-efficacy, function, and work presenteeism). There was one possible treatment-related serious adverse event: a participant with no signs of infection at randomisation died from endocarditis four months after USGI triamcinolone/lidocaine. BCT plus USGI triamcinolone/lidocaine was less costly (mean cost difference per participant £-161.59) and associated with significantly higher quality-adjusted life-years (QALYs) than BCT only over 6 months (mean difference 0.0477 (0.0257, 0.0699). Increased number of visits to NHS consultants and hip-related surgery in the BCT only group accounted for the majority of cost difference. Conclusions: USGI triamcinolone/lidocaine combined with BCT leads to greater improvements in pain and function over 6 months in adults with hip OA than BCT alone, and was highly cost-effective. There was no significant difference in hip pain intensity over 6 months between the groups receiving USGI triamcinolone/lidocaine and USGI/lidocaine only raising the possibility of a degree of placebo effect.

Is implicit motor imagery altered in people with shoulder pain? The shoulder left/right judgement task

BackgroundImplicit motor imagery performance is altered in a variety of chronic pain conditions, but it is not known whether this is the case in shoulder pain. ObjectivesThe aim of this study was to assess implicit motor imagery performance, using a valid and reliable shoulder left/right judgement task in people with shoulder pain. DesignCross-sectional observational study. MethodsParticipants with (n = 369) and without (n = 747) shoulder pain completed the shoulder left/right judgement task (LRJT). Response times (RT), accuracy were determined. Age, gender, hand dominance, current pain intensity, Shoulder Pain and Disability Index (SPADI) and pain duration recorded. Planned analysis included ANOVAs for current pain, RT and accuracy. ResultsGender and hand dominance distribution were similar between groups (p > 0.5). The shoulder pain participants were older, mean age (SD); 47(14)years, than the control group; 41(14)years, p < 0.01. Participants with shoulder pain were slower, mean RT(SD); 1809(746)ms than the controls; 1701(749)ms; p = 0.02, but no different in accuracy, mean % (SD); 93.2(8.5)% to controls; 94.1(9.4)%; p = 0.13. The differences in RT were resolved when age was entered as a covariate (p = 0.83). Regression of the data from the shoulder pain group only found that current pain was positively related to RT (B = 43.97) and negatively to accuracy (B = -0.70). ConclusionsParticipants with shoulder pain do not demonstrate poorer implicit motor imagery performance than people who are pain-free. However, more intense shoulder pain is associated with poorer implicit motor imagery performance. We recommend further research utilising the LRJT in well-defined clinically homogenous groups, with verified pain severity, functional disability, and chronicity.

Rheumatological care in rural areas : The Rheuma-Bus project 2018.

To explore the medical care of individuals in rural areas during apublic health awareness project on musculoskeletal disorders (MSD). Atour bus was adapted to accommodate rheumatological consultations at widely accessible sites in 16towns, providing individual medical advice with respect to MSD. The participating rheumatologists assessed the nature (e.g. inflammatory/non inflammatory), extent and duration of MSD and, where possible, made atentative diagnosis and gave further advice on the course of action. In addition, age, sex and pre-existing care were recorded. All individuals were asked to assess their own severity of pain using anumeric ordinal scale from "no" (0) to "extreme" (10). A total of 647 individuals visited the service. Median current pain intensity was 5 (interquartile range [IQR]3-6), mean 4.9 (standard deviation [SD] 2.3). Osteoarthritis was suspected in 381 clients (59.6%), inflammatory rheumatic disease in 247 (38.7%), and in 104 (16.3%) other diseases. 307 (50%) were treated by aGP, 95 (15.5%) were under orthopaedic care, 204 (33.2%) under rheumatological care and 81 (13.1%) under supervision of other specialists. 104 clients (17%) had never consulted aphysician for their MSD symptoms before. 27 (4.2%) of all the clients had anewly detected inflammatory rheumatic disease and 62 (9.6%) patients with suspected inflammatory rheumatic disease were not under previous rheumatological care. The findings showed that there is still alot of negligence in awareness and knowledge of rheumatic diseases, at least in rural areas.

Neck-Related Headache in Patients With Cervical Disc Disease After Surgery and Physiotherapy: A 1-Year Follow-up of a Prospective Randomized Study.

A prospective randomized multicenter trial. To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain. The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging-verified disc disease is unknown. One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups. Post-hoc tests showed a significant difference between baseline and 6 weeks (P ≤ 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, β = 0.40). There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity. 2.

Pain reduction by inducing sensory-motor adaptation in Complex Regional Pain Syndrome (CRPS PRISMA): protocol for a double-blind randomized controlled trial

BackgroundComplex Regional Pain Syndrome (CRPS) presents as chronic, continuous pain and sensory, autonomic, and motor abnormalities affecting one or more extremities. People with CRPS can also show changes in their perception of and attention to the affected body part and sensory information in the affected side of space. Prism Adaptation (PA) is a behavioural intervention targeted at reducing attention deficits in post-stroke hemispatial neglect. PA also appears to reduce pain and other CRPS symptoms; however, these therapeutic effects have been demonstrated only in small unblinded studies. This paper describes the protocol for an ongoing double-blind, randomized, sham-controlled clinical trial that will evaluate the efficacy of PA treatment for CRPS. The secondary aims of the study are to examine the relationships between neuropsychological changes (such as spatial attention, space and body representation, and motor spatial performance) and clinical manifestations of CRPS, as well as symptom improvement.MethodsForty-two participants with upper-limb CRPS type I will undergo 2 weeks of twice-daily PA treatment or sham treatment. The primary outcome measures are current pain intensity and CRPS severity score, measured immediately before and after the treatment period. Secondary outcome measures include the results of self-report questionnaires about pain, movement, symptoms interference, and body representation; clinical assessments of sensory, motor, and autonomic functions; and computer-based psychophysical tests of neuropsychological functions. Data are collected in four research visits: 4 weeks and 1 day before treatment, and 1 day and 4 weeks after the end of treatment. Additional follow-up through postal questionnaires is conducted 3 and 6 months post-treatment.DiscussionIt is hypothesised that participants undergoing PA treatment, compared to those receiving sham treatment, will show greater reduction in pain and CRPS severity score, and improvements on other clinical and neuropsychological measures. Also, more pronounced neuropsychological symptoms are predicted to correlate with more severe clinical CRPS symptoms. This study will provide the first randomized double-blind evaluation of the therapeutic effects of PA that could be implemented as a rehabilitation method for CRPS, and will contribute to the understanding of how neuropsychological changes in body representation and attention pertain to the manifestation and treatment of CRPS.Trial registration(27/03/2017): ISRCTN46828292 (ISRCTN - ISRCTN46828292: Treatment of complex regional pain syndrome (CRPS) with sensory-motor adaptation).

Imagined Examples of Painful Experiences Provided by Chronic Low Back Pain Patients and Attributed a Pain Numerical Rating Score.

ObjectiveThe pain numerical rating scale (NRS) is widely used in pain research and clinical settings to represent pain intensity. For an individual with chronic pain, NRS reporting requires representation of a complex subjective state as a numeral. To evaluate the process of NRS reporting, this study examined the relationship between reported pain NRS levels and imagined painful events reported by study subjects.DesignA total of 149 subjects with chronic low back pain characterized by the NIH Research Task Force Recommended Minimal Dataset reported current pain NRS and provided imagined examples of painful experiences also attributing to these an NRS. We present a quantitative and qualitative analysis of the 797 pain examples provided by the study subjects.ResultsStudy subjects tended to be able to imagine both highly painful 10/10 events and non-painful events with relative agreement across subjects. While NRS for the pain examples tended to increase with example severity, for many types of examples there was wide dispersion around the mean pain level. Examination of pain examples indicated unexpected relationships between current pain and the intensity and nature of the imagined painful events.ConclusionsOur results indicate that the pain NRS does not provide a reliably interpretable assessment of current physical pain intensity for an individual with chronic pain at a specific moment.

Pain Severity and Alcohol Use Among Daily Tobacco Cigarette Smokers.

Pain is associated with hazardous alcohol use. Drinkers have reported using alcohol for pain-coping, and negative affect may be a key mechanism in pain-induced motivation to drink. However, no previous study has examined pain severity in relation to alcohol consumption, dependence, and alcohol-related consequences. Moreover, no studies have examined pain-alcohol interrelations among tobacco cigarette smokers. These secondary analyses tested the hypotheses that greater past 4-week pain severity would be positively associated with indices of hazardous drinking (ie, quantity/frequency, harmful use, and dependence), and that the current pain intensity would be positively/indirectly associated with the urge to drink via negative affect. Participants included 225 daily smokers (43% female; MCPD = 22) who completed the baseline session for a larger experimental study. Every one-point increase in pain severity was associated with a 47% increased likelihood of hazardous drinking, and pain severity was positively associated with quantity/frequency of alcohol consumption, harmful patterns of drinking, and alcohol dependence level (Ps < .05). Pain intensity was indirectly associated with urge to drink via negative affect (P < .05). These findings provide initial evidence that smokers with greater pain severity may also report hazardous patterns of alcohol use. This is the first study to demonstrate that past 4-week pain severity may be one factor that maintains three conceptually distinct patterns of hazardous drinking among smokers. The current results also provide the first evidence that greater pain intensity may be associated with an increased urge to drink alcohol, via negative affect. (Am J Addict 2020;29:134-140).

Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation

Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) -0.18, 95% confidence interval -0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0-10 scale) -2.01, 95% CI -1.40 to -2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. This study is registered as PROSPERO CRD42017068512. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 7. See the NIHR Journals Library website for further project information.

Effectiveness of a multidisciplinary BIOPSYCHOSOCIAL intervention for non-specific SUBACUTE low back pain in a working population: a cluster randomized clinical trial

BackgroundLow back pain (LBP) is a multifactorial condition with individual and societal impact that affects populations globally. Current guidelines for the treatment of LBP recommend pharmacological and non-pharmacological strategies. The aim of this study was to compare usual clinical practice with the effectiveness of a biopsychosocial multidisciplinary intervention in reducing disability, severity of pain and improving quality of life in a working population of patients with subacute (2–12 weeks), non-specific LBP.MethodsLongitudinal cluster randomized clinical trial conducted in 39 Primary Health Care Centres (PHCC) of Barcelona, with patients aged 18–65 years (n = 501; control group = 239; 26 PHCC, intervention group = 262; 13 PHCC). The control group received usual clinical care. The intervention group received usual clinical care plus a biopsychosocial multidisciplinary intervention, which consisted of physiotherapy, cognitive-behavioural therapy and medication. The main outcomes were changes in the Roland Morris Disability Questionnaire (RMDQ), and the minimal clinically important differences. Secondary outcomes were changes in the McGill Pain (MGPQ) and Quality of Life (SF-12) questionnaires. Assessment was conducted at baseline, 3 and 12 months. Analysis was by intention-to-treat and analyst-blinded. Multiple imputations were used.ResultsOf the 501 enrolled patients, 421 (84%) provided data at 3 months, and 387 (77.2%) at 12 months. Mean age was 46.8 years (SD: 11.5) and 64.7% were women. In the adjusted analysis of the RMDQ outcome, only the intervention group showed significant changes at 3 months (− 1.33 points, p = 0.005) and at 12 months (− 1.11 points, p = 0.027), but minimal clinically important difference were detected in both groups. In the adjusted analysis of the RMDQ outcome, the intervention group improvement more than the control group at 3 months (− 1.33 points, p = 0.005) and at 12 months (− 1.11 points, p = 0.027). The intervention group presented a significant difference. Both groups presented a minimal clinically important difference, but more difference in the intervention group. The intervention group presented significant differences in the MGPQ scales of current pain intensity and VAS scores at 3 months. No statistically significant differences were found in the physical and mental domains of the SF-12.ConclusionsA multidisciplinary biopsychosocial intervention in a working population with non-specific subacute LBP has a small positive impact on disability, and on the level of pain, mainly at short-term, but no difference on quality of life.Trial registrationISRCTN21392091 (17 oct 2018) (Prospectively registred).

Self-administered acupressure for knee osteoarthritis in middle-aged and older adults: a pilot randomized controlled trial

To test the acceptability and feasibility of self-administered acupressure as an intervention for knee pain among middle-aged and older adults with knee osteoarthritis (KOA). In this pilot randomized controlled trial, 35 participants with KOA were randomized to receive self-administered acupressure (n = 17, two self-administered acupressure training sessions followed by self-practice for 6 weeks) or knee health education (n = 18, two health education sessions about KOA management followed by self-care for 6 weeks). Current pain intensity (primary outcome) was measured using a Numeric Rating Scale (NRS) at baseline and weeks 1, 2, 4 and 6 (post-intervention). Secondary outcome measures included worst and least pain intensity, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM) of the knee joints and Short-Form Six-Dimension (SF-6D) scores for health-related quality of life. Participants in both groups attended all training sessions. In the self-administered acupressure group, all subjects mastered the acupressure technique and passed a consistency check. Both groups showed a decreasing trend in current knee pain intensity measured using NRS post-intervention. A medium between-group effect size (0.40) was found, but between-group differences were not statistically significant. The other secondary outcome measures were also comparable between both groups post-intervention (all p > 0.05). A two-session self-administered acupressure training was acceptable to and feasible in participants with KOA. The data generated allowed for calculation of a sample size for a definitive randomized controlled trial (RCT) to confirm whether self-acupressure is effective for pain management in KOA. Furthermore trials with adequate power and longer follow-up periods are warranted.

AFFECTIONATE PHYSICAL TOUCH MITIGATES PAIN AND EMOTIONAL DISTRESS IN OLDER ADULTS

Although research suggests that social interactions can decrease pain and emotional distress, it is unclear what produces these salubrious effects. We examined whether older adults experienced lower pain and emotional distress after two types of social interactions (affectionate physical contact and non-physical pleasant interactions) using data from the Einstein Aging Study (N=193, age=70-92). Participants completed a 14-day ecological momentary assessment protocol via which they reported the quality of recent social interaction, types of physical touch, levels of current stress, negative affect, and pain intensity five times a day. Multilevel models indicated that, following affectionate physical contact, individuals reported low levels of current pain intensity, negative affect, and stress (ps<.05). Following a pleasant non-physical interaction, individuals reported low negative affect (p<.05); pleasant interactions did not predict current pain or stress. Results highlight the potential unique utility of affectionate physical contact versus mere pleasant social interactions in older adults’ daily lives.

Effects of occlusal splint therapy in patients with migraine or tension-type headache and comorbid temporomandibular disorder: A randomized controlled trial.

Background:Migraine and tension-type headache often occur comorbid with temporomandibular disorder; occlusal splint therapy is the most common treatment for temporomandibular disorder. The aim of this study was to assess the effects of occlusal splint therapy on headache symptoms in patients with migraine and/or tension-type headache comorbid with temporomandibular disorder.Methods:Sixty adult patients with migraine and/or tension-type headache and comorbid temporomandibular disorder were randomly assigned to individualized occlusal splint therapy applied during day- and nighttime plus usual care (n = 30) or usual care alone (n = 30). Primary outcome was the change in current pain intensity on a 100 mm visual analogue scale from week 1 to week 12. Secondary outcomes included changes in headache days and headache hours assessed by headache diaries over a 2-week period, health-related quality of life (SF-36), and adverse events from week 1 to week 12 and (in the occlusal splint plus usual care group only) to week 24.Results:No group differences in changes in pain intensity from week 1 to week 12 were found. The number needed to treat was 3.8. Physical quality of life reduced stronger in the usual care group than in the occlusal splint plus usual care group. In the occlusal splint plus usual care group, headache intensity significantly decreased and physical quality of life significantly increased from week 1 to week 12 and to week 24 (all P < .001). No adverse events were reported.Conclusions:A day- and night-time occlusal splint therapy in addition to usual care was not superior to usual care alone in patients with chronic headache and comorbid TMD. Four patients need to be treated to induce a minimal clinically relevant improvement in one patient. The small sample size and lack of power limit these findings.

Menthol cigarette use and pain reporting among African American adults seeking treatment for smoking cessation.

Nicotine has acute pain-relieving properties, and tobacco smokers often report using cigarettes to cope with pain. The proportion of smokers using menthol cigarettes has increased in recent years, and there is reason to suspect that menthol may enhance the analgesic effects of nicotine. Up to 90% of African American smokers report using menthol cigarettes, and African Americans tend to report more severe pain and greater difficulty quitting. Yet no known research has examined the relationship between menthol cigarette use and pain reporting. Thus, the goal of the current study was to test associations between menthol (vs. nonmenthol) cigarette use and pain among a sample of African American smokers. Current daily cigarette smokers (N = 115; 70% male; Mage = 47.05; MCPD = 15.2) were recruited to participate in a smoking cessation study. These data were collected at the baseline session. Daily menthol (vs. nonmenthol) cigarette use was associated with lower current pain intensity, lower average and worst pain over the past 3 months, and less pain-related physical impairment over the past 3 months. This study demonstrates that menthol (vs. nonmenthol) cigarette use is associated with less pain and pain-related functional interference among African American smokers seeking tobacco cessation treatment. Future research is needed to examine the potential acute analgesic effects of menthol versus nonmenthol cigarette use, examine temporal covariation between menthol cigarette use and pain reporting, and test whether pain-relevant processes contribute to the maintenance of menthol cigarette smoking among those with and without chronic pain. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Efficacy and Practicality of Opioid Therapy in Japanese Chronic Noncancer Pain Patients

BackgroundMany Japanese adults suffer from chronic pain. However, 50% of these individuals discontinue treatment despite the persistence of pain. Both clinicians and patients in Japan tend to be concerned about the safety and efficacy of opioid therapy, and the use of opioids in chronic non-cancer pain remains less common in Japan than elsewhere. AimsThis study examined the effects of opioid therapy on the daily lives of patients with chronic noncancer pain in Japan, where use of opioids for this type of pain remains uncommon. DesignProspective cross-sectional questionnaire study. SettingData were collected over two periods, between March and April 2014 at one hospital, and between February and April 2015 at the other hospital. Subjects were recruited at the respective clinics by the study interviewer between March 1, 2014 and April 15, 2014 and between February 1, 2015 and April 15, 2015. Participants/SubjectsThis study included 34 outpatients with chronic non-cancer pain who were being treated with opioid analgesics at pain clinics in two hospitals in Sapporo. MethodsThirty-four Japanese patients receiving opioid medications for chronic noncancer pain in outpatient pain clinics were enrolled. Participants underwent interviews and completed the Japanese versions of the Short Form 36 (SF-36v2) and the Coping Strategies Questionnaire (CSQ). ResultsSleep disruption, claiming compensation for work-related accidents, and current pain level were negatively correlated with opioid effectiveness (p < .05). Additionally, opioid effectiveness was negatively correlated with the catastrophizing subscale of the CSQ (r = −0.50, p < .01). The effects of opioid therapy had a low positive correlation with the emotional functioning role subscale of the SF-36v2 (r = 0.38, p < .05). Daily equivalent morphine dose was positively correlated with opioid therapy duration, interference with appetite, and current pain intensity. Morphine dose was also positively correlated with scores for the catastrophizing subscale of the CSQ (r = 0.36, p < .05) and negatively correlated with scores in all subdomains of the SF-36v2. ConclusionsIt is important to focus on adaptive, cognitive, and emotional factors, such as emotional role functioning, to determine the efficacy of opioid treatment for chronic noncancer pain. Moreover, patients with catastrophizing significantly increased their morphine doses, resulting in an increased risk of overdose.

Psychometric Evaluation of the MOBID Dementia Pain Scale in U.S. Nursing Homes

PurposeThe Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US. DesignCross-sectional study. SettingsSixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama. ParticipantsOne hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment. MethodsValidity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician’s pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach’s alpha. ResultsMOBID overall scores were significantly associated with expert clinician’s rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (α = 0.83). Conclusions and Clinical ImplicationsResult of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff.

Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

PurposeTreatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the long-term follow-up results of the same program. The hypothesis is that previously reported results are maintained.MethodsStructured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response).ResultsOutcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0–100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP.ConclusionSelected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

(299) The Effect of a ‘Stand Up and Move More’ Intervention on Pain in Older Adults

Older adults spend the majority of their day in sedentary activities (i.e., sitting, reclining). Currently, it is unknown whether interventions designed to reduce sedentary time have an impact on pain in older adults. Fifty-six adults (mean age = 74 yrs, SD = 7) from 3 counties in Wisconsin were randomly assigned to a sedentary behavior intervention (i.e., “Stand Up and Move More”) or a waitlist control group. The intervention, grounded in self-regulation theory, was aimed at breaking up prolonged bouts of sitting, and consisted of four weekly group sessions and one refresher session. Participants completed assessments at baseline, post-intervention (4-weeks), and at follow-up (12-weeks). Pain outcomes included the PROMIS (pain interference and current pain intensity) and the SF-36 (bodily pain) questionnaires, and sedentary time was assessed objectively (mins/day). Results from repeated measures ANOVA revealed significant reductions in pain interference and current pain intensity scores from baseline to 4-weeks in the intervention group (p

Factors Associated With Acute Pain Estimation, Postoperative Pain Resolution, Opioid Cessation, and Recovery

Acute postoperative pain is associated with the development of persistent postsurgical pain, but it is unclear which aspect is most estimable. To identify patient clusters based on acute pain trajectories, preoperative psychosocial characteristics associated with the high-risk cluster, and the best acute pain predictor of remote outcomes. A secondary analysis of the Stanford Accelerated Recovery Trial randomized, double-blind clinical trial was conducted at a single-center, tertiary, referral teaching hospital. A total of 422 participants scheduled for thoracotomy, video-assisted thoracoscopic surgery, total hip replacement, total knee replacement, mastectomy, breast lumpectomy, hand surgery, carpal tunnel surgery, knee arthroscopy, shoulder arthroplasty, or shoulder arthroscopy were enrolled between May 25, 2010, and July 25, 2014. Data analysis was performed from January 1 to August 1, 2018. Patients were randomized to receive gabapentin (1200 mg, preoperatively, and 600 mg, 3 times a day postoperatively) or active placebo (lorazepam, 0.5 mg preoperatively, inactive placebo postoperatively) for 72 hours. A modified Brief Pain Inventory prospectively captured 3 surgical site pain outcomes: average pain and worst pain intensity over the past 24 hours, and current pain intensity. Within each category, acute pain trajectories (first 10 postoperative pain scores) were compared using a k-means clustering algorithm. Fifteen descriptors of acute pain were compared as predictors of remote postoperative pain resolution, opioid cessation, and full recovery. Of the 422 patients enrolled, 371 patients (≤10% missing pain scores) were included in the analysis. Of these, 146 (39.4%) were men; mean (SD) age was 56.67 (11.70) years. Two clusters were identified within each trajectory category. The high pain cluster of the average pain trajectory significantly predicted prolonged pain (hazard ratio [HR], 0.63; 95% CI, 0.50-0.80; P < .001) and delayed opioid cessation (HR, 0.52; 95% CI, 0.41-0.67; P < .001) but was not a predictor of time to recovery in Cox proportional hazards regression (HR, 0.89; 95% CI, 0.69-1.14; P = .89). Preoperative risk factors for categorization to the high average pain cluster included female sex (adjusted relative risk [ARR], 1.36; 95% CI, 1.08-1.70; P = .008), elevated preoperative pain (ARR, 1.11; 95% CI, 1.07-1.15; P < .001), a history of alcohol or drug abuse treatment (ARR, 1.90; 95% CI, 1.42-2.53; P < .001), and receiving active placebo (ARR, 1.27; 95% CI, 1.03-1.56; P = .03). Worst pain reported on postoperative day 10 was the best predictor of time to pain resolution (HR, 0.83; 95% CI, 0.78-0.87; P < .001), opioid cessation (HR, 0.84; 95% CI, 0.80-0.89; P < .001), and complete surgical recovery (HR, 0.91; 95% CI, 0.86-0.96; P < .001). This study has shown a possible uniform predictor of remote postoperative pain, opioid use, and recovery that can be easily assessed. Future work is needed to replicate these findings. ClinicalTrials.gov Identifier: NCT01067144.

Pain intensity and tobacco smoking among Latinx Spanish-speaking adult smokers

Some research suggests that pain intensity is greater among Latinx persons compared to non-Hispanic-Whites, and that the experience of more intense pain among this group is related to poorer mental health and impairment. Yet, the degree to which pain-smoking relations generalize to Latinx smokers is unknown. The present study tested whether past-month pain intensity among adult Latinx smokers was related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.81). Consistent with prediction, current pain intensity was significantly related to greater cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. These novel data provide preliminary evidence that individual differences in the intensity of experienced pain in the past month is related to a range of clinically-significant smoking variables among a large sample of Latinx smokers. The findings suggest that pain intensity may be important to Latinx smokers, a group that often showcases pain-related disparities compared to other racial/ethnic groups.

A Cross-Sectional Study of the Impact of Pain in Older People with Frailty: Findings from the Community Ageing Research 75+ (CARE75+) Study

Background: Pain prevalence is higher in older people with frailty compared to fit older people. However, little is known about pain impact on the lives of older people with frailty. Objectives: To investigate pain impact in community dwelling older people (≥75 years) using data from the Community Ageing Research 75+ (CARE75+) cohort study (UKCRN 18043). Methods: Participants were assessed as not frail, pre-frail or frail (phenotype model of frailty). Pain impact was measured using the Geriatric Pain Measure Short-Form (GPM-12), an instrument incorporating 10 items on how pain impacts on ambulation, social engagement, ability to accomplish tasks and sleep, along with current pain intensity and average pain intensity (last 7 days). Intrusive pain was calculated from an item in the Short-Form 36 questionnaire. Differences in the GPM-12 scores between frailty categories were compared using Kruskal-Wallis H tests. Logistic regression models were used to investigate the association between frailty and intrusive pain. Results: 887 participants: not frail 139; pre-frail 471; and frail 268. Total GPM-12 median (IQR): not-frail 5.0 (0.0, 12.5); pre-frail 10.0 (0.0, 27.5); and frail 40.0 (10.0, 65.0) (p ≤ 0.0001). Current pain: not frail 0.0 (0.0, 1.0); pre-frail 0 (0.0, 3.0); and frail 3.0 (0.0, 5.0) (p ≤ 0.0001). Average pain: not-frail 0.0 (0.0, 2.0); pre-frail 1 (0.0, 4.0); frail 4.0 (2.0, 6.8) (p ≤ 0.0001). There was a strong association between being frail and intrusive pain (adjusted for sex, ethniciaty, mood and high comorbid burden): OR 3.53 (95% CI 2.47, 5.04). Conclusions: This research has identified an important new finding that pain in older people with frailty appears to be of sufficient severity to impact negatively on multiple aspects of day-to-day life