Higher Risk Of Chronic Pain Research Articles

Chronic pain over time among Syrian refugees resettled in Norway

Abstract Background Chronic pain disproportionately impacts vulnerable groups such as migrants and refugees. This study investigates the long-term changes in chronic pain experienced by Syrian refugees in Norway and explores the factors influencing these changes. Methods This prospective cohort study used data from the CHART and Integration for Health studies, with data collection at three points: in Lebanon (Wave-1), one year (Wave-2), and four years post-arrival in Norway (Wave-3). All participants who completed surveys at these timepoints were included (n = 132). Chronic pain was measured by asking about pain lasting at least six months. Mixed-effects logistic regression was used to examine changes in prevalence and assess how age, gender, educational level (categorized as low, ≤9 years, and high, >9 years), and mental health symptoms (anxiety, depression, and post-traumatic disorders) affect these changes. Results Between Wave-1 and Wave-3, the proportion of participants reporting chronic pain increased from 31% to 53%, with an odds ratio of 3.6 (95% CI 2.2 - 5.8). There was an interaction between changes in chronic pain over time and participants’ educational level, where the increase in pain prevalence over time was more pronounced among participants with lower educational levels than higher levels. No modification with the other factors were detected. Conclusions The study observed an increase in the number of participants reporting chronic pain over time. Low educational level at baseline emerged as a useful indicator for identifying those at higher risk of chronic pain. Understanding this correlation can be crucial for guiding preventive strategies and optimizing resource allocation to assist those most vulnerable. Key messages • Chronic pain disproportionately impacts vulnerable groups such as refugees. • Refugees with lower education levels at baseline were more likely to experience chronic pain over time.

Optimizing pain management in breast cancer care: Utilizing 'All of Us' data and deep learning to identify patients at elevated risk for chronic pain.

The aim of the study was to develop a prediction model using deep learning approach to identify breast cancer patients at high risk for chronic pain. This study was a retrospective, observational study. We used demographic, diagnosis, and social survey data from the NIH 'All of Us' program and used a deep learning approach, specifically a Transformer-based time-series classifier, to develop and evaluate our prediction model. The final dataset included 1131 patients. We evaluated the deep learning prediction model, which achieved an accuracy of 72.8% and an area under the receiver operating characteristic curve of 82.0%, demonstrating high performance. Our research represents a significant advancement in predicting chronic pain among breast cancer patients, leveraging deep learning model. Our unique approach integrates both time-series and static data for a more comprehensive understanding of patient outcomes. Our study could enhance early identification and personalized management of chronic pain in breast cancer patients using a deep learning-based prediction model, reducing pain burden and improving outcomes.

Temporomandibular disorders in individuals with Marfan syndrome: an exploratory analysis

BackgroundThis study aims to analyze to what extent patients with Marfan syndrome (MFS) are affected by temporomandibular disorders (TMD) and its impact on oral health-related quality of life (OHRQoL). To collect data, an online questionnaire was created to recruit participants from Germany, Austria, and Switzerland through social media and support groups. The questionnaire consists of free-text questions, the German versions of the Oral Health Impact Profile (OHIP-G14), the Depression Anxiety Stress Scale (DASS), and the Graded Chronic Pain Status (GCPS).ResultsA total of 76 participants with diagnosed MFS were included. Of these, 65.8% showed TMD symptoms, the most common being pain or stiffness of the masticatory muscles in the jaw angle (50.0%). Only 14.5% of the participants were already diagnosed with TMD. Of the participants with an increased likelihood of a depression disorder, 76.9% showed TMD symptoms. Of those with a critical score for an anxiety disorder, 90.9% showed TMD symptoms. 73.3% of participants with TMD symptoms reached the critical score for a stress disorder. TMD symptoms were associated with a higher risk for chronic pain. In the median, participants with TMD showed statistically notably higher OHIP-G14 scores than participants without TMD (11.5 [IQR 17] vs. 1 [IQR 3] points, p ≤ 0.001).ConclusionTMD symptoms had a noticeable impact on OHRQoL in patients with MFS, i.e., chronic pain and psychological impairment. TMD seems underdiagnosed, and more research is needed to prevent the associated chronification of pain and psychological burden to improve the OHRQoL.

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.
 The aim: to identify factors that influence the negative results of pain treatment in combatants after mine-blast wounds during the war in Ukraine
 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.
 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<0.001), OR=0.06 (95% CI 0.04-0.09); 2) high intensity of pain according to VAS on admission (p<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).
 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.

Chronic pain and satisfaction with treatment outcomes in patients with mine-blast injuries

Chronic pain in patients after mine-explosive wounds occurs, on average, in 83.3% of cases. It has already been found that the neuropathic component of pain and the number of localizations of injured anatomical parts of the body have a direct impact on such a high frequency of chronicity. However, the level of satisfaction with treatment results remains unexplored, which is important because it reflects the quality of life from the distant perspective of treatment.The goal of the work. To investigate the level of satisfaction with the results of treatment in patients with mine-explosive wounds.Material and Methods. Data on the treatment of 280 patients with mine-explosive wounds are presented. The level of satisfaction with the treatment results using the Chaban quality of life scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The law of distribution differed from the normal one, the median value (Me) and interquartile range (QI-QIII) were given to represent quantitative indicators, the comparison of indicators in two groups was carried out according to the Mann-Whitney test. To analyze the dynamics of the indicators, the Friedman test was used for related samples, the posterior comparison was carried out using the Bonferroni correction. For qualitative indicators, the absolute frequency of symptom manifestation and relative frequency (%) are presented, and for the comparison of two groups, the chi-square test was used, taking into account the correction for continuity. When conducting the analysis in all cases, the critical level of significance was taken equal to 0.05.Results. The data of the Chaban quality of life scale indicate that the level of satisfaction with the results of the treatment in the studied patients during the entire observation period was maximum before discharge from the inpatient treatment and ranged from 68 to 73 points – the average level of satisfaction. Later, after 1, 3, 6 and 12 months of observation, this indicator decreased and ranged from 62 to 65 points, which corresponds to the average level of satisfaction with the treatment results.Conclusions. The low level of satisfaction with the results of treatment in patients after mine-explosive wounds is probably a consequence of chronic pain. Patients with mine-explosive wounds have a very high risk of chronic pain – 15% higher than patients with gunshot wounds and 57.5% higher than civilian injured patients. Therefore, more attention should be paid to the problem of pain treatment at the stages of treatment.

Prevalence and quality of temporomandibular disorders, chronic pain and psychological distress in patients with classical and hypermobile Ehlers-Danlos syndrome: an exploratory study

BackgroundThe Ehlers-Danlos syndromes are a group of clinically and genetically heterogeneous hereditary diseases affecting the connective tissue. They are characterized by hypermobility of the joints, hyperextensible skin and friable tissue. According to current classification, 13 subtypes can be distinguished, of which the hypermobile and the classical subtype are the most prevalent. This study aimed to evaluate patients with classical (cEDS) and hypermobile (hEDS) Ehlers-Danlos syndrome regarding temporomandibular disorder (TMD), chronic pain, and psychological distress.MethodsSupport groups from Germany, Austria, and Switzerland were contacted, and social media were used to recruit participants. Free text questions, the German version of the Depression Anxiety and Stress Scale (DASS), and the German version of the Graded Chronic Pain Status (GCPS) were used.Results259 participants were included (230 hEDS/29 cEDS). At least 49.2% of the participants had painful or restricted jaw movements, and at least 84.9% had pain in the masticatory muscles, with 46.3% already having a diagnosed TMD. Multivariate analysis showed a significant correlation between TMJ involvement and chronic pain with a 2.5-fold higher risk of chronic pain with a diagnosed TMD. 22.8% of participants had a critical score for depression, 53.3% had a critical score for anxiety, and 34.0% had a critical score for stress.ConclusionThere is a high prevalence of TMD problems and chronic pain in patients with cEDS and hEDS. The lack of knowledge about these problems can create psychological distress. More research is needed to provide adequate treatment for patients with EDS.

Chronic pain after hospital discharge on patients hospitalized for COVID-19: an observational study

BackgroundThere are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome. MethodsA cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3 months after discharge and their hospital's health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05. ResultsOf 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body. ConclusionChronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

Effectiveness of pain treatment for patients with mine-blast wounds depending on the number of localizations in military mobile hospitals

Patients with gunshot wounds suffer from chronic pain in 70% of cases, and those with mine-blast wounds – in 83.3% of cases. Civilian patients, after serious injuries, in 11-40% of cases. Unfortunately, there is not enough data to study the causes of such a high frequency of pain chronicity. Therefore, the study of the results of pain treatment at the stage of treatment in military mobile hospitals may be able to reveal the reasons for such a high frequency of chronicity.&#x0D; Methods. The treatment of 280 patients with mine-blast wounds was analyzed. The intensity of pain was diagnosed using a visual analog scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The law of distribution differed from the normal one, the median value (Me) and interquartile range (QI-QIII) were given to present quantitative indicators, and the comparison of indicators in the two groups was performed by the Mann-Whitney test. To analyze the dynamics of indicators, the Friedman criterion for linked samples was used, and the posterior comparison was performed using the Bonferroni correction. For qualitative indicators, the absolute frequency of the trait and the relative frequency (%) are presented, and the chi-square test with the correction for continuity was used to compare the two groups. In all cases, the critical level of significance was set at 0.05.&#x0D; Results. The analysis of pain intensity according to the VAS, before anesthesia, upon admission to military mobile hospitals, showed that patients experienced high-intensity pain reaching 7 points. This indicates a lack of effective pain control both at the initial stage of treatment and during evacuation. After anesthesia, VAS data indicate the presence of moderate pain – 4 points. The intervals between analgesic treatments averaged 6 hours. Although the effectiveness of analgesia according to VAS was low.&#x0D; Conclusions. Patients with mine-blast injuries have a very high risk of chronic pain – 57.5% higher than in injured patients in civilian life. The study results point to ways to improve treatment outcomes for this category of patients. Achieving high-quality pain control at the stage of treatment in military mobile hospitals and maintaining the continuity of treatment during an evacuation can potentially reduce the incidence of pain chronicity.

PAIN WITH A NEUROPATHIC COMPONENT IN COMBATANTS AFTER GUNSHOT WOUNDS

Background. In combatants with gunshot wounds, the frequency of pain chronicization is observed in 63.4-78.5% of cases. The reason for this high frequency of chronicization may be a neuropathic component. However, this hypothesis remains unexplored.&#x0D; Aim: To study the frequency of neuropathic pain in combatants after gunshot wounds.&#x0D; Materials and methods. We analyzed the treatment of 769 combatants after gunshot wounds. The neuropathic component of pain was identified using the Douleur Neuropathique 4 questions. The statistical analysis was performed using the Shapiro-Wilk, Friedman, chi-square, and Bonferroni correction.&#x0D; Results. The obtained data indicate that all combatants with chronic pain after gunshot wounds have a neuropathic component of pain (DN4 - from 4 to 5 points). Moreover, the results between the groups did not differ after 1 month - p=0.918, and after 3 months - 0.713, 6 months - p=0.824 and 12 months - p=0.911.&#x0D; Conclusion. Combatants who sustained gunshot wounds have a high risk of chronic pain. It was found that the neuropathic component of pain is present in all patients in this category, so it may be one of the key components of such a high frequency of pain chronicity, which requires further research.

Presence of a neuropathic pain component in patients with chronic pain after gunshot wounds

In patients with gunshot wounds, chronic pain is observed in 70% of cases. One of the factors that influence such a high frequency of pain chronicity is the number of localizations of injured anatomical parts of the body – in patients with injuries in 1 or 2 anatomical parts of the body, the frequency of chronicity is 69.7%, and in patients with injuries in 3 – 71.2% of cases. Also, the presence of a neuropathic component of pain in this category of patients and its possible impact on such a high frequency of chronicity remains unexplored.&#x0D; Materials. The treatment of 769 patients was analyzed. The Douleur Neuropathique 4 questions were used to identify neuropathic pain. The Shapiro-Wilk, Mann-Whitney, Friedman's Bonferroni correction, and chi-square test with a continuity correction were also used. In all cases, the critical level of significance was set at 0.05.&#x0D; Results. Douleur Neuropathique 4 questions data indicate that all patients had a neuropathic pain component (scores range from 4 to 5). At the time of discharge at the stage of treatment in military medical clinical centers, we observed the absence of a neuropathic component of pain in some patients – these were those patients who did not have chronic pain. After 1 month – p=0.918, 3 months – 0.713, 6 months – p=0.824, and 12 months – p=0.911 observation, the data did not differentiate.&#x0D; Conclusions. Patients who received gunshot wounds have a high risk of chronic pain. It was found that the neuropathic component of pain is present in all patients of this category, so it may be one of the key components of such a high frequency of chronicity.

0480 Psychoactive Substance Use and Sleep Characteristics Among Individuals with Untreated Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is characterized by recurrent airway obstruction causing intermittent hypoxia, arousal from sleep, and autonomic instability, and is associated with a variety of long-term health sequala. The fragmented sleep resulting from these respiratory events leads to disruption in normal sleep architecture and progression to deeper stages of sleep, a potential mediator for some of the functional and neurocognitive impairments seen in this population. Similarly, psychoactive substance use (i.e., nicotine, alcohol, and caffeine) impacts sleep architecture in healthy individuals, but their effects in those with OSA have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA. Methods We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol, and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and co-morbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety). Results Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Current smokers exhibited lower sleep duration (0.3 hours) and longer sleep latency (5 minutes) compared with non-smokers (all p-values&amp;lt; 0.05). REM sleep increased in those with moderate and heavy alcohol use (2.5 and 5% of total sleep time respectively), and moderate caffeine use (2%, all p-values &amp;lt; 0.05)). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 hours) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9). . Conclusion Both psychoactive substances and untreated OSA impact normal sleep architecture, their cumulative effect may have clinical implications in this subgroup. Stimulating or sedating substances may be used in OSA patients to mitigate daytime and nighttime symptoms respectively. Further investigation into the effects substances have on this population may present opportunities to better understand disease mechanisms and increase the effectiveness of treatment in OSA Support (if any)

Gender differences in epigastric hernia repair: a propensity score matching analysis of 15,925 patients from the Herniamed registry.

In recent surgical literature, gender-specific differences in the outcome of hernia surgery has been analyzed. We already know that female patients are at higher risk to develop chronic postoperative pain after inguinal, incisional, and umbilical hernia surgery. In this study, we evaluated the impact of gender on the outcome after epigastric hernia surgery. A covariable-adjusted matched-paired analysis with data derived from the Herniamed registry was performed. In total of 15,925 patients with 1-year follow-up data were included in the study. Propensity score matching was performed for the 7786 female (48.9%) and 8139 male (51.1%) patients, creating 6350 pairs (81.6%). Matched-paired analysis revealed a significant disadvantage for female patients for pain on exertion (12.1% vs. 7.6%; p < 0.001) compared to male patients. The same effect was demonstrated for pain at rest (6.2% in female patients vs. 4.1% in male patients; p < 0.001) and pain requiring treatment (4.6% in female patients vs. 3.1% in male patients; p < 0.001). All other outcome parameters showed no significant differences between female and male patients. Female patients are at a higher risk for chronic pain after elective epigastric hernia repairs compared to the male patient population. These results complete findings of previous studies showing the same effect in inguinal, umbilical, and incisional hernia repair.

Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea.

Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA. We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety). Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m2). Current smokers exhibited lower sleep duration (0.3h), longer sleep latency (5min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users. Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fullyand increase the effectiveness of treatment in OSA.

PECULIARITIES OF CHRONIC PAIN AND PAIN-RELATED STRESS MARKERS IN PRETERM INFANTS

Preterm infants are a special cohort of newborns that require long-term treatment in the neonatal intensive care unit (NICU). NICU stay, accompanied by numerous excessive stimuli, painful procedures, and separation from parents leads to a high risk of chronic pain and stress.The aim of research was to study the level of chronic pain and pain-related stress markers in preterm infants with a gestational age of less than 34 weeks, and their associations with various factors.Materials and methods. The study involved 104 preterm infants with gestational age (GA) less than 34 weeks who were treated in the NICU. The level of chronic pain and pain-related stress markers (dopamine, β-endorphin, serotonin) in urine samples was determined by an enzyme-linked immunosorbent assay using kits for the quantitative determination of dopamine (Dopamine Elisa kit, Elabscience, Wuhan, China), β-endorphin (β-endorphin Elisa kit, Elabscience, Wuhan, China), serotonin (Serotonin Elisa kit, Elabscience, Wuhan, China). Samples were analyzed in duplicate, and assays were performed using provided controls according to the manufacturer’s instructions.Ethics approval was obtained from the appropriate local ethics committee and research was conducted under the World Medical Association’s Helsinki Declaration. Informed consent was obtained from all the participants who took part in the study.All computations were performed using StatSoft STATISTICA Version 13 (Tulsa, OK). Quantitative data are presented as the median and interquartile range (IQR; 25th to 75th percentiles). For qualitative parameters, absolute and relative frequencies are presented. The Mann-Whitney U-test (for two independent groups) and Kruskal-Wallis test (for three groups) were used to compare numerical data. Significance was assumed at p&lt;0.05. Correlations were analyzed using Spearman’s rank correlation coefficient.The study is a part of the scientific research: Implementation of the neuro-developmental care elements for preterm infants and their follow-up observation (0120U104281, 01.01.2020-12.31.2022).Research results and their discussion. Dopamine level in the urine of preterm infants was 132.20 [104.80; 183.70] pg/ml. It was significantly higher in children who underwent mechanical ventilation compared to non-ventilated neonates (164.60 [110.00; 253.70] pg/mL vs. 123.20 [98.65; 158.70] pg /ml), p=0.030, and was associated with the severity of respiratory disorders (H=5.84; p=0.049). Dopamine level was significantly lower in twins compared to singleton infants (113.70 [78.75; 164.70] vs. 145.10 [111.80; 208.50], p=0.017.β-endorphin level in the urine of preterm newborns was 29.87 [20.61; 46.94] pg/ml. It was significantly higher in twins compared to singletons (38.30 21.97; 59.61] vs. 27.80 [19.66; 39.16], p=0.046). β-endorphin level was significantly lower in children with neonatal seizures (p=0.039).Serotonin level in the urine of preterm infants was 23.49 [16.13; 32.19] pg/ml. It was significantly higher in neonates born by caesarean section compared to those born naturally (25.62 [18.87; 38.53] ng/ml vs. 17.41 [13.36; 27.89] ng/ml, p=0.017), and it was higher in twins compared to singletons (27.19 [18.87; 41.75] ng/ml vs. 21.98 [14.41; 29.70] ng/ml), however, with no statistical significance (р=0.073).The study revealed the positive correlation between serotonin and β-endorphin levels (r=0.68; p&lt;0.001) in infants who required mechanical ventilation and in newborns with neonatal seizures (r=0.59; p&lt;0.001). Positive correlation between β-endorphin and serotonin levels in twins also was found (r=0.72, p&lt;0.001).Conclusion. This prospective cohort study showed that severe respiratory disorders in preterm infants were associated with decreased dopamine level, while serotonin and β-endorphin levels were correlated in this case. Neonatal seizures were associated with decreased β-endorphin level, while a positive correlation was found between β-endorphin and serotonin levels. Dopamine levels were significantly lower and β-endorphin levels significantly higher in twins compared to singleton preterm neonates. Serotonin level was significantly higher in neonates born by caesarean section. Gestational age, birth weight, gender, early-onset sepsis, and intraventricular hemorrhage were not associated with increased or decreased levels of pain and pain-related stress markers in preterm infants.

Chronic pain in patients with gunshot wounds

BackgroundIn civilian life, from 11 to 40% of patients suffer from chronic pain after receiving injuries. There are almost no data on chronic pain in patients with gunshot wounds, isolated clinical cases have been published. The purpose of our study is to determine the factors that can potentially affect the results of treatment of such patients, namely the frequency of development of chronic pain, acute stress reactions, satisfaction with the results of treatment and the number of wound localizations.MethodsThe treatment of 769 patients was analyzed. Pain intensity was diagnosed using a visual analog scale (VAS). To detect neuropathic pain, the Douleur Neuropathique 4 questions (DN4). The presence of an acute stress reaction (ASR) was diagnosed using The hospital anxiety and depression scale (HADS) and medical history, the diagnosis was established by a psychiatrist. Satisfaction with treatment results was studied using the Chaban quality of life scale (CQLS). Group comparisons were made using the Mann–Whitney test and the chi-square test, taking into account continuity correction.ResultsChronic pain was observed in 538 (70% 95% CI 66.7%-73.1%) patients with gunshot wounds: of them, 439 patients had wounds in 1, 2 anatomical parts of the body, here the frequency of pain chronicity is 69.7% (95% CI 66.0%-78.5%), and 99 patients had wounds in 3 or more anatomical parts of the body – 71.2% (95%CI 63.4%-78.5%). DN4 data suggest the presence of a neuropathic pain component in these patients. Also, all patients were diagnosed with ASR upon admission: the number of HADS points ranged from 9 to 25 points. CQLS data indicate that satisfaction with treatment outcomes was high (76 points) before hospital discharge, but subsequently decreased to a low level (64 points).ConclusionsPatients with gunshot wounds have a high risk of chronic pain, averaging 45% higher than the general population in civilian trauma patients. A greater frequency of the neuropathic component of pain and acute stress reactions is the reason for such chronicity. A decrease in the level of satisfaction with the results of treatment, in the remote period of observation, compared to the level at the time of discharge from the hospital, is probably a consequence of the formation of chronic pain.Trial registrationClinicalTrials.gov: Retrospectively registered on August 1, 2022, NCT05489029.

Treatment of pain in patients with mine blast wounds during treatment in military medical clinical centers

Considering the war situation in Ukraine, the treatment of pain in patients with mine blast injuries is of great importance in today's medical practice because, during the Anti-Terrorist Operation/Joint Forces Operation, such injuries account for more than 25%, and chronic pain after such injuries is diagnosed in 83.3% of cases. Such injuries are characterized by significant damage. Data on pain treatment at the stage of treatment in military medical clinical centers are scarce.The goal of the work. To investigate the results of pain treatment of patients with mine blast wounds at the stage of treatment in military medical clinical centers of the Armed Forces of Ukraine.Methods. Data on the treatment of 280 patients with mine blast injuries are presented. Pain intensity was diagnosed using a visual analog scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The distribution law differed from the normal one; the median value (Me) and the interquartile range (QI-QIII) were given to represent quantitative indicators. The comparison of indicators in two groups was carried out according to the Mann-Whitney test. To analyze the dynamics of the indicators, the Friedman test for related samples was used, the posterior comparison was carried out using the Bonferroni correction. For qualitative indicators, the absolute frequency of symptom manifestation and the relative frequency (%) are presented, and for the comparison of two groups, the chi-square test was used, taking into account the correction for continuity. When conducting the analysis in all cases, the critical significance level was equal to 0.05.Results. Pain intensity according to VAS before analgesia at the stage of treatment in military medical clinical centers shows that before analgesia in group 2 it was significantly higher than in patients of group 1 (p&lt;0.001) and is 7 points – severe pain. Patients of group 1 experienced pain of average intensity on admission - 4 points. After analgesia, the average value of the VAS indicator in the two groups was practically not different, but it was statistically significant (p=0.012), this indicator was higher in group 2. During in-patient observation for 2-6 days (p&lt;0.001) and before discharge from in-patient treatment (p=0.013) values of the VAS indicator in group 2 were higher than in group 1. The dynamics of the intervals between analgesia indicate that in groups 1 and 2 there is a statistically significant difference during the 1 day of observation (p=0.005) and 9-14 days of observation (p&lt;0.001).Conclusions. Taking into account the obtained data, it is clear that the effectiveness of analgesia, both in the previous stages of treatment and during the transportation of patients, was at a low level. It is also worth noting that during discharge from inpatient treatment, patients still felt mild pain. Patients with mine blast injuries have a high risk of chronic pain. The obtained results of the study indicate ways to improve the results of treatment in this category of patients. Achieving good pain control in the early stages of treatment and maintaining continuity of care during evacuation can potentially reduce the frequency of chronic pain.

Changes in opioid prescription, potential misuse, and substance use disorder in pediatric cancer survivors following the 2016 CDC opioid prescribing guideline.

6506 Background: The 2016 Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids, despite not being intended for cancer-related pain, has been shown to be associated with declines in opioid prescriptions among adults with cancer. We examine the changes in opioid prescription, potential misuse, and substance use disorder (SUD) following the guideline release among pediatric cancer survivors, a population at high risk for chronic pain. Methods: Using nationwide private insurance claims data, we identified survivors (aged ≤21 years at cancer diagnosis) who completed treatment for leukemia, lymphoma, central nervous system, bone, or gonadal cancers in 2009-2018 (N=8,969). We also identified enrollees without cancer who were matched based on age, gender, and region as a control group (N=44,845). Outcomes included (1) any opioid prescription and (2) any indicator for potential misuse or SUD within 1-year post-therapy. We conducted interrupted time series analysis, where time period was assessed by quarters based on the quarter-year of patients’ therapy completion. Segmented linear regression was conducted to estimate the immediate change (“level” change) and the change in the time trend (“slope” change) in each outcome after the guideline release in March 2016, accounting for autocorrelation. Results: Before the guideline release, opioid prescription rate (21.1% vs. 7.2%) and rate of potential misuse or SUD (5.6% vs. 1.9%) were higher among survivors than controls ( p&lt;0.05). Post guideline release, we found a declining trend in opioid prescription rate among survivors (slope change = -1.0 percentage point [ppt]; p&lt;0.001). Survivors also experienced an immediate level decrease (-2.0 ppt; p=0.040) and a decreasing trend (slope change = -0.4 ppt; p=0.004) in the rate of potential misuse or SUD. Among controls, there were decreasing trends in opioid prescription rate (slope change = -0.3 ppt; p&lt;0.001) and rate of potential misuse or SUD (slope change = -0.1 ppt; p=0.042). By three years post guideline release, relative reductions in opioid prescription rate and rate of potential misuse or SUD were 51.8% and 76.0%, respectively, among survivors ( p&lt;0.05), with controls experiencing smaller relative reductions (29.4% and 36.5%; p&lt;0.05). Conclusions: Following the release of the CDC opioid prescribing guideline in March 2016, there were reductions in opioid prescription rate and rate of potential opioid misuse or SUD among both pediatric cancer survivors and controls, with survivors experiencing greater reductions.

Identifying Patients at High Risk of Chronic Pain After Video-Assisted Thoracoscopic Surgery Using Thermal Quantitative Sensory Testing

To examine whether perioperative thermal quantitative sensory testing could be used to identify patients at high risk of chronic pain after video-assisted thoracoscopic surgery (VATS). A single-center, prospective, observational study. At the Peking University People's Hospital. A total of 111 patients scheduled to undergo VATS were enrolled. Quantitative sensory testing was conducted at the anterior intercostal incision prior to surgery and after chest tube removal. The patient's chronic pain was assessed at 3 months after surgery using a questionnaire. The incidence of chronic pain was 35 out of 107 evaluable patients (32.7%). Among the 35 patients with chronic pain, 26 had features characteristic of neuropathic pain (74.3%). Compared to the patients without chronic pain, subjects with chronic pain had a significantly greater perioperative change in cold pain threshold (CPT; p=0.032), but not cold detection threshold, warm detection threshold, and hot pain threshold . In the multivariate regression, perioperative CPT change was associated with chronic pain after VATS (odds ratio=1.043, p=0.026). Chronic pain after VATS is typically neuropathic. The change in perioperative CPT at the incision site may help to identify patients at higher risk of chronic pain after VATS.

Making a business plan for starting a transitional pain service within the US healthcare system

Chronic pain imposes a tremendous economic burden of up to US$635 billion per year in terms of direct costs (such as the costs of treatment) and indirect costs (such as...

Narrative Review - Knee Pain in the Pediatric Athlete.

This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.