High Incidence Of Chronic Pain Research Articles

Postoperative Analgesia and Palliative Care of Peng Block for Terminal Osteosarcoma.

Palliative care involves patients with a high incidence of chronic pain and inadequate treatment related to opioid abuse. In terminal patients, the side effects of opioids may result in lower quality of life due to their deleterious immunosuppression and gastrointestinal effects. In our routine clinical practice, we consider the ultrasound-guided PENG block as a palliative analgesic technique to improve end-of-life care to terminal patients.

Symmetry Function: The Differences between Active and Non-Active Above-the-Knee Amputees.

The number of patients with unilateral above-knee amputation (AKA) due to non-vascular causes has remained stable over the years, at 0.92 per 1000 people per year. Post-AKA individuals are at risk of experiencing a higher incidence of chronic pain. Post rehabilitation, it is estimated that between 16–62% of patients with musculoskeletal disabilities fail to meet the minimum criteria for physical activity in comparison to a healthy population. The current study included 14 participants (11 men and 3 women) with a mean age of 46.1 ± 14.2 years, body height of 1.76 ± 0.09 m, and weight of 79.6 ± 18.3 kg, who were all post-unilateral above-the-knee amputees. Patients in the study were divided into two groups: active (AC) and non-active (NAC). This study was conducted in a certified Laboratory of Biomechanical Analysis using the BTS Smart-E system (BTS Bioengineering). In order to investigate the symmetry function (SF) of gait, the only measurements included were the time series assessment of gait variables defining pelvic and lower limb joint motion and ground reaction forces (GRF). Both groups had an asymmetrical gait pattern with a different magnitude and relative position in the gait cycle, which was revealed by SF. The differences in terms of median, minimum, and maximum were statistically significant (p < 0.05), with SF ranging from –25 to 24% for the AC group and from 43 to 77% (59% on average) for the NAC group. The AC’s pattern was more symmetrical compared to the NAC’s pattern, especially in the case of pelvic and hip joint motion.

Feasibility and efficacy of cryoneurolysis analgesia in robotic-assisted thoracoscopic surgery (CARTS): a pilot study.

Opioid therapy has been the mainstay therapy of post-operative pain management in thoracic surgery patients. With the high incidence of chronic pain in thoracic surgery patients and adverse effects of opioids, we examined the safety and efficacy of cryoneurolysis as an adjunct for narcotic-free pain management in robotic-assisted thoracoscopic lobectomies. Ten consecutive patients undergoing robotic-assisted (DaVinci) pulmonary resection and cryoneurolysis were compared to ten patients managed without intraoperative cryoneurolysis. All patients received multimodal pain regimen including paravertebral blocks as per our institutional enhanced recovery pathway. Patients with chronic pain and chronic opioid use were excluded. We compared inpatient and outpatient opioid consumption measured in morphine equivalents (mme), incidence of opioid-free outpatient recovery, and adverse events. The two groups did not differ significantly in terms of baseline demographics. Both inpatient (88.13 vs 26.92mme) and outpatient (118.5 vs 34.5mme) use of narcotics were significantly lower in the cryoneurolysis group (p < 0.05) with seven of ten patients receiving cryoneurolysis able to recover without the use of opioids in the outpatient setting, compared to two in the control group. One patient reported post-operative neuralgia in each cryoneurolysis and control group. There were no readmissions in either group and mean length of stay was identicalat 1.7days in control group and 1.1days in experimental group (p = 0.33). The use of intraoperative intercostal cryoneurolysis may safely reduce the utilization of outpatient opioids in patients undergoing robotic-assisted thoracoscopic surgery. A randomized controlled trial is warranted to validate these findings in a larger cohort of patients.

Patient-reported outcome measures of abdominal wall morbidity after flank incision for open partial nephrectomy.

To compare patient-reported outcome measures in patients with and without abdominal wall complications after open partial nephrectomy (OPN) via flank incision. Patient-reported outcome measures were collected in 2017 from all patients operated on with OPN via flank incision between 2004 and 2016 in Västerbotten County, Sweden. Patients were mailed the ventral hernia pain questionnaire (VHPQ) and an abdominal wall asymmetry (AWA) questionnaire to evaluate postoperative AWA, attributed to bulge or incisional hernia. Demographic and follow-up data were retrieved from patient records. A total of 198 patients were eligible for the study, and 146 questionnaires were returned (74%). Forty-five patients (31%) reported postoperative AWA and 27 (18%) reported ongoing pain. Three patients who reported AWA had a known incisional hernia. Pain and abdominal wall stiffness were more common in patients with AWA than in those without (P < 0.01 and P < 0.01, respectively). Of the 45 patients with AWA, 25 (56%) reported this as being negative cosmetically and 16 (36%) as negative regarding activities. Patients that reported AWA were younger and had a higher body mass index at surgery (P = 0.03 and 0.04, respectively). Abdominal wall asymmetry is a common sequel of flank incision for OPN and is associated with a higher incidence of chronic pain and abdominal stiffness compared to absence of postoperative AWA. Some patients reported that the effect on daily activities and the cosmetic effect caused by AWA had a negative impact on their quality of life.

Pre-Operative Bariatric Surgery Imparts An Increased Risk of Infection, Re-Admission and Operative Intervention Following Elective Instrumented Lumbar Fusion.

Retrospective cohort study. To evaluate the impact of bariatric surgery on patient outcomes following elective instrumented lumbar fusion. A retrospective review of a prospectively collected database was performed. Patients who underwent a bariatric procedure prior to an elective instrumented lumbar fusion were evaluated. Lumbar procedures were performed at a large academic medical center from 1/1/2012 to 1/1/2018. The primary outcome was surgical site infection (SSI) requiring surgical debridement. Secondary outcomes were prolonged wound drainage requiring treatment, implant failure requiring revision, revision secondary to adjacent segment disease (ASD), and chronic pain states. A randomly selected, surgeon and comorbidity-matched group of 59 patients that underwent an elective lumbar fusion during that period was used as a control. Statistical analysis was performed using Student's two-way t-tests for continuous data, with significance defined as P < .05. Twenty-five patients were identified who underwent bariatric surgery prior to elective lumbar fusion. Mean follow-up was 2.4 ± 1.9 years in the bariatric group vs. 1.5 ± 1.3 years in the control group. Patients with a history of bariatric surgery had an increased incidence of SSI that required operative debridement, revision surgery due to ASD, and a higher incidence of chronic pain. Prolonged wound drainage and implant failure were equivalent between groups. In the present study, bariatric surgery prior to elective instrumented lumbar fusion was associated increased risk of surgical site infection, adjacent segment disease and chronic pain when compared to non-bariatric patients.

A retrospective analysis of the effects of different analgesics on the pain of patients with traumatic thoracolumbar fractures in the peri-treatment period

ObjectiveTo analyze and compare the effects of peri-treatment analgesics on acute and chronic pain and postoperative functional recovery of patients with thoracolumbar fractures, so as to guide the clinical drug use.MethodsSeven hundred nineteen patients with thoracolumbar fractures were collected and divided into acetaminophen dihydrocodeine, celecoxib, and etoricoxib groups. The main indicators were the degree of postoperative pain (visual analog scale (VAS)), the incidence of chronic pain and postoperative functional recovery (Oswestry dysfunction index (ODI) and Japanese Orthopedics Association score (JOA)), which were continuously tracked through long-term telephone follow-up. The correlation analysis of ODI-pain score, peri-treatment VAS score, and ODI index was performed, and bivariate regression analysis was conducted to understand the risk factors for chronic pain.ResultsRegression analysis showed that severe spinal cord injury and peri-treatment use of acetaminophen dihydrocodeine were both one of the risk factors for postoperative chronic pain. But there were no statistically conspicuous differences in basic characteristics, preoperative injury, and intraoperative conditions. Compared with the other two groups, patients in the acetaminophen dihydrocodeine group had longer peri-therapeutic analgesic use, higher pain-related scores (VAS 1 day preoperatively, VAS 1 month postoperatively, and ODI-pain 1 year postoperatively), higher VAS variation, higher incidence of chronic pain 1 year after surgery, and higher ODI index. And other ODI items and JOA assessments showed no statistically significant differences. In addition, the correlation analysis showed that the peri-treatment pain score was correlated with the severity of postoperative chronic pain.ConclusionAlthough the peri-treatment analgesic effect of acetaminophen dihydrocodeine is good, it is still necessary to combine analgesics with different mechanisms of action for patients with severe preoperative pain of thoracolumbar fracture, so as to inhibit the incidence of postoperative chronic pain and improve the quality of postoperative rehabilitation.

Chronic Pain has become a Chronic Problem in Norway. What are we doing Wrong? A Report from a Norwegian Pain Clinic

hronic pain occurs in around 20% of European adults [1], affecting 100 million people. In Norway 30% of the population suffer from chronic pain [2]. Reasons for why Norwegians have such a high incidence of chronic pain is not known. Chronic pain has been associated with socio-economic deprivation [3]. However, the World Bank has declared Norway the richest country in the world [4]. All residents are covered by the National Insurance Scheme. Private medical insurance is limited and most hospitals are public. Outpatient care and medicines used in chronic diseases are usually heavily subsidized or free. Is it possible that these support systems and the provision of sick pay paradoxically reduce motivation in individuals to increase levels of activity, and reduce the use of medication, thereby delaying a return to work?

The role of α7-nicotinic acetylcholine receptor in a rat model of chronic nicotine-induced mechanical hypersensitivity

Smokers have a higher incidence of chronic pain than non-smokers, but the neural mechanism is not yet fully understood. Nicotine is the main component of tobacco and acts as an agonist for nicotinic cholinergic receptors (nAChRs) in the nervous system.This study was approved by the IACUC of UM. The effects of chronic nicotine administration on mechanical sensitivity were studied using a rat model. The changes in the expression levels of the α7 isoform of nAChR (α7-nAChR), inflammatory cytokines TNFα and COX-2, as well as the density of neuro-immune cells (astrocytes and microglia) were measured concurrently.The results indicate that long-term nicotine administration induces hypersensitivity to mechanical stimuli, as demonstrated by a significant reduction in the pain perception threshold. In response to nicotine, the expression levels of α7-nAChR increased in the periaqueductal gray matter (PAG) and decreased in the spinal cord. Acute administration of the selective α7-nAChR agonist CDP-Choline reversed this hypersensitivity. Chronic nicotine administration led to an increase of microglial cells in the dorsal horn of the spinal cord and increased expression levels of the cytokines TNFα and COX-2.This study suggests that decreased α7-nAChR expression in the spinal cord, as a result of long-term exposure to nicotine, may be causatively linked to chronic pain. Simultaneously, the increase of neuro-immune factors in the spinal cord is also a potential factor leading to chronic pain.

PGE2/EP4 receptor and TRPV1 channel are involved in repeated restraint stress-induced prolongation of sensitization pain evoked by subsequent PGE2 challenge

Prevalence of prior stressful experience is linked to high incidence of chronic pain. Stress, particularly repeated stress, is known to induce maladaptive neuroplasticity along peripheral and central pain transmission pathways. These maladaptive neuroplastic events facilitate sensitization of nociceptive neurons and transition from acute to chronic pain. Pro-inflammatory and pain mediators are involved in inducing neuroplasticity. Pain mediators such as prostaglandin E2 (PGE2), EP4 receptor and transient receptor potential vanilloid-1 (TRPV1) contributes to the genesis of chronic pain. In this study, we examined role of PGE2/EP4 signaling and TRPV1 signaling in repeated restraint stress-induced prolongation of sensitization pain, a model for transition from acute to chronic pain, in both in vivo and in vitro models. We found that pre-exposure to single restraint stress induced analgesia that masked sensitization pain evoked by subsequent PGE2 challenge. However, pre-exposure to 3d consecutive restraint stress not only prolonged sensitization pain, but also increased stress hormone corticosterone (CORT) in serum, COX2 levels in paw skin, EP4 and TRPV1 levels in dorsal root ganglion (DRG) and paw skin. Pre-exposure to CORT for 3d, not 1d, also prolonged sensitization pain evoked by PGE2. Co-injection of glucocorticoid receptor (GR) antagonist RU486, COX2 inhibitor NS-398, EP4 receptor antagonist L161, 982 or TRPV1 antagonist capsazepine prevented 3d restraint stress prolonged sensitization pain evoked by PGE2. In DRG cultures, CORT increased EP4 and TRPV1 protein levels through GR activation. These data suggest that PGE2/EP4 signaling and TRPV1 signaling in peripheral pain pathway contributes to repeated stress-predisposed transition from acute to chronic pain.

Opioid Use in Long-Term Care: Guidelines and Policy Recommendations

Older adults living in long-term care (LTC) settings experience a higher incidence of chronic pain than those living in the community and are prescribed opioids at approximately twice the rate. Opioids are effective in managing pain in LTC residents, who are often not candidates for nonopioid pharmacological or nonpharmacological therapies. The recent Centers for Disease Control and Prevention guideline for opioid stewardship recommends conservative opioid prescribing and discourages long-term opioid use for chronic pain management, raising concern that pain may not be adequately treated for LTC residents. The Society for Post-Acute and Long-Term Care Medicine recently published a policy statement that addresses responsible opioid stewardship in LTC. The current article describes clinical guidelines and standards that can guide LTC nurses in assessing, treating, and monitoring opioid use so that residents have diminished pain without significant adverse events. [Journal of Gerontological Nursing, 45(9), 5-10.].

PGE2/EP4 receptor and TRPV1 channel are involved in repeated restraint stress-induced prolongation of sensitization pain evoked by subsequent PGE2 challenge

Prevalence of prior stressful experience is linked to high incidence of chronic pain. Stress, particularly repeated stress, is known to induce maladaptive neuroplasticity along peripheral and central pain transmission pathways. These maladaptive neuroplastic events facilitate sensitization of nociceptive neurons and transition from acute to chronic pain. Pro-inflammatory and pain mediators are involved in inducing neuroplasticity. Pain mediators such as prostaglandin E2 (PGE2), EP4 receptor and transient receptor potential vanilloid-1 (TRPV1) contribute to the genesis of chronic pain. In this study, we examined the role of PGE2/EP4 signaling and TRPV1 signaling in repeated restraint stress-induced prolongation of sensitization pain, a model for transition from acute to chronic pain, in both in vivo and in vitro models. We found that pre-exposure to single restraint stress induced analgesia that masked sensitization pain evoked by subsequent PGE2 challenge. However, pre-exposure to 3d consecutive restraint stress not only prolonged sensitization pain, but also increased stress hormone corticosterone (CORT) in serum, COX2 levels in paw skin, and EP4 and TRPV1 levels in dorsal root ganglion (DRG) and paw skin. Pre-exposure to CORT for 3d, not 1d, also prolonged sensitization pain evoked by PGE2. Co-injection of glucocorticoid receptor (GR) antagonist RU486, COX2 inhibitor NS-398, EP4 receptor antagonist L161,982 or TRPV1 antagonist capsazepine prevented 3d restraint stress prolonged sensitization pain evoked by PGE2. In DRG cultures, CORT increased EP4 and TRPV1 protein levels through GR activation. These data suggest that PGE2/EP4 signaling and TRPV1 signaling in peripheral pain pathway contribute to repeated stress-predisposed transition from acute to chronic pain.

SUICIDE-RELATED OUTCOMES IN OLDER VETERANS: IMPLICATIONS FOR INTERVENTION AND PREVENTION OF SUICIDE: Session 301

This session will highlight the particular challenges of addressing suicide among older veterans in VHA care using epidemiological and novel statistical approaches, and offer a promising way forward for early identification and prevention of late-life suicide. The research presented here will highlight various unique factors in older veterans that may be missing from the suicide prevention conversation, including the saliency of physical health, pain, high-risk subpopulations, and psychosocial interventions. Drs. Byers and Morin will present findings on late life suicide in VHA using medical record data for novel investigations of administrative data. First, using her database of over 5 million veterans receiving VHA care, Dr. Byers will provide a big picture overview of nationally based estimates of the occurrence of suicide-related outcomes, including non-fatal attempts and death by suicide, in veterans over age 50. Additionally, she will discuss factors that influence risk of a first attempt in later life, as well as factors that further influence, among survivors, who goes on to repeat an attempt and who does not. Next, Dr. Morin will describe physical and mental health comorbidity profiles of 2,131 veterans over 65 who attempted suicide between 2012 and 2014, and last saw a primary care provider prior to their attempt. The relatively minimal depression prevalence as well as high incidence of chronic pain in more than half of these attempters, as well as higher rates of fatality using firearms among these individuals compared to those with multiple mental health comorbidities will be discussed. These findings raise awareness about possible points of intervention in a group that may otherwise not be considered to be as high-risk as a population with significant comorbid mental health concerns. Drs. Barry and Van Orden will speak about more specific subgroups of older veterans, with recommendations for possible intervention to reduce unintended death and suicide, emphasizing the importance of transition of care models for prevention of late-life suicide. Dr. Barry will provide an example of increased risk for suicide and unintended death among older veterans transitioning from prison to the community. Findings show that those re-entering society following a prison sentence are at significantly higher risk for suicide attempt by multiple means, with higher rates of fatality compared to matched controls. These results highlight the urgent need for assistance during this vulnerable period of transition. Finally, Dr. Van Orden will discuss transition of care models more specifically and their importance in combating loneliness, a major risk factor for late-life suicide. She will share compelling findings related to a novel intervention currently being studied on the benefits of volunteer-provided peer companionship for older veterans transitioning from community living center (CLC) stays back into the community. This intervention is targeted to support upstream suicide prevention.

(103) - Patients with sickle cell disease exhibit increased functional connectivity and centrality of the locus coeruleus compared to anemic controls

Vaso-occlusive pain crises are the “hallmark” of sickle cell disease (SCD). SCD patients have a high incidence of chronic pain thought to develop via central sensitization. Research in rodents has shown that locus coeruleus (LC) function in pain regulation shifts from a pain inhibitory to a facilitative effect after exposure to continuous nociceptive input via increased activity of noradrenergic LC-prefrontal cortex (PFC) circuitry. We compared the role of the LC in anemic patients (AC) with and without SCD using fMRI assessing resting-state (RS) activity of the LC. We hypothesized SCD patients would exhibit increased functional connectivity (FC) from the LC and increased functional network (FN) centrality. Eighteen SCD patients (mean age = 21.2 ± 2.3) and 12 ACs (mean age = 24.2 ± 7.4) underwent a standardized imaging procedure: a high-resolution T1 structural scan and 8-min resting state (RS) functional scan on a 3T Philips Achieva. All scans were segmented into 167 brain regions (ROIs) using the Destrieux Atlas including two 2 mm seeds at the bilateral LC. FNs were created representing correlation coefficients of time-course BOLD signal between each ROI. A seed-to-voxel (STV) whole-brain RS-FC analysis was conducted with the initial cluster-forming threshold set at P < .001 and significance level set at p(FWE) < .05. A graph-theory FN analysis using in-house MATLAB code and Graph-Theory Toolbox investigated differences in centrality of the LC. Significance level was set at p(FDR) < .05. STV analyses revealed SCD patients had increased FC from the LC to dorsolateral prefrontal cortex (dlPFC) (p(FWE) < .03). FN analyses revealed SCD patients had increased betweenness centrality in the LC (p(FDR) < .005). These findings support increased connectivity of the LC-PFC circuit, and increased information flow from the LC to other brain regions in SCD patients. These findings provide support for investigating cellular mechanisms, including noradrenaline and GABA activity underlying this link and mind-body therapies to reduce chronic pain by decreasing connectivity within this pathway.

Incidence, ultrasound evaluation and outcome of syndesmotic injuries in patients with ankle sprain

Background and Objectives: Ankle sprain is one of the most common injuries in general population. Lateral ankle sprain make up a majority of these injuries and literature describes a high degree of success with quick return to function. Injury to Syndesmotic ligament occurs in 10-18 percent of all ankle sprains. Its incidence is higher in individuals participating in sports activities like football, downhill skiing and hockey. These injuries are associated with high incidence of chronic pain, significant long term complication as compared to lateral ankle sprain. Recognizing these injuries and intervening at an appropriate time is crucial to prevent long-term morbidity. The workup of these patients involve complete history, weight bearing radiographs, external rotation stress testing and in some cases MRI. In stable injuries non-operative treatment and physiotherapy may work while in unstable injuries tendon repair and other operative interventions may be required. We attempted to study the incidence of Syndesmotic injury in patients of ankle sprain by combining clinical, radiographic and ultrasound examinations. Follow up of all patients was done for 6 months to evaluate their functional outcome. Materials and Methods: This was a prospective cohort study conducted in the orthopedics department of a tertiary care hospital situated in an urban area to find out the incidence of Syndesmotic injuries in patients with ankle sprain by combining clinical and radiological methods and to know the utility of ultrasound examination in these patients. 66 patients with history of ankle sprain were included in this study after taking into consideration inclusion and exclusion criteria. The patients were assessed on the basis of history, clinical examination, squeeze test, external rotation stress test, anterior drawer test and imaging (X-Ray and Musculoskeletal Ultrasound using high frequency probe). The incidence of Syndesmotic injuries, their mechanism, clinical and imaging evaluation and outcome was studied. The results were studied using various statistical methods. P

Predicting pain outcomes after traumatic musculoskeletal injury.

Traumatic musculoskeletal injury results in a high incidence of chronic pain; however, there is little evidence about the nature, quality, and severity of the pain. This study uses a prospective, observational, longitudinal design to (1) examine neuropathic pain symptoms, pain severity, pain interference, and pain management at hospital admission and 4 months after traumatic musculoskeletal injury (n = 205), and (2) to identify predictors of group membership for patients with differing moderate-to-severe putative neuropathic pain trajectories. Data were collected on mechanism of injury, injury severity, pain (intensity, interference, neuropathic quality), anxiety (anxiety sensitivity, general anxiety, pain catastrophizing, pain anxiety), depression, and posttraumatic stress while patients were in-hospital and 4 months after injury. A third of patients had chronic moderate-to-severe neuropathic pain 4 months after injury. Specifically, 11% of patients developed moderate-to-severe pain by 4 months and 21% had symptoms immediately after injury that persisted over time. Significant predictors of the development and maintenance of moderate-to-severe neuropathic pain included high levels of general anxiety while in-hospital immediately after injury (P < 0.001) and symptoms of posttraumatic stress 4 months after injury (P < 0.001). Few patients had adequate pharmacological, physical, or psychological pain management in-hospital and at 4 months. Future research is needed among trauma patients to better understand the development of chronic pain and to determine the best treatment approaches.

Pain Sensitivity in Patients With Major Depression: Differential Effect of Pain Sensitivity Measures, Somatic Cofactors, and Disease Characteristics.

Patients with depression often report pain. Evidence regarding altered pain sensitivity in depressed patients remains, however, inconclusive. In a large cross-sectional study we investigated the association between depression and pain sensitivity with regard to 2 different dimensions of pain sensitivity, as well as the effect of somatic cofactors, symptom severity, and subtype of depression. In 735 patients with a current episode of major depression and 456 never-depressed control participants pain thresholds (pressure pain thresholds, PPTs) were measured at the index finger pad and self-rated suprathreshold pain intensity ratings were obtained using the Pain Sensitivity Questionnaire (PSQ)-minor subscore, an instrument that assesses pain intensity in daily life situations. Additionally, lifestyle factors, medical, and psychiatric conditions were assessed. Unadjusted, patients with depression had lower PPTs and higher PSQ-minor scores indicating increased pain sensitivity. After adjusting for potential mediators, such as poor sleep quality and physical inactivity, patients did not differ from control participants regarding PPTs, but still had significantly higher PSQ-minor ratings. Among patients with depression, severity of anxiety symptoms predicted higher PSQ-minor scores. In conclusion, we found a differential effect of depression on the 2 pain sensitivity dimensions: Decreased experimentally obtained pain thresholds were explained by depression-associated somatic factors whereas increased self-rated suprathreshold pain intensity ratings were associated with increased anxiety symptoms. Because increased pain intensity perception is hypothesized to be a risk factor for the development of chronic pain, our findings may contribute to understanding the high incidence of chronic pain in depressed patients. They also encourage clinicians to consider the role of anxiety in treatment programs for pain in patients with depression.

‘Plug Free’ Connector Placement Modification of a Bilayer Patch Device in Male Indirect Inguinal Hernioplasty

The bilayer patch device (Ethicon, Prolen Hernia System®) for inguinal hernia repair has a connector that acts as a ‚plug‘ in the internal inguinal ring. The position of this ‚plug‘ component may be responsible for higher incidence of chronic pain and intestinal damage. We assumed that changing the position of the connector of a bilayer patch device (PHS®) and placing it medially in Hesselbach triangle would contribute to lower incidence of chronic pain and would not result in intestinal damage, with good clinical outcome following indirect inguinal hernioplasty. This retrospective study included 73 patients with 76 indirect inguinal hernias, who underwent the procedure of modifying the position of the bilayer patch device in the 2005-2015 period. The mean age of the patients was 57 years. Three patients had early postoperative complications (3.95%), two of which had postoperative seroma and one had postoperative pain. Three patients (3.95%) had late postoperative complications. One patient (1.32%) had chronic pain. There was one recurrence (1.32%) and one patient (1.32%) needed the mesh removed due to discomfort. The ‘plug free’ position of the connector of a bilayer patch device in patients with indirect inguinal hernioplasty is a safe procedure with low rate of chronic pain, no intestinal damage, and standard low recurrence.

Chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and the relationship between sleep disorder and pain level, quality of life, and disability.

[Purpose] The aim of this study was to ascertain the prevalence of chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and to assess the relationship between sleep disorder and pain, quality of life, and disability. [Subjects and Methods] Seventy-four patients were included in the study and classified as having mild, moderate, or severe obstructive sleep apnea. Chronic widespread pain, quality of life, and disability were evaluated. [Results] Forty-one patients (55.4%) had chronic widespread pain. Female patients had a higher incidence of chronic pain, and female patients with chronic pain had higher body mass indexes, pain levels, and disability scores than did male patients. Physical component scores of female patients with chronic pain were lower than those of male patients. No correlation was observed between the degree of sleep disorder and severity of pain, pain duration, disability, or quality of life in obstructive sleep apnea patients with pain. [Conclusion] This study showed a 55.4% prevalence of chronic widespread pain in patients with obstructive sleep apnea and a greater risk of chronic pain in female than in male patients. Female patients with obstructive sleep apnea and chronic pain have higher pain and disability levels and a lower quality of life.

Outcomes of laparoscopic fundoplication with the use of bio-mesh in patients with gord or large symptomatic hiatal hernias

Outcomes of laparoscopic fundoplication with the use of bio-mesh in patients with gord or large symptomatic hiatal hernias

Socioeconomic status and the risk for being diagnosed with spondyloarthritis and chronic pain: a nested case–control study

Socioeconomic status could potentially impact on which type of rheumatic diagnosis a patient receives. We determined whether different socioeconomic status is a risk factor for being diagnosed with spondyloarthritis (SpA) or chronic pain. In a nested case-control study, we identified two sets of adult cases diagnosed with (i) SpA (n = 1,194) and (ii) chronic pain (n = 3,730) during 2010-2012 in Skåne region, Sweden. We randomly sampled controls matched for age and sex. Level of education, marital status, and income were identified in national registers 4 years before inclusion. We also studied health-care utilization, prescribed pharmaceuticals, and work status. We used conditional logistic regressions and included socioeconomic variables and geographic area in the models. Low (odds ratio [OR] 1.69 95 % CI 1.50-1.91) or moderate education (OR 1.43 95 % CI 1.30-1.57), and low (OR 1.40 95 % CI 1.25-1.57) or moderate income (OR 1.24 95 % CI 1.10-1.38) were associated with a chronic pain diagnosis. For a SpA diagnosis, moderate income (OR 1.25 95 % CI 1.04-1.50) was the only significant factor identified. Both case groups had a larger proportion that did not work (P < 0.001), used more health care (P < 0.001), and were more frequently prescribed NSAIDs (P < 0.001) 4 years before diagnosis than controls. We confirmed that lower levels of education and income are associated with a chronic pain diagnosis. This association may reflect a true higher incidence of chronic pain and/or increased consultation propensity for such pain in people with socioeconomic status. We found no such association for SpA.