Pain Experience Research Articles

The impact of breaking up sitting during simulated nightshifts on musculoskeletal pain: A randomised controlled trial

ObjectivesProlonged sitting is associated with an increased risk of musculoskeletal pain, especially in nightshift workers. However, research investigating effects of breaking up sitting on musculoskeletal pain during nightshifts is lacking. This study evaluated effects of prolonged sitting or breaking up sitting with short bouts of light-intensity physical activity on pain in healthy adults during simulated nightshifts. MethodsAn in-laboratory randomised controlled trial was undertaken with 52 healthy adults completing five simulated nightshifts. Participants were randomised to prolonged sitting (Sit9; n = 26) or breaking up prolonged sitting (Break9; n = 26). Break9 group completed 3-min walking every 30 min during nightshifts, while Sit9 group remained seated. Musculoskeletal pain intensity and sensory/affective pain experiences were assessed. Linear mixed models examined pain within nights (pre-to post-shift) and across nights (pre-shift-night-1 to pre-shift-night-5). ResultsMusculoskeletal pain intensity increased within nights for both Sit9 (mean change [95%CI] points: 0.14 [0.05, 0.24]) and Break9 (0.09 [0.001, 0.19], but not across nights (Sit9: −0.13 [-0.33, 0.08]; Break9: 0.07 [-0.14, 0.29]). Sensory-pain experience improved across nights for Sit9 (−3.08 [-4.72, −1.45]), but not within nights (0.77 [-0.004, 1.55]). There was no change in affective-pain experience in either group. Between-group difference was observed favouring Sit9 for improving sensory-pain across nights (β: 3.71 [1.42, 5.99]). No other between-group difference was observed. ConclusionBoth prolonged sitting and breaking up sitting were associated with a within-night increase in musculoskeletal pain intensity. Compared to prolonged sitting, breaking up sitting did not induce benefits on pain in healthy adults working simulated nightshifts. Trial registrationACTRN12619001516178.

Inequality in the Origins and Experiences of Pain: What “Big (Qualitative) Data” Reveal About Social Suffering in the United States

Inequality in the Origins and Experiences of Pain: What “Big (Qualitative) Data” Reveal About Social Suffering in the United States

GABA Analogue HSK16149 in Chinese Patients With Diabetic Peripheral Neuropathic Pain

Many patients with diabetic peripheral neuropathic pain (DPNP) experience inadequate relief, despite best available medical treatments. There are no approved and effective therapies for patients with DPNP in China. To evaluate the efficacy and safety of capsules containing γ-aminobutyric acid (GABA) analogue HSK16149 in the treatment of Chinese patients with DPNP. This phase 2 to 3 adaptive randomized clinical trial was multicenter, double blind, and placebo and pregabalin controlled. The trial started on December 10, 2020, and concluded on July 8, 2022. In stage 1, various doses of HSK16149 were evaluated to determine safety and efficacy for stage 2. The second stage then validated the efficacy and safety of the recommended dose. In stage 1, enrolled patients (n = 363) were randomized 1:1:1:1:1:1 to 4 HSK16149 doses (40, 80, 120, or 160 mg/d), pregabalin (300 mg/d), or placebo. In stage 2, patients (n = 362) were randomized 1:1:1 to receive HSK16149, 40 or 80 mg/d, or placebo. The final efficacy and safety analysis pooled data from patients receiving the same treatment. The primary efficacy end point in stage 1 was the change from baseline in average daily pain score (ADPS) at week 5. The primary efficacy end point in stage 2 was the change from baseline in ADPS at week 13. When the final statistical analysis was performed, the P values calculated from the independent data of each phase were combined using the weighted inverse normal method to make statistical inferences. Of 725 randomized patients in the full-analysis set (393 men [54.2%]; mean [SD] age, 58.80 [9.53] years; 700 [96.6%] of Han Chinese ethnicity), 177 received placebo; 178, HSK16149, 40 mg/d; 179, HSK16149, 80 mg/d; 66, HSK16149, 120 mg/d; 63, HSK16149, 160 mg/d; and 62, pregabalin, 300 mg/d. A total of 644 patients (88.8%) completed the study. The 40- and 80-mg/d doses of HSK16149 were recommended in stage 2. At week 13, the ADPS mean (SD) change from baseline was -2.24 (1.55) for the 40-mg/d and -2.16 (1.79) for 80-mg/d groups and -1.23 (1.68) for the placebo group, showing statistical significance for both HSK16149 doses vs placebo (both P < .001). In a safety set (n = 726), 545 patients (75.1%) had adverse events, which were generally mild to moderate, with dizziness and somnolence being the most common. Forty- and eighty-mg/d doses of HSK16149 were recommended for treating patients with DPNP in China. The efficacy of HSK16149 capsules was superior to placebo in all groups for relieving DPNP and appeared well tolerated. ClinicalTrials.gov Identifier: NCT04647773.

Pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries under topical anesthesia.

Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery. Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery. However, patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery. The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts. Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system. Immunological, neuropsychological, and pharmacological factors work together in the enhancement of intraoperative pain. Accumulating published literatures have focused on the pain enhancement during the second-eye phacoemulsification surgeries. In this review, we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb. 1, 2024. We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive second-eye phacoemulsification cataract surgeries. This review aimed to provide novel insights into strategies for improving patients' intraoperative experience in second-eye cataract surgeries.

'The Lost Peace': Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia.

Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer's minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.

Patients’ preferences, experiences and expectations with wait time until surgery in gynaecological oncology: a mixed-methods study in two gynaecological oncological centres in the Netherlands

ObjectivesPatient-centredness of care during wait time before surgery can be improved. In this study we aimed to assess (1) patients’ experiences with and preferences regarding wait time before surgery; (2)...

Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial

BackgroundTask-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether...

Symptom experience and symptom distress in patients with malignant brain tumor treated with proton therapy: A five-year follow-up study

Background and purposeSince patients with primary brain tumor are expected to become long-term survivors, the prevention of long-term treatment-induced side effects is particularly important. This study aimed to explore whether symptom experience and symptom distress change over five years in adults with primary brain tumors treated with proton therapy. An additional aim was to explore whether symptom experience and symptom distress correlate. Materials and methodsThe study had a longitudinal observational design. Adult (≥18 years) patients (n = 170) with primary brain tumors treated with proton therapy were followed over five years. Symptom experience and symptom distress were evaluated using the patient-reported Radiotherapy-Related Symptom Assessment Scale. Data from baseline, 1, 12, and 60 months were analyzed using non-parametric tests. ResultsOf the 170 patients, the levels of symptoms and symptom distress were low. Fatigue increased at 1 (p=0.005) and 12 months (p=0.025) and was the most frequent symptom from baseline to 60 months’ follow-up. Cognitive impairment increased at 12 (p=0.027) and 60 months (p<0.001) and was the most distressing symptom at 60 months’ follow-up. There were significant, moderate to strong, correlations at all time points between symptom experience and symptom distress of fatigue, insomnia, pain, dyspnea, cognitive impairment, worry, anxiety, nausea, sadness, constipation, and skin reactions. ConclusionSymptom experience and symptom distress changed in intensity over time with cognitive impairment as the most distressing symptom at 60 months. Future research should focus on identifying effective interventions aimed at alleviating these symptoms and reducing symptom distress for this vulnerable group of patients.

Surgical management strategies for unstable sacral fractures: Case series and surgical guideline

IntroductionUnstable sacral fractures usually have posterior pelvic and spinopelvic instability, which usually be classified as AO type C. There are many controversial points concerning the management of these fractures due to their rarity. Herein, we retrospectively review cases of this injury and propose a surgical guideline. Case presentationA 37-year-old female experienced back pain after a motor vehicle accident. Diagnostic imaging revealed an AO type C1 sacral fracture, Isler subtype 2a (case No. 7). Preoperative CT scan and CT reconstruction images showed a longitudinal fracture with a simple intraarticular fracture of the left S1 superior facet. Although the patient sustains a lumbosacral facet joint injury, the lumbosacral motion seems preservable after healing. The triangular osteosynthesis was chosen because it provides both transverse plane and vertical plane stability. The patient was allowed to continue weight-bearing ambulation after the operation. To maintain lumbosacral motion, the spinopelvic rod was removed in the postoperative seventh month. DiscussionThe unstable sacral fracture might have instability in both the vertical and transverse planes. The fixation construct should provide both vertical and transverse stability. Regarding vertical fixation, it might cost a loss of lumbosacral motion, which the treating surgeon has to consider. The lumbosacral injury is sometimes trivial, and long-term lumbosacral motion is expectable. So, permanent spinopelvic fixation is not necessary. The patient's character is also an important factor. Whether the patient needs or does not need early progressive weight bearing after the operation determines the fixation method. ConclusionUnstable sacral fractures are rare conditions usually resulting from a high-energy injury. We have proposed a surgical management strategy for this group of fractures with an optimal fixation method based on three factors: 1) fracture morphology, 2) lumbosacral integrity, and 3) concomitant injury.

What is the Status Quo of Patient-Centred Physiotherapy Management of People with Headache within a Biopsychosocial Model? - A Narrative Review.

Patient-centred care (PCC) is deemed essential in the rehabilitation of musculoskeletal pain. Integrating such care within a biopsychosocial framework, enables to address all facets of the individual pain experience, and to manage the individual instead of the condition. This narrative review describes the status quo of PCC physiotherapy management of people with headache within a biopsychosocial model. PubMed, EMBASE, Web of Science, Scopus were searched (update 07.05.2024). The search-query comprised terminology relating to "headache", "patient-centred", "biopsychosocial", "physiotherapy". Additional eligibility criteria were reviews, trials, cohort, case report, case-control studies in English, Dutch, French. Gaps are exposed in patient-centred physiotherapy management of migraine, tension-type headache, and cervicogenic headache. While a biopsychosocial approach is advised to manage migraine and tension-type headache, its use in clinical practice is not reflected by the literature. A biopsychosocial approach is not advised in cervicogenic headache. Psychosocial-lifestyle interventions are mainly delivered by health-care providers other than physiotherapists. Additionally, psychologically-informed practice is barely introduced in physiotherapy headache management. Though, managing the social context within a biopsychosocial framework is advised, the implementation by physiotherapists is unclear. Comparable conclusions apply to PCC. PCC is recommended for the physiotherapy management of primary and secondary headache. Such recommendation remains however theoretical, not reaching clinical implementation. Yet, a shift from the traditional disease-centred model of care towards PCC is ongoing and should be continued in physiotherapy management. With this implementation, clinical and economical studies are needed to evaluate its effectiveness.

The online PhD dropout: narratives and meanings of withdrawal

Online doctoral dropout is a persistent yet largely overlooked issue by institutions and researchers. This qualitative study investigated thecandidates’ circumstances leading to withdrawal, its emotional repercussions, and subsequent academic trajectories. We conducted in-depth interviews with ten former part-time online PhD students and employed thematic analysis to identify dominant narratives of withdrawal. Findings showed three narratives: reluctance, grief, and relief. Reluctant dropouts perceived themselves as “being dropped out" and were more inclined to complete their doctorates in the future due to sustained motivation. Grieving dropouts experienced frustration and guilt, still processing a painful experience. Relieved dropouts viewed leaving the PhD as the right decision considering their circumstances and were ready to move forward in their lives. We argue that online doctoral dropout is polysemic and should not be automatically equated to the final chapter of the doctoral trajectory. Recommendations for institutions include implementing exit interviews, follow-up procedures, and re-engagement paths.

Is there an association between pelvic pain and gender-affirming testosterone therapy in trans masculine adolescents? An exploratory cross-sectional study

Background High rates of pelvic pain have been reported in trans individuals on testosterone, but the pathophysiology of pain and the potential role of testosterone are unclear. Aims The aim of this exploratory study was to determine whether the proportion of pelvic pain in trans adolescents is different among those on testosterone therapy compared to those who are not. Secondary objectives were to determine the characteristics, potential contributing factors, impact, and treatment of pelvic pain in trans adolescents. Methods An online cross-sectional study about pelvic pain was conducted among trans individuals assigned female at birth, aged 12 and over, and who had sought care at our institution since 2017. Results Among 102 participants, 79 (77.5%) reported having experienced pelvic pain over the last 6 months. The proportion of individuals who reported pelvic pain was lower in individuals on testosterone (n = 43/62, 69.4%) compared to those not on testosterone (n = 36/40, 90%), with a difference in proportion of −20.6% (95% CI −35.4 to −5.9%, p = 0.006). Half of participants reported school or work absenteeism and two thirds missed extracurricular activities because of pelvic pain. A wide range of treatment options were used, with variable rates of reported effectiveness. Conclusion Pelvic pain is frequently reported by trans adolescents. This exploratory study found a lower proportion of pelvic pain in trans adolescents using testosterone therapy compared to those who were not. Nevertheless, this study was limited by a small number of participants, its cross-sectional nature, and the risk of recruitment bias, thus limiting its generalizability. Longitudinal studies are required to better understand the development and evolution of pelvic pain in trans adolescents.

Suicide risk in the context of relationship breakup among young adults: emotional pain and mental health indicators

ABSTRACT Objective This study examined the relationship between the experience of emotional pain and psychological distress, suicidal behaviours, and mental wellbeing following romantic relationships and interrelationship breakups among young adults from Ghana. Method This study adopted a quantitative approach. Three hundred and thirty-three (330) university students, comprising of 86 males and 239 females, with ages ranging from 18 to 24 were conveniently sampled. The sample responded to items on the Psychache Scale, Kessler Psychological Distress Scale – K10, Suicide Behaviors Questionnaire – Revised and Warwick–Edinburgh Mental Well-being Scale. Results Analysis revealed that there were no gender and age differences in the experience of psychological distress following relationship breakup; however, differences existed in relation to the type of relationship breakup. Further, majority of the respondents experienced various suicidal behaviours following relationship breakup. Also, some of the respondents were at risk of suicide death. There was a significant positive relationship between the experience of unbearable emotional pain and suicidal behaviours and suicide risk. There was a strong positive association between unbearable emotional pain and psychological distress. Both unbearable emotional pain and psychological distress were significantly and negatively related to one’s mental wellbeing. Discussion In the midst of other socio-demographic variable and psychological distress, unbearable emotional pain only was the strongest significant predictor of suicide risk. This study highlights the importance of providing students with periodic education/information on relationships and emotional pain in formal educational setting to ensure students are well equipped to handle these experiences so it does not impact their psychosocial and academic life.

Agreement between child self-report and parent-proxy report for functioning in pediatric chronic pain

PurposeAccurate assessment of chronic pain and functional disability in children and adolescents is imperative for guiding pain management interventions. Parents have multifaceted roles in their child’s pain experience and frequently provide parent-proxy reports of pain-related functioning. However, cross-informant variance is often observed with limited understanding of contributing factors. This study aims to examine the degree of alignment between child and parent-proxy reports for Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference domain among children with chronic pain and to identify factors associated with improved child-parent agreement.MethodsThis study includes a sample of 127 youth (66.1% female) with mixed etiology chronic pain, ranging in age from 8 to 17 (M = 12.24; SD = 1.598), and their parent. Data was collected at an interdisciplinary pediatric pain clinic and online peer support groups. Measures of demographic, pain intensity, and functioning were collected.ResultsMeans of parent-proxy reports were significantly lower than child self-reports on the PROMIS (p < 0.05). A statistically significant association between child’s pain intensity (β = 0.953, P < 0.05) and the difference between child self-reported and parent-proxy reported PROMIS functional interference scores was found.ConclusionParents underestimated pain-related functional disability relative to children’s self-reports. The difference between the paired child self-report and parent-proxy report of functional disability was significantly associated with greater child self-reported pain intensity. Although parent-proxy reports in pediatric chronic pain is often used in research and practice, findings underscore the importance of incorporating child and adolescent self-report, when possible, to comprehensively capture the child’s pain experience and best inform clinical interventions.

A Mixed-Methods study of the impact of sex and situational pain catastrophizing on pain sensitivity.

It is well established that catastrophic thinking about pain modulates clinical pain severity, but it may also relate to interindividual differences in the pain experience during procedures. This mixed-methods study investigated the relationship between ratings of situational pain catastrophizing and reported pain sensitivity in the context of receiving a nerve block without sedation, and explored participants' experiences. Healthy volunteers (n = 42) completed baseline psychosocial questionnaires, underwent quantitative sensory testing, and received a lower extremity nerve block, followed by further psychosocial assessment and interviews. Associations of catastrophizing scores with pain sensitivity and procedural site pain were assessed using Spearman's correlations. Interviews were reviewed using an immersion/crystallization approach to identify emergent themes. Greater situational catastrophizing scores were associated with higher pain sensitivity, measured as lower pain threshold and tolerance. Although females exhibited greater pain sensitivity generally, moderation analysis revealed a significant association between situational catastrophizing scores and pain sensitivity only among male participants. Qualitative interviews revealed the importance of participants' emotional responses to pain, and a mismatch of expectation and experience with procedural pain. Males also reported more negative comments about procedural pain. Examination of the variable subjective experience while receiving a nerve block in this experimental lab-based study revealed an important relationship between situational pain catastrophizing scores and pain sensitivity, which was more prominent among male participants. These findings reinforce how insight into individual expectations, emotions, and thought processes may impact pain sensitivity during procedures, and may inform strategies to personalize care, improving patient satisfaction and procedural acceptance.

Early childhood risk factors for later onset of pediatric chronic pain: a multi-method longitudinal study

BackgroundPediatric chronic pain (i.e., pain lasting ≥ 3 months) is prevalent, disabling, and costly. It spikes in adolescence, interrupts psychosocial development and functioning, and often co-occurs with mental health problems. Chronic pain often begins spontaneously without prior injuries and/or other disorders. Prospective longitudinal cohort studies following children from early childhood, prior to chronic pain onset, are needed to examine contributing factors, such as early pain experiences and mental health. Using data from a longitudinal community pregnancy cohort (All Our Families; AOF), the present study examined the associations between early developmental risk factors, including early childhood pain experiences and mental health symptoms, and the onset of pediatric chronic pain at ages 8 and 11 years.MethodsAvailable longitudinal AOF data from child age 4 months, as well as 1, 2, 3, 5, 8, and 11 years, were used. Mothers reported their child’s pain experiences (e.g., hospitalizations, vaccinations, gut problems) at each timepoint from 4 months to 8 years, child chronic pain at age 8, and child mental health symptoms at ages 5 and 8 years. Children reported their chronic pain frequency and interference at age 11. Adaptive least absolute shrinkage and selection operator (LASSO) regressions were used to select predictor variables. Complete case analyses were complemented by multiple imputation using chained equation (MICE) models.ResultsGut problems, emergency room visits, frequent pain complaints, and headaches at age 5 or earlier, as well as female sex, were associated with increased risk of maternal reported child chronic pain at age 8. Maternal reported chronic pain at age 8 was associated with higher levels of child-reported pain frequency and pain interferences at age 11. Boys self-reported lower levels of pain interference at age 11.ConclusionsSome, but not all, painful experiences (e.g., gut problems, ER visits, pain complaints) in early life contribute to pediatric chronic pain onset and should be considered for screening and early intervention.

Am I Hurt?: Evaluating Psychological Pain Detection in Hindi Text Using Transformer-based Models

The automated evaluation of pain is critical for developing effective pain management approaches that seek to alleviate pain while preserving patients’ functioning. Transformer-based models can aid in detecting pain from Hindi text data gathered from social media by leveraging their ability to capture complex language patterns and contextual information. By understanding the nuances and context of Hindi text, transformer models can effectively identify linguistic cues and sentiments and expressions associated with pain, enabling the detection and analysis of pain-related content present in social media posts. The purpose of this research is to analyze the feasibility of utilizing NLP techniques to automatically identify pain within Hindi textual data, providing a valuable tool for pain assessment in Hindi-speaking populations. The research showcases the HindiPainNet model, a deep neural network that employs the IndicBERT model, classifying the dataset into two class labels {pain, no_pain} for detecting pain in Hindi textual data. The model is trained and tested using a novel dataset, दर्द-ए-शायरी (pronounced as Dard-e-Shayari ), curated using posts from social media platforms. The results demonstrate the model's effectiveness, achieving an accuracy of 70.5%. This pioneer research highlights the potential of utilizing textual data from diverse sources to identify and understand pain experiences based on psychosocial factors. This research could pave the path for the development of automated pain assessment tools that help medical professionals comprehend and treat pain in Hindi-speaking populations. Additionally, it opens avenues to conduct further NLP-based multilingual pain detection research, addressing the needs of diverse language communities.

Pengaruh Pemberian Ekstrak Jahe terhadap Penurunan Intensitas Dismenore pada Remaja

Background: Dysmenorrhea occurs when the hormone prostaglandin increases excessively during menstruation. Dismenorrhea complaints in adolescents, when untreated, can cause discomfort that interferes with daily activities and school activities. Dysmenorrhea experienced by teenagers can be overcome by consuming ginger extract. Objective: To find out the impact of giving ginger extract on decreasing the intensity of dysmenorrheic pain in adolescents at ‘Aisyiyah Surakarta University. Research methods: This study uses a pre-experimental design with a one-group pretest-posttest approach with samples of 23 respondents. The measurement used the NRS (Numeric Rating Scale) and analyzed data using the Wilcoxon Sign Rank test. Result: It was found that of the 23 respondents before giving ginger extract the majority experienced severe pain (60.86%), and after being given ginger extract, the majority experienced mild pain (56.52%). In light of the Wilcoxon signed rank test p value &lt;0,001 smaller than 0,05. Conclusion: at ‘Aisyiyah Surakarta University, we found that administering ginger extract reduced the severity of dysmenorrhea in adolescents.

Postoperative pain trajectory and opioid requirements after laparoscopic bariatric surgery: a single-centre historical cohort study.

Concerns around delayed emergence and opioid-induced ventilatory impairment in bariatric surgery can lead to intraoperative reliance on short-acting opioids and avoidance of long-acting analgesics with potential sedative effects. Nevertheless, an overly-conservative intraoperative analgesic strategy may result in significant pain at emergence and higher opioid requirements in later phases of care. We sought to establish the pattern of intraoperative analgesic use in bariatric surgical patients as well as their postoperative pain trajectory and opioid requirements. We undertook a single-centre historical cohort study. We explored associations between intraoperative analgesic interventions and pain scores and opioid requirements in postanesthesia care units (PACUs), and associations between the quality of analgesia at emergence and subsequent pain and patient-centred recovery outcomes. We extracted perioperative data for 939 patients who underwent bariatric metabolic surgery between January 2018 and October 2019. Only 39% of patients received long-acting opioids intraoperatively and there was minimal use of nonopioid analgesic adjuncts. Nearly 80% of patients reported moderate-to-severe pain on PACU arrival; 97% of patients received intravenous opioids for rescue analgesia (mean dose, 31mg oral morphine equivalents). Lower pain scores at PACU admission and discharge were associated with subsequent lower inpatient pain scores, lower opioid requirements, shorter time to ambulation, and shorter length of hospital stay. In bariatric surgical patients, effective intraoperative analgesic strategies that improve early pain control may have an impact on recovery and pain experience. Judicious use of intraoperative opioids coupled with opioid-sparing multimodal analgesic techniques should be considered and balanced against concerns regarding opioid-related adverse effects in this patient population.

“I JUST WANTED TO GET THE PAIN OUT OF THE WAY”: WHY PEOPLE WITH SIGNS AND SYMPTOMS OF SUSPECTED CAUDA EQUINA SYNDROME ATTEND THE EMERGENCY DEPARTMENT

Purpose and backgroundCauda Equina Syndrome (CES), a rare (&lt;1 per 100,000) and potentially devasting condition, involves compression of the lumbosacral nerve roots. If not quickly identified and treated, it can lead to lasting disability, and high medicolegal costs (&gt;£186 million in the decade to 2018). This study identified why people with suspected CES attend the emergency department (ED) and explored any delays in attending.Methods and ResultsThe design was a secondary analysis of a qualitative dataset comprising patients with back pain who attended the ED, undertaken using an interpretivist approach. Fourteen patients (8M:6F, aged 23–63 years) with suspected CES were purposively sampled from 4 EDs (2 Northern and 2 Southern) in England between August and December 2021. Semi-structured interviews were conducted online, audio-recorded, transcribed verbatim and analysed thematically.Acopia with pain was the biggest factor in a participant's decision to attend the ED, along with the need for a diagnosis. This pain was the worst ever experienced and debilitating, leaving people unable to cope and desperate for relief. 12/14 were advised to attend the ED following identification of red flags by: GPs (n=9); physiotherapists (n=2); surgical colleague (n=1); and 111 (n=1). Factors such as guilt, previous experience of being disregarded, and symptom misattribution were seen to cause delays in seeking care.ConclusionThis paper revealed a disconnect between the priorities of patients and clinicians prior to attending the ED. Clinicians need to validate the pain experience, communicate clearly why signs and symptoms are concerning, and convey the urgency and potential impact of CES.Conflicts of interestNoneSources of fundingFunding for primary data: Health Education England &amp; NationalInstitute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)