Higher Pain Research Articles

Vagal tone, pain sensitivity and exercise-induced hypoalgesia: The effect of physical activity level.

Vagal activity has analgesic effects that are attributed to exercise-induced hypoalgesia (EIH). High vagal tone and low pain sensitivity are reported in individuals who routinely exercise yet, their association is unclear. Furthermore, it is unknown if the heightened vagal tone following high physical activity predicts and intensifies EIH. Fifty-one healthy participants (27 low-moderately physically active; 27 females) underwent a resting-state electrocardiogram followed by heart rate variability analysis. Pain measurements, including pressure (PPT) and heat (HPT) pain thresholds, ratings of tonic heat pain (THP) and conditioned pain modulation (CPM) paradigm, were conducted pre- and post-exercise on a cycle ergometer. The highly active group demonstrated higher vagal tone compared to the low-moderately active (root mean square of successive differences between R-R intervals: 63.96.92 vs. 34.78 ms, p = 0.018; percentage of successive R-R intervals that exceed 50 ms: 24.41 vs. 11.52%, p = 0.012). Based on repeated-measure ANOVA, the highly active group showed higher PPT at pre-exercise, compared to the low-moderately active group (382 kPa vs. 327 kPa; p = 0.007). Post-exercise, both groups demonstrated EIH, increased HPT (p = 0.013) and decreased THP ratings (p < 0.001). Linear regression revealed that only in the low-moderately active group, higher vagal tone was associated with more efficient pre-exercise CPM and a greater reduction in THP ratings post-exercise (p ≤ 0.01). Highly active individuals demonstrate greater vagal tone and lower pain sensitivity but no greater EIH. Vagal tone moderates pain inhibition efficiency and EIH only in low-moderately active individuals. These findings suggest that physical activity level moderates the vagal-pain association via the endogenous analgesia system. Highly physically active individuals exhibit greater vagal tone and reduced sensitivity to experimental pain, yet they do not benefit more from exercise-induced hypoalgesia (EIH) compared to low-moderately active individuals. Moreover, low-moderately active individuals with greater vagal tone exhibited more efficient endogenous pain inhibition and greater EIH, suggestive of the moderation effect of physical activity level on vagal-pain associations.

Content validity of the electronic faces thermometer scale for pain in children: is a picture worth more than a thousand words?

Early recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0-10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children. A mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8-17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations. A total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0-1) and pain (level 2-10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2-10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments. The variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits.

Musculoskeletal shoulder pain: Home exercise frequency and adherence to appointments are not mediators of outcome

ObjectiveTo investigate whether appointment adherence and frequency of home exercises mediates the association of baseline i) pain self-efficacy (PSE) or ii) patient expectation of recovery, with outcome at 6 months. DesignMulticentre longitudinal cohort study. MethodsSix-month outcome data (SPADI, QuickDASH) were provided by 810 of 1030 recruited participants. Daily frequency of home exercises over 6 weeks, were expressed as the proportion of days exercises were completed. Measures of adherence included proportion of appointments attended and completing a course of physiotherapy. Mediation analyses were conducted using Baron and Kennys’ four-step method, and for continuous variables, testing the indirect effect using a non-parametric version of Sobel’s test. ResultsAppointment adherence, completing a course of physiotherapy and frequency of home exercise did not mediate the relationship between PSE or patient expectation with 6 months SPADI or QuickDASH. Higher PSE was significantly associated with appointment adherence and completing a course of physiotherapy. Patient expectation was significantly associated with frequency of home exercise. However, none of the hypothesised mediators had a significant effect on outcome. ConclusionAppointment adherence and higher frequency of home exercise do not appear to be the mechanisms by which high PSE or expectation of recovery predict a good outcome. This study was not designed to address the effectiveness of a home exercise programme for which no conclusions should be drawn. However, our results do support the need for a greater emphasis on the assessment and incorporation of techniques to facilitate high pain self-efficacy and expectation of recovery.

Understanding the role of mental pain in suicidal individuals: from clinical to neuroimaging perspective.

IntroductionIn the attempt to shed light on the phenomenology of suicide, this contribution focuses on the role of mental pain as a main ingredient of suicide.ObjectivesPrevious studies have shown that mental pain, childhood negative experiences, and maltreatment are associated with suicide risk. Neuroimaging studies demonstrated that such emotional pain shares the same neuroanatomical circuit of somatic pain. Furthermore, concepts related to death, failure, or other unfortunate circumstances activate specific cerebral areas in a suicidal individual compared to a non-suicidal subject.MethodsThe author, through a multicenter investigation, conducted a sizeable clinical study on mental pain related to psychiatric disorders and suicide risk. With this aim, a dataset of more than 2200 psychiatric patients is explored to investigate suicide risk, mental pain, childhood trauma, and the role of depressive symptomatology. Implications emerging from neuroimaging studies are investigated.ResultsA framework emerges about the role of childhood traumatization in mediating between suicide risk and mental pain; furthermore, when individuals experience high mental pain and high depressive symptomatology, regardless of the diagnoses, they are exposed to higher suicide risk.ConclusionsSuch results are presented in light of neuroimaging studies’ role in identifying how mental pain and brain activation are detected in suicidal individuals. Therefore, this contribution aims to understand better mental pain’s role in clinical practice and research activities.Disclosure of InterestNone Declared

Quality of Life Assessment in Patients with Knee Osteoarthritis

IntroductionOsteoarthritis is one of the most common diseases and a leading cause of functional limitation and dependence, significantly impacting the quality of life (QOL).ObjectivesThe aim of this study was to evaluate the impact of knee osteoarthritis on QOL and identify associated factors.Methods This prospective cross-sectional descriptive study was conducted in the Physical Medicine and Functional Rehabilitation Department over a 4-month period, involving patients with symptomatic bilateral knee osteoarthritis (according to the American College of Rheumatology (ACR) criteria). Sociodemographic data, comorbidities, and characteristics of knee osteoarthritis were collected. The assessment of QOL and the functional impact of knee osteoarthritis were based on the KOOS (Knee Injury and Osteoarthritis Outcome Score) self-questionnaire, Lequesne Index, and modified WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) Score. The KOOS questionnaire included 5 subscales: pain (KOOS-Pain), symptoms other than pain (KOOS-Symptoms), activities of daily living (KOOS-ADL), sports and recreational function (KOOS-Sport), and QOL (KOOS-QOL).Results We included 30 patients with an average age of 59.27±6.3; the male-to-female ratio was 0.15. Sixty percent of patients lived in urban areas, with varying levels of education: primary (n=10), secondary (n=4), and university (n=4), while the majority were illiterate (40%). Most of our patients were employed, with 64.28% engaging in significant physical activity, resulting in an average of 6±2 days of work absenteeism every 3 months due to knee pain. The mean duration of knee osteoarthritis was 7.97 years±3.14. The average pain visual analog scale (VAS) score was 5.2±0.4. Knee osteoarthritis was classified as stage 2 in 40% and stage 3 in 60% of cases. Regarding functional impact, the mean WOMAC global index was 16.6±4.68, and the mean Lequesne Index was 11.05±3.45; moderate disability was observed in 16.7%, significant disability in 50%, and severe disability in 16.7% of patients. Furthermore, the KOOS questionnaire revealed decreased KOOS-Sport and KOOS-QOL scores, with mean values of 35±10.2 and 37±8.9, respectively. Our study identified factors associated with a poor quality of life: age &gt; 65 years (p&lt;0.05), disease duration (p=0.02), and VAS pain &gt; 5 (p=0.02).ConclusionsImproving the quality of life is an essential therapeutic goal in managing knee osteoarthritis. Our study demonstrates that advanced age, longer disease duration, and high pain intensity can negatively impact quality of life.Disclosure of InterestNone Declared

Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain

BackgroundThe Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm. ObjectiveEvaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain. MethodsForty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria. ResultsModerate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001). ConclusionsThe diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

The impact of social deprivation on healthcare utilization patterns following rotator cuff repair

BackgroundDisparities in social determinants of health have been linked to worse patient reported outcomes, higher pain, and increased risk of revision surgery following rotator cuff repair. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized. MethodsThis is a retrospective review of a single institution's experience with primary rotator cuff repair between 2012-2020. Demographic variables (age, race, gender, ASA score) and healthcare utilization (hospital readmission, emergency department visits, follow-up visits, telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index (ADI) was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared. ResultsA total of 1695 patients were included. The upper, middle, and lower terciles of ADI consisted of 410, 767, and 518 patients, respectively. The most deprived tercile had greater emergency department visitation and office visitation within 90 days of surgery relative to the least and intermediate deprived terciles. Higher levels of social deprivation were independent risk factors for increased ED visitation and follow-up visitation. There was no difference in 90-day readmission rates or telephone calls made between the least, intermediate, and most deprived patients. ConclusionsPatients with higher levels of deprivation demonstrated greater postoperative hospital utilization. We hope to use these results to identify risk factors for increased hospital use, guide clinical decision making, increase transparency, and manage patient outcomes following rotator cuff repair surgery.

Enteric fever masquerading as parotitis

Parotitis is commonly associated with viral infections, while some cases can be bacterial. Parotitis with enteric fever is very rare and has not been reported in pediatric population. An 8-years-old girl presented with parotitis, high grade fever, abdominal pain and vomiting. Salient examination findings were bilateral parotitis, cervical lymphadenopathy on right side, tonsillar hypertrophy with exudates over the right tonsil. Abdominal examination did not reveal any hepatosplenomegaly. Blood culture showed Salmonella paratyphi A., while other test for etiology of parotitis were non-conclusive. Parenteral ceftriaxone was given for a total duration of 14 days. The child responded well clinically and was kept under close follow-up. Presence of parotitis with enteric fever is a very rare finding. Blood culture is a gold standard test for diagnosing enteric fever. It should be incorporated in first line investigations in cases presenting with high grade fever and parotitis.

Comparative evaluation of two methods of prolonged femoral nerve block using an elastomeric pump after knee arthroplasty: a prospective randomized controlled study

BACKGROUND: The number of knee arthroplasty (KA) surgeries is increasing annually. These surgeries are associated with severe pain. The optimal method of choice in perioperative analgesia in these patients remains controversial. The use of regional analgesia, including prolonged analgesia, allows for high pain relief and increased patient satisfaction. Modern elastomeric pumps (EP) provide prolonged conduction analgesia, which significantly expands the possibilities of perioperative pain relief. OBJECTIVE: To evaluate the effectiveness of prolonged femoral nerve block using EP with and without bolus after KA. MATERIALS AND METHODS: This prospective randomized study included 75 patients who were divided into two clinical groups: group 1 (n=36), patients who received prolonged regional analgesia using EP with controlled injection without bolus, and group 2 (n=39), patients who received prolonged regional analgesia using EP with bolus. In the postoperative period, the level of pain at rest and during movement was assessed after 6, 12, 24, and 48 hours as well as the need for opioid analgesics, consumption of local anesthetic for various options of continued regional analgesia, quadriceps femoris muscle function, and distance traveled by patients after surgery in the first 2 days. RESULTS: No significant differences were noted in pain level at rest and during movement in the observation period between the groups (p=0.213). No additional prescription of opioid analgesics was required. Local anesthetic consumption was lower in group 2 (group 1.384±33.4 ml; group 2.237±25.1 ml; p=0.031). Patients in group 2 had greater activity in knee extension and, thus, greater distance traveled after surgery. CONCLUSION: The use of EP with a bolus has been demonstrated to provide adequate levels of analgesia and better functional recovery in patients with bolus after KA than in patients without bolus. This technique is recommended as a component of enhanced recovery program after surgery.

In Vivo Bioequivalence Study of Drug: An Analysis of Bidding in Vietnam Period 2018 - 2022

To promote the development of bioequivalent drugs, the Ministry of Health of Vietnam has classified a separate bidding group for bioequivalent drugs. According to the results of bidding for bioequivalent drugs in the period 2018 - 2022 has achieved very encouraging results, the ratio of domestic bioequivalent drugs compared to foreign bioequivalent drugs winning bids is from 2.13 to 3.63 times higher. Regarding active pharmaceutical ingredients of bioequivalent drugs, bioequivalent drugs with the highest total winning value (including all dosage forms, concentrations,...) focus mainly on antibiotics (cefuroxime, cefixime,…), anti-diabetic drugs (gliclazide, metformin,...), high blood pressure drugs (amlodipine), antipyretic and pain relievers (paracetamol). The winning drug dosage forms are still mainly conventional dosage forms (tablets, film-coated tablets, capsules) and their active ingredients are almost single. In particular, several multi-component bioequivalence drugs have a large total winning value but do not belong to the pharmaceutical group on the list of mandatory bioequivalence test reports when registering the drug, such as the combination of Gliclazide + Metformin; Glibenclamide + Metformin; Glimepiride + Metformin. The trend of selecting pharmaceutical substances/groups of pharmaceutical substances that manufacturers focus on researching/registering bioequivalent drugs in Vietnam is focused on drugs on the list of drugs covered by health insurance.&#x0D;

The Effect of Pain on Self-Esteem and Self-Care Agency in Hysterectomy Patients

Objective: The study aimed to determine the effect of pain on self-esteem and self-care agency in patients with hysterectomy. Materials and Methods: A total of 486 female patients who underwent hysterectomy were included in this cross-sectional study. Patient Identification Form, Rosenberg’s Self-Esteem Scale, Self-Care Agency Scale and VAS were used to collect data. Since the patients experienced severe pain on the 1st postoperative day and their communication could not be maintained in a healthy manner, the data were collected face-to-face in the patient's room on the 2nd postoperative day. The data were analyzed in SPSS 23.0 using descriptive statistics and correlation analysis. Results: The mean scores of the patients the pain, self-care agency, and self-esteem levels were 3.58 ± 1.42, 117.40 ± 26.67, and 11.74 ± 2.99, respectively. A negative correlation was found between postoperative pain and self-care agency, self-esteem scores, while a positive correlation between self-care agency and self-esteem scores. Conclusion: High postoperative pain is negatively correlated with self-care agency and self-esteem in patients with hysterectomy. Self-esteem increase when self-care agency increase in patients with hysterectomy.

Identification of group differences in predictive anticipatory biasing of pain during uncertainty: preparing for the worst but hoping for the best.

Pain anticipation during conditions of uncertainty can unveil intrinsic biases, and understanding these biases can guide pain treatment interventions. This study used machine learning and functional magnetic resonance imaging to predict anticipatory responses in a pain anticipation experiment. One hundred forty-seven participants that included healthy controls (n = 57) and individuals with current and/or past mental health diagnosis (n = 90) received cues indicating upcoming pain stimuli: 2 cues predicted high and low temperatures, while a third cue introduced uncertainty. Accurate differentiation of neural patterns associated with specific anticipatory conditions was observed, involving activation in the anterior short gyrus of the insula and the nucleus accumbens. Three distinct response profiles emerged: subjects with a negative bias towards high pain anticipation, those with a positive bias towards low pain anticipation, and individuals whose predictions during uncertainty were unbiased. These profiles remained stable over one year, were consistent across diagnosed psychopathologies, and correlated with cognitive coping styles and underlying insula anatomy. The findings suggest that individualized and stable pain anticipation occurs in uncertain conditions.

Psychophysiological Responses to High-Intensity Interval Training Exercise over Menstrual Cycle Phases: An Exploratory Study.

Although there is potential for the menstrual cycle to impact psychophysiological responses to exercise, there has been a paucity of studies investigating this aspect, specifically in the context of high-intensity interval training (HIIT). This exploratory study aimed to examine the psychophysiological responses to HIIT over the menstrual cycle. Twenty-three healthy and physically active young women were recruited. Each woman completed a cycle ergometer HIIT session in the menstrual, follicular, and luteal phases of the menstrual cycle in a random order. Psychophysiological variables of interest were collected at baseline, and during and after exercise. Primary variables of interest were anxiety, mood, motivation, enjoyment, arousal, affect, and menstrual distress. Higher pain, water retention, behavior change (related to social interactions, eating habits, and self-performance), and autonomic reactions (consisting of nausea, dizziness, hot flashes, and cold sweats) were observed before HIIT during the menstrual phase compared with the follicular phase ( P < 0.05). Participants exhibited worse psychological responses to HIIT sessions during the menstrual phase, followed by the luteal phase. Findings also noted participants arrived to the laboratory with lower motivation to initiate HIIT sessions during the luteal and menstrual phases compared with the follicular phase. This difference was observed before and during HIIT. Motivation and depressive symptoms showed a significant reduction from pre-HIIT to post-HIIT ( P < 0.05), regardless of menstrual phase. The findings revealed that the menstrual cycle had a significant impact on psychophysiological responses. Moreover, HIIT could be adopted to improve motivation and depressive symptoms; however, further research is needed to explore the effects of HIIT across the menstrual cycle in women with clinical depression.

The association of resilience and positive mental health in systemic sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) cohort cross-sectional study

ObjectiveA previous study using Scleroderma Patient-centered Intervention Network (SPIN) Cohort data identified five classes of people with systemic sclerosis (also known as scleroderma) based on patient-reported somatic (fatigue, pain, sleep) and mental health (anxiety, depression) symptoms and compared indicators of disease severity between classes. Across four classes (“low”, “normal”, “high”, “very high”), there were progressively worse somatic and mental health outcomes and greater disease severity. The fifth (“high/low”) class, however, was characterized by high disease severity, fatigue, pain, and sleep but low mental health symptoms. We evaluated resilience across classes and compared resilience between classes. MethodsCross-sectional study. SPIN Cohort participants completed the 10-item Connor-Davidson-Resilience Scale (CD-RISC) and PROMIS v2.0 domains between August 2022 and January 2023. We used latent profile modeling to identify five classes as in the previous study and multiple linear regression to compare resilience levels across classes, controlling for sociodemographic and disease variables. ResultsMean CD-RISC score (N = 1054 participants) was 27.7 (standard deviation = 7.3). Resilience decreased progressively across “low” to “normal” to “high” to “very high” classes (mean 4.7 points per step). Based on multiple regression, the “high/low” class exhibited higher resilience scores than the “high” class (6.0 points, 95% confidence interval [CI] 4.9 to 7.1 points; standardized mean difference = 0.83, 95% CI 0.67 to 0.98). ConclusionsPeople with worse disease severity and patient-reported outcomes reported substantially lower resilience, except a class of people with high disease severity, fatigue, pain, and sleep disturbance but positive mental health and high resilience.

Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system

ObjectiveAssess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center. DesignThis open study assessed an OAMP designed to deliver care in 1–5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017–1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability. ResultsMost patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4–3.9 on 0–10 scale, p ​= ​0.002). BMI did not significantly change (p ​= ​0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4–24 ​h weekly) and serving 953 patients over four years demonstrated OAMP sustainability. ConclusionsOAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.

A Dangerous Relationship: A Case of Imported Plasmodium falciparum and Salmonella Typhi Coinfection.

Malaria is a parasitic disease transmitted by the bite of female Anopheles mosquitoes. Although domestic malaria case notification in our country is not seen in World Health Organization records, cases originating from abroad are detected. Travelers to countries where malaria is endemic can become infected with the parasite. In our country, an average of 200-250 cases of malaria originating from abroad are reported every year. Approximately 75% of malaria cases of foreign origin detected in our country are P. falciparum malaria. Malaria and salmonellosis are infections especially seen in developing countries. Although malaria-Salmonella coinfection is rare, early diagnosis and treatment are important in terms of its high mortality rate. Preliminary information and initiation of chemoprophylaxis in travels to regions where the disease is endemic remain important in transmission. In this presentation, a case was examined following a business trip to Africa without any chemoprophylaxis, who applied to a local hospital upon symptoms and was diagnosed with P. falciparum and Salmonella Typhi coinfection but given incomplete treatment. After returning to our country, the patient applying to us with complaints of high fever, chills, nausea, diarrhea and abdominal pain and was discharged with ful recovery. Keywords: Coinfection, malaria, Plasmodium falciparum, Salmonella Typhi.

A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children

BackgroundProcedural sedation and analgesia are commonly used in the Emergency Departments. Despite this common need, there is still a lack of options for adequate and safe analgesia and sedation in children. The objective of this study was to evaluate whether intranasal dexmedetomidine could provide more effective analgesia and sedation during a procedure than intranasal esketamine.MethodsThis was a double-blind equally randomized (1:1) superiority trial of 30 children aged 1–3 years presenting to the Emergency Department with a laceration or a burn and requiring procedural sedation and analgesia. Patients were randomized to receive 2.0 mcg/kg intranasal dexmedetomidine or 1.0 mg/kg intranasal esketamine.The primary outcome measure was highest pain (assessed using Face, Legs, Activity, Cry, Consolability scale (FLACC)) during the procedure. Secondary outcomes were sedation depth, parents’ satisfaction, and physician’s assessment.Comparisons were done using Mann–Whitney U test (continuous variables) and Fisher’s test (categorical variables).ResultsAdequate analgesia and sedation were reached in 28/30 patients. The estimated sample size was not reached due to changes in treatment of minor injuries and logistical reasons. The median (IQR) of highest FLACC was 1 (0–3) with intranasal dexmedetomidine and 5 (2–6.75) with intranasal esketamine, (p-value 0.09). 85.7% of the parents with children treated with intranasal dexmedetomidine were “very satisfied” with the procedure and sedation compared to the 46.2% of those with intranasal esketamine, (p-value 0.1). No severe adverse events were reported during this trial.ConclusionsThis study was underpowered and did not show any difference between intranasal dexmedetomidine and intranasal esketamine for procedural sedation and analgesia in young children. However, the results support that intranasal dexmedetomidine could provide effective analgesia and sedation during procedures in young children aged 1–3 years with minor injuries.Trial registration: Eudra-CT 2017-00057-40, April 20, 2017. https://eudract.ema.europa.eu/

(287) Influence of Severe Chronic Scrotal Pain on Men’s Sexual Activity: An Indication for Surgery?

Abstract Introduction Severe chronic scrotal pain significantly influences numerous aspects of a patient’s life and activities, particularly sexual activity. Objectives This study seeks to explore the clinical characteristics and the effects of chronic scrotal pain on male sexual activity, with a focus on patients with severe chronic scrotal pain who were candidates for microsurgical denervation of the spermatic cord. Methods This is an observational study that encompassed all patients with severe chronic scrotal pain who underwent microsurgical denervation of the spermatic cord at the Department of Andrology, Binh Dan Hospital, from January 1, 2022, to May 31, 2023, after other causes had been excluded. Results Thirty-one patients with chronic scrotal pain underwent surgery, with a mean age of 24.2 ± 4.3 years and a pain duration of 2.3 ± 1.6 years. Pain was located in the scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), and inguinal (15.1%), with postepididymitis (45.3%) being the predominant cause. The average Numerical Rating Scale (NRS) pain score before surgery was 6.8 ± 2.3. Thirteen out of thirty-one patients experienced severe pain (NRS = 7-10). The Quality of Life (QOL) scores were 6.75 ± 1.1 for patients with moderate pain and 4.6 ± 4.0 for those with severe pain. A smaller testicle size was observed in 43.5% of patients, and 51.6% had varicose veins on ultrasound, measuring 3.4 ± 1.2 mm. Sixteen out of thirty-one patients reported that scrotal pain impacted their sexual activity. Patients with higher pain scales (NRS 7-10) had significant effects on erectile function compared to those with moderate pain (P &amp;lt; 0.05). Decreased libido was reported in 34.1%, and lowered testosterone levels in 37.5% of the patient group. Sexual activity induced pain in 60.9% of cases, and the incidence of erectile dysfunction was significantly higher in the high pain scale group (P = 0.02). No significant statistical difference was observed between the duration of intercourse and the severity of scrotal pain. Conclusion Chronic scrotal pain, predominantly observed in young patients, has substantial impacts on the quality of life and sexual performance. Therefore, a meticulous consideration of sexual factors is imperative in male patients with chronic scrotal pain. Surgical indications for chronic scrotal pain treatment may be deemed necessary for sexual disorders associated with scrotal pain. Disclosure No.

Efficiency of PROMIS MCAT Assessments for Orthopaedic Care

ABSTRACT Administration of patient-reported outcome measures (PROs), using multidimensional computer adaptive tests (MCATs) has the potential to reduce patient burden, but the efficiency of MCAT depends on the degree to which an individual’s responses fit the psychometric properties of the assessment. Assessing patients’ symptom burden through the administration of MCATs is gaining popularity in clinical settings, especially in orthopeadics where patients reporting low physical functioning and high pain interference may not always report high levels of depression. Are MCATs more efficient and precise than unidimensional CATs in a patient profile where the person-item fit varies between symptoms? Results depend on the item selection algorithm used in the assessments. Constraining item selection algorithm can substantially reduce test lengths where person-item fit is poor. This study demonstrates how MCAT can reduce patient burden in settings where collecting PROs is becoming part of routine care. Abbreviations: PRO: Patient-reported outcome; PROMIS®: Patient-Reported Outcomes Measurement Information System; CAT: Computer Adaptive Test; IRT: item response theory; EHR: electronic health record; UCAT: unidimensional computer adaptive tests; MCAT: multidimensional computer adaptive tests; HRQOL: health-related quality of life; MEPV: minimum expected posterior variance; SE: standard error; RMSE: root mean squared error; EAP: Expected a priori; MPEV-P: minimum expected posterior variance with domain preference; KL: Kullback-Leibler.

Conscientiousness and Pain Interference in Older Age.

Conscientiousness is associated with positive health behaviors and outcomes and has been shown to increase as individuals age. Both age and Conscientiousness affect pain, a highly prevalent correlate of aging. This study investigated the effect of Conscientiousness on the relationship between pain and pain interference and vice versa among older adults, who experience pain and functional limitations disproportionately compared with younger adults. A total of 196 community-dwelling older adults (Mage = 73) provided pain and interference ratings semiannually for up to 10 years. Conscientiousness was assessed at the first visit and, on average, 7.6 years later. Multilevel models tested the effect of Conscientiousness on the relationship between pain and interference. Hierarchical regression modeled changes in Conscientiousness. Across all pain levels, higher Conscientiousness was associated with less pain interference (γ02 = -0.126, SE = 0.048, p < .01, 95% confidence intervals (95% CI) [-0.22, -0.03]). This effect was more pronounced at higher levels of pain and older age. Conscientiousness increased slightly over time, but older baseline age (b = -0.01, 95% CI [-0.03, -0.001], R2 = 0.02) and more mean pain interference over the study period (b = -0.17, 95% CI [-0.30, -0.03], R2 = 0.03) were associated with less increase in Conscientiousness at follow-up. Higher pain and older age are associated with more pain interference, and Conscientiousness provided the most protection for these same individuals-those with higher pain and older age. Conscientiousness facilitated reduced interference, which may feed forward into higher Conscientiousness, potentially shaping a cycle between personality and health that extends through older adulthood.