Group Of Pain Patients Research Articles

Investigational Pregabalin Effect on Sleep in Patients with Neuropathic Pain and Sleep Maintenance Disturbance: A Multicentric Study

Objective: Our goal is to research how Pregabalin affects sleep maintenance in a group of neuropathic pain patients. Method and Material: A cross-sectional study including a sample of 600 patients was carried out. Patients with a neuropathic pain diagnosis were selected from three hospitals in Gandhinagar. After a medical professional diagnosed the patients with neuropathic pain, they were given a detailed description of the study's approach and asked for their informed consent. Subjects who are open to participating in the study and meet the inclusion and exclusion requirements. The demographic baseline evaluation and PSQI score were completed during Visit-01. After Visit-01, patients began receiving Pregabalin. After approximately 30 days from the date of enrolment, the patient was being monitored. The PSQI score was evaluated 30 days later. The Independent Ethics Committee (IEC) approved the PSQI Questioner and Informed Consent form after reviewing them. SPSS was used to statistically analyze the data (p < 0.05). Results: To evaluate variations in the distribution of "sleep disturbances vs. Sleep maintenance" (PSQI), we looked at the PSQI by time point. By using two-tailed paired t-tests, PSQI were compared for baseline and intervention conditions. Pregabalin treatment pre- and post-treatment were shown to differ significantly. Discussion: Sleep disturbances are prevalent characteristics of neuropathic pain that are well-known and well-documented. Patients with Neuropathic Pain had statistically significant improvements in sleep maintenance in the current investigation. Conclusion: The data presented here show that Pregabalin improves sleep quality in patients being treated for neuropathic pain

Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes.

Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

Interscalene Block Versus Periarticular Liposomal Bupivacaine for Pain Control Following Reverse Shoulder Arthroplasty: A Randomized Trial.

Interscalene nerve blocks and local anesthetic infiltration are two methods commonly used in multimodal analgesia regimens for shoulder arthroplasty. Liposomal bupivacaine is a novel anesthetic that can be detected more than 24 hours following local administration. Studies comparing liposomal bupivacaine with conventional analgesic methods have found mixed results regarding pain and narcotic consumption, and there is little information available regarding patient satisfaction and the role of psychosocial variables. This is a randomized study of 76 adult patients undergoing reverse shoulder arthroplasty who were assigned to receive a preoperative interscalene nerve block with ropivacaine (BLOCK=38) or an intra-operative periarticular injection of liposomal bupivacaine (LOCAL=38). The primary outcomes were narcotic consumption (MEq, morphine equivalents), visual analog scale (VAS) pain scores, and satisfaction (0-10). The secondary outcomes were the effect of patient group preference (BLOCK vs LOCAL) and psychosocial variables (Pain Catastrophizing Scale, Brief Resilience Scale) on satisfaction. Length of stay, pain related phone calls, pain related readmissions, and the number of narcotic refills were tracked from the day of surgery through the first postoperative appointment, which was routinely 7-14 days following surgery. Intraoperative and day 0 narcotic consumption was lower in the BLOCK group by 17.3 and 21.6 MEq (p < 0.001, p = 0.035) with no differences on day 1 or 2. There was no difference in VAS pain scores, length of stay, pain related phone calls, pain related readmissions, or the number of narcotic refills. Patient satisfaction was higher in the BLOCK group [8.3 vs. 6.8, p = 0.017]. Pain catastrophizing, resilience, and patient group preference did not have any significant relationship with patient satisfaction. Patients undergoing reverse shoulder arthroplasty have higher satisfaction with a conventional interscalene block compared to a periarticular injection of liposomal bupivacaine. There were no clinically important differences in narcotic consumption, VAS pain scores, length of stay, pain related phone calls, pain related readmissions, or the number of narcotic refills. The Pain Catastrophizing Scale, Brief Resilience Scale, and patient preferences did not have any relationship with patient satisfaction.

Behavioral modeling and neuroimaging of impaired risky decision making in patients with chronic musculoskeletal pain.

Performance during risky decision making is one of the essential cognitive functions that is impaired in several psychiatric disorders including addiction. However, the cognitive mechanism and neural correlates underlying risky decision making in chronic pain patients are unclear. To our knowledge, this study is among the first to construct computational models to detect the underlying cognitive process of chronic pain patients during risky decision making. This study aimed at inspecting the significantly abnormal risky decision-making patterns of chronic pain patients and its neuro-cognitive correlates. In this case-control study, 19 chronic pain patients and 32 healthy controls (HCs) were included to measure the risky decision making in a balloon analogue risk task (BART). Optical neuroimaging using functional near-infrared spectroscopy, together with computational modeling, was carried out to systematically characterize the specific impairments based on BART. Computational modeling findings on behavioral performance demonstrated that the chronic pain patient group exhibited significant deficits in learning during BART (), tending to make decisions more randomly without deliberation (). In addition, significant brain deactivation alternation in the prefrontal cortex (PFC) during the task was detected for the patient group compared with that from the control group (). Long-term aberrant pain responses significantly disrupted the PFC function and behavioral performance in chronic pain patients. The joint behavioral modeling and neuroimaging techniques open a new avenue for fully understanding the cognitive impairment and brain dysfunction of risky decision making associated with chronic pain.

Oswestry Disability Index Scores and the Relationship to Age, Gender and Diagnosis in a Cohort of Patients with Low Back Pain

Background: The Oswestry Disability Index (ODI) is a commonly used patient reported outcome measure for measuring disability and Quality of Life (QOL) impairment in adult patients in both clinical and research practice. Whilst excellent reliability has been demonstrated the effect of variables such as gender and age on ODI scores appear less well reported. Objective: This study explores the relationship between total ODI scores and factors such as age, gender and diagnosis in a group of low back pain patients. Methods: All patients attending a Spinal Assessment Clinic (SAC) completed the ODI questionnaire at their initial appointment. Data was also collected on age, gender and provisional diagnosis. Results: ODI summary scores were available for 573 patients, with non-specific pain (n=444, 77%), lumbar radiculopathy (n=87, 15%) and spinal claudication (n=42, 7%). Only gender was related to ODI score, with females reporting higher ODI scores across all diagnostic categories, although the average difference between male and female scores failed to reach the Minimally Clinically Important Difference in all categories. Conclusions: A patient’s self-reported levels of disability, as measured by the ODI are influenced by their gender more than by their diagnosis or age

RNA profiling of human dorsal root ganglia reveals sex differences in mechanisms promoting neuropathic pain.

Neuropathic pain is a leading cause of high-impact pain, is often disabling and is poorly managed by current therapeutics. Here we focused on a unique group of neuropathic pain patients undergoing thoracic vertebrectomy where the dorsal root ganglia is removed as part of the surgery allowing for molecular characterization and identification of mechanistic drivers of neuropathic pain independently of preclinical models. Our goal was to quantify whole transcriptome RNA abundances using RNA-seq in pain-associated human dorsal root ganglia from these patients, allowing comprehensive identification of molecular changes in these samples by contrasting them with non-pain-associated dorsal root ganglia. We sequenced 70 human dorsal root ganglia, and among these 50 met inclusion criteria for sufficient neuronal mRNA signal for downstream analysis. Our expression analysis revealed profound sex differences in differentially expressed genes including increase of IL1B, TNF, CXCL14 and OSM in male and CCL1, CCL21, PENK and TLR3 in female dorsal root ganglia associated with neuropathic pain. Coexpression modules revealed enrichment in members of JUN-FOS signalling in males and centromere protein coding genes in females. Neuro-immune signalling pathways revealed distinct cytokine signalling pathways associated with neuropathic pain in males (OSM, LIF, SOCS1) and females (CCL1, CCL19, CCL21). We validated cellular expression profiles of a subset of these findings using RNAscope in situ hybridization. Our findings give direct support for sex differences in underlying mechanisms of neuropathic pain in patient populations.

Profiles of Resilience and Risk in Chronic Pain: Loneliness, Mindfulness, and Optimism Coming Out of the Pandemic

Individuals experience variable degrees of severity and interference from chronic pain. While clinical diagnosis and pain symptomology may importantly inform treatment options, person-level characteristics may also impact treatment efficacy. The biopsychosocial model of pain includes several pain-modulatory factors which may inform meaningful categorization, or clustering, of individuals with chronic pain, and help predict pain outcomes. In this observational, longitudinal study conducted approximately shortly after the onset of social distancing, patients with chronic pain (N=94) completed validated assessments of known psychosocial (depression, stress, sleep, catastrophizing) pain modulators and pain intensity, which were used to empirically cluster patients into 3 groups using a two-step hierarchical approach. Subsequently, at 1 year later, degree of pain interference, loneliness, social support, mindfulness, and optimism were compared between these 3 groups using ANOVAs. Participants clustered empirically into three groups: 1) Global Elevation Symptoms (GES), characterized by high psychological distress and moderate pain intensity; 2) Pain Intensity Predominant (PIP), characterized by high pain intensity, but average psychological distress; and 3) Less Elevated Symptoms (LES), characterized by low pain intensity and psychological distress. At the 1-year follow-up, patients in the GES cluster reported significantly greater pain interference than the other two clusters, as well as greater feelings of loneliness and lower mindfulness and optimism compared to the LES cluster. This study supports prior research suggesting that psychosocial-based clustering of patients can be used to identify distinct groups of chronic pain patients. In particular, patients identified as belonging to the GES cluster (high psychological distress, high pain intensity early after onset of social distancing) were at greater risk of suffering from pain a year later, as well as loneliness and less mindfulness and optimism. Patient clustering techniques may help identify high risk patients and suggest behavioral interventions to improve pain by addressing psychosocial modulators of pain. Grant support from 5R35GM128691-02.

Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study

BackgroundA significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT).MethodsThis is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4–6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared.ResultsWe included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score’s (AUC 0.74 versus 0.71, p = 0.0082).ConclusionsUsing the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.

Internal lumbar disc derangement with instability catch from monosegmental discopathy. The forgotten mechanical and kinetic surgical back pain syndrome

Study designThis is a retrospective cohort experience reported with concurrent survey PROM outcomes. ObjectiveTo describe the results of open PLIF reconstruction for a select group of mechanical back pain patients who have mono- or bi-segmental discopathy on MRI imaging, a clinical history of repeated severe and disabling acute mechanical back pain symptoms, and the irregular lumbar motion pattern in returning erect from the flexed position known as the “instability catch”. Summary of background dataThe literature of fusion surgery for back pain relief in “mechanical” back pain reveals inconsistent results and in the majority presents only a vague description of these syndromes. Internal Lumbar Disc Degeneration with Instability catch “ILDDIC” may be one subset of these patients who are uniquely benefitted from spine stabilization. MethodsThe senior author (DAB) in midsummer 2015 began to offer smaller fusion procedures to selected patients on an overnight-stay basis using a standard perioperative care protocol. For practice audit, in December 2020 a mailed survey questionnaire requesting VAS pain scores and SF-36 physical function scores was sent out to all 111 patients who had been treated this way, which group included 30 cases of ILDDIC. We report here on the success of open PLIF reconstruction in achieving back pain relief for these patients. ResultsSome 24 of 30 patients returned the mailed survey questionnaire, and the remaining six could not be reached. All 24 responders reported significant relief of back pain and improved physical function, at a mean of 30 months from surgery. Review of the available clinical records (LFU < 1 year) from the six nonresponders also recorded positive early benefit. ConclusionThe diagnosis of ILDDIC requires both imaging and clinical correlates and may define a subgroup of the mechanical back pain population uniquely suited to achieve pain relief through lumbar fusion.

Unsupervised Machine Learning Approaches Reveal Distinct Phenotypes of Perceived Bladder Pain: A Pilot Study.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as an unpleasant sensation perceived to be related to the bladder with associated urinary symptoms. Due to difficulties discriminating pelvic visceral sensation, IC/BPS likely represents multiple phenotypes with different etiologies that present with overlapping symptomatic manifestations, which complicates clinical management. We hypothesized that unique bladder pain phenotypes or “symptomatic clusters” would be identifiable using machine learning analysis (unsupervised clustering) of validated patient-reported urinary and pain measures. Patients (n = 145) with pelvic pain/discomfort perceived to originate in the bladder and lower urinary tract symptoms answered validated questionnaires [OAB Questionnaire (OAB-q), O'Leary-Sant Indices (ICSI/ICPI), female Genitourinary Pain Index (fGUPI), and Pelvic Floor Disability Index (PFDI)]. In comparison to asymptomatic controls (n = 69), machine learning revealed three bladder pain phenotypes with unique, salient features. The first group chiefly describes urinary frequency and pain with the voiding cycle, in which bladder filling causes pain relieved by bladder emptying. The second group has fluctuating pelvic discomfort and straining to void, urinary frequency and urgency without incontinence, and a sensation of incomplete emptying without urinary retention. Pain in the third group was not associated with voiding, instead being more constant and focused on the urethra and vagina. While not utilized as a feature for clustering, subjects in the second and third groups were significantly younger than subjects in the first group and controls without pain. These phenotypes defined more homogeneous patient subgroups which responded to different therapies on chart review. Current approaches to the management of heterogenous populations of bladder pain patients are often ineffective, discouraging both patients and providers. The granularity of individual phenotypes provided by unsupervised clustering approaches can be exploited to help objectively define more homogeneous patient subgroups. Better differentiation of unique phenotypes within the larger group of pelvic pain patients is needed to move toward improvements in care and a better understanding of the etiologies of these painful symptoms.

The importance of professional based questionnaire in the dog’s acute and chronic pain evaluation

The measurement of pain levels is made differently depending if acute or chronic pain is diagnosed, objective (e.g. cortisol, prolactin, serotonin, catecholamines, or the cardiac frequency and arterial pressure evaluation) or subjective methods being imagined. All subjective methods are including questionnaires and specific additional methods. The aim was the verifying the effectiveness of drug and physiotherapy combinations by using an owner based questionnaire for the chronic patients and a veterinary professional based questionnaire for the acute pain patient group. In this study a total of 20 dogs with observable pain were selected and two groups (n = 10 / group), constituted: G1 - chronic pain, and G2 - acute pain. The treatment of dogs with acute signs of pain was made oral or injectable with NSAIDs administration and for dogs with signs of chronic pain, physiotherapy treatment and drug therapy was administered. The owners of the dogs with chronic pain received the HCPI questionnaire in order to evaluate their dog’s pain level subjectively. For the dogs with acute pain the veterinarian filled out the short form of Glasgow Composite Measure Pain Scale (CMPS-SF). After initiating a Paired t-test in Excel 2010 with the scores obtained with HCPI and CMPS-SF, there was observed a significant reduction of pain after associated drug administration and physiotherapy and no significant evidence of acute pain after drug therapy. The used physiotherapy and drug combinations delivered a significant reduction of chronic pain, both clinically and visually mirrored in score reduction after treatments. The HCPI questionnaire could be considered a valuable tool for evaluating chronic pain in patients in the clinic environment. The CMPS-SF has also proven to be a very useful questionnaire in diagnose of acute pain and evaluation of the effectiveness of drug therapy used.

Pain experience and social support of endometriosis patients during the COVID-19 pandemic in Germany - results of a web-based cross-sectional survey.

BackgroundEndometriosis is a chronic pain condition in premenopausal women. Pain is mainly characterized by pain intensity and may induce disability in all areas of daily life. Nevertheless, pain is influenced by emotional and social factors as well. Social distancing measures or quarantine, as reaction to rapidly rising infections with the COVID-19 virus due to the SARS-CoV-2 pandemic, were implemented across Europe to prevent the spread of the virus and social distancing measures were imposed by the German government by beginning of March 2020 with initiation of the lockdown by the end of March 2020. The objective of this study was to assess, how social distancing measures during the lockdown impacted the various aspects of pain perception in a group of chronic pain patients, such as women suffering from endometriosis.MethodsBetween 6th to 27th April 2020, an online questionnaire was activated at internet platforms of endometriosis patients support groups. Participants were asked retrospectively at one time point about their visual pain intensity measured by the visual analogue scale (VAS) and pain disability via pain disability index (PDI) prior to initiation of social distancing measures in Germany (VASP, PDIP), as well as the pain intensity and pain disability since implementation of social distancing measures (VASI, PDII). Differences of VAS and PDI previous and after implementation of social distancing measures were displayed as ΔVAS and ΔPDI. Pain experience and social support were assessed by a 5-point Likert scale.Results285 participants completed at least one question regarding pain intensity, disability, pain experience or social support. Dysmenorrhea, the symptom with the highest level of pain assessed by VAS, decreased significantly during the SARS-CoV-2 pandemic compared to the time period prior to social isolation (45.30% respondents experienced improvemenet vs 40.50% who experienced worsening; p = 0.025). The global physical impairment improved significantly (improvement of pain induced disability in 48.20% vs 40.90% with worsening of pain symptoms; p = 0.032) after the implementation of social distancing measures. Pain experience was negatively affected by social distancing measures, since frequency of pain awareness increased in 43.6% (p<0.001) of participants and 30.0% (p<0.001) more participants experienced pain as a threat. Verbalization of pain experience was reduced in 36.6% (p = 0.001) of participants and 14.6% (p = 0.91), 21.9% (p<0.001) and 31.5% (p<0.001) of participants reported less social support from their partner, family and friends.ConclusionsPhysical pain and disability on one hand and emotional and social pain experience on the other were differentially affected by the emerged emotional, social and health care constraints related to the SARS-CoV-2 pandemic.

Refinement and validation of a tool for stratifying patients with musculoskeletal pain.

Patients with musculoskeletal pain in different body sites share common prognostic factors. Using prognosis to stratify and treatment match can be clinically and cost-effective. We aimed to refine and validate the Keele STarT MSK Tool for prognostic stratification of musculoskeletal pain patients. Tool refinement and validity was tested in a prospective cohort study, and external validity examined in a pilot cluster randomized controlled trial (RCT). Study population comprised 2,414 adults visiting U.K. primary care with back, neck, knee, shoulder or multisite pain returning postal questionnaires (cohort: 1,890 [40% response]; trial: 524). Cohort baseline questionnaires included a draft tool plus refinement items. Trial baseline questionnaires included the Keele STarT MSK Tool. Physical health (SF-36 Physical Component Score [PCS]) and pain intensity were assessed at 2- and 6-month cohort follow-up; pain intensity was measured at 6-month trial follow-up. The tool was refined by replacing (3), adding (3) and removing (2) items, resulting in a 10-item tool. Model fit (R2 ) was 0.422 and 0.430 and discrimination (c statistic) 0.839 and 0.822 for predicting 6-month cohort PCS and pain (respectively). The tool classified 24.9% of cohort participants at low, 41.7% medium and 33.4% high risk, clearly discriminating between subgroups. The tool demonstrated model fit of 0.224 and discrimination 0.73 in trial participants. Multiple imputation confirmed robustness of findings. The Keele STarT MSK Tool demonstrates good validity and acceptable predictive performance and clearly identifies groups of musculoskeletal pain patients with different characteristics and prognosis. Using prognostic information for stratification and treatment matching may be clinically/cost-effective. The paper presents the first musculoskeletal pain prognostic stratification tool specifically for use among all primary care patients with the five most common musculoskeletal pain presentations (back, neck, knee, shoulder or multisite pain). The Keele STarT MSK Tool identifies groups of musculoskeletal pain patients with clearly different characteristics and prognosis. Using this tool for stratification and treatment matching may be clinically and cost-effective.

The inhibitory effect of conditioned pain modulation on temporal summation in low-back pain patients.

The literature on conditioned pain modulation (CPM) is inconclusive in relation to low-back pain and it is unclear how CPM affects temporal summation as a proxy of central pain integration. The aim of this study was to examine whether the CPM effect would be different on pain induced by temporal summation than single stimuli in a group of low back pain patients. A total of 149 low-back pain patients were included. CPM was examined using single, repeated and temporal summation (repeated-single difference) of mechanical pressure pain as test stimuli at an individualized, fixed supra-pain-threshold force, before and after 2min of cold pressor test (0-2 degrees Celsius). Participants werecategorized as CPM responders or non-responders according to three different criteria: simple (any pain inhibition), strict (pain inhibition of more than 10VAS) and reversed (pain inhibition or facilitation of less than 10VAS). Clinical data on back pain was collected for correlation and descriptive purposes. Significant modulation was observed for all three test stimuli. Effects sizes were comparable in relative terms, but repeated pressure pain modulation was greater in absolute terms. No correlations to clinical data were observed, for any measure. The current data suggests that repeated pressure pain may be better suited as the CPM test stimuli, than single pressure pain and temporal summation of pressure pain, as the CPM effect in absolute terms was greater. Employing temporal summation as the test stimulus in a CPM paradigm may be more sensitive than a single test stimulus.

The Diagnostic Accuracy of Cardiac Enzymes-Lipid Profile Ratio for Diagnosing Coronary Heart Disease in Chest Pain Patients

Background: Lipid abnormalities increase Coronary Heart Disease (CHD) risk. Our developed indexes 1,2 were reported in scientific Journals. Here, we verified and evaluated the cardiac enzymes-lipid profile ratio's diagnostic value for diagnosing CHD patients. Methods: Lipid profiles and cardiac enzymes were estimated in all chest pain patients. The area under the receiver-operating characteristic curve (AUC) was used to evaluate the markers' diagnostic accuracy. Results: There were varieties of significant differences (P &lt; 0.01- P &lt; 0.0001) of Creatine Kinase MB (CK-MB) - lipid profile ratio and Troponin I-lipid profile ratio within the groups of chest pain patients. For discriminating between Non-Coronary Chest Pain (NCCP) and Stable Angina (SA) groups, the AUCs were the greatest for CK-MB- High-density Lipoprotein (HDL) ratio (0.62) and for Troponin I-HDL (0.62). Moreover, for discriminating between NCCP and Unstable Angina (UA) groups, the AUC was the greatest for CK-MB-HDL ratio (0.97). Also, for discriminating between NCCP and Acute Myocardial Infarction (AMI) groups, the AUC was the greatest for index 2 (0.99). Similarly, for discriminating between SA and UA groups, the AUC was the greatest for CK-MB-HDL ratio (0.90). For discriminating between SA and AMI groups, the AUC was the greatest for index 2 (0.97). Finally, for discriminating between UA and AMI groups, the AUC was the greatest for index 2 (0.78). Conclusion: Independent CK-MB-HDL ratio can be used as a good and simple index for diagnosing CHD in chest pain patients and discriminating between the different groups of these patients

Recovering from nonspecific low back pain despair: Ultrasound-guided intervention in iliolumbar syndrome.

Background:Iliolumbar syndrome is a frequent cause of chronic nonspecific low back pain. The cornerstone of its treatment lies upon the specific diagnosis of the iliolumbar syndrome. The ultrasound guided interventions have the potential for the specific diagnosis and treatment of the iliolumbar syndrome.Objective:To assess the role of ultrasound-guided intervention for the diagnosis and treatment of the iliolumbar syndrome.Materials and Methods:The study comprised of fifty-seven patients of nonspecific low back pain with the clinically suspected iliolumbar syndrome. Two-staged ultrasound-guided interventions were performed: Primary diagnostic and secondary therapeutic interventions. Favorable response after the injection of local anesthetic agent in iliolumbar ligament (defined as VAS score to ≥3) was classified as confirmed Ilio-lumbar syndrome. Clinico radiological efficacy after platelet-rich plasma (PRP) injection in confirmed iliolumbar syndrome patients was done.Results:Out of 57 patients, 45 (78.95%) were diagnosed with confirmed Iliolumbar syndrome after primary diagnostic intervention. The mean value of VAS at presentation was 8.02 ± 0.72 which was decreased to 3.16 ± 1.63; P < 0.0001. All 45 patients underwent PRP injection in iliolumbar ligament and 42 patients (93.33%) showed reduction in mean VAS score from 8 ± 0.67 (at presentation) to 0.89 ± 1.23 after 6 weeks follow up; P < 0.0001. Iliolumbar ligament thickness was decreased from the day of presentation (2.66 ± 0.22) to 6 weeks after therapeutic intervention (0.91 ± 0.42); P < 0.0001.Conclusion:The ultrasound guided diagnostic and therapeutic intervention were found to result in a specific diagnosis and remarkable recovery in the iliolumbar syndrome group of nonspecific low back pain patients.

Pain therapy care in Germany-Do patients receiving day care differ from those receiving outpatient or inpatient care at the start of treatment? : Afurther evaluation based on the KEDOQ-pain data set

The direct comparison of day care pain patients with patients from other treatment sectors with respect to sociodemographic, pain-related and psychological characteristics has not yet been the subject of systematic analyses. The project core documentation and quality assurance in pain therapy (KEDOQ-pain) of the German Pain Society (Deutsche Schmerzgesellschaft e.V.) makes this comparison possible. This second analysis of the available KEDOQ data was intended to show how patients receiving day care treatment can be characterized using the core data set and whether and to what extent they differ from patients receiving outpatient or inpatient treatment. This is acontinuation of the first publication, which showed remarkably small differences between outpatients and inpatients but did not include day care patients.The KEDOQ-pain data from 25centers with atotal of 8953 patients were evaluated. Patients had completed the German pain questionnaire (DSF) between January 2012 and March 2017 and received day care (n = 1264), outpatient (n = 4082) or inpatient (n = 3607) pain therapy treatment. Sociodemographic, pain-related and psychometric data of the DSF reported by patients were evaluated as well as physician information on the pain chronification stage and pain localization. The evaluation was descriptive and compared groups using univariate and multivariate procedures.Day care treated patients were significantly younger, had ahigher level of education, were more frequently employed, reported higher impairment values and showed ahigher severity index according to von Korff than inpatients and outpatients treated for pain. In addition, they described ashorter pain duration as well as worse habitual well-being (Marburg questionnaire on habitual well-being, MFHW). These predictors explained roughly half of the variance in the prediction of the day care treatment setting. The comparison of outpatients and inpatients showed significant group differences for some variables; however, the effects were very small.The evaluations suggest that pain therapy day care facilities treat aspecial group of pain patients that significantly differ from patients in other treatment sectors. Cautious conclusions are drawn regarding the systematic allocation of patients to care appropriate to their treatment needs.

The Influence of Chronic Pain on Number Sense and Numeric Rating Scale: A prospective Cohort Study.

BackgroundSeveral studies have demonstrated an association between chronic pain and impairment of cognitive capabilities. Since the number sense is one of the cognitive ability involved in the evaluation of pain intensity using some pain measurement tools, impairment of number sense may impact pain assessment. Therefore, the validity of number-based pain assessment tools should be re-evaluated.ObjectivesThis study aimed to determine whether number sense is altered in chronic and acute pain patients compared to healthy subjects.MethodsOverall, 150 participants were recruited and divided into the three groups of controls, chronic and acute pain patients. Pain intensity was evaluated using numeric and verbal rating scales as pain assessment tools. Number sense was assessed using number naming, number marking, and line bisection tasks. Deviation from correct answers was measured for each task.ResultsPatients with chronic pain (migraine headache) had higher pain intensity scores than acute pain subjects. Chronic pain patients showed significant deviation from the expected responses compared to controls in the line bisection task.ConclusionsChronic pain patients may have impaired number sense and may differently use number-based pain assessment tools in comparison with healthy individuals.

The influence of nociceptive and neuropathic pain states on the processing of acute electrical nociceptive stimulation: A dynamic causal modeling study

IntroductionDespite the worldwide increase in prevalence of chronic pain and the subsequent scientific interest, researchers studying the brain and brain mechanisms in pain patients have not yet clearly identified the exact underlying mechanisms. Quantifying the neuronal interactions in electrophysiological data could help us gain insight into the complexity of chronic pain. Therefore, the aim of this study is to examine how different underlying pain states affect the processing of nociceptive information. MethodsTwenty healthy participants, 20 patients with non-neuropathic low back-related leg pain and 20 patients with neuropathic failed back surgery syndrome received nociceptive electrical stimulation at the right sural nerve with simultaneous electroencephalographic recordings. Dynamic Causal Modeling (DCM) was used to infer hidden neuronal states within a Bayesian framework. ResultsPain intensity ratings and stimulus intensity of the nociceptive stimuli did not differ between groups. Compared to healthy participants, both patient groups had the same winning DCM model, with an additional forward and backward connection between the somatosensory cortex and right dorsolateral prefrontal cortex. DiscussionThe additional neuronal connection with the prefrontal cortex as seen in both pain patient groups could be a reflection of the higher attention towards pain in pain patients and might be explained by the higher levels of pain catastrophizing in these patients. ConclusionIn contrast to the similar pain intensity ratings of an acute nociceptive electrical stimulus between pain patients and healthy participants, the brain is processing these stimuli in a different way.

Online teletherapy for chronic pain: A systematic review

Objective A systematic review designed to evaluate the benefits of remote group pain management for persons with chronic pain was performed. Methods PubMed, EMBASE and PsychINFO databases were searched in April 2019. Eligible studies evaluated teletherapy for chronic pain based on set inclusion and exclusion criteria. Two reviewers independently screened eligible studies, assessed risk of bias and extracted data. Each study design was rated and study quality was assessed using an 11-point scale of methodological quality. Results Comprehensive searches identified 12 studies that met all inclusion/exclusion criteria and each study was assessed for type of technology, study design, outcome measures, study findings and limitations. No published studies investigated synchronous teletherapy for groups of chronic pain patients. Methods of assessment varied considerably across studies. Strength of evidence was moderate and many of the selected studies had issues with treatment compliance/adherence and selection bias. Teletherapy strategies for persons with chronic pain were shown to improve pain, mood, disability and catastrophising, however half of the studies selected did not meet the criteria for acceptable standards for internal validity. Those trials with limited therapist involvement appeared to be less beneficial and tended to report lower adherence than those which had higher levels of therapist guidance or peer support. Conclusions Preliminary findings suggest that teletherapy and remote online cognitive behavioural therapy strategies can be effective in improving quality of life among persons with chronic pain, although the overall quality of evidence is moderate. Controlled trials are needed to assess live remote teletherapy for chronic pain.