Extent Of Pain Research Articles

Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial

BackgroundImpaired cervical joint position sense and balance are associated with neck pain. Specific therapeutic exercise and manual therapy are effective for improving neck pain and functional ability but their effects on joint position sense and balance impairments remain uncertain. Changes in the joint position sense and balance may need to be addressed specifically. The primary objective is to investigate the most effective interventions to improve impaired cervical joint position sense and balance in individuals with neck pain. The secondary objective is to assess the effectiveness of the interventions on pain intensity and disability, pain location, dizziness symptoms, cervical range of motion, gait speed, functional ability, treatment satisfaction and quality of life.MethodsA 2 × 2 factorial, single blind RCT with immediate, short- and long-term follow-ups. One hundred and sixty eight participants with neck pain with impaired joint position sense and balance will be recruited into the trial. Participants will be randomly allocated to one of four intervention groups: i) local neck treatment, ii) local treatment plus tailored sensorimotor exercises, iii) local treatment plus balance exercises, and iv) local treatment plus sensorimotor and balance exercises. Participants receive two treatments for 6 weeks. Primary outcomes are postural sway and cervical joint position error. Secondary outcomes include gait speed, dizziness intensity, neck pain intensity, neck disability, pain extent and location, cervical range of motion, functional ability, perceived benefit, and quality of life. Assessment will be measured at baseline, immediately after treatment and at 3, 6, 12 month-follow ups.DiscussionNeck pain is one of the major causes of disability. Effective treatment must address not only the symptoms but the dysfunctions associated with neck pain. This trial will evaluate the effectiveness of interventions for individuals with neck pain with impaired cervical joint position sense and balance. This trial will impact on clinical practice by providing evidence towards optimal and efficient management.Trial registrationClinicalTrials.gov (NCT03149302). May 10, 2017.

(218) - Evaluating the psychometric properties of the widespread pain index to assess pain extent in youth with painful conditions

(218) - Evaluating the psychometric properties of the widespread pain index to assess pain extent in youth with painful conditions

Prevalence of pain flashbacks in posttraumatic stress disorder arising from exposure to multiple traumas or childhood traumatization

ABSTRACT Background Flashbacks are a form of multisensory memory that are experienced with a “happening in the present” quality. Pain flashbacks are a re-experiencing of pain felt at the time of a traumatic event. It is unclear how common pain flashbacks are. Aims The current study was designed primarily to assess the prevalence of pain flashbacks in a sample of patients with posttraumatic stress disorder (PTSD). Methods We assessed the prevalence of pain flashbacks over a period of 2 years in patients (n = 166) referred to a psychological trauma service in the UK. Patients underwent a clinical screen for PTSD and completed a self-report measure of pain flashbacks. Results Pain flashbacks were classified as present in 49% of a sample of complex trauma patients meeting criteria for PTSD. Pain flashbacks were positively associated with the extent of pain at the time of trauma. Conclusions Pain re-experiencing in PTSD, and its relative absence in nonclinical populations, supports an account of memory in which perceptual details can be re-experienced when memories have been encoded under conditions of extreme stress. It may be possible to conceptualize some cases of unexplained pain as pain flashbacks or of having a trauma origin.

Widespread pain is associated with greater perceived pain and disability, but not with psychological features in patients with cervical radiculopathy

Purpose: People with cervical radiculopathy (CR) present with varying pain extent indicative of an interplay of differing pain mechanisms. A widespread distribution of perceived pain may reflect central sensitisation and could be associated with poorer psychological functioning as seen in other conditions such as individuals with whiplash associated disorders (WAD). No studies have evaluated the relation of pain extent to perceived pain and disability, general health and psychological status in individuals with CR.

Pain extent predicts the outcome following a programme of neck specific exercise in patients with chronic whiplash-associated disorders

Pain extent predicts the outcome following a programme of neck specific exercise in patients with chronic whiplash-associated disorders

Trait anxiety and sensory processing profile characteristics in patients with non-specific chronic low back pain and central sensitisation - A pilot observational study

IntroductionPeople with non-specific chronic low back pain (NSCLBP) and central sensitisation (CS) exhibit sensory processing alterations, somatosensory hypersensitivity and differences in the brain's emotional networks. The concept that CS relates to pre-morbid trait sensory processing and anxiety characteristics is unknown.The aims of this pilot observational study were to test concept plausibility in a NSCLBP population with central sensitisation by investigating:1) the range of Central Sensitisation Inventory scores, to determine the extent of symptoms of central sensitisation, 2) whether there are identifiable patient characteristics of trait anxiety and trait sensory profile differences; and 3) whether potential relationships exist between trait anxiety, trait sensory profiles and the extent of symptoms of central sensitisation. MethodsPeople with NSCLBP and CS were recruited from physiotherapy outpatient clinics in New Zealand and the United Kingdom. Outcomes included the Central Sensitisation Inventory (CSI), Adolescent/Adult Sensory Profile and the State/Trait Anxiety Inventory (trait section) with the Marlowe Crowne Sociable Desirability Scale. Descriptive and non-parametric tests for correlation were used to analyse the data, p=<0.05. ResultsOf the 21 people recruited, 16 (76.2%) had CSI scores ≥40 in association with 1) an abnormally high prevalence of extreme scores of a) high trait Sensory Sensitive, Sensation Avoiding and Low Registration sensory profiles and b) low trait Sensation Seeking profile, 2) high trait anxiety sub-types and 3) minimal low trait anxiety. Moderate correlations were identified between trait sensory profiles and 1) CS pain (Sensory Sensitive R = 0.57, p < 0.01, CI = 0.07 to 0.88, p < 0.01, Sensation Seeking R = −0.47, p < 0.05, CI = −0.72 to −0.02) and 2) trait anxiety (Sensory sensitive: R = 0.65, p < 0.01, CI = 0.27 to 0.91) and Low Registration (R = 0.49, p < 0.05, CI = 0.03 to 0.84). The CSI scores moderately correlated with trait anxiety (R = 0.63, p < 0.01, CI = 0.22 to 0.86). ConclusionThese results provide concept plausibility that the extent of CS pain in people with NSCLBP might be associated with pre-morbid trait anxiety sub-types and abnormal trait sensory processing profiles. A larger study to confirm the findings is warranted.

Preliminary outcomes of percutaneously looped thread transection in the surgical treatment of stenosing tenosynovitis

Objective: To investigate the percutaneously looped thread transection for treatment of stenosing tenosynovitis and evaluate its treatment outcome. Methods: From January 2014 to October 2016, Eighty-four patients with stenosing tenosynovitis were randomly divided into the open decompressionand group (42 cases) and percutaneously looped thread transection group (42 cases) in Department of Orthopedics, Affiliated Laiwu Hospital of Taishan Medical College. Incision near the digit horizontal stripes, tendon sheath were cut off in the open decompressionand group. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse tendon sheath, respectively, forming loops to cut off and decompressed the flexor tendon. Visual analog scale(VAS) was used to evaluate the extent of pain before the operation and 1 or 4 weeks after the operation, the comprehensive curative effect were evaluated 3 months after the operation. Results: In the two groups pain was alleviated. The VAS improved from (7.0±1.3)prior operation to(5.2±1.6) and (2.8±1.1)1 week and 4 weeks after the operation in the open decompressionand group , respectively. The difference before and after the operation was significant(P<0.05). The VAS improved from (7.1±1.4) prior operation to(2.7±1.3) and (0.6±0.2)1 week and 4 weeks after the operation in the percutaneously looped thread transection group, respectively. The difference before and after the operation was significant(P<0.05). The difference of VAS scores between two groups at 1 week and 4 weeks after the operation were different(P<0.05). The difference of the comprehensive curative effect between two groups at 3 months after the operation were not different(P>0.05). There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups. Conclusion: Percutaneously looped thread transaction under ultrasound for the surgical treatment of stenosing tenosynovitis has less trauma and rapid recovery. It has such advantage as being effective, simple , and reach the same effects as the open decompression surgery.

Profiling the Location and Extent of Musicians' Pain Using Digital Pain Drawings.

Background and AimsAccording to existing literature, musicians are at risk of experiencing a range of painful musculoskeletal conditions. Recently, a novel digital technology was developed to investigate pain location and pain extent. The aim of this study was to describe pain location and pain extent in musicians using a digital method for pain drawing (PD) analysis. Additionally, the association between PD variables and clinical features were explored in musicians with pain.MethodsOne hundred and fifty‐eight musicians (90 women and 68 men; aged 22.4 ± 3.6 years) were recruited from Swiss and U.K. conservatories. Participants were asked to complete a survey including both background musical information and clinical features, the QuickDASH (QD) questionnaire, and the digital PDs.ResultsOf the 158 participants, 126 musicians (79.7%) reported having pain, with higher prevalence in the areas of the neck and shoulders, the lower back, and the right arm. The mean percentage of pain extent was 3.1% ± 6.5%. The mean QD score was higher for musicians with pain than for those without pain. Additionally, the results indicated a positive correlation between the QD score and pain extent, and there were significant correlations between age and pain intensity, as well as between pain extent and pain intensity.ConclusionsThe high prevalence of pain among musicians has been confirmed using a digital technique for PD acquisition and analysis. In addition, positive correlations between pain extent and upper limb disability have been demonstrated. Our findings highlight the need for effective prevention and treatment strategies for musicians.

Laparoscopic versus open appendectomy retrospective study

Background: Laparoscopic cholecystectomy is taken into account as a standard method of performing cholecystectomy and has substituted the old method throughout the world, while laparoscopic appendectomy still not attaining that reputation. In this paper, a retrospective study was done to compare between both laparoscopic and open appendectomy.Methods: Two hundred eighty-five patients were analyzed after appendectomy using either open or laparoscopic procedures. The data was compared over a period of 36 months. Surgical technique was the same among 6 surgeons, standard postoperative care for all patient groups. The outcome measures included comparing of mean operative time, days of hospitalization, postoperative pain and rate of wound infection.Results: Concerning open appendectomy the mean time was 28 minutes with 2 days of hospitalization. The postoperative pain extent was for 36 hours and rate of wound infection was 8/159. While in laparoscopic appendectomy the mean time was 55 minutes with one day hospitalization. The postoperative pain was for 12 hours and zero rate of wound infection.Conclusions: In general laparoscopy has plenty of gains over open surgery as discussed before but laparoscopic appendectomy is not easier, nor does it avoid general anesthesia. The cost for laparoscopic appendectomy is higher than for open appendectomy. The operative and post-operative complications are more critical (e.g.: intra-abdominal abscesses &amp; perforation of bowel) as compared to open appendectomy. We have to assess the advantages and disadvantages, indications and contraindications when taking a decision for laparoscopic surgery. We suppose it would be very early to say that laparoscopic appendectomy is superior or can replace open appendectomy.

Clinical and Psychosocial Predictors of Urological Chronic Pelvic Pain Symptom Change in 1 Year: A Prospective Study from the MAPP Research Network

We examined baseline clinical and psychosocial characteristics that predict 12-month symptom change in men and women with urological chronic pelvic pain syndromes. A total of 221 female and 176 male patients with urological chronic pelvic pain syndromes were recruited from 6 academic medical centers in the United States and evaluated at baseline with a comprehensive battery of symptom, psychosocial and illness-impact measures. Based on biweekly symptom reports, a functional clustering procedure classified participant outcome as worse, stable or improved on pain and urinary symptom severity. Cumulative logistic modeling was used to examine individual predictors associated with symptom change as well as multiple predictor combinations and interactions. About 60% of participants had stable symptoms with smaller numbers (13% to 22%) showing clear symptom worsening or improvement. For pain and urinary outcomes the extent of widespread pain, amount of nonurological symptoms and poorer overall health were predictive of worsening outcomes. Anxiety, depression and general mental health were not significant predictors of outcomes but pain catastrophizing and self-reported stress were associated with pain outcome. Prediction models did not differ between men and women and for the most part they were independent of symptom duration and age. These results demonstrate for the first time in a large multisite prospective study that presence of widespread pain, nonurological symptoms and poorer general health are risk factors for poorer pain and urinary outcomes in men and women. The results point to the importance of broad based assessment for urological chronic pelvic pain syndromes and future studies of the mechanisms that underlie these findings.

Predictors and Prevalence of Pain and Its Management in Four Regional Cancer Hospitals in India.

PurposeMore than 1 million new occurrences of cancer are diagnosed in India annually. Among patients with cancer, pain is a common and persistent symptom of the disease and its treatment. However, few studies to date have evaluated the prevalence of pain and the adequacy of pain management in Indian hospitals. This cross-sectional study aimed to assess the prevalence and sociodemographic patterns of cancer pain and pain management among a sample of inpatients and newly registered outpatients at four large regional cancer centers in India.MethodsA sample of 1,600 patients with cancer who were current inpatients or newly registered outpatients were recruited and administered a questionnaire that was based on the Brief Pain Inventory. The survey tool included questions on demographics, medical history, and extent of clinical pain experienced. In addition, a pain management index score was created to link the severity of cancer pain with medication prescribed to treat it.ResultsA total of 88% of patients reported pain in the past 7 days, and approximately 60% reported that their worst pain was severe. Several demographic and medical characteristics of the study population predicted severe pain, including the following: lower educational level, outpatient status, and debt incurred as a result of illness. A total of 67% of patients were inadequately treated with analgesics. Inadequate pain management was associated with both treatment hospital and patient type, and patients who reported debt as a result of their illness were more likely to have inadequate pain management.ConclusionA majority of Indian patients with cancer experience significant pain and receive inadequate pain management. Improvement of pain management for Indian patients with cancer is needed urgently.

Pain Extent Is Associated with the Emotional and Physical Burdens of Chronic Tension-Type Headache, but Not with Depression or Anxiety.

Earlier studies suggest that pain extent, extracted from the patients' pain drawings, can help clinicians to identify people with central sensitization or worse clinical features. Our aim was to investigate possible associations between perceived pain extent and clinical pain features, burden of headache, psychological outcomes, and pressure sensitivity in people with chronic tension-type headache (CTTH). Ninety-nine people (27% men) with CTTH reported their pain on four different body charts representing the head and neck. Pain extent and frequency maps were obtained using customized software. Clinical features of headache, burden related to headache (Headache Disability Inventory [HDI]), anxiety and depression (Hospital Anxiety-Depression Scale [HADS]), and anxiety state/trait (State-Trait Anxiety Inventory [STAI]) levels were assessed. Pressure pain thresholds (PPT) were assessed over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and the tibialis anterior muscle (distant pain-free area) to determine widespread pressure sensitivity. Associations between pain extent and all outcomes were analyzed. Pain extent showed significant positive associations with age (r = 0.221, P = 0.029) and burden of the headache (emotional: r = 0.213, P = 0.030; physical: r = 0.208, P = 0.039), but no other significant association was found. Pain extent weakly correlated with older age as well as with higher emotional and physical burden of the headache in CTTH. In this population, there was no relationship between pain extent and PPT, indicating that larger pain areas were not associated with signs of central sensitization. Pain drawings can complement other clinical pain features for better characterization of CTTH, but further studies are needed.

Association between pain extent and health status in whiplash associated disorders

Background. Whiplash associated disorders (WAD) are a complex phenomenon associated with relevant social and economic burdens. Many people with chronic WAD show widespread pain which can be observed from the patient’s pain drawing. No studies have evaluated the relation of pain extent to perceived pain and disability, financial status, general health and psychological status in individuals with chronic WAD. Purpose. To evaluate the relation of pain extent to a number of variables related to the patients’ perceived pain and disability, their financial status, general health and psychological status. Methods. A total of 205 individuals with chronic WAD grade 2 or 3 were selected. The main outcome measure was pain extent, extracted from the pain drawing. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was then used to verify whether pain extent was significantly associated with the other health indicators including perceived pain intensity and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy. Results: Pain extent was influenced by the sex of the participant (p<0.01) with larger pain extent in women compared to men (7.88±7.66 vs 5.40±6.44). People with unsettled insurance claims (p<0.05) and those with a worse financial situation (p<0.01) showed 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). Conclusion: Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status reported more widespread pain. When controlling for these factors, larger pain areas remained associated with perceived pain and disability, depression and self-efficacy. Implications: Pain drawings support the clinical evaluation of people with chronic WAD.

Complexity and extension of periodontal and implant surgery are associated with the extent of pain

Complexity and extension of periodontal and implant surgery are associated with the extent of pain

Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome.

Widespread pain is considered a sign of central sensitization in people with chronic pain. Our aim was to examine whether pain extent, assessed from the pain drawing, relates to measures from quantitative sensory testing in fibromyalgia syndrome (FMS). Thirty women with FMS and no other co-morbid conditions completed pain drawings (dorsal and ventral views) and clinical and related disability questionnaires. Pain extent and pain frequency maps were obtained from the pain drawings using a novel customized software. Pressure pain thresholds were assessed over the 18 tender points considered by the 1990 American College of Rheumatology criteria for FMS diagnosis and over two additional standardized points. Heat and cold pain thresholds were also assessed on the dorsal aspect of the neck, the dorsal aspect of the wrist, and the tibialis anterior. Spearman's correlation coefficients were used to assess the relationship between pain extent and quantitative sensory testing outcomes as well as clinical symptoms. Larger extent of pain was associated with a higher pain intensity (dorsal area: r s=0.461, P=0.010; total area: r s=0.593, P=0.001), younger age (ventral area: r s=-0.544, P=0.002; total area: r s=-0.409, P=0.025), shorter history of pain (ventral area: r s=-0.367, P=0.046), and higher cold pain thresholds over the tibialis anterior muscle (r s=-0.406, P=0.001). No significant association was observed between pain extent and the remaining outcomes. Pain drawings constitute an easy and accurate approach to quantify widespread pain. Larger pain extent is associated with pain intensity but not with signs of central sensitization in women with FMS.

Unimpaired endogenous pain inhibition in the early phase of complex regional pain syndrome.

The complex regional pain syndrome (CRPS) is characterized by distal generalisation of pain beyond the initial trauma. This might be the result of impaired endogenous pain inhibition. We compared Conditioned Pain Modulation (CPM) between patients with CRPS (n=24; pain: 4.5±2.2, NRS 0-10; disease duration <1year), neuralgia (n=17; pain: 5.5±1.1) and healthy subjects (n=23) and its correlation with loss and gain of function as assessed by Quantitative Sensory Testing (QST). CPM was assessed with heat as test stimulus (TS) and cold water as conditioning stimulus (CS). The early CPM-effect was calculated as difference between heat pain during and before conditioning, the late CPM-effect, 5minutes after and before conditioning, respectively. Heat pain decreased comparably after CS in all groups, resulting in a significant CPM-effect (healthy: -12.5±12.4, NRS 0-100; CRPS: -14.7±15.7; neuralgia: -7.9±9.8; p<0.001). When compared to healthy subjects, heat pain declined significantly steeper in CRPS patients (healthy: -2.0±5.5, NRS 0-100/10s; CRPS: -6.3±8.1; p<0.05). Only CRPS patients demonstrated a late CPM effect (-6.0±9.0, p<0.005). Neither spontaneous pain nor any QST parameter correlated with CPM, with the exception of a decreased cold pain threshold, which correlated with an enhanced CPM in CRPS patients only (r=-0.456, p<0.05). An impairment of endogenous pain inhibition does not explain the extent of pain in the early stage of CRPS or in neuralgia. The unexpectedly high CPM in CRPS patients might result from activation of the intact descending pathways in response to central sensitization, as cold hyperalgesia correlated with the CPM-effect. Conditioned pain modulation (CPM) is not impaired in the early phase of complex regional pain syndrome (CRPS) and neuralgia. Only in CRPS higher CPM was associated with lower cold pain thresholds.

Pain extent and function in youth with physical disabilities

BackgroundThe aim of this study was to increase our understanding of the role that spatial qualities of pain (location and extent) play in functioning, among youths with disabilities and chronic pain.MethodsOne-hundred and fifteen youths (mean age 14.4 years; SD ±3.3 years) with physical disabilities and chronic pain were interviewed and were asked to provide information about pain locations and their average pain intensity in the past week, and to complete measures of pain interference, psychological function and disability. Most of the participants in this sample were males (56%), Caucasian (68%), and had a cerebral palsy (34%) or muscular dystrophy (25%) problem. Most participants did not report high levels of disability ( , SD ±9.5, range 0–60) or global pain intensity ( , SD ±2.4, range 0–10).ResultsPain at more than one body site was experienced by 91% of participants. There were positive associations between pain extent with pain interference (r = 0.30) and disability (r = 0.30), and a negative association with psychological function (r = –0.38), over and above average pain intensity. Additionally, pain intensity in the back (as opposed to other locations) was associated with more pain interference (r = 0.29), whereas pain intensity in the shoulders was associated with less psychological function (r = –0.18), and pain intensity in the bottom or hips was associated with more disability (r = 0.29).ConclusionThe findings support the need to take into account pain extent in the assessment and treatment of youths with physical disabilities and chronic pain, call our attention about the need to identify potential risk factors of pain extent, and develop and evaluate the benefits of treatments that could reduce pain extent and target pain at specific sites.

Comparative Study of the Effect of Intravenous Paracetamol and Tramadol in Relieving of Postoperative Pain after General Anesthesia in Nephrectomy Patients.

Aim:The aim of this study was to compare the effect of intravenous paracetamol and tramadol in relieving of postoperative pain after general anesthesia for nephrectomy in prospective donor patients for kidney transplantation.Materials and Methods:A randomized study was conducted on 100 adult patients scheduled for nephrectomy aged from 35 to 55 years of both sexes and divided into two groups and were administered intravenous paracetamol and tramadol for postoperative pain relief and assessed with visual analog scale score and variations in vital parameters to assess extent of pain relief.Results:After statistical interpretation of collected data, the observations were extrapolated. There was a statistically significant difference in the pain intensity scores obtained between the paracetamol and tramadol groups.Conclusion:On the basis of the present study, it is concluded that tramadol due to its lesser onset of action time was superior to paracetamol in providing acute postoperative pain relief.

PUB132 Health-Related Quality of Life Questionnaires in Lung Cancer Patients Attending a Tertiary Care Hospital

Lung cancer is usually diagnosed at an advanced stage and survival has not improved in spite of several therapeutic advancements. Since most patients depend on palliative care, it is imperative to evaluate and maintain a satisfactory quality of life in them. Several questionnaires, mostly in western languages, have been used for this purpose. However, Indian data on this aspect is sparse. A 26-item WHO-Quality of Life questionnaire in local language was used to assess the quality of life in lung cancer patients attending a Tertiary care hospital. This questionnaire comprises four domains-Physical, Psychological, Social and Environmental. A total of 76 patients were evaluated. 66 (86.8%) were males, had a mean age of 55.36 years; presented with cough (82.9%), dyspnea (72.4%), chest pain (65.8%), and hemoptysis (43.4%). Eight patients (10.5%) had superior venacaval obstruction. The mean duration of symptoms was 5.9 months. 89.5% had Non-Small Cell Cancer (NSCLC). The mean pack-years was 23.7. Most patients had Karnofsky Performance Scale (KPS) of 70 (52.6%).There was no significant correlation of any quality of life domain with age, sex, duration of symptoms, extent of smoking, cough, dyspnea, chest pain, hemoptysis or hemoglobin. The environmental domain correlated significantly with the serum albumin (p<0.016). The physical domain scores of patients with KPS of 80% correlated significantly with those having KPS of 70% and 60% (p < 0.001 and p < 0.003 respectively). The psychological domain scores of patients with KPS 80% correlated significantly with those having KPS 70% (p < 0.005). Quality of life in lung cancer is not affected by age, sex, presence of symptoms and their duration or extent of smoking. Karnofsky Performance Scale is a useful surrogate marker of quality of life in these patients.

Health eRide: Outcomes of a Pilot Program Leveraging Principles of Gamification and SMS Messaging to Help Veterans Self-Manage Chronic Pain

Background: Chronic pain creates a significant public health burden and disproportionately affects veterans. Over 56% of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) veterans have a diagnosis of chronic pain. The frequency and extent of pain, posttraumatic stress disorder (PTSD), traumatic brain injury, and the co-occurrence of all three conditions (post-deployment multi-symptom disorder, PMD) can complicate and reduce the effectiveness of traditional treatments for pain. Taken in combination with the opioid crisis in the United States, there is an urgent need for innovative and integrative approaches to non-medical pain management. However, readiness to engage in pain self-management varies. Objective: The objective of this Phase I pilot was to design, develop, and establish the feasibility of a theoretically-grounded, mobile-optimized, interactive pain self-management intervention for veterans that leverages principles of gamification. Methods: The development of Health eRide: Your Journey to Managing Pain included extensive end-user input including a veteran advisory panel (n=5), formative focus groups (n=20), and iterative usability testing (n=20). Health eRide is tailored not only to veterans’ preference for pain self-management strategies but also their readiness to adopt those strategies as measured by a Transtheoretical Model-based stage of change assessment. The program incorporates core components of promising treatments for PMD by intervening on sleep hygiene and stress management. Health eRide includes (1) an online computer-tailored intervention that provides tailored behavior change guidance and (2) an individually tailored subway-themed “map” of their pain management journey. Stops along the map include stage-based interactive activities designed to further users along in their journey to self-managing pain. The program also included optional text messaging and a Facebook page. A pilot study with a 30-day follow-up was conducted with 69 veterans (81% male, 58% Caucasian, average age=50) to examine the acceptability and preliminary effectiveness of Health eRide. Users completed stage of change algorithms and pain rating scales at baseline and follow-up and completed a measure of acceptability and the System Usability Scale (SUS) at follow-up. Results: A total of 44 veterans (64%) completed the follow-up assessment (no significant differences on baseline demographics between those who completed the follow-up assessment and those who did not). The mean rating of acceptability for Health eRide was 3.20 on a 4 point scale, indicating that users found the program useful, informative, reliable, and easy to navigate. Likewise, the mean score on the SUS was 65.4, indicating the program meets standards for usability. The results show significant changes in movement to readiness to adopt strategies to self-manage pain (54.5% at baseline vs 79.5% at follow-up, P=.007) and effectively manage stress (50% vs 88.6%, P<.001). While there was movement to readiness to adopt healthy sleep habits (25% vs 38.6%), the change was not significant. There were significant improvements in ratings of pain: “How would you rate your pain right now?” (partial η2=.205, P=.002) and “How would you rate your usual pain in the last week?” (partial η2=.378, P<.001). Conclusions: Findings provide encouraging evidence of the acceptability and effectiveness of incorporating principles of gamification into a theoretically grounded intervention for veterans at all levels of readiness for self-managing chronic pain.