Higher Pain Intensity Research Articles

Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life.

To identify the factors associated with the pain-related functional interference level in people with chronic low back pain. Cross-sectional. Chronic low back pain patients. Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level. 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037). Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Relationships between personality factors and DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders

This cross-sectional analytical study aimed to assess the relationship between personality factors and the DC/TMD Axis II scores of psychosocial impairment among patients with pain related temporomandibular disorders (TMD). 120 participants (60 females and 60 males) who were diagnosed with pain related TMD according to the Axis I DC/TMD protocol were recruited. The participants were requested to complete four tests including the NEO Five Factor Inventory (NEO-FFI) to assess personality factors and three Axis II DC/TMD tools; the Graded Chronic Pain Scale (GCPS) Version 2.0 to assess TMD pain intensity and pain-related disability, Patient Health Questionnaire-4 (PHQ-4) to assess psychological distress due to TMD pain, and Generalized Anxiety Disorder-7 (GAD-7) to assess patients’ stress reactivity. Results showed that 49.2% of the participants experienced high intensity of characteristic pain, 14.2% reported pain related disability more than 30 days (grade 3 disability days) and had disability scores of 70 or above (grade 3 disability scores), 16.7% demonstrated severe distress, and 18.3% reported severe anxiety due to TMD pain. Females scored higher on all these variables than males (P < .05). Multiple regression analyses indicated that higher extraversion scores, higher agreeableness scores and being a female were associated with higher intensity of characteristic pain (p < .05). Also, higher neuroticism and agreeableness scores were associated with more disability days (p < .05). In addition, higher agreeableness scores were associated with higher disability scores and disability point values (p < .05). Furthermore, lower neuroticism scores and being a female were associated with higher PHQ total scores, while being a female and having a lower level of education were associated with higher GAD total scores (p < .05). In conclusion, personality profiles and gender significantly impact the DC/TMD Axis II scores of psychosocial impairment among patients with pain related TMD.

A biopsychosocial approach to phenotyping people with knee osteoarthritis awaiting total knee arthroplasty: A secondary cohort analysis

BackgroundPrevious research showed chronic post-total knee arthroplasty (TKA) pain in 20% of people with knee osteoarthritis (KOA). Various preoperative biopsychosocial-related factors have been described, but phenotyping people with KOA awaiting TKA based on these factors is still lacking. This could be relevant to understanding differences in TKA surgery responses. ObjectiveTo identify phenotypes in people with KOA awaiting TKA and differences in post-TKA pain based on preoperative biopsychosocial factors. MethodsPeople with KOA awaiting TKA in 4 hospitals in Belgium and the Netherlands were included. A cross-sectional latent profile analysis was conducted on structural, metabolic, functional, pain-related, psychological and social variables. Concurrent validity was tested using 3-step multinomial logistic regression. The difference in one-year post-TKA pain was examined with linear mixed model analysis. ResultsTwo hundred and seventeen participants were included in the latent profile analysis with a mean (SD) age of 65.5 (7.7) years, including 109 women. A model with 2 phenotypes differed in 14 out of 21 variables. Participants with phenotype 2 (28%) had a higher body mass index (BMI), higher chance of having less structural damage (KOA grade), lower mean quadriceps strength and physical function (Knee Society Scoring System functional and 30-second chair stand test), higher pain intensity, number of pain locations, and indices of central sensitisation (temporal summation, central sensitisation inventory score, and lower pressure pain thresholds), higher pain catastrophising, anxiety and depression, and higher post-TKA pain intensity compared to phenotype 1 (72%). Concurrent validity was confirmed in 3 out of 4 variables. ConclusionsPhenotype 2 (28%) with nociplastic pain characteristics in combination with worse psychological factors, BMI, functional and structural factors, and phenotype 1 (72%) not representing these characteristics were identified. Phenotype 2 had worse pain intensity scores after TKA compared to phenotype 1. Attention to the characteristics of phenotype 2 is warranted concerning post-TKA pain. Database registrationThe protocol is registered at ClinicalTrials.gov (NCT05380648).

Pain in palliative cancer patients – Analysis of the German National Palliative Care Registry

Palliative care aims to improve the quality of life in patients with progressive diseases such as cancer. Effective cancer pain management is a major challenge of palliative treatment. Empirical data on the prevalence of cancer pain, the efficiency of pain treatment and influencing factors are scarce. Here, we investigated pain in cancer patients treated on inpatient palliative care wards in Germany. N = 4779 data sets provided by the German Palliative Care Registry from yearly evaluation periods between 2015 and 2020 were included. Pain ratings were assessed by professionals through a checklist of symptoms and problems (HOPE-SP-CL). More than half of the included patients suffered from moderate/severe pain at the beginning of inpatient palliative care and in 71% of these patients, pain relief was achieved at the end of inpatient treatment. Pain intensity, depression and ECOG performance status at admission were weak predictors of later pain relief. The highest pain intensity at the beginning and least pain relief were found in patients with bone and cartilage cancer. The highest percentage of adequate pain control (81%) was seen in 2020. Data from the German Palliative Care Registry confirmed that although increasingly better addressed over the years, insufficiently controlled cancer pain remains a challenge for palliative care units. Patient-specific (e.g. psychological comorbidity) and cancer-related (e.g. bone or cartilage cancer) risk factors for poor pain treatment underline the need for individualized multimodal pain management including psychological support.

Patient self rated pain: headache versus migraine a retrospective chart review

BackgroundThe International Classification of Headache Disorders (ICHD-3) uses moderate or severe pain intensity in the diagnostic criterion for migraine. However, few studies have analyzed pain rating on a visual analog scale to identify the numerical intensity that correlates with migraine.ObjectiveTo evaluate the impact of daily self-rated headache pain among patients with either episodic or chronic migraine. This study specifically aims to evaluate the probability of patients labeling their head pain as a headache vs. migraine based on the pain level reported.MethodsA retrospective chart review was conducted on patients with a clinical diagnosis of migraine from July 1, 2014, to July 1, 2019.ResultsData of 114 subjects (57 episodic migraine and 57 chronic migraine) were used for analysis. Patients with episodic migraine on average rated a migraine more severe than a headache (4.1 vs. 6.4; p < 0.001). Patients with chronic migraine on average also rated migraine more severe than a headache (4.3 vs. 6.8; p = 0.0054). Chronic migraine patients transitioned from calling head pain a headache to a migraine significantly later than episodic migraine patients (4.5 vs. 6.8; p < 0.05).ConclusionA migraine is perceived as having higher pain intensity than a headache in patients with both episodic and chronic migraine. On average, patients with chronic migraine had a higher pain rating at which they report head pain to be considered a migraine.

Pain intensity and comorbid depressive symptoms in the general population: An analysis of the German Health Update Study (GEDA 2019/2020-EHIS).

Pain and depressive symptoms often co-occur, but the influence of pain intensity remains unclear. This study analyses the association between pain intensity and depressive symptoms in the general adult German population. Data was obtained from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Pain intensity in the last 4 weeks was categorized into no pain, mild, moderate, and severe. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire (PHQ-8). The prevalence of depressive symptoms was analysed including a 95% confidence interval (95% CI). A multivariable logistic regression analysed associated factors with depressive symptoms by odds ratio (OR). Of 22,708 participants (51.0% women, 35.1% aged 45-64 years), 41.2% reported no pain, 32.1% mild, 15.3% moderate, and 11.5% severe pain. Depressive symptoms were present in 8.3% overall (women 9.1%, men 7.5%). Participants with no pain, mild, moderate, and severe pain reported depressive symptoms in 2.5%, 6.5%, 14.4%, and 27.1%, respectively. In the multivariable analysis, higher pain intensity was associated with a higher risk of depressive symptoms (mild pain OR 1.8, 95% CI 1.3-2.4; moderate pain OR 2.8, 95% CI 2.0-4.0; severe pain OR 4.0, 95% CI 2.8-5.6). Depressive symptoms were further associated with a Body Mass Index (BMI) under 18.5 kg m-2 (OR 2.4; 95% CI 1.4-4.1), but not with sex (OR 1.1; 95% CI 0.9-1.3). Higher pain intensity increases the risk of depressive symptoms. We suggest regular assessment of pain and further assessment of depressive symptoms in patients with moderate or severe pain. Our study found a clear association between higher pain intensity and depressive symptoms in the general population across all types of pain. Further, being underweight was linked to depressive symptoms overall and the highest prevalence of depressive symptoms was found in underweight persons with severe pain. These findings highlight the importance of assessing depressive symptoms in patients with higher pain intensity, especially in underweight patients.

Objective Measures of Work and Non-Work Physical Behaviors Associated with Neck and Back Pain in Viticulture Workers

Musculoskeletal disorders are prevalent among agricultural workers, increasing the risk of work-related diseases due to manual labor, repetitive tasks, and prolonged postures. This study evaluates the association between physical behaviors during work and non-work, measured objectively, and musculoskeletal pain in the neck, upper back, and lower back in viticulture workers. A cross-sectional quantitative study was conducted with 75 viticulturists of both sexes aged 18 years or older. An accelerometer measured physical behaviors (lying down, sitting, standing, moving, walking, and sleeping) during work and non-work periods. Pain intensity was quantified using a 0–10 scale and categorized as “Low” and “High” pain intensity. Binary logistic regression tested the association between pain and time spent on physical behaviors. Results indicated a high prevalence of pain: 46.7% cervical, 52% upper back, and 60% lower back. Standing was the most common behavior during work, while lying and sitting were predominant during non-work. An increased sleeping time was associated with a decreased probability of experiencing high-intensity neck pain. Increased time spent lying down during non-work hours was associated with an increased probability of experiencing high-intensity upper back pain. No physical behavior was associated with high-intensity lower back pain. In conclusion, sedentary behaviors worsen upper back pain, and sleep reduces neck pain in viticulture workers.

Group empathy for pain is stronger than individual empathy for pain in the auditory modality.

Humans live in collective groups and are highly sensitive to perceived emotions of a group, including the pain of a group. However, previous research on empathy for pain mainly focused on the suffering of a single individual ("individual empathy for pain"), with limited understanding of empathy for pain to a group ("group empathy for pain"). Thus, the present study aimed to investigate the cognitive neural mechanisms of group empathy for pain in the auditory modality. The study produced group painful voices to simulate the painful voices made by a group, and recruited 34 participants to explore differences between their responses to group painful voices and individual painful voices using the event-related potential (ERP) techniques. The results revealed that group painful voices were rated with higher pain intensity, more negative affective valence, and larger P2 amplitudes than individual painful voices. Furthermore, trait affective empathy scores of the participants were positively correlated with their P2 amplitudes of group painful voices. The results suggested that the group empathy for pain may facilitate affective empathetic processing in auditory modality.

Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study.

Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved. The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas. Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness. Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support. identifier NCT02511626.

Prevalence of psychosocial findings and their correlation with TMD symptoms in an adult population sample

Background and aimSome studies suggested an association between Temporomandibular Disorders (TMD) and psychosocial status, but most of them are focused on samples of patients looking for treatment or present limits of sample representativeness. The aim of the present study was to evaluate the psychosocial status in a large sample of adult population, further than to assess its association to TMD symptoms, oral behaviours, and self-reported facial trauma.Resultsthe study sample included 4299 subjects older than 18 years randomly recruited from general population in public spaces during their daily life (1700 Males, 2599 Females mean ± SD age = 40.4 ± 18.1). Psychosocial status and pain-related disability were assessed by means of Patient Health Questionnaire 4 (PHQ-4) and Graded Chronic Pain Scale (GCPS). TMD symptoms were assessed by RDC/TMD and validated screening tools for TMD pain. Oral Behaviours Checklist was used to investigate on oral behaviours. Logistic regression model was used to evaluate the association of the psychosocial status, TMD symptoms, trauma, and oral behaviours. The association was tested using both univariate and multivariate models. The PHQ4 evaluation showed a severe impairment in 4.6% of our sample, moderate in 18.8% and mild in 32.5%. We found a Characteristic Pain Intensity (CPI) level and Interference Score greater that 30 respectively in 36.2% and 22.2% of the study sample. The GCPS status revealed a high disability with severe limitation in 2.5% of the sample, high disability with moderate limitation in 7.0%, low disability high pain intensity in 7.4% and low disability low pain intensity in 37.8%. Anxiety and depression’s levels were significantly associated with gender, TMD pain, coexistence of TMD Pain and sound, and oral behaviours. GCPS status was significantly associated with age, TMD Pain, coexistence of TMD pain and sound, trauma, and oral behaviours.ConclusionsIn the general population, psychosocial impairment is associated to TMD pain, female gender, and report of oral behaviours. Hence, in adults with TMD accompanied by pain, psychosocial status should also be evaluated.

Impact of International Classification of Functioning, Disability and Health personal factors on outcomes following lower limb orthopaedic surgery in children with cerebral palsy: a systematic review

Purpose To investigate impact of International Classification of Functioning, Disability and Health (ICF) personal factors on pain, function, or quality of life following lower limb orthopaedic surgery in children with cerebral palsy (CP). Materials and methods Systematic review of prospective studies of lower limb orthopaedic surgery in children with CP reporting relationships between ICF personal factors, and pain, function, or quality of life. Results Eight prospective studies reporting various orthopaedic procedures (median follow-up 2.1 years) were eligible, but not sufficiently homogenous for meta-analysis. Functional outcomes most reported (n = 6), then pain (n = 3) and quality of life (n = 1). Personal factors were age (n = 3), sex (n = 4), child education (n = 1), and co-morbidities (n = 1). Older children had lower function (p < 0.01), and children in “special education” greater improvement in function compared to those in “regular” education (p = 0.001) post-single-event multi-level surgery (SEMLS). Age and sex not associated with function, pain, or quality of life post-single-joint procedures (p > 0.05), except females with higher pain intensity (p = 0.019) and lower function (p = 0.018) post-Schanz procedure. No association between sex and function post-SEMLS (p > 0.05). Conclusions Further prospective cohort studies are needed to understand the influence of personal factors identified in this review and investigate the effect of other personal factors on pain, quality of life, and function.

Amplified pain and complex regional pain syndrome in children: clinical cases and literature review

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study

BackgroundThe prevalence and risk factors of postpartum depression after cesarean delivery remain unclear. ObjectiveTo assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery. MethodsProspective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an EPDS cutoff value of 11 or higher. ResultsThe questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval (CI), 14.9-18.0%) with an EPDS score of 13 or higher and 23.1% (95%CI, 21.4-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were pre-pregnancy characteristics such as young age (aOR 0.83, 95%CI 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (aOR 2.58, 95%CI 1.85-3.59 for North Africa; aOR 1.57, 95%CI 1.09-2.26 for Sub-Saharan Africa and aOR 1.99, 95%CI 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (aOR 1.70, 95%CI 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (aOR 1.36, 95%CI 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (aOR 1.73, 95%CI 1.32-2.26) and bad memories of delivery on day 2 postpartum (aOR 1.67, 95%CI 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (aOR 0.73, 95%CI 0.53-0.97). ConclusionAround one woman in six had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Comparison between Conditioned Pain Modulation Paradigms Using Cold Pressor Conditioning Stimulus versus Ischemic Pressure Stimulus in Women with Fibromyalgia and Its Impact on Clinical Status: A Cross-Sectional Study.

Background/Objectives: Fibromyalgia (FM) is a syndrome characterized by widespread chronic pain as the primary symptom. Neurophysiological pain mechanisms, such as the function of the descending inhibitory system, are impaired in this condition. The main objective of this study was to compare the results of two paradigms to evaluate CPM in women with FM. The secondary objective was to correlate the results of each CPM paradigm with the clinical status of patients with FM. Methods: One hundred and three FM women were divided into two groups: fifty patients diagnosed with FM were assigned to the conditioned pain modulation (CPM) group using a cold pressor stimulus, and fifty-three patients were assigned to the CPM group using the ischemic pressure stimulus. The main outcome measures were pain intensity, disability, mechanical hyperalgesia, and CPM. Results: The primary analysis revealed significant differences between the results obtained from the different CPM protocols. Poorer outcomes in the cold pressor test correlated with higher pain intensity and a greater disability index. Conclusions: Pain modulation abnormalities in FM patients were evident when using either the cold pressor or ischemic pressure stimuli to establish the CPM paradigm. The cold pressor conditioning stimulus elicited a stronger response than the ischemic pressure stimulus in FM patients.

Loneliness and pain among community-dwelling middle-aged and older Black, Latino, and White adults in the United States.

Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States. Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors. Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (β = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (β = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness. Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.

Hematological biomarkers of systemic inflammation in predicting long-term treatment response of temporomandibular disorders

BackgroundChronic systemic inflammation has been proposed as the underlying mechanism of pain chronicity in several pain conditions. In spite of the growing evidence supporting the role of systemic inflammatory markers as a diagnostic tool, their role has not been analyzed in a well-defined group of temporomandibular disorders (TMD) patients until now. This study aimed to investigate the association between various clinical features and comorbidity levels of TMD in relation to hematological markers and seek its association with long-term treatment response.MethodsClinical features and hematological indices including those for systemic inflammation were assessed in TMD patients (n = 154). Examinations were re-done after 6 months of conservative treatment. Patients were divided into pain improved and unimproved groups based on ≥ 2 numeric rating scale improvement in pain intensity at 6 months for final analysis.ResultsThe portion of patients with low lymphocyte-to-monocyte ratio (p = 0.026), total protein (p = 0.014), hemoglobin (p = 0.040), and mean corpuscular hemoglobin concentration (p = 0.042) values showed significant differences according to prognosis groups. Low hemoglobin levels were significantly associated with unfavorable response to long-term treatment (β = 1.706, p = 0.018). High pre-treatment pain intensity (β=-0.682, p < 0.001) and low Graded Chronic Pain Scale (β = 1.620, p = 0.002) could predict significant pain improvement with long-term treatment.ConclusionsHematologic assessment could be considered in addition to clinical examination to better determine long-term prognosis in TMD patients.

Evolution and characteristics of nocturnal knee pain after knee arthroplasty.

Nocturnal knee pain and sleep disorders are two common but poorly studied issues contributing to dissatisfaction following knee arthroplasty. This study aims to evaluate the prevalence and associated factors of nocturnal pain and sleep disturbance in a population undergoing knee arthroplasty. We included in this prospective observational study 111 patients undergoing knee athroplasty (79 TKA and 32 UKA). Sleep quality, nocturnal knee pain (preoperatively, at day 3, at 3 and 6 weeks, at 3 months and one year after surgery), pain during mobilization and neuropathic pain were evaluated by scores. Painkillers and sleeping pills intake were recorded. Potentially predictive factors for postoperative nocturnal pain evolution were studied. Poor sleeping quality rate was 54% for the pre-operative patients and was still 53% at one year after surgery. The prevalence of nocturnal knee pain was 38,74% before surgery and 2,9% at one year after arthroplasty. This study has been performed at the University Hospital Saint Luc Brussels. Evolution and Characteristics of nocturnal knee pain after knee arthroplasty. Nocturnal pain after knee surgery was significantly associated with higher pain scores at rest during activity and at night. Nocturnal pain was significantly associated with a higher PSQI and DN4 scores and a higher consumption of painkillers or sleeping pills at W6. The multiple variable regression showed a statistically significant correlation between preoperative and postoperative nocturnal pain at D3 and W3. Compared to TKA, UKA patients reported significantly less nocturnal pain at W3 and W6. Bad sleeping quality is present in 54% of knee arthroplasty patients before and after surgery. Nocturnal pain is present in 39% of knee arthroplasty patients before surgery and this drops to 3% after one year. Nocturnal pain is associated with higher pain intensity, neuropathic symptoms, increased medication consumption and poor sleeping quality. Night pain disappeared faster after UKA than TKA, with a tipping point around 6 weeks postoperatively.

Relationship Between Patient-reported Outcome Measures and Accelerometer-measured Physical Activity and Sleep in Patients With Postherpetic Neuralgia.

Available treatment for chronic neuropathic pain is still limited, and the positive effects are modest. Thus, clinicians aim to improve activity and quality of life despite pain. The objective monitoring of activity is attracting attention in chronic pain assessments. Therefore, we objectively evaluated daytime activity and sleep in patients with postherpetic neuralgia (PHN), using actigraphy to determine risk factors for decreased activity. Participants with PHN wore an actigraph (a wristwatch-like accelerometer) on the nondominant hand. The actigraph measured day-time activity and sleep, which were compared with participant-reported subjective pain and sleep assessments. Fifty-four individuals with PHN who visited our outpatient clinic completed questionnaires and a week of actigraph monitoring. Subjective scores of pain intensity, neuropathic pain, disability in daily life, pain-catastrophizing thoughts, and insomnia were all well correlated. However, the actigraph-monitored activity levels, using 2 equations, and sleep quality were not associated with any pain or sleep-related subjective scores. The discrepancy between the subjective and objective scores in this study may be due to (1) features of PHN, an archetype of peripheral neuropathic pain affecting no motor nerves, (2) actigraph measurement limitations regarding the sedentary life of the elderly, or (3) activity misperception, a new proposition explaining the discrepancy between subjective and objective measures of activity, similar to the sleep state misperception. In patients with PHN, high pain intensity may be reported in those with highly maintained activity, in which treatment must be selected cautiously to prevent interruption of their physical abilities.

ANALYSIS OF PAIN TREATMENT IN SOME MEDICAL INSTITUTIONS IN KYIV THAT TREAT WOUNDED COMBATANTS

Summary. On the way to reducing the incidence of pain chronicity, it is first of all necessary to analyze the existing problem, prioritize and differentiate factors that can potentially improve the situation. By analyzing the pain management system of a medical institution, it is easy to track its effectiveness, especially when it comes to the wounded, because a certain percentage of such patients nevertheless continue treatment at the next stage through strategic medical evacuation. Studying the intensity of pain during strategic medical evacuation allows, to some extent, to assess the effectiveness of pain treatment. Objective. To study the intensity of pain in combatants after wounds in medical institutions of Kyiv. Methods. The results of pain treatment in 368 combatants after wounds in some Kyiv hospitals are presented. Pain intensity was assessed using the numerical pain scale (NPS). Results. The analysis data show that the highest pain intensity score on the WSS was in the Municipal Nonprofit Enterprise "Kyiv City Clinical Hospital No. 6" and averaged 5.7 points, which meets the criteria for moderate pain. In the Municipal Nonprofit Enterprise Kyiv City Clinical Hospital No. 1 of the Executive Body of the Kyiv City Council (Kyiv City State Administration), this indicator was 4.0 points, in the Municipal Nonprofit Enterprise Kyiv City Clinical Hospital No. 4 – 3, 3 points, at the Municipal Nonprofit Enterprise "Kyiv City Clinical Hospital of Emergency Care" – 3.0 points, at the Municipal Nonprofit Enterprise "Kyiv City Clinical Hospital No. 8" and the Municipal Nonprofit Enterprise "Oleksandrivska Clinical Hospital of Kyiv" – 2.5 points, at Feofaniya Clinical Hospital of the State Administration of Affairs – 2.3 points, and at the National Military Medical Clinical Center "Main Military Clinical Hospital" – 2.2 points. High-intensity pain was experienced in 5% of cases, moderate pain in 19%, mild pain in 74%, and no pain in 2% of cases. Conclusion. Pain management in some Kyiv hospitals treating wounded requires the introduction of new approaches, as better pain control during treatment and evacuation can potentially improve long-term treatment outcomes. Supplementing the healthcare system with a pain management system may be important given the war and the number of wounded.

Self-reported prolonged standing work is not associated with lower back and lower extremity pain in viticulture workers

This cross-sectional study investigated the association between prolonged standing at work and pain in the lower back and lower limbs in viticulture workers. Prolonged standing was self-reported. Lower back and lower extremity pain were obtained using a 0-10 scale and categorized as “present” and “absent.” The association between standing work and the presence of pain was tested using binary logistic regression. 320 viticulture workers were evaluated. Participants were mainly female (78.4%), with a mean age of 36.2 (±9.1) years, 83.1% worked in the field, and 16.9% in packaging. The prevalence of pain was 50.3% for the lower back, 18.1% for the hip, 20.9% for the knee, and 24.4% for the ankle/foot. Logistic regression showed a negative association between dynamic standing at work and high-intensity pain in the lower back.