Higher Pain Intensity Research Articles

Long-term postoperative regional analgesia of the lower third of the face in patients with tumors of the oral cavity

Pain has a certain number of physical, psychological and social consequences. Pain is of particular importance in the postoperative period for patients with tumors of the oral cavity and of the oropharynx. The effectiveness of analgesia in the postoperative period is a serious problem in maxillofacial surgery. Postoperative pain is not always removable, sometimes it becomes chronic. Pronounced pain syndrome in the postoperative period is experienced by 40 to 75% of patients, but 50% of patients experience pain of medium and high intensity. The aim of this study was a comparative assessment of the effectiveness of a new alternative method of a long-term postoperative regional analgesia and the use of non-narcotic analgesics in patients with tumors of the oral cavity and oropharynx in the postoperative period. The study was conducted in 48 patients (38 men, 10 women, average age 58,05±12,31 years) with tumors of the oral cavity and oropharynx. Patients were divided into two groups depending on the method of postoperative analgesia. In the main group (22 patients) pain was suppressed by a long-term postoperative regional analgesia. In the control group (26 patients) analgesia was performed with non-narcotic analgesics. To control the effectiveness of analgesia, a visual analog scale was used, the duration of analgesia and the manifestation of dysphagia on the day 1, 3 and 10 after surgical intervention as well as similar effects were assessed. On the day 10 of using a long-term postoperative regional analgesia, a positive trend towards a reduction in pain syndrome was observed (2.0±0.63), in contrast to drugs of general action (p<0.05). Over the course of a long-term postoperative regional analgesia it was noted that analgesic effect increases from blockade to blockade. In 80% of patients of the main group, stage II-IVa the act of swallowing was nearly restored, only in 2 patients 2 degree of dysphagia was observed (p<0.05). The advantage of the proposed method in the adequacy and duration of analgesia was established (p<0.05), as well as a lower frequency of side effects – 9.1% and 23.3%, and restoration of act of swallowing (p<0.05). The technique of long-term postoperative regional analgesia allows reducing the invasiveness of the manipulation.

DISRUPTING THE NEGATIVE AFFECT AND PAIN CONNECTION IN OLDER ADULTS: THE ROLE OF SOCIAL INTERACTIONS AND ENJOYMENT

Abstract Although it is well-established that negative affect is bi-directionally linked with pain, little research has examined their relationship in daily life among older adults. Even less is known about what social factors may help attenuate the affect-pain connection. We examined whether social interactions and reported enjoyment in daily life were associated with an attenuated link between negative affect and two important pain outcomes (pain intensity and perceived interference from pain). This was examined among a socioeconomically and racially diverse sample of 317 older adults aged 70+ (Mage = 77.45 ; 67% women; 40% Black; 13% Hispanic) who were recruited from the Bronx, NY as part of the Einstein Aging Study and who completed ecological momentary assessments five times daily for 14 days. Three-level multilevel models were estimated, controlling for mild cognitive impairment (MCI) status, gender, age, education, body mass index, and average level positive affect for models that did not include enjoyment. In given moments, higher negative affect and lower enjoyment were associated with higher pain intensity and pain interference (ps<.05). Moment-level negative affect and enjoyment significantly interacted to predict both higher pain intensity (p=.005) and pain interference (p<.0001), with patterns suggesting a buffering effect of enjoyment. In addition, a three-way interaction emerged such that during moments when no interactions occurred and negative affect was lower than a person’s average, there was a buffering effect of momentary enjoyment on pain intensity. Findings extend understanding of the affect-pain connection and the potential mitigating impact of social interactions and moments of enjoyment.

PAIN INTENSITY AND INTERFERENCE PREDICT STAGE OF ENGAGEMENT IN SELF-MANAGEMENT IN OLDER AFRICAN AMERICAN ADULTS

Abstract Osteoarthritis in African American older adults often causes a disproportionate burden of severe chronic joint pain that interferes with physical and emotional/cognitive activities. One tool commonly used in clinical research studies to evaluate patterns in pain intensity and pain interference is the Brief Pain Inventory-SF (BPI-SF). Confirmatory factor analysis validated a three-factor structure of the BPI-SF comprising pain intensity, activity-related pain interference, and affective pain interference. However, what is unclear and novel, is whether these three factors predict stage of readiness to engage in osteoarthritis self-management. Stage of readiness to engage (pre-contemplation, preparation, action) were assessed for seven recommended osteoarthritis self-management strategies: land-based exercise, water exercise, strength training/stretching, assistive devices, warm/cool compresses, medications, and self-management education. Using secondary data from 110 African American men and women (Mean Age 68.4, SD= 12.4), we performed ANOVA and ordinal logistic regression in SPSS. Pain intensity, activity-related pain interference, and affective pain interference were not significantly different between stages of engagement in pain self-management strategies except for medication use and assistive devices (p<.05). After controlling for age and employment, higher pain intensity was significantly associated with 27% reduction in the odds of being in preparation phase for water exercise, and higher levels of activity interference was associated with a 42% increase in the odds of being in the action phase for assistive devices. These results help us understand the relationship between behaviors and pain, particularly the impact of pain intensity and interference with physical activities on which strategies African Americans select to manage pain.

Tonic cuff pressure pain sensitivity in chronic pain patients and its relation to self-reported physical activity.

Physical inactivity is a global health concern and a significant problem among chronic pain patients. They often experience pain flare-ups when they try to increase their physical activity level. Most research on the relationship between pain sensitivity and physical activity has been on healthy participants. Data on chronic pain patients are lacking. Using cuff pressure algometry, this study investigated tonic cuff pressure pain sensitivity and its associations to self-reported physical activity and other patient-reported outcomes in chronic pain patients. Chronic pain patients (n=78) were compared to healthy controls (n=98). Multivariate data analysis was used to investigate the associations between tonic cuff pressure pain sensitivity, physical activity, and other patient-reported outcome measures. The three most important variables for group discrimination were perceived health status (EQVAS: p(corr)=-0.85, i.e., lower in patients), depression (HADS-D: p(corr)=0.81, i.e., higher in patients), and the tonic cuff pressure pain sensitivity variable maximum pain intensity (VAS-peak-arm: p(corr)=0.75, i.e., higher in patients). In patients, the most important predictors for high VAS-peak-arm were female sex (p(corr)=-0.75), higher number of painful regions (p(corr)=0.72), higher pain intensity (p(corr)=0.55), followed by lower level of self-reported physical activity (p(corr)=-0.39). VAS-peak-arm in patients correlated negatively with self-reported physical activity (rho=-0.28, p=0.018). Physical activity may be the most important patient-changeable variable correlating to pain sensitivity. This study highlights the importance of more research to further understand how increased physical activity may decrease pain sensitivity in chronic pain patients.

Lateral Lumbar Spinal Stenosis: Associations With the Oswestry Disability Index, Visual Analogue Scale, and Magnetic Resonance Imaging.

Introduction Degenerative lumbar spinal stenosis is a communal problem in the sixth decade of life involving L4/L5 and L5/S1 levels. Lateral spinal stenosis is often underestimated because of no established relationship between the clinical symptoms and MRI findings. We conducted a study to establish an association between the degree of anatomical lateral stenosis, posterior disc height, and disc degeneration from MRI with the daily disability and pain severity for lateral lumbar spinal stenosis. Methods This was a cross-sectional study involving 121 patients with distinct clinical symptoms of lateral lumbar spinal stenosis evaluated from February 2018 to December 2019. The clinical data were evaluated using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), while magnetic resonance imaging (MRI) was assessed qualitatively for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. Statistical analysis for the correlation between posterior disc height and ODI and VAS scores was evaluated using Pearson's correlation test via SPSS version 23.0 (IBM Inc., Armonk, New York), and the association between the extent of lateral stenosis and disc degeneration on MRI with ODI and VAS scores was determined by the Fisher Exact Test via STATA version 14.0 (StataCorp LLC, College Station, Texas). The association was considered statistically significant with a P-value of less than 0.05. Results The analysis of 121 patients showed the mean age of the patients was 58.7 ± 7.1 years old. The number of female patients was higher compared tomale patients, 52.9% and 47.1%, respectively. 97.5% of the patients were married or cohabiting, and 76.0% had an abnormal body mass index. The mean score of ODI and VAS was 62.2 ± 10.7% and 79.3 ± 8.6 respectively. 49.6% of the patient presented with a crippling disability with ODI assessment, while 59.5% presented with high pain intensity with VAS assessment. MRI assessment of anatomical grading lateral stenosis of L4/L5 level revealed that 45.5% of the patients had grade 2 lateral recess stenosis, 63.6% had grade 2 foraminal stenosis, and 44.6% had extraforaminal stenosis. L5/S1 level analysis showed that 43.0% had grade 2 lateral recess stenosis, 62.0% had grade 2 foraminal stenosis, and 29.8% had extraforaminal stenosis. 64.5% of patients had grade 4 disc degeneration of L4/L5 with mean posterior disc height of 7.0mm ±1.7mm while 59.5% had grade 4 disc degeneration of L5/S1 with mean posterior disc height of 6.3mm ±1.8mm. However, no statistically significant association between clinical symptoms and MRI findings was found. Conclusions There was no significant association between the clinical symptoms of pain and disability and the MRI findings for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. A comprehensive clinical evaluation remains essential for an accurate diagnosis, emphasizing the necessity of appropriately correlating MRI findings with their clinical significance.

Prevalence of Low Back Pain Among University Attendants in Tabuk City During 2023: A Cross-Sectional Study in Saudi Arabia.

College students are at a higher risk of suffering low back pain (LBP). Assessing the magnitude of the problem and the associated risk factors can help reduce the suffering and disability in future doctors. This study was conducted to investigate the prevalence and related factors of LBP among medical students in the University of Tabuk and emphasize the need for targeted interventions that could help alleviate the burden of LBP among the students and improve their quality of life. This cross-sectional study used an online well-structured, self-report questionnaire to collect the respondents' data. The questionnaire explored the participants' sociodemographic factors, lifestyle, and the severity of LBP-related disability using the modified Oswestry Low Back Pain Disability Questionnaire (Oswestry Disability Index (ODI)) score. The prevalence rate of LBP was 26.8%. The independent factors that significantly increased the probability of LBP included overweight/obesity (odds ratio (OR): 1.696, 95% confidence interval (CI): 1.086 to 2.648, p = 0.020) and stretching exercises (OR: 1.784, 95% CI: 1.104 to 2.883, p = 0.018). The independent predictors that significantly increased the severity of ODI included married marital status (p = 0.007), back surgery (p = 0.031), and higher pain intensity (p < 0.001). We found that the prevalence rate of LBP among our sample was around 26%. This rate is approximate to the rates reported in previous studies. Furthermore, the activities most affected by LBP were sitting, standing, and lifting. Future studies should explore other risk factors and attempt to determine the onset of pain. A longitudinal study design is recommended to identify the onset of developing LBP.

Nocturnal Autonomic and Vasoconstriction Parameters By Wearable Wrist Photoplethysmography Predict Intensity of Imminent Pain in Subjects with Sickle Cell Disease

Introduction: Sudden and unpredictable onset of pain is one of the biggest contributors to the morbidity of sickle cell disease (SCD), thought to occur due to obstruction of microvascular blood flow by rigid sickle-shaped red blood cells. Autonomic mediated vasoconstriction in the peripheral vasculature, with resulting decrease in tissue perfusion, is likely a triggering mechanism for the onset of vaso-occlusive pain, while the autonomic nervous system is also implicated in the pathogenesis of chronic neuropathic pain. Our analysis of 212 polysomnograms in SCD subjects showed that greater magnitude of nocturnal vasoconstriction (Mvasoc) is predictive of increased frequency of hospitalizations for vaso-occlusive pain crises (VOC) in the subsequent years (Chalacheva et al., Am J Hematol, 2020). In order to further develop this finding into a biomarker of more imminent pain, we monitored nocturnal photoplethysmography (PPG) at home with a wearable wristband device to measure vasoconstriction activity and heart rate variability, along with a daily electronic pain survey. Methods: 10 subjects with SCD were consented and underwent autonomic monitoring with a wristband device (Biostrap Inc) that uses an optical sensor to measure continuous PPG during sleep, with the raw PPG waveforms available from a cloud-based server. A unique biomarker (Mvasoc) was used to quantify the magnitude of vasoconstriction from the raw PPG signal, considering the frequency, magnitude, and duration of autonomic mediated spontaneous vasoconstrictions each night. Heart rate variability was derived from the pulse-to-pulse interval (PPI) of the PPG signal. Spectral indices of the PPI represent parasympathetic activity (high frequency power; HFP) and sympatho-vagal balance (Low to high Ratio; LHR = low frequency power(LFP)/HFP). Subjects concurrently documented daily pain incidence using an electronic text-based REDCap survey, with pain intensity measured on a scale of 1-10 if experiencing pain. Daily stress levels were also recorded on a scale of 1-10. Multivariate regression analysis was performed. Results: The subjects had a mean age of 25 years (range 14- 40 years) with an average hemoglobin of 8.8 g/dl . A total of 68 usable nocturnal PPG recordings were made (3-16 nights per subject). Therewere 25 incidents of pain on the day following autonomic monitoring with Biostrap, with the pain intensity ranging from 3-8. Multivariate analysis of nocturnal autonomic and vasoconstriction parameters revealed that a lower HFP ( p =0.0002) and a higher Mvasoc ( p=0.02) both preceded a higher intensity of pain the following day (Table 1). These results are consistent with a greater parasympathetic withdrawal and a higher magnitude of peripheral vasoconstriction predicting higher intensity of imminent pain. Age, gender, hemoglobin, stress levels and LHR were not predictive of pain the following day. Conclusion: Augmented nocturnal vasoconstriction and parasympathetic withdrawal noted prior to high intensity of pain imply that dysautonomia, with attendant changes in peripheral perfusion, has a significant role in pathogenesis of pain in SCD. Furthermore, autonomic vasoreactivity parameters were not significantly altered on the night after pain onset suggesting that the dysautonomia precedes pain. These results support the possibility of employing indices of nocturnal autonomic vasoreactivity as a predictive biomarker for imminent pain in SCD and provides a potential window for therapeutic intervention. This pilot study demonstrates the successful use of a wearable device PPG to remotely monitor nocturnal autonomic vasoreactivity and the ability to objectively quantify peripheral vasoconstriction responses. These findings will need to be applied in a larger cohort of SCD subjects with longer term monitoring for further validation and development of autonomic vasoreactivity as a predictive tool for pain in SCD.

FACTORS THAT INFLUENCE THE NEGATIVE RESULTS OF TREATMENT OF COMBATANTS' PAIN AFTER MINE-BLAST WOUNDS DURING THE WAR IN UKRAINE

Introduction: In 83.3% of cases, pain in combatants who sustained mine-blast injuries during the war in Ukraine becomes chronic. Chronic pain leads to a number of negative aspects that affect the quality of life of combatants, and when they return to military service after treatment for professions that require people to act under pressure, it increases the risk not only for them but also for their teammates and the mission. Therefore, the issue of pain chronicity in this category of patients requires further study, and the identification of factors that influence the frequency of chronicity can potentially improve the results of treatment of this category of patients.&#x0D; The aim: to identify factors that influence the negative results of pain treatment in combatants after mine-blast wounds during the war in Ukraine&#x0D; Materials and methods: We analyzed the treatment of 660 combatants with mine-blast wounds. Treatment outcomes were assessed using a visual analog scale (VAS). Groups were compared using the Mann-Whitney test and the chi-square test with a continuity correction. To analyze the association of the risk of a negative treatment outcome with the factor characteristics, we used the method of building univariate and multivariate logistic regression models. The quality of the models was assessed by the area under the ROC curve (AUC). The odds ratio was calculated to quantify the degree of influence of the factor attribute.&#x0D; Results: It was found that the factors of negative results of pain treatment in combatants with mine-blast wounds are: 1) method of pain treatment (p&lt;0.001), OR=0.06 (95% CI 0.04-0.09); 2) high intensity of pain according to VAS on admission (p&lt;0.001), OR=3.16 (95% CI 2.52-3.98); 3) anesthetic risk according to ASA (p=0.049) OR=0.67 (0.45-0. 99); 4) number of injured anatomical body parts (p=0.015), OR=1.17 (95% CI 1.03-1.32); 5) a combination of indicators: method of pain treatment, patient age and number of injured anatomical body parts AUC=0.82 (95% CI 0.79-0.85).&#x0D; Conclusions: Our study demonstrates that if combatants with mine-blast wounds use a method of pain treatment that does not provide reliable control over the intensity of pain, then during evacuation to a medical facility, such pain becomes high-intensity pain. In addition, the conditions of the injury (combat conditions) and the injury itself cause a significant anesthetic risk according to the ASA. Such patients are associated with a higher risk of chronic pain. In the future, in-depth studies are needed to demonstrate the effectiveness or benefits of combining pain management with regional anesthesia methods. High-quality pain control during the medical evacuation of wounded from the battlefield to a medical facility could potentially improve the treatment outcomes of these combatants and reduce the incidence of pain chronicity.

Opioid dose risk, clinician and patient characteristics, and adherence to opioid prescribing recommendations in chronic non-cancer pain.

This study aims to assess associations between morphine-equivalent daily dose (MEDD) of opioids, clinician and patient characteristics, and prescriber adherence to guidelines for long-term opioid therapy (LTOT) in chronic noncancer pain (CNCP) and to elucidate potential relationships associated with increased-risk opioid prescribing. Retrospective cross-sectional study. Academic health system's 33 primary care clinics. Adults (≥18 years old) prescribed LTOT (10 + outpatient prescriptions in the past year) for CNCP. Electronic health record data on prescribed opioids (for MEDD), clinician/patient characteristics, and adherence rates to LTOT guideline-concordant recommendations. A total of 2,738 patients were eligible, 61.6 percent Lower, 15.7 percent Moderate, and 22.7 percent Higher Risk MEDD (<50, 50-89, and ≥90 mg/day, respectively). Higher MEDD correlated (p < 0.001) with Medicare insurance, current cigarette smoking, higher pain intensity and interference scores, and the presence of opioid use disorder diagnoses. Male clinicians more frequently prescribed (p < 0.001) and male patients were more likely to be prescribed (p < 0.001) higher MEDD compared to their female counterparts. Higher Risk MEDD was associated with higher coprescribed benzodiazepines (p = 0.015), lower depression screening (p = 0.048), urine drug testing (p = 0.003), comparable active treatment agreement (p = 0.189), opioid misuse risk screening (p = 0.619), and prescription drug monitoring checks (p = 0.203). This study documented that higher MEDD was associated with risks of worse health outcomes without improved adherence to opioid prescribing guideline recommendations. Enhanced clinician awareness of factors associated with MEDD has the potential to mitigate LTOT risks and improve overall patient care.

Burden of Depression and Associated Factors among Patients with Sickle Cell Disease in Fako Division, Cameroon

Background: Depression is a major public health challenge causing significant suffering and disability worldwide. Patients with Sickle Cell Disease (SCD) suffer from various complications during their lifetime and are prone to depression. However, there is a paucity of information on depression and associated factors among sickle cell patients in Cameroon. Objectives: To determine the prevalence of depression and associated factors among patients with SCD aged 7-40 years receiving care in three hospitals in Fako Division. Methods: We carried out a hospital based cross-sectional descriptive and analytic study. Socio-demographic data, clinical variables and depressive symptoms were evaluated using a structured questionnaire. Depression was evaluated using the Patient Health Questionnaire Module 9 and the Children’s Depression Inventory. The Statistical Package for Social Sciences (SPSS) version 25 was used for analysis of data. Statistical significance was set at p value &lt;0.05 while bivariate and multivariate analysis was used to test for associations. Results: We recruited 163 participants and the prevalence of depression was 43%(n=70), of which 30.67%(n=50) were mildly depressed and 12.27%(n=20) were moderately depressed. The prevalence of suicidal ideation was 20%. On multivariate analysis, an unmarried status (AOR 7.41; 95%CI 1.74-31.54, P&lt;0.007) high pain intensity (AOR 8.70; 95%CI 17.77-42.82, P&lt;0.008) and history of painful crises within the previous month (AOR 7.31,95%CI 1.52-35.14, P&lt;0.013) were associated with depression among these patients. Conclusion: Almost half of our patients with SCD are depressed, with 2 of them out of 10 thinking of suicide. Some socio-demographic and clinical factors induce this depressive state.

The impact of depression and anxiety on pain reported by patients with rheumatoid arthritis undergoing treatment

This study analyzed the joint pain of 46 patients with rheumatoid arthritis (RA) undergoing treatment with disease-modifying antirheumatic drugs (DMARD), for at least one year, and evaluated by pain intensity numeric scale and by the McGill Pain Questionnaire (MPQ), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). We compared them with 46 patients without RA matched by age and sex. We also examined the relationships between anxiety and depression and pain intensity, disease activity and physical dysfunction accessed by the Rheumatoid Arthritis Disease Activity Index (RADAI) and the Health Assessment Questionnaire (HAQ), respectively. Most patients with RA, 93.5%, continued to report joint pain and had higher pain intensity and higher scores in all domains of the McGill Pain Questionnaire (MPQ) than 58.7% of the 46patients without RA with joint pain. Patients with RA were more likely to have depression defined by HADS≥11 than the controls but the association was non-significant when adjusted for the presence of pain. The median score of anxiety symptoms was significantly higher in patients with RA than in those without RA. There was an association of depression and a positive significant correlation of anxiety symptoms with higher intensity of pain, disease activity and physical dysfunction. There was no difference between patients with RA and depression and without depression on the sensory domain and in the total MPQ score. Otherwise, there was a moderate significant correlation of the levels of anxiety with all pain domains of the MPQ, except the sensory one. In conclusion, pain remains a prevalent symptom in RA patients despite treatment. More studies are necessary to verify if the qualitative assessment of pain could be used to evaluate the influence of anxiety and depression on pain reported by these patients.

Negative back beliefs are associated with increased odds of low back pain and disability: a 10-year cohort study in men

Abstract Objective Although negative back beliefs are associated with high-intensity low back pain (LBP)/disability, whether they influence incident high-intensity LBP/high disability over the long-term is unknown. This study aimed to investigate whether negative back beliefs were associated with developing high-intensity LBP and/or high disability over 10 years in men. Methods Men with no or low-intensity LBP and/or disability attending the Geelong Osteoporosis Study between 2006 and 2010 were included. Data on age, body mass index, mobility, education, back beliefs (Back Beliefs Questionnaire), LBP and disability (Graded Chronic Pain Scale) were collected between 2006 and 2010. Beliefs, LBP and disability were re-assessed in 2016–2021. Binary logistic regression was used to examine the association between negative back beliefs and incident high-intensity pain and/or high disability, adjusting for age, body mass index, mobility and education. Results At baseline, 705 participants (mean age 53.8 years) had no or low LBP and no or low disability; 441 (62.6%) participants completed a 10-year follow-up. Of these, 37 (8.4%) developed high-intensity pain and/or high disability. In multivariate analyses, participants with more negative back beliefs at baseline were more likely to develop high-intensity pain and/or high disability (odds ratio 1.05; 95% CI: 1.00, 1.11). Developing more negative back beliefs was also associated with incident high-intensity pain and/or high disability (odds ratio 1.20; 95% CI: 1.12, 1.30). Conclusion In a male community-based population, negative beliefs regarding the consequences of LBP were associated with an increased likelihood of developing high-intensity pain and/or high disability. Addressing negative back beliefs in the community may reduce the incidence of high-intensity pain and/or high disability over 10 years in men.

Characterizing Extreme Phenotypes for Pain Interference in Persons With Chronic Pain Following Traumatic Brain Injury: A NIDILRR and VA TBI Model Systems Collaborative Project.

To define and characterize extreme phenotypes based on pain interference for persons with chronic pain following traumatic brain injury (TBI). Eighteen Traumatic Brain Injury Model System (TBIMS) Centers. A total of 1762 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview. The Brief Pain Inventory (BPI) interference scale, sociodemographic, injury, functional outcome, pain, and treatment characteristics. Participants were predominantly male (73%), White (75%), middle-aged (mean 46 years), and who were injured in motor vehicle accidents (53%) or falls (20%). Extreme phenotypes were identified based on upper and lower 25th percentiles to create low-interference ( n = 441) and high-interference ( n = 431) extreme phenotypes. Bivariate comparisons found several sociodemographic, injury, function, pain, and treatment differences between extreme phenotype groups, including significant differences ( P < .001) on all measures of concurrent function with those in the low-interference extreme phenotype experiencing better function than those in the high-interference extreme phenotype. Lasso regression combined with logistic regression identified multivariable predictors of low- versus high-interference extreme phenotypes. Reductions in the odds of low- versus high-interference phenotypes were significantly associated with higher pain intensity (odds ratio [OR] = 0.33), having neuropathic pain (OR = 0.40), migraine headache (OR = 0.41), leg/feet pain (OR = 0.34), or hip pain (OR = 0.46), and more pain catastrophizing (OR = 0.81). Results suggest that for those who experience current chronic pain, there is high variability in the experience and impact of pain. Future research is needed to better understand how pain experience impacts individuals with chronic pain and TBI given that pain characteristics were the primary distinguishing factors between phenotypes. The use of extreme phenotypes for pain interference may be useful to better stratify samples to determine efficacy of pain treatment for individuals with TBI.

Physical Complaints of Pain and Heartburn as Part of The Symptoms of Somatization

Introductions: One of the mental health disorders that have an impact on physical health is called somatization disorder. Somatization is characterized by the appearance of complaints of pain in body parts that occur repeatedly. Anxiety, various physical complaints, and an increasing number of symptoms accompany symptoms of somatization disorder. The most common physical complaint is heartburn. Case: This case report discusses the case of a 36-year-old woman who complained of heartburn by visiting various doctors, but no medical results showed any abnormalities. Purpose: This case report aims to provide a literature review of heartburn symptoms due to somatization. Discussion: The Relationship between Heartburn Levels and Somatoform Disorders Psychosocial stressors are related to psychological factors that influence medical conditions that cause prominent psychological and somatic disorders. Psychological disorders and vice versa can cause physical disturbances. The patient’s bodily medical condition can cause psychological disorders. Patients with severe acute pain will experience anxiety, fear, and sleep disturbances. This is due to the patient’s discomfort with his condition, where he suffers from the pain he experiences and cannot move. With increasing duration and intensity of pain, the patient may experience a depressive disorder, and then the patient will be frustrated and irritable towards those around him and himself. Conclusion: The high pain intensity in the patient will cause sensitivity and increase his concern for his physical, lowering the threshold for detecting physical sensations or expressing distress and pain.

Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain.

Significant costs and utilisation of healthcare resources are associated with hospitalisations for non-specific low back pain despite clinical guidelines recommending community-based care. The aim of this systematic review was to investigate the predictors of hospitalisation for low back pain. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42021281827) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Database search of Ovid Medline, Emcare, Embase, PsycINFO, Cochrane Library, PEDro and OTSeeker was conducted. Studies were included if they examined a predictor of hospitalisation for non-specific low back pain with or without referred leg pain. Data was extracted and descriptively synthesised. Risk of bias of included studies was assessed using the Critical Appraisal Skills Programme Checklists. There were 23 studies published over 29 articles which identified 52 predictor variables of hospitalisation for low back pain. The risk of hospitalisation was grouped into themes: personal, health and lifestyle, psychology, socioeconomic, occupational, clinical, and health systems and processes. There was moderate level evidence that arrival to an emergency department via ambulance with low back pain, and older age increase the risk of hospitalisations for low back pain. There was low level evidence that high pain intensity, past history of low back pain, opioid use, and occupation type increase the risk of hospitalisation for low back pain. Further research into psychological and social factors is warranted given the paucity of available studies. Hospital avoidance strategies, improved patient screening and resource utilisation in emergency departments are considerations for practice.

Characteristics Of Temporomandibular Disorders And Orofacial Pain In Individuals With Rheumatoid Arthritis.

To compare characteristics of temporomandibular disorders (TMDs) in patients with rheumatoid arthritis (RA) to controls without RA. The sample included 80 subjects (aged 33 to 73 years; 88% women), 40 in each group. An international diagnostic protocol for TMD was followed. Arthralgia was the most prevalent TMD in the RA group. Orofacial pain was more common than in controls (42.5% vs 15%, P = .031), with higher chronic pain grade and pain intensity (P ≤ .005). Somatization and depression were also increased (P < .001). In multiple logistic regression analysis, arthralgia (OR: 6.4; 95% CI: 1.1 to 37.1; P = .038) and age ≥ 55 years were predictors of RA (OR 3.9; 95% CI: 1.4 to 10.8; P = .009) when controlling for the effects of gender and pain intensity. TMD was related to 7.4-times higher odds for presence of orofacial pain, while RA was related to 3.4-times higher odds for pain. RA patients experienced more orofacial pain and higher pain intensity, somatization, and depression compared to healthy individuals. Pain is more influenced by TMD than by RA.

PECULIARITIES OF PAIN MANAGEMENT IN PATIENTS WITH GUNSHOT WOUNDS IN MEDICAL AND NURSING TEAMS

Background. The experience of military doctors in the treatment of pain in patients after gunshot wounds indicates that chronicization of pain in this category of patients may occur much earlier - at the time of injury. Gunshot wounds are accompanied by high intensity pain. At the stage of treatment in medical and nursing teams, effective pain relief is important, because in the long term, more than 70% of such patients are diagnosed with chronic pain. Therefore, studying the features of pain management at this stage of treatment can play an important role in improving the results of their treatment.&#x0D; Aim: To study the peculiarities of pain treatment in patients after gunshot wounds at the stage of treatment in nursing teams.&#x0D; Materials and methods. We used EZR v.1.35 (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria). Criteria: Shapiro-Wilk, Mann-Whitney, Friedman, chi-square, Bonferroni correction.&#x0D; Results. The results of the study of pain management in nursing teams in 769 patients after gunshot wounds indicate that before analgesia, the VAS values on admission to the stages of treatment in nursing teams in group 1 were statistically different from group 2 (p&lt;0.001). In group 2, this figure was higher. Special attention should be paid to the issue of pain relief during evacuation from the battlefield to the medical and nursing team, because in both groups of observation at the time of admission to the medical and nursing team, the pain intensity of the VAS was 7-8 points, which meets the criteria for high intensity.&#x0D; Conclusion. At the stage of treatment in nursing teams, more attention should be paid to the treatment of pain in patients with gunshot wounds, as we should try to achieve high-quality pain control. Probably ineffectively treated high intensity pain can potentially have an impact on the chronicization of pain in the future. The absence or insufficiency of analgesia can have a significant impact on the long-term outcomes of pain treatment.

Impact of Sleep Disturbance on Fatigue, Nausea, and Pain: Mediating Role of Depressive Symptoms Among Youth With Disorders of Gut-Brain Interaction.

A high degree of sleep disturbance is reported among youth with disorders of gut-brain interaction (DGBIs). Given that sleep quality impacts a range of pediatric health outcomes including somatic sensations (eg, pain) and depressive mood occurs relatively frequently among youth with DGBIs, there is a dire need to disentangle the unique contributions of sleep and depressive mood on the somatic sensations experienced by youth with DGBIs. We aimed to examine whether depressive mood mediates the relations among sleep disturbance and pain intensity, nausea, and fatigue among youth with DGBIs. One hundred eighteen patients aged 8-17 years ( Mage = 14.05, SD = 2.88; 70.34% female), 83.05% White/non-Hispanic recruited at a pediatric neurogastroenterology clinic completed measures of sleep disturbance, nausea, fatigue, pain intensity, and depressive mood. Three mediation models examined the effect of sleep disturbance on nausea, fatigue, and pain, with depressive mood as a mediator. Participants reported moderate sleep disturbance. Depressive mood partially mediated the significant, respective relations between greater sleep disturbance and more severe nausea and fatigue. Sleep disturbance was significantly associated with higher pain intensity; however, depressive mood was not a significant mediator of this relation. Sleep quality is a major concern among youth with DGBIs. Low sleep quality may worsen nausea and fatigue via co-occurring increases in depressive mood symptoms. In contrast, sleep disturbance may directly increase pain, regardless of youths' depressive mood symptoms. Future research should explore these relations through prospective studies leveraging a combination of subjective and objective assessment approaches.

Neural mechanisms of priming effects of spicy food pictures induced analgesia

In this study, the effects of the priming of spicy food pictures on pain perception were evaluated in female participants using standardized methods of pain. Results from behavior tests revealed that the priming of spicy food pictures significantly reduced pain perception, particularly at high-pain intensities. Electrophysiological analysis showed that the analgesic effects of spicy food pictures were linked to decreased pain-related event-related potentials, such as N2 and P2 amplitudes, and suppressed θ-oscillations in the sensorimotor cortex. Both N2 amplitudes and θ-oscillations activities were found to be correlated with participants' pain perception. These results suggest that spicy-arousal stimuli may act as an “antagonist” to the increase in N2 amplitudes and θ-oscillations power induced by pain and influence the neuronal networks involved in integrating spontaneous nociceptive resources, which supports the dissociation theory of pain sensation and affection. These findings highlight the potential use of spicy-arousal stimuli as an analgesic and emphasize the importance of considering both the intensity of the stimuli and the individual's emotional state in the assessment and treatment of pain

PECULIARITIES OF PAIN MANAGEMENT IN PATIENTS WITH GUNSHOT WOUNDS IN MEDICAL AND NURSING TEAMS

Summary. During the Anti-Terrorist Operation/Joint Forces Operation in eastern Ukraine, gunshot wounds account for about 74% of the casualties. Such injuries are accompanied by high intensity pain. At the stage of treatment in medical and nursing teams, effective pain management is important, because in the long term, more than 70% of these patients suffer from chronic pain. Therefore, studying the features of pain management at this stage of treatment can play an important role in improving the results of their treatment.&#x0D; Objective. To study the peculiarities of pain treatment in patients after gunshot wounds at the stage of treatment in medical and nursing teams.&#x0D; Methods. Study of patients with gunshot and mine-blast wounds. A visual analog scale was used to study the intensity of pain. The results of the study were analyzed using the EZR v.1.35 package (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria). The Shapiro-Wilk, Mann-Whitney, Friedman, and Bonferroni correction criteria were used.&#x0D; Results. The results of the study of 769 patients after gunshot wounds indicate that: 1) upon admission to the nursing teams (before anesthesia), the VAS pain intensity in group 1 was statistically different from group 2 (p&lt;0.001) – in group 2, this indicator was higher; 2) the dynamics of VAS pain intensity during 2 days of observation shows no difference between the observation groups: 1 day – p=0.636, 2 days – p=0.465; 3) intervals between analgesia during the 1st day indicate a statistically significant difference between the groups (p=0.001), and on the 2nd day of observation no such difference was observed (p=0.818).&#x0D; Conclusion. At the time of admission to the medical and nursing team, the pain intensity according to the VAS was 7-8 points, which meets the criteria for high intensity. This intensity of pain is likely to affect the chronicization of pain in the future. The number of injured anatomical areas of the body is important for determining the tactics of pain treatment in patients with gunshot wounds, because the intervals between the administration of painkillers indicate that those patients who were injured in 3 or more anatomical areas of the body more often needed the administration of painkillers.