Extent Of Pain Research Articles

Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample

BackgroundTotal knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. MethodsA total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. ResultsApproximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR)=2.11, 95% CI=1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR=3.17, 95% CI=2.26, 4.44 when both were coded ‘yes’). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR=4.9, 95% CI=2.2, 11.1). ConclusionA variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.

Association of sleep duration with rheumatoid arthritis in Korean adults: analysis of seven years of aggregated data from the Korea National Health and Nutrition Examination Survey (KNHANES)

ObjectivesTo investigate the association between rheumatoid arthritis (RA) and self-reported sleep duration.SettingThe present study analysed 7 years of aggregated cross-sectional data (2007–2013) from the Korea National Health and Nutrition Examination...

Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia.

Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P < 0.001) indicating induction of CPM. Conditioned pain modulation in CLP was significantly higher than that in CWP and FMS (P < 0.001), but CPM in CWP and FMS did not differ. Interestingly, a higher number of painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values <0.01). Our findings suggest that CPM dysfunction is associated with CWP and not with FMS as suggested previously. FMS seems to differ from CWP without FMS by higher psychosocial burden. Moreover, patients with CBP should be stratified into CLP and CWP, and centrally acting treatments targeting endogenous pain inhibition seem to be more indicated the higher the pain extent.

External Validation of a Prognostic Model for Predicting Nonresponse Following Knee Arthroplasty

BackgroundInstruments designed to predict the extent of pain and function following knee arthroplasty (KA) recovery has strong potential to guide patients and clinicians in shared decision making. Our purpose was to test the external validity of a recently developed prognostic instrument designed to estimate the probability of nonresponse following KA. MethodsWe used data from the Osteoarthritis Initiative (OAI), a 9-year multisite National Institutes of Health study designed to examine the natural history of knee osteoarthritis in 4796 subjects. A total of 427 subjects underwent KA over the study period. Dowsey et al examined the prognostic role of obesity, general mental health, pain and function, and Kellgren and Lawrence knee osteoarthritis grades. Calibration of the prognostic model was determined using a calibration curve. The c-statistic was used to indicate discrimination of the model. ResultsIn the primary analysis, 63 (19.3%) of 326 subjects in OAI were classified as nonresponders. The calibration curve generated from OAI data indicated poor calibration relative to the recently developed instrument. Discrimination as measured by the c-statistic was 0.76. ConclusionThe external validity of the prognostic instrument was partially supported. While discrimination of the model was very similar to the recently developed instrument, calibration was poor indicating poor agreement between actual vs predicted probabilities of nonresponse. Western Ontario and McMaster Universities Arthritis Index and Kellgren and Lawrence grades show strong potential for use in future prognostic model development. Measurements of general mental health and obesity were not prognostic for nonresponse.

Systemic inflammation and painful joint burden in osteoarthritis: a matter of sex?

We investigated the association between serum levels of C-reactive protein (CRP) and the extent of multijoint pain among individuals with hip/knee osteoarthritis (OA) and determined whether the association differs by sex. Serum CRP and cartilage oligomeric matrix protein (COMP) were determined by enzyme-linked immunosorbent assay (ELISA) in 189 individuals (101 female, 88 male) scheduled for total hip/knee arthroplasty for OA. Patients indicated on a homunculus all painful joints; a summed count was derived. A series of negative binomial regression models was used to investigate the cross-sectional association between painful joint count (outcome) and serum CRP concentrations, adjusting for age, sex, body mass index (BMI), comorbidity count and COMP. An interaction between sex and these biomarkers was tested. Mean age: 66 among women, 65 among men. Women had higher mean joint count (3.7 vs 2.5, P<0.01; 4+joint count reported by 37% women, 25% men). Median CRP concentration was higher in women (15.4mg/l vs 9.3, P=0.07). From adjusted analyses, the effects of both ln(CRP) and ln(COMP) were modified by sex (P<0.05). Increasing ln(CRP) was associated with greater painful joint count among women, but not men. There may be a dose-response association between painful joint burden in OA and systemic inflammation, and it appears the association is sex-specific, which may in part explain inconsistent findings in the literature. Our results underline the importance of showing sex-specific associations in OA, especially when studying the influence of inflammation.

The relation between pain extent and quality-of-life, psychological factors and neck function in patients with chronic neck pain

The relation between pain extent and quality-of-life, psychological factors and neck function in patients with chronic neck pain

Chronic Pain, Quality of Life, and Functional Impairment After Surgery Due to Small Bowel Obstruction.

Emergency laparotomy is a high-risk procedure regarding short-term outcomes; however, long-term outcomes are not well described. The aim of this study was to determine the frequency of chronic postoperative pain, pain-related functional impairment, and incisional hernias and to evaluate the gastrointestinal quality of life after emergency laparotomy due to small bowel obstruction. This study was a questionnaire study, conducted at a major gastrointestinal-surgery department in a single tertiary university hospital in Denmark. Patients who had been through emergency laparotomy due to small bowel obstruction were included in the study. The extent of acute and chronic postoperative pain and the prevalence of incisional hernias were examined with specially designed questionnaires, while the pain quality was assed by the self-report version of the S-LANSS-questionnaire. Pain-related functional impairment and quality of life were measured using the AAS and the GIQLI questionnaire, respectively. A total of 90 patients returned the questionnaire (response rate 82%). Nineteen patients (21%) suffered from chronic postoperative pain. Seventeen patients (19%) had pain-related functional impairment as a result of the surgery, and 17 patients (19%) had an incisional hernia at follow-up. Patients with chronic postoperative pain had significantly lower gastrointestinal quality of life score compared with the remaining study population (109 (IQR 39) vs. 127 (IQR 19), P<0.001). Chronic postoperative pain is a common long-term complication after emergency laparotomy, and it is related to decreased quality of life. These results should be confirmed in prospective studies.

The Course of the Spatial Extent of Pain in Nonspecific Chronic Back Pain: A Prospective Population-based Cohort Study With Clinical Evaluation.

Longitudinal population-based studies on the natural course of nonspecific chronic back pain (nsCBP) concerning the spatial extent of pain are scarce. This study aims to assess the natural course of nsCBP patients concerning their spatial extent of pain and physical impairment over time. Analyses were based on a prospective, population-based survey with clinical evaluation. A representative population-based sample of 4000 German adults was sent a pain questionnaire. Patients mentioning nsCBP in the questionnaire were invited to a comprehensive clinical evaluation, including 1- and 2-year follow-ups. On the basis of pain drawings, the course of the spatial extent of pain over time was classified as "constant-local," "constant-widespread," "constant-amelioration," "constant-spreading," or "variable." Physical impairment was assessed by the Back Performance Scale as an objective clinical assessment tool that measures self-reported activity limitation in daily functioning caused by nsCBP. Pain drawings and physical assessment from 3 visits were available from 165 patients. The course of the spatial extent of pain was constant-local in 39.4% and constant-widespread in 18.2% of all patients, whereas 11.5% reported a variable course. Constant-amelioration was observed in 18.2% and constant-spreading was observed in 12.7%. Physical impairment remained unchanged over the time in all groups and was worst in the constant-widespread group. Most nsCBP patients report a stable pain extent over the time of the study, whereas a constant spread of pain is observed only in a minority of nsCBP patients. These findings challenge the concept of a continuous transition from local to widespread pain.

Pain Extent, Pain Intensity, and Sleep Quality in Adolescents and Young Adults.

Pain has been shown to be associated with poor sleep quality. The aim of this study was to better understand the role that pain intensity and pain extent (number of painful areas) may play in the sleep quality of young people with acute and chronic pain. Cross-sectional survey. A convenience sample of adolescents and young adults with acute or chronic pain; 414 individuals ages 12 to 24 (44% with chronic pain). We performed a hierarchical regression analysis with sleep as the dependent variable and pain intensity, extent, age and pain chronicity as predictors. Pain extent and pain intensity made significant and independent contributions to the prediction of sleep quality (βs = 0.23 [P < 0.001] and 0.14 [P < 0.01]). Young adults reported poorer sleep than adolescents (β = 0.13, P < 0.01). Two significant interactions emerged: age × intensity (β = 0.39, P < 0.05) and chronicity × intensity (β = 0.88, P < 0.001). Sleep quality in young people could be improved by teaching them strategies to better manage pain intensity and pain extent. Clinical trials to evaluate the efficacy of (and best timing for) pain interventions to improve sleep quality are warranted.

Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders.

Completion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored. A novel method was applied to quantify pain extent from the pain drawings of 205 individuals with chronic WAD. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including perceived pain and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy. Pain extent was influenced by sex (χ(2) :10.392, p<0.001) with larger pain extent in women compared to men (7.88±7.66% vs. 5.40±6.44%). People with unsettled insurance claims (χ(2) : 7.500, p<0.05) and those with a worse financial situation (χ(2) :12.223, p<0.01) also had larger pain extent. Multiple linear regression models revealed that, when accounting for age, sex, education, insurance status, financial status and neck pain intensity, pain extent remained associated with perceived disability (p<0.01), depression (p<0.05) and self-efficacy (p<0.001). By utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. WHAT DOES THIS STUDY ADD?: Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.

387. Transfer of Hyaluronic Acid Synthase-2 Gene into Canine Joints Using Adeno-Associated Viral Vectors

Osteoarthritis (OA) is one of the more common causes of lameness in dogs and is estimated to affect approximately 20% of dogs >1 year old. OA is a progressive and degenerative disease that results in pain, inflammation and reduced joint mobility. Novel, safe and efficacious therapies that improve joint lubrication and reduce the extent of inflammation and pain are potential solutions for the management of canine OA. Here, we evaluated the efficiency of gene transfer to canine joint by intra-articular injections of recombinant adeno-associated virus (rAAV) vectors encoding therapeutic genes. Specifically, we generated rAAV vectors (either AAV2 and AAV5 serotypes vectors) encoding canine codon-optimized hyaluronic acid (HA) synthase-2 (HAS2) to provide local and continuous synthesis of HA in the joint. Twenty-two adult healthy dogs that were seronegative for anti-AAV2 and -AAV5 antibodies were injected intra-articularly with rAAV2/HAS2 (1, 5 and 10×1011 vg/joint), rAAV5/HAS2 (5×1011 vg/joint) or PBS (control). No adverse clinical signs were observed following the 28-day study period. Histopathological analysis showed minimal synovial inflammation in the joints of dogs treated with rAAV5/HAS2 and no significant changes in the rAAV2/HAS2 treated dogs. Vector genomes (VG) were detected in the synovium of all the rAAV-treated joints and in the majority of cartilage samples tested. The rAAV5/HAS2 vector resulted in findings of higher and more consistent detection of VG and transcripts compared to rAAV2/HAS2 in both the synovial and cartilage samples. Preliminary analysis also showed a trend towards increased HA levels in the synovial fluid of the treated joints. In summary, our study demonstrated that rAAV2 and rAAV5-mediated gene transfer to canine joint tissues is feasible and that both vectors present an acceptable safety profile following a single intra-articular injection.

Test-retest Reliability in Reporting the Pain Induced by a Pain Provocation Test: Further Validation of a Novel Approach for Pain Drawing Acquisition and Analysis.

Pain drawings (PD) are frequently used in research to illustrate the pain response to pain provocation tests. However, there is a lack of data on the reliability in defining the extent and location of pain. We investigated the test-retest reliability in reporting an acute painful sensation induced by a pain provocation test using a novel approach for PD acquisition and analysis in healthy volunteers. Forty healthy volunteers participated. Each participant underwent 2 upper limb neurodynamic tests 1 (ULNT1), once to the point of pain onset (PO) and once until the point of submaximal pain (SP). After each ULNT1, participants completed 2 consecutive PD with an interval of 1 minute. Custom software was used to quantify the pain extent and analyze the pain overlap. The test-retest reliability of pain extent was examined using Intraclass Correlation Coefficient (ICC 2,1 ) and Bland-Altman plots. Pain location reliability was examined using the Jaccard similarity coefficient (JSC). The ICC values for PO and SP were 0.98 (95% CI: 0.96-0.99) and 0.97 (95% CI: 0.95-0.98), respectively. The mean difference and 95% limits of agreement (± 1.96 SD) in the Bland-Altman plots were 14 pixels (-1080;1110) for PO, and 145 (-1610;1900) for SP. The median JSCs (Q1;Q3) were 0.73 (0.64;0.80) for PO and 0.76 (0.65;0.79) for SP. Pain drawings is a reliable instrument to investigate pain extent and pain location in healthy individuals experiencing an acute painful sensation induced by a pain provocation test.

Hand pains in women and men in early rheumatoid arthritis, a one year follow-up after diagnosis. The Swedish TIRA project

Purpose This research analysed general pain intensity, hand pain at rest and hand pain during activity in women and men in early rheumatoid arhtritis (RA). Method Out of the 454 patients that were recruited into the Swedish early RA project “TIRA” the 373 patients (67% women) that remained at 12 months follow-up are reported here. Disease activity 28 joint score (DAS-28), disability (Health Assessment Questionnaire = HAQ) and pain (VAS) were recorded at inclusion and after 3 (M3), 6 (M6) and 12 (M12) months. General pain, hand pain during rest, hand pain during test of grip force as assessed by Grippit™, prescribed disease-modifying anti-inflammatory drugs (DMARDs) and hand dominance were recorded. Results DAS-28 and HAQ scores were high at inclusion and improved thereafter in both women and men. There were no significant differences between sexes at inclusion but women had higher DAS-28 and HAQ at all follow-ups. Women were more often prescribed DMARDs than were men. In both women and men all pain types were significantly lower at follow-up compared to at inclusion and women reported higher pain than men at follow-ups. The pain types differed significantly from each other at inclusion into TIRA, general pain was highest and hand pain during rest was lowest. There were no significant differences in hand pain related to hand dominance or between right and left hands. Conclusions Disease activity, disability and pain were high at inclusion and reduced over the first year. Despite more DMARDs prescribed in women than in men, women were more affected than were men. General pain was highest and not surprisingly hand pain during active grip testing was higher than hand pain during rest that was lowest in both sexes. Although our cohort was well controlled, it was evident that hand pain remains a problem. This has implications for rehabilitation and suggests potential ongoing activity limitations that should continue to receive attention from a multi-professional team.Implications for RehabilitationGeneral pain and hand pain remain a problem in RA despite today’s early intervention and effective disease control with new era biologics.The extent of hand pain evidenced in our work gives a more detailed and comprehensive account of pain status.Higher hand pain during active grip testing than that during rest indicates a potential relationship to ongoing activity limitation.Hand pain assessment can help guiding multi-professional interventions directed to reduce hand pain and thereby probably reduce activity limitations.

ЛИПОДЕРМАТОСКЛЕРОЗ КАК РАЗНОВИДНОСТЬ ЛОБУЛЯРНОГО ПАННИКУЛИТА: КЛИНИЧЕСКИЕ ОСОБЕННОСТИ

Objective: to to study and reveal the diagnostic signs of lipodermatosclerosis (LDS) as one of the types of panniculitis (PN). Materials and methods. A total of 550 patients were examined; LDS with its duration of 18.97 ± 7.4 months was verified in 53 (9.6 %) patients (3 men and 50 women; whose age was 18–80 years), including 32 overweight ones. All the patients underwent comprehensive clinical examination and laboratory and instrumental studies involving biochemical and immunological parameters, as well as chest computed tomography and Doppler ultrasound (DUS) of the lower limb vascular bed. While characterizing the skin lesion, the extent, skin color, number and intensity of pain were assessed using the visual analogue scale (VAS) in the affected areas. Chronic venous insufficiency (CVI) was evaluated in accordance with the international classification and the classification developed by V.S. Savel’ev et al. The skin and hypodermic tissue were biopsied from an area of the highest lesion and further pathomorphologically examined. Results. Thirty-seven (70 %) of the 53 patients with LDS were noted to have predominantly inflammation of the subcutaneous adipose layer of the leg (88.6 %) on its medial surface (54.7 %) with the development of the glass symptom (79.2 %) (p = 0.005). Main types of the disease course (acute, subacute, and chronic) were identified, which differed in clinical symptoms. ROC analysis indicated that the VAS sensitivity (86 %) and specificity (58 %) in the patients with LDS corresponded to a separation point of 40 mm. In 46 % of the cases, skin lesion was associated with polyarthralgias (n = 15) or myalgias (n = 12) in the presence of insignificant inflammatory activity. Twenty-eight patients (including 19 with chronic LDS) had CVI with a duration of 10.2 ± 1.3 years, which was verified by DUS of the lower limb vessels (p < 0.05). All the patients took venous tonics, nonsteroidal anti-inflammatory drugs, aminocholines, and antioxidants for 3 months. A therapeutic effect was observed in 68 % of the cases. A therapeutic effect was absent in 23 % of the patients and worse health was seen in 9 %, which needed glucocorticoid therapy to be added. Conclusion. LDS is a clinical type of lobular PN, which requires an extensive diagnostic search. The factors contributing to the development of LDS are female sex, middle age, overweight, anamnestic predisposition, and CVI of the lower extremities. Asymmetric indurations with their characteristic color on the medial surface of the leg with the development of subcutaneous adipose layer dystrophy (the glass symptom) are a diagnostic sign of LDS.

Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery: results of an emergency department-based cohort study.

Motor vehicle collision (MVC) can trigger chronic widespread pain (CWP) development in vulnerable individuals. Whether such CWP typically develops through the evolution of pain from regional to widespread or through the early development of widespread pain with nonrecovery is currently unknown. We evaluated the trajectory of CWP development (American College of Rheumatology criteria) among 948 European-American individuals who presented to the emergency department (ED) for care in the early aftermath of MVC. Pain extent was assessed in the ED and 6 weeks, 6 months, and 1 year after MVC on 100%, 91%, 89%, and 91% of participants, respectively. Individuals who reported prior CWP at the time of ED evaluation (n = 53) were excluded. Trajectory modeling identified a 2-group solution as optimal, with the Bayes Factor value (138) indicating strong model selection. Linear solution plots supported a nonrecovery model. Although the number of body regions with pain in the non-CWP group steadily declined, the number of body regions with pain in the CWP trajectory group (192/895, 22%) remained relatively constant over time. These data support the hypothesis that individuals who develop CWP after MVC develop widespread pain in the early aftermath of MVC, which does not remit.

An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review

Aims of the review were to establish the prevalence of acute pain for adults in hospital, to identify the amount of severe or unacceptable pain reported and to examine the prevalence of acute pain within medical units. Acute Pain Services have been established in the United Kingdom (UK) to improve pain management within surgical settings. Acute pain is a common symptom across all hospital settings. However, medical settings have traditionally been considered low risk for acute pain and have therefore not always been included in the provision provided by APS. As a result 82% of APS surveyed in the UK felt that pain management was suboptimal on medical units. This review follows the process of a systematic review. Hospital-wide pain prevalence obtained ranged from 37·7-84%, severe pain prevalence ranged from 9-36%. The papers reviewed were of variable quality and heterogeneous resulting in the wide range of pain prevalence. Higher prevalence of pain was found for surgical patients compared to medical patients, although up to 55% of medical patients' reported pain. It is difficult to determine a definite prevalence of pain for adults in hospital due to the variability of the studies examined. However, pain does remain a significant symptom with up to 35% of patients reporting severe pain and approximately 50% of medical patient reported pain. Awareness of the extent of pain as a problem for patients is the first step to improving practice. This review has demonstrated that there is a need for similar Acute Pain Teams and services for the staff and patients admitted to all areas of the hospital, including medical units to help clinicians assess and treat pain in all areas of a hospital setting.

Elevated CCL2/MCP-1 Levels are Related to Disease Severity in Postmenopausal Osteoporotic Patients.

Chemokine (C-C) ligand-2 (CCL2), also named monocyte chemoattractant protein 1 (MCP-1), is an important chemotactic factor involved in a wide range of diseases. Recent studies have shown that CCL2/MCP-1 plays crucial roles in the osteoclastogenic process. The current study was performed to measure serum CCL2 levels in postmenopausal osteoporotic patients and investigate the relationship between CCL2 concentrations in serum and disease severity in postmenopausal osteoporotic patients. A total of 62 postmenopausal osteoporotic female patients (PMOP group), 68 postmenopausal non-osteoporotic female patients (PMNOP group), and 65 healthy women of childbearing age (Control group) were enrolled in the study. The calcaneal quantitative ultrasound was utilized to conduct bone mineral density (BMD) measurements, confirmed at the left femoral neck, greater trochanter, total hip, and L1 - L4 lumbar spine by dual energy X-ray absorptiometry (DXA). Serum CCL2, TNF-α as well as IL-6 levels were measured with enzyme-linked immunosorbent assay. Estrogen-2 (E2) was measured with radioimmunoassay. The Visual Analogue Scores (VAS) was utilized to assess the extent of pain in PMOP. We demonstrated for the first time that CCL2 levels were increased in postmenopausal women compared with controls. We also found that elevated CCL2 levels were linked with decreased BMD and attenuated E2 concentrations. In addition, CCL2 levels were positively correlated with inflammation markers TNF-α, IL-6, and VAS scores. CCL2 in serum serves as a potential biomarker for reflecting disease severity in postmenopausal osteoporotic patients. Therapeutic interventions that target CCL2 and its related signaling pathways in order to delay osteoporosis development deserve further study.

Effects of auricular-plaster therapy on pain and serum levels of cortisol and IL-6 after cesarean section

PurposeTo evaluate APT (APT) for its analgesic effects and influence on serum cortisol and IL-6 levels after cesarean section. Methods108 puerperae prepared for cesarean section were randomly divided into three treatment groups: APT, patient-controlled intravenous analgesia (PCIA), and a combination of APT and PCIA. The degrees of incision pain (including pain at rest and pain evoked by changing position in bed) and oxytocin-mediated uterine cramping pain were determined using a visual analogue scale (VAS). The serum concentrations of cortisol and IL-6 were measured preoperatively and postoperatively. ResultsUterine cramping pain was lower in the APT group than the PCIA group and lowest in the combination therapy group. Incision pain was similar between the APT group and the PCIA group but lower in the combination therapy group. On the second morning after surgery, the serum concentrations of cortisol and IL-6 were similar between the APT group and the PCIA group but lower in the combination therapy group. The extent of pain was highly related to cortisol levels and moderately related to IL-6 levels. ConclusionAPT can relieve uterine cramping pain after cesarean section, and in combination with PCIA can decrease serum levels of cortisol and IL-6.

Correlation between pain response and improvements in patient-reported outcomes and health-related quality of life in duloxetine-treated patients with diabetic peripheral neuropathic pain.

ObjectiveWe assessed whether quality of life (QoL) improvement in duloxetine-treated patients with diabetic peripheral neuropathic pain (DPNP) correlates with the extent of pain relief.MethodsPooled data from three multicountry, double-blind, 12-week, placebo-controlled trials of duloxetine-treated (duloxetine 60 mg once daily; total number =335) patients with DPNP were analyzed. Based on improvement in 24-hour average pain scores, patients were stratified into four groups. Improvement in QoL, which was measured as the change from baseline in two patient-reported health outcome measures (Short Form [SF]-36 and five-dimension version of the EuroQol Questionnaire [EQ-5D]), was evaluated and compared among the four groups. Pearson’s correlation coefficient was calculated to assess the correlation between improvement in pain scores and improvement in QoL.ResultsThe group with more pain improvement generally showed greater mean change from baseline in all of the SF-36 scale scores and on the EQ-5D index. Pearson’s correlation coefficients ranged from 0.114 to 0.401 for the SF-36 scale scores (P<0.05), and it was 0.271 for the EQ-5D (P<0.001).ConclusionImprovement in pain scores was positively correlated with improvement in QoL and patient-reported outcomes in duloxetine-treated patients.

Spatial acuity of healthy subjects in locating two identical pressure stimuli using digital body chart

Background: Body charts are a useful tool to assess pain in clinical practice. Patients report their complaints by drawing on body chart the location and the extent of pain. Reporting pain or symptoms over a body chart is a complex task as it involves subjective body spatial cognition and also recognition over a standard two-dimensional template that does not take into account body structures variability. Several methods, paper-based or digital, for completing and analyzing pain drawings have been proposed, and their good test-retest or inter-examiner reliability were described. However, subjects’ spatial acuity in reporting two successive identical stimulus over a body chart has never been investigated. Purpose: The aim of the present study is to assess spatial acuity in reporting two successive identical stimulus over a digital body chart in a group of healthy subjects. Moreover, we investigated if spatial acuity is influenced by the size and the location of the stimulus. Methods: Fifty healthy subjects participated in the study. All subjects received in well defined body parts twenty pressure stimulations, randomly distributed all over the body. Pressure stimulations involved points (1cm2) or larger areas (60cm2) over the body and were applied respectively by an algometer of 1,5 Kg and a flat weight of 2 kg. Each stimulus was performed twice, in a randomized sequence and exactly in the same body location. After each of the forty stimulations, participants were requested to represent the perceived stimulation on a digital body chart. To investigate spatial acuity in reporting perceived stimulus, an appropriate software compared each couple of drawings (D1 and D2) representing the identical stimulations. For the point-like drawings, the distance in pixel between D1 and D2 whereas for drawings of larger areas, the not overlapping area between D1 and D2 were calculated. Results: The median of distance between point-like drawings was 8.8 pixel (IQR: 12.06), the median of not-overlapping area was 48.67% (IQR: 36.34) of the total area (D1+D2). Friedman Test showed a significant change in accuracy of point-like drawings in different body regions: the lower distance (5.9 pixels) between D1 and D2 has been found in the anterior part of the arm, the larger distance (16.1 pixels) in the anterior part of the thigh. Overlapping of reported areas was not significantly different in different body regions. Conclusion The results of the present study showed that the two identical pressure stimuli were reported over a digital body chart in non-identical locations. Moreover, this phenomena has resulted different among different body parts. Implications: It will be interesting to analyze if the same spatial acuity could be observed in patients with pain, in order to evaluate if pain is responsible of an alteration of this variable. Consequently, it will be also possible to assess more precisely pain drawings reliability.