Higher Pain Intensity Research Articles

Ultrasound-guided Dry Needling in Jumper’s Knee: A Case Report

Abstract Background Jumper’s knee is a highly prevalent tendon condition in volleyball players population. Research on clinical effects of tendon dry needling in jumper’s knee is scarce. Therefore, the aim of this study was to present clinical effects of ultrasound-guided dry needling of quadricipital tendon in a patient with jumper’s knee. Methods A 23-years-old volleyball player, who experienced pain in quadricipital tendon for 5 months, was presented and treated by ultrasound-guided dry needling of quadricipital tendon with one session. Slightly limited knee flexion range of motion, high scores in Visual Analogue Scale (VAS) at rest and during Single-Leg decline Squat test (SLDS) related to high pain intensity, low scores in Victorian Institute of Sport Assessment (VISA-P) scale and Lower Extremity Functional Scale (LEFS) were found. Further examination revealed sensitization of the quadricipital tendon (low pressure pain threshold). Results We found important improvements in VISA-P, LEFS and VAS. Besides, pressure pain threshold and knee flexion during SLDS also showed improvements. Results which were obtained were better in all the variables studied and these recoveries were stable for 6 months. Conclusions Our findings showed improvements in pain and function in medium term and could provide preliminary evidence of beneficial effects of quadricipital tendon dry needling in patients with jumper’s knee. Future studies are needed to clarify our results and compare dry needling with conservative treatments.

Persistent Pain, Physical Dysfunction, and Decreased Quality of Life After Combat Extremity Vascular Trauma

Combat-related extremity vascular injuries (EVI) have long-lasting impact on Iraq/Afghanistan veterans. The purpose of this study is to describe long-term functional outcomes in veterans with EVI using survey measures and identify modifiable factors that may be improved to reduce chronic pain and injury-related dysfunction. Veterans with upper and lower EVI undergoing an initial limb salvage attempt were identified using the Department of Defense Trauma Registry and validated with chart abstraction. Surveys measured pain; Short Musculoskeletal Function Assessment (SMFA) for self-reported bother and dysfunction; and Veterans RAND 12-Item Health Survey (VR-12) physical and mental component scores (PCS; MCS) for quality of life, depression, post-traumatic stress disorder, and the potentially modifiable factors of reintegration into civilian life, resilient coping, resilience, and family functioning. Eighty-one patients responded with an average time since injury of 129months (SD: 31; range 67-180months). Mechanism of injury included 64% explosions and 31% gunshot wounds; 16% of the respondents were diagnosed with moderate/severe/penetrating traumatic brain injury. Limb salvage rates were 100% and 77% for upper and lower extremities, respectively (P=0.004). Respondents screened positive for probable depression (55%) and post-traumatic stress disorder (51%). Compared with population norms, SMFA bother and dysfunction indices were higher (worse), MCS was lower (worse), and PCS was similar. The multivariable models adjusted for age, marital status and pain. The higher SMFA is part of the results of the multivariable models. MCS decreased with difficulty reintegrating into civilian life and was positively correlated with increased resilience and resilient coping. SMFA scores were greater for patients with high pain intensity and increased 6-11 points per point increase in difficulty with civilian-life reintegration. SMFA dysfunction was associated with better family functioning. EVI results in significant long-term disability with lasting deficits in physical function, frequent depressive symptoms, and below average self-reported quality of life. Strengthening modifiable factors including resiliency and resilient coping, and providing ongoing assistance to improve reintegration into civilian life, may ameliorate the functional disabilities and chronic pain experienced by veterans with EVI.

Not as "blurred" as expected? Acuity and spatial summation in the pain system.

Spatial acuity measured by 2-point discrimination (2PD) threshold and spatial summation of pain (SSp) are useful paradigms to probe the pain system in humans. Whether the results of these paradigms are influenced by different stimulus modalities and intensities is unclear. The aim of this study was to test 2PD controlling the stimulus modality and the intensity and to investigate the effect of modality on SSp. Thirty-seven healthy volunteers were tested for 2PDs with 2 stimulus modalities (electrocutaneous and mechanical) and intensity (noxious and innocuous). For each condition, participants received stimuli to either 1 or 2 points on their lower back with different distances (2-14 cm, steps of 2 cm). It was found that 2PDs were significantly smaller for noxious stimuli for both modalities. By contrast, between-modality comparison reproduced previous reports of impaired acuity for noxious stimulation. Higher pain intensities were reported when a larger area was stimulated (SSp), independent of the modality. Furthermore, reported pain intensities were higher when the distance between 2 stimulated areas was increased from 2 to 6 cm (P < 0.001), 8 cm (P < 0.01), and 14 cm (P < 0.01). 2PDs determined by mechanical and electrocutaneous stimuli were significantly correlated within both stimulus intensities, ie, innocuous (r = 0.34, P < 0.05) and noxious (r = 0.35, P < 0.05). The current results show 3 novel findings: (1) the precision of the pain system might be higher than in the innocuous (tactile) system when mechanical and electrocutaneous modalities are used, (2) the pattern of distance-based and area-based SSp seems to be comparable irrespective of the modality applied (mechanical and electrocutaneous), and (3) both modalities are moderately correlated.

Muscular fitness is associated with spinal pain among young people: A cross-sectional exploratory study

Purposethe aim of this study was to analyze the association between upper limb muscular fitness and spinal pain in the cervical, thoracic, and lumbar regions among young people. MethodsCross-sectional study involving a probabilistic sample of 1054 participants (547 female) with ages ranging from 10 to 17 years, from Brazil. The dependent variable was pain in the cervical, thoracic, and lumbar regions of the spine, assessed by a self-report instrument. The independent variable was muscular fitness, verified using the 90° push-up test with the cut-offs proposed by FITNESSGRAM. The covariates were age, sex, socioeconomic status, physical activity, and body mass index. Ordinal logistic regression was adopted to conduct the multivariate association and estimate the Odds Ratios (OR). Two separate analyses were conducted: one with the whole sample and the other with only participants who reported pain. ResultsThe prevalences of spine pain in the cervical, thoracic, and lumbar regions were 24.4, 28.3, and 31.0%. In the whole sample, young people who achieved the criterion-referenced standard for muscular fitness were less likely to present high intensity pain in the thoracic region (OR = 0.67, 0.50–0.90). The same occurred when analyzing only those who reported pain for cervical region (OR = 0.48, 0.29–0.79). No association was found between muscular fitness and lumbar pain. ConclusionsUpper limb muscular fitness can be used as an additional tool to prevent high levels of spine pain in the thoracic region among young people as well as the severity of cervical pain in those who report pain.

Features of chronic pain syndrome in professional polyneuropathies

Pain in the hands is a key symptom of professional upper limb polyneuropathy. Its occurrence is caused by physical overloads and functional overstrain of the upper limb muscles, leading to traumatization of peripheral nerve fibers due to tension or damage to the nerve endings in the tense muscle in conditions of a pronounced decrease in blood flow.The aim of study was to study the features of pain syndrome in professional polyneuropathies is an important task, the solution of which can contribute to more effective treatment of the main clinical manifestations of this disease.We examined 236 patients with a diagnosis of occupational upper limb polyneuropathy aged 18 to 65 years without significant comorbidities. The study was conducted using standard questionnaires (DN4 neuropathic pain diagnostic questionnaire, short pain questionnaire, hospital scale of anxiety and depression).The DN4 questionnaire survey revealed the presence of a neuropathic component of pain syndrome in 91.4% of patients. Quantitative assessment of pain using a short pain questionnaire confirmed the high intensity of pain in the hands of patients, as well as its impact on professional activities and other areas of life. In addition, most of the examined individuals showed signs of subclinical and clinical anxiety and depression.Pain in the hands is a key symptom of professional upper limb polyneuropathy. Its occurrence is caused by physical overloads and functional overstrain of the upper limb muscles, leading to traumatization of peripheral nerve fibers due to tension or damage to the nerve endings in the tense muscle in conditions of a pronounced decrease in blood flow. The study of the features of pain syndrome in professional polyneuropathies is an important task, the solution of which can contribute to more effective treatment of the main clinical manifestations of this disease.We examined 236 patients with a diagnosis of occupational upper limb polyneuropathy aged 18 to 65 years without significant comorbidities. The study was conducted using standard questionnaires (DN4 neuropathic pain diagnostic questionnaire, short pain questionnaire, hospital scale of anxiety and depression).The DN4 questionnaire survey revealed the presence of a neuropathic component of pain syndrome in 91.4% of patients. Quantitative assessment of pain using a short pain questionnaire confirmed the high intensity of pain in the hands of patients, as well as its impact on professional activities and other areas of life. In addition, most of the examined individuals showed signs of subclinical and clinical anxiety and depression.Hand pain in patients with occupational polyneuropathy is a complex problem due to its high intensity, long-term chronic course and impact on many aspects of the patient’s daily life. The disease is characterized by a mixed nociceptive-neuropathic nature of the pain syndrome. This explains the persistence of pain for many years after the termination of contact with the etiological harmful production factor (physical overload) and the low effectiveness of conventional courses of conservative therapy. Persistent symptoms of professional upper limb polyneuropathy, confirmed by clinical and instrumental methods of diagnosis, dictate the need to search for new methods of therapy aimed at reducing patient complaints and clinical manifestations of the disease.

Pain and analgaesics in patients with hard-to-heal ulcers: using telemedicine or standard consultations.

To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-square test (χ2). A p value of less than 0.05 was considered to indicate statistical significance. Predictors for pain and pain treatment were analysed in multiple regression analyses. The results showed a high presence of pain; 71% of patients with pain reported severe ulcer pain. There was no significant difference in ability to assess pain by VAS in the group diagnosed via video consultation (90%) compared with the group diagnosed in person (86%) (χ2, p=0.233). A significantly higher amount of prescribed analgesics was found for patients diagnosed via video (84%) compared with patients diagnosed by in-person assessment (68%) (χ2, p=0.044). Predictors for high-intensity pain were female gender or ulcers due to inflammatory vessel disease, while the predictors for receiving analgesics were older age, longer healing time and being diagnosed via video consultation. To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.

Postextractional pain management

Tooth extraction that is tooth removal is one of the most common surgical procedures in the dental practice. Like every surgical treatment tooth extraction is a tissue injury. Because during the procedure pain is controlled by the means of local or general anaesthesia post-procedural complaints are common, crucial, and inevitable problem. There is a varying degree of pain severity between patients depending on the level of complexity of the procedure – the pain reported after surgical extractions involving bone removal and tooth sectioning is significantly higher than in the cases of simple, uncomplicated tooth extraction. Intensity of pain is also higher in cases where the inflammation is present. In most cases the pain is acute in character and is usually localised to the extraction site, it can however affect the adjacent tooth on times. The inflammatory component together with mechanical trauma play a significant role in the etiology of postextractional pain. Alveolar osteitis, known as ‘dry socket’, is a special case of postprocedural complication with high pain intensity. The phenomenon relates to the blood clot resolution, which is the most optimal extraction wound dressing. In the paper pre-, intra- and postprocedural strategies were discussed, including general and local pharmacological actions and non-pharmacological actions including physical ones like cold compress and alternative methods like acupuncture, electroacupencture, transcutaneous nerve stimulation or conditioned pain modulation. Furthermore treatment of ‘dry socket’ a painful tooth removal complication was presented.

Multimodal Analgesia: Polypharmacy in Pain Relief or Rational Use of Non-Steroidal Anti-Inflammatory Drugs to Prevent Pain Chronicity

Pain is the psychophysiological reaction of an entire organism to a damaging factor. According to the literature, 30.0–75.0 % of patients suffer from severe pain in the postoperative period. The greatest risk of chronicity is severe pain after highly traumatic operations and in cases where there is a neuropathic component of acute pain. The purpose of the work is to evaluate the feasibility of using non-steroidal anti-inflammatory drugs with multimodal analgesia to prevent pain chronicity. Despite the detailed mechanisms of pain formation, to date, there is no ideal analgesic or method for the treatment of acute postoperative pain of high intensity. The most significant complication in the use of opioid analgesics is iatrogenic hyperalgesia, which leads to an increase in the intensity of acute postoperative pain, which is also a risk factor for the formation of chronic postoperative pain. It is possible to get closer to solving the problem of adequate postoperative analgesia only by implementing the concept of multimodal analgesia in the clinic, which involves the simultaneous use of two or more analgesics that have different mechanisms of action and have a synergistic effect. The use of the non-steroidal anti-inflammatory drugs as part of multimodal analgesia reduces the risk of their long-term use, due to effective analgesia and prevention of chronic pain syndrome.

An experimental investigation into the mediating role of pain-related fear in boosting nocebo hyperalgesia.

Nocebo hyperalgesia refers to increases in perceived pain that putatively result from negative expectations regarding a nocebo stimulus (eg, an inert treatment, compared with no treatment). The precise cognitive-emotional factors contributing to the origins of nocebo effects are poorly understood. We aimed to test the effects of experimentally induced pain-related fear on the acquisition and extinction of nocebo hyperalgesia in healthy participants (N = 72). Acquisition and extinction of nocebo hyperalgesia were compared between a group receiving standard nocebo conditioning (Control group) and 2 groups receiving distinct fear inductions: high intensity of pain stimulations (High-pain group) or a threat manipulation (High-threat group). During nocebo acquisition, the Control and High-threat groups were administered thermal pain stimulations of moderate intensity paired with sham electrical stimulation (nocebo trials), whereas high pain intensity was administered to the High-pain group. During extinction, equivalent pain intensities were administered across all trials. Pain-related fear was measured by eyeblink startle electromyography and self-report. Nocebo hyperalgesia occurred in all groups. Nocebo effects were significantly larger in the High-pain group than those in the Control group. This effect was mediated by self-reported fear, but not by fear-potentiated startle. Groups did not differ in the extinction rate. However, only the High-pain group maintained significant nocebo responses at the end of extinction. Anticipatory pain-related fear induced through a threat manipulation did not amplify nocebo hyperalgesia. These findings suggest that fear of high pain may be a key contributor to the amplification of nocebo hyperalgesia, only when high pain is experienced and not when it is merely anticipated.

Prediction of pain intensity with uterine morphological features and brain microstructural and functional properties in women with primary dysmenorrhea

Primary dysmenorrhea (PDM), defined as painful menstrual cramps of uterine origin, could cause brain structural and functional changes after long-term menstrual pain. Here, we aimed to investigate the predictive value of uterine morphological features and microstructural/functional properties of the brain extracted from periovulatory phases for the intensity of menstrual pain as rated by women with PDM during their subsequent menstrual period. Forty-five women with PDM were recruited and classified into the high and mild pain intensity groups. Pelvic MRI was employed to extract the uterine texture features. White matter diffusion properties, grey matter and functional connectivity features were extracted as brain features. Multivariate logistic regression models with iteration optimization were built for classifying different pain intensity groups. Texture features from myometrium and uterine junction zone had outstanding prediction performance with an area under the receiver operating characteristic (AUC) of 0.96 (P < 0.05, permutation test), and diffusion properties along the thalamic fiber bundles were the most discriminative features with AUC of 0.95. Applying features from uterus and brain together, we could gain better prediction performance. Our results indicated that accumulated differences in menstrual pain were associated not only with uterine structure but also diffusion properties of thalamic-related fiber tracts, suggesting that treatment options of PDM patients may be expanded from only being able to manage pain in the uterus focusing on the functional/structural modifications of the pain processing system.

Pain severity and analgesics use in the community-dwelling older population: a drug utilization study from Germany

PurposeChronic pain is common in the older population and a significant public health concern. However, comprehensive studies on analgesics use in this age group from Germany are scarce. This study aims to give a comprehensive overview on the use of the most common therapeutic groups of analgesics in community-dwelling older adults from Germany.MethodsA cross-sectional study was carried out using data from a German cohort of 2038 community-dwelling adults aged 63–89 years. Descriptive statistics and logistic regression models were applied to assess the utilization of analgesics by age, sex, pain severity, pain duration, and locations.ResultsOne out of four study participants was suffering from high-intensity or disabling pain. Approximately half of those taking analgesics still reported to suffer from high-intensity or disabling pain. Among analgesics users, occasional non-steroidal anti-inflammatory drugs (NSAIDs) use was the most frequent pain therapy (in 43.6% of users), followed by metamizole (dipyrone) use (16.1%), regular NSAIDs use (12.9%), strong opioids use (12.7%), and weak opioids use (12.0%). In multivariate logistic regression models, higher age, higher pain severity, longer pain duration, abdominal pain, and back pain were statistically significantly associated with opioids use. Metamizole use was also statistically significantly associated with higher pain severity but inversely associated with pain duration.ConclusionsA significant number of older German adults are affected by high-intensity and disabling chronic pain despite receiving analgesics. Long-term studies are needed to compare the effectiveness and safety of different treatments for chronic pain in older adults.

Ehlers-Danlos Syndrome and Hypermobility Syndrome Compared with Other Common Chronic Pain Diagnoses-A Study from the Swedish Quality Registry for Pain Rehabilitation.

Although chronic pain is common in patients with Ehlers–Danlos syndrome (EDS) and hypermobility syndromes (HMS), little is known about the clinical characteristics of these groups. The main aim was to compare EDS/HMS with common local and generalized pain conditions with respect to Patient Reported Outcome Measures (PROMs). Data from the Swedish Quality Register for Chronic Pain (SQRP) from 2007 to 2016 (n = 40,518) were used, including patients with EDS/HMS (n = 795), fibromyalgia (n = 5791), spinal pain (n = 6693), and whiplash associated disorders (WAD) (n = 1229). No important differences in the PROMs were found between EDS and HMS. Women were represented in > 90% of EDS/HMS cases and fibromyalgia cases, and in about 64% of the other groups. The EDS/HMS group was significantly younger than the others but had a longer pain duration. The pain intensity in EDS/HMS was like those found in spinal pain and WAD; fibromyalgia had the highest pain intensity. Depressive and anxiety symptoms were very similar in the four groups. Vitality—a proxy for fatigue—was low both in EDS/HMS and fibromyalgia. The physical health was lower in EDS/HMS and fibromyalgia than in the two other groups. Patients with EDS/HMS were younger, more often female, and suffered from pain for the longest time compared with patients who had localized/regional pain conditions. Health-care clinicians must be aware of these issues related to EDS/HMS both when assessing the clinical presentations and planning treatment and rehabilitation interventions.

Prevalence and Correlates of Frailty in Community-Dwelling Older Adults with Chronic Pain: A Cross-Sectional Study

BackgroundFrailty is a frequent health condition in older adults of decreased functional reserve that leads to vulnerability to internal and external stressors. It has been associated with chronic pain, which is a common, costly and incapacitating condition in older adults. AimsTo describe frailty status in a sample of community-dwelling older adults with chronic pain attending a primary health care centre. DesignCross-sectional investigation. ParticipantsAdults aged 65 years or older with chronic pain. MethodsThe Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) was used to assess frailty status and a visual analogue scale to assess pain intensity. Descriptive and analytical statistics were performed. ResultsAmong 154 participants recruited, 20.1% were frail, 38.3% pre-frail and 41.6% robust. Women were more likely to be classified as frail or pre-frail (OR: 4.62, 95% CI: 2.23-9.59), as well as participants aged 75 years or older (OR: 3.41, 95% CI: 1.74-6.68) and participants reporting moderate and severe pain (OR: 4.20, 95% CI: 2.10-8.40). These results remained significant after adjustment. ConclusionsThere is an association between frailty status and other variables such as older age, female gender and higher pain intensity.

Lumbo-pelvic Ratio And Conjunct Movements Differ Between Pain Intensity Groups In Low Back Pain Patients

Back pain is linked to alterations in movement behaviour. Yet, the interaction between pain intensity and movement is not fully understood. In particular, it remains unknown if the movement quality differs between (chronic) pain intensities. PURPOSE: To compare trunk movement behaviour, assessed by lumbar/pelvic and conjunct lateral flexion contributions to the total range of motion (RoM) during trunk flexion, between people with low and moderate to high back pain intensities. METHODS: A multi-centre study on 607 people with back pain was performed. Chronic pain intensity scores (INT [0-100]; sub-score of the Graded Chronic Pain Scale) were used to group participants into comparably low (LP; Score <30 points) and moderate to high pain intensity (HP; Score ≥ 30 points). Accordingly, 211 participants (49% f; 37±13y; 73±15kg; 174±9cm; INT 18±7) were allocated to LP and 393 participants (57% f; 41±14y; 75±16kg; 173±9cm; INT 46±13) were allocated to HP. Motion was assessed during maximal trunk flexion in upright standing. A mobile IMU system (six sensors), distinguishing between total, lumbar and pelvic motion in all three movement planes, was used. Outcome measures were total RoM, lumbo-pelvic ratio (LPR) and amount of conjunct lateral motion (CLM; sum of angular changes in lateral flexion, RoM-normalized). Between-group comparisons using adjusted unpaired t-tests/Mann-Whitney U test for RoM and LPR and two-way ANOVAs for CLM were performed. RESULTS: Significant between-groups differences in trunk flexion movement were found for LPR (LP 0.92±0.65; HP 0.72±0.49; p<0.0001) but not for RoM (LP 101±27°; HP 104±25°; p=0.28). CLM differed significantly between groups during downward movements in lumbar (LP 8.0±3.1; HP 7.1±2.7; p<0.01) but not in pelvic segments (LP 7.6±3.5; HP 8.3±3.4; p=0.06). No significant difference was found (lumbar: LP 8.7±3.3 HP 8.5±3.2; p=0.62; pelvic: LP 8.5±4.1; HP 9.2±4.0; p=0.08) during upward movements of the trunk. CONCLUSION: Though total RoM between subclinical and clinical back pain patients is not different, lumbar contribution on total trunk flexion movement is reduced and conjunct lateral movements at the lumbar area are increased with higher pain intensities. This might reflect a strategy to reduce potential pain at the lumbar back during flexion movements of the trunk.

Presença de dor após o acidente vascular cerebral e sua relação com a função e a qualidade de vida

Objetivo: Avaliar a presença da dor em indivíduos com acidente vascular cerebral (AVC) e sua relação com o desempenho funcional e a qualidade de vida (QV). Métodos: Estudo transversal onde 50 indivíduos com AVC atendidos em um centro de reabilitação foram avaliados por meio da Escala Visual Numérica (EVN), Questionário de Dor McGill, SF-36 e Índice de Barthel (IB). A estatística inferencial foi realizada por meio do Teste T e do coeficiente de correlação de Pearson. Resultados: A presença de dor foi verificada em 64% da população, com média sete na EVN e expressivo número e intensidade de descritores do McGill. Os pacientes com dor apresentaram piores escores para QV nos domínios saúde mental (p = 0,046), estado geral da saúde (p = 0,021), aspectos emocionais (p = 0,034) e dor (p &lt; 0,0001). A dor no hemicorpo hígido estava presente em 37% dos pacientes. A EVN correlacionou-se com o estado geral da saúde da SF-36 (r = -0,359; p = 0,043); já o McGill com a saúde mental (r = -0,364; p = 0,041), capacidade funcional (r = -0,365; p = 0,039) e aspectos emocionais (r = -0,374; p = 0,035). Não houve relação entre a dor e o IB. Conclusões: Este estudo mostrou alta incidência e intensidade de dor em indivíduos com AVC, mesmo em reabilitação. A presença da dor interferiu mais na QV do que na função e o McGill relacionou-se com mais domínios da SF-36 do que a EVN.

Experimental muscle pain and music, do they interact?

Music is used to evoke audio analgesia during dental procedures, but it is unknown if experimental pain and music interact. This study aimed to explore the multisensory interaction between contrasting types of music and experimentally induced muscle pain. In 20 healthy women, 0.3mL sterile hypertonic saline (5.8%) was injected into the masseter muscle during three sessions while contrasting music (classical and black metal) or no music was played in the background. Pain intensity was assessed every 15seconds with a 0-100mm visual analogue scale (VAS) until pain subsided. Pain spread (pain drawings), unpleasantness (VAS), anxiety (VAS), and pain quality (McGill Questionnaire) were assessed after the last pain assessment. Pain of high intensity was evoked at all sessions with a median (interquartile range) peak pain intensity of 78 (30) in the black metal music, 86 (39) in the classical music, and 77 (30) in the control session. The pain duration was 142 (150) seconds in the black metal music, 135 (150) seconds in the classical music, and 135 (172) seconds in the control session. The corresponding pain-drawing areas were 42 (52), 37 (36), and 44 (34), arbitrary units respectively. There were no differences in any of these variables (Friedman's test; P´s>.368), or in unpleasantness, anxiety, or pain quality between sessions (P´s>.095). Experimentally induced muscle pain does not seem to be influenced by contrasting types of background music. Further studies exploring the multisensory integration between music and experimental muscle pain are needed.

AB0276 DIFFERENCES BETWEEN IMPACT OF BIOLOGICAL THERAPY AND IMPACT OF CONVENTIONAL TREATMENT ON PRODUCTIVITY AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Number of patients with rheumatoid arthritis in Montenegro amounts around 3,000, while 8% of them are on biological therapy. This percent is similar, or even higher in comparison to countries that are highly comparable to Montenegro. However, the percentage is still lower than in European countries.Objectives:Objective of the study was to identify the differences between impact of biological and conventional therapy on quality of life of RA patients, their work ability and productivity, mental health, emotional state and social inclusion.Methods:The analysis was based on data gathered from the questionnaires filled by RA patients in Montenegro: 92 patients treated with biological therapy and 78 treated with conventional therapy. More insights and information from examined patients were gathered on two focus groups. Following indicators were used in the study: two indicators that measure work ability and productivity: one monetized – Work Productivity and Activity Impairment Questionnaire General Health V2.0 (WPAI-GH) and one non-monetized – RA Work Instability Scale (RA WIS), and two indicators that measure quality of life – Health Assessment Questionnaire (HAQ-DI) and RAND 36-Item Health Survey (SF-36).Results:WPAI-GH results are used in evaluation of absenteeism and presentism costs per RA patient per annum, which are caused exclusively by rheumatoid arthritis. WPAI-GH results are presented in the following figure. Total cost of absenteeism and presenteeism of RA patients in Montenegro amounts to 3.8 million EUR per annum. Results of RA WIS indicator suggest that patients treated with biological therapy are characterized by low to moderate level of work instability, and patients treated with conventional therapy by moderate level. Patients treated with biological therapy have shown 25% lower level of work instability. HAQ-DI indicator shows that both groups of patients are characterized by mild difficulties to moderate disability in performing everyday activities. However, patients treated with conventional therapy deal with higher level of difficulties, even though their level of RA progression is lower, on average. SF-36 indicator shows that patients treated with conventional therapy have lower level of physical functioning, followed by 26% higher pain intensity. They are 25% more exposed to limitations due to physical health problems caused by RA, and 20% more to limitations due to emotional problems. Patients treated with biological therapy, on average, rate their health with 50% higher rank in comparison to subjective health rate of patients treated with conventional therapy. They also feel that their health has improved during the past year, or stayed approximately the same, while patients treated with conventional therapy feel that their health condition has aggravated, or stayed unchanged.Conclusion:Results show that health condition, emotional state and life quality are better among the patients treated with biological therapy. Also, their productivity is higher compared to patients treated with conventional therapy. This conclusion is additionally supported by the fact that there is more progression of disease among RA patients treated with biological therapy, as well as by the fact that the average duration of RA is almost two times longer among examinees who are on biological therapy than among examinees who are on conventional therapy. Accordingly, access to biological therapy for greater number of patients in earlier stage of disease would result in reduction costs of lost productivity and work disability connected to RA, as well as in mitigation of RA impact on lives and functionality of patients.Figure 1.WPAI-GHDisclosure of Interests:None declared

0733 Retrospective Pain Reports In OSA Patients: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures

Abstract Introduction Exploring the relationship between OSA and pain, some studies showed hyperalgesia, and others, hypoalgesia. It was proposed that apnea-related sleep fragmentation causes hyperalgesia, and hypoxemia, hypoalgesia. However, SpO2 nadir had opposite relationships with pain measures in different studies. A 2018 review of over 1000 studies reported lack of consistent relationship between OSA and pain variables. Further, OSA was shown to relate to depressed mood, which may alter pain perception. Presently, retrospective reports of pain are analyzed as a function of polysomnographic and self-report sleep variables and depressive symptomatology in patients evaluated for OSA. Methods A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI, PSQI, ESS, and Chronic Pain Grade Scale yielding pain intensity (PI) and functional effect (FE) scores. PI and FE were separately regressed onto age, sex and BMI, followed by PSG and self-report variables meeting p&amp;lt;0.1 criterion. AHI and SpO2nadir were forced into the models. Results Mean AHI=29.6±34.7, range 0-167/hr, 72.3% had AHI≥5. Higher PI related to higher AHI (p=0.005, R2&amp;lt;1%), lower total arousal index (TAI, p=0.006, R2&amp;lt;1%), higher total sleep time (TST, p=0.003, R2&amp;lt;1%), higher PSQI (p&amp;lt;0.001, R2=5%), and higher CESD (p=0.001, R2&amp;lt;1%), without interactions with sex. Higher FE related to higher AHI (p=0.004, R2&amp;lt;1%), lower TAI (p&amp;lt;0.001, R2=1%), higher PSQI (p&amp;lt;0.001, R2=3%, and higher CESD (p&amp;lt;0.001, R2=2%). Sex had a significant interaction only with AHI (p=0.032); the FE-AHI relationship was significant in women (p=0.012), but not in men. Conclusion On retrospective reports of pain in this large sample, higher AHI related to greater pain intensity in both sexes and to greater functional effect in women only. Unexpectedly, higher pain measures were also related to lower TAI and higher TST. Higher depressive symptomatology and subjective sleep disturbance on PSQI were related to greater pain intensity and its functional effect. Only a small portion of the variance in pain measures was accounted for by PSG and self-report variables. Support none

Relationship between diabetic neuropathic pain and comorbidity. Their impact on pain intensity, diabetes complications and quality of life in patients with type-2 diabetes mellitus

ObjectiveTo compare cognitive function, mood and sleep status in patients with and without diabetic neuropathic pain (DNP) and their relationship with pain intensity, diabetes complications, and quality of life. To determine whether these relationships differ depending on the sensorial phenotype. MethodsCross-sectional study performed on patients with type-2 diabetes-mellitus and neuropathy. Presence of DNP, pain intensity and phenotype, mood status, sleep characteristics and quality of life were measured. ResultsA total of 130 patients (65 with DNP) were included. DNP was related to poor sleep quality (OR = 1.03;CI95%:1.02–1.05), pain treatment (OR = 3.00,CI95%:1.24–7.29) or previous anxiety (OR = 2.70,CI95%:1.05–6.99). Patients with specific phenotypes or depression (=0.82,CI95%:−0.02–1.67) referred more severe pain. More complications were related to older age (OR = 1.40,CI95%:1.12–1.66), higher pain intensity (OR = 1.51,CI95%:1.00–2.28), lower cognitive performance (OR = 1.25,CI95%:1.09–1.43), previous anxiety (OR = 10.48,CI95%:1.46–75.24) and insulin treatment (OR = 124.50,CI95%:6.64–2335.06). Decrease in mental quality of life was associated with sleep disorders (β = −0.33,CI95%:−0.48,−0.23), physical comorbidities (β = −9.73,CI95%:−18.15, −1.31) and previous anxiety (β = −7.91,CI95%:−13.04, −2.77). Lower scores in physical quality of life were related to sleep disorders (β = −0.12,CI95%:−0.21, −0.18), obesity (β = −8.35,CI95%:−13.16, −3.55), longer time since diagnosis (β = −0.72,CI95%:−1.44;0.01) and disability (β = −14.58,CI95%:−24.69; −4.48). ConclusionsThe results support the idea that mental comorbidity and sleep disorders are factors associated with DNP and greater pain intensity, more diabetes complications and lower quality of life. Moreover, they highlight the relationship between sensorial phenotypes and pain intensity, and lower cognitive performance and diabetes complications.

Episodic Cancer Pain: Patient Reporting, Prevalence, and Clinicodemographic Associations at Initial Cancer Pain Clinic Assessment.

Background Better understanding of the episodic cancer pain (CP) spectrum, including pains that occur in addition to its conventionally defined breakthrough CP (BTcP) and incident CP (IcP) components, may inform CP assessment and management. This study aimed to determine the prevalence of episodic patient-reported CP and the prevalence and associations of study-defined BTcP (S-BTcP) and IcP (S-IcP) in patients with CP. Methods In a cross-sectional study at their first CP clinic attendance, participants with CP had the following assessments: Brief Pain Inventory (BPI); Pain Management Index (PMI), with PMI-negative status indicating undertreatment; standardized neuropathic pain component (NPC) status; S-BTcP (no trigger identified) and S-IcP (trigger identified) status, based on a preceding 7-day history of transitory pain flares distinct from background pain, and BPI-Worst or BPI-Now pain intensity ≥ 4. Clinicodemographic variables' association with S-BTcP and S-IcP was examined in logistic regression analyses. Results Of 371 participants, 308 (83%) had episodic CP by history alone; 140 (37.7%) and 181 (48.8%) had S-BTcP and S-IcP, respectively. Multivariable analyses demonstrated significant (p < 0.05) associations (odds ratios: 95% CIs) for 6 variables with S-BTcP: head and neck pain location (2.53; 1.20–5.37), NPC (2.39; 1.34–4.26), BPI average pain (1.64; 1.36–1.99), abdominal pain (0.324; 0.120–0.873), S-IcP (0.207; 0.116–0.369), and PMI-negative status (0.443; 0.213–0.918). Similar independent associations (p < 0.05) occurred for S-IcP with NPC, BPI average pain, and PMI-negative status, in addition to radiotherapy, S-BTcP, soft tissue pain, and sleep interference. Conclusions Episodic or transient patient-reported CP flares often do not meet the more conventional criteria that define BTcP and IcP, the principal episodic CP types. Both BTcP and IcP occur frequently and both are associated with a NPC, higher pain intensity, and less opioid underuse in the management of CP. Further studies are warranted to both better understand the complex presentations of episodic CP and inform its classification.