Higher Pain Intensity Research Articles

Bone mineral density is not associated with incident high-intensity back pain: a 10-year cohort study in men.

Although patients believe that osteoporosis is a painful condition, health professionals assume it is painless unless a fracture occurs. The association between BMD and back pain has not been examined longitudinally in community-based adults in an unbiased population using gold-standard measures. This study aimed to examine the association between BMD and incident high-intensity back pain and/or high disability over 10years in Australian men without high-intensity symptoms at baseline. Men with no high-intensity back pain and/or high disability attending the Geelong Osteoporosis Study at the 5-year visit (occurring between 2006-2010) (considered the baseline for the current study) were followed for 10years (reassessed between 2016-2021). Back pain and disability were assessed using the Graded Chronic Pain Scale at both time points. At baseline, DXA was used to measure lumbar spine and total hip BMD and spinal artefacts. The relationships between BMD and incident high-intensity pain and/or high disability at follow-up were examined using binary logistic regression, adjusted for age, body mass index, depression, education, smoking, mobility, and spinal artefacts. A total of 679 participants had no to low-intensity pain and/or no to low disability at baseline. A total of 441 attended follow-up, providing back pain and disability data. Thirty-seven men developed high-intensity pain and/or high disability. No association of BMD at any site was seen with incident high-intensity pain and/or high disability. BMD was not associated with incident high-intensity pain or disability in community-based men. These data provide evidence to dispel the erroneous community-held belief that low BMD is related to back pain and disability.

Total blood loss and early clinical outcomes under different tranexamic acid regimes in total knee arthroplasty.

Many different regimes of intravenous and local tranexamic acid (TXA) reduce total blood loss (TBL) in patients undergoing total knee arthroplasty (TKA). However, the most effective TXA regime in reducing blood loss might not be most beneficial for the patient. The aim of the present study was to investigate the effect of commonly used TXA regimes on blood loss and on early clinical outcomes. We performed this monocentric retrospective study in patients undergoing primary TKA. Primary outcome was the estimated TBL. Secondary outcomes were the rates of adverse events (AE) as well as the range of motion (ROM), mobility and pain intensity during the first three physiotherapy sessions (PTS). We analysed the data of 1250 TKAs. 5 different TXA regimes were applied. TBL (mean ± SE) was 953 ± 64ml (2xiv), 999 ± 19ml (2xiv + 1xlocal), 1075 ± 19ml (1xiv + 1xlocal), 1191 ± 39ml (1xlocal) and 1241 ± 48ml (1xiv) (p < 0.01). In the linear regression model for TBL a lower number of TXA applications was a predictor for increased blood loss (p < 0.01). AE rates were lowest under 2xiv (0%) and 2xiv + 1xlocal (4.8%). Highest mobility and lowest pain intensity were observed under 1x iv and 2x iv. The largest portions of fully mobile patients on day three were observed under 1xiv (100%), 2xiv (100%) and 2xiv + 1local TXA (86.9%). Our results suggest that multiple applications of TXA are more effective in decreasing blood loss than excessive dosing of TXA. Interestingly, local use of TXA might be associated with higher pain intensity and decreased mobility on the first days after surgery.

Deep endometriosis – diagnosis and impact on quality of life

Introduction. Deep infiltrating endometriosis (DIE) is considered the most painful form of endometriosis, responsible for reducing the women’s quality of life (QoL). Its management presents difficulties in medicine. The #Enzian classification reflects locations of DIE and simplifies its medical management. International guidelines recommend studies of QoL in women with endometriosis. Objective. To investigate the symptoms of DIE and determine its impact on QoL to optimize its diagnostics. Materials and methods. A cohort study was conducted over 2 years at the Gheorghe Paladi Municipal Clinical Hospital, including 190 patients with endometriosis, who were divided into groups: main group - 85 patients with DIE, control group - 105 other endometriosis forms. To objectify the pain, Visual Analog Scale and Biberoglu and Behrman (B&amp;B) were used. Endometriosis was staged with the #Enzian classification. For the analysis of QoL, three standardized questionnaires were used. Data were recorded in Excel and statistically calculated with the SPSS program. Results. Pelvic pain syndrome according to the Visual Analog Scale and B&amp;B scales in the main group was 3 times more pronounced than in the control group (p &lt; 0.01). Lesions of DIE according to the #Enzian statistically correlated with chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, dyschezia &gt;7 points (VAS), catamenial rectal tenesmus, defecation disorders, menometrorrhagia, hematuria, bladder tenesmus, hydronephrosis with ureteral stenting during pregnancy, catamenial cough and hemoptysis, chest pain and spontaneous pneumothorax, hemorrhagic scar, hiccups, and the frenicus symptom (p &lt; 0.05). According to the questionnaires of QoL, DIE significantly influences life determinants by 44.27%, compared to the control group at 3.64% (p &lt; 0.01), allowing realization of life determinants in a maximum of 58.54% vs. the control group’s 92.18% (p &lt; 0.01). Additionally, psychological well-being in patients with DIE is lower than that in the control group (44.29% vs. 81.38%, p &lt; 0.01). Conclusions. High-intensity pain syndrome and extragenital symptoms correlated with compartments of #Enzian will assist in the preoperative multidisciplinary diagnosis of DIE. The high influence on life determinants, the low realization of life potential, and the low psychological well-being confirm the significant impact of DIE on QoL, classifying it as a disability.

Visuotactile integration in individuals with fibromyalgia.

Our brain constantly integrates afferent information, such as visual and tactile information, to perceive the world around us. According to the maximum-likelihood estimation (MLE) model, imprecise information will be weighted less than precise, making the multisensory percept as precise as possible. Individuals with fibromyalgia (FM), a chronic pain syndrome, show alterations in the integration of tactile information. This could lead to a decrease in their weight in a multisensory percept or a general disruption of multisensory integration, making it less beneficial. To assess multisensory integration, 15 participants with FM and 18 pain-free controls performed a temporal-order judgment task in which they received pairs of sequential visual, tactile (unisensory conditions), or visuotactile (multisensory condition) stimulations on the index and the thumb of the non-dominant hand and had to determine which finger was stimulated first. The task enabled us to measure the precision and accuracy of the percept in each condition. Results indicate an increase in precision in the visuotactile condition compared to the unimodal conditions in controls only, although we found no intergroup differences. The observed visuotactile precision was correlated to the precision predicted by the MLE model in both groups, suggesting an optimal integration. Finally, the weights of the sensory information were not different between the groups; however, in the group with FM, higher pain intensity was associated with smaller tactile weight. This study shows no alterations of the visuotactile integration in individuals with FM, though pain may influence tactile weight in these participants.

Efficacy and safety of CO2 fractional laser versus Er:YAG fractional laser in the treatment of atrophic acne scar: A meta-analysis and systematic review.

To date, a consensus on the relative efficacy and safety of CO2 fractional laser versus erbium-doped yttrium aluminum garnet (Er:YAG) fractional laser treatments for atrophic acne scars has not been reached. This meta-analysis aims to systematically assess and compare their effectiveness and safety in clinical practice. For this meta-analysis, we conducted comprehensive searches in Pubmed, Embase, and Cochrane databases, covering publications from their inception up to August 2023. Our focus was on studies comparing fractional CO2 laser with Er:YAG fractional laser treatments for atrophic acne scars. We excluded duplicate publications, research lacking full-text access, incomplete data, or cases where data extraction was not feasible. Additionally, animal experiments, reviews, and systematic reviews were not considered. Data analysis was performed using STATA 15.1. Eight studies (seven randomized controlled trials (RCTs) and a retrospective study) were included in this meta-analysis. The sample size ranged from 28 to 106 with a total of 418 patients, including 210 in the CO2 fractional group and 208 in Er:YAG fractional group. The pooled results showed that the effective rate of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (OR = 1.81, 95% CI: 1.08-3.01) and the downtime of CO2 fractional laser in treating atrophic acne scar was significantly shorter than that of Er:YAG fractional laser (Weighted Mean Difference (WMD) = -2.11, 95% CI: -3.11 to -1.10). In addition, VAS of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (WMD = 1.77, 95% CI: 1.32-2.21) and the duration of erythema of CO2 fractional laser in treating atrophic acne scar was significantly longer than that of Er:YAG fractional laser (WMD = 1.85, 95% CI: 1.63-2.07). However, there was no significant difference in the duration of pain and incidence of PIHbetween CO2 fractional laser and of Er:YAG fractional laser. When it comes to treating atrophic acne scars, CO2 fractional laser demonstrates superior efficacy and leads to shorter downtime. However, it is important to note that CO2 fractional laser treatments tend to result in higher pain intensity and may carry a higher risk of post-treatment pigmentation compared to Er:YAG fractional laser procedures.

Comparing the Effectiveness of Oral Celecoxib with Oral Tramadol as Pre-Emptive Analgesia in Ambulatory Surgery

Nociception pathway is thought to be pre-emptively inhibited in hope to reduce acute pain in an anticipated procedural related tissue injury intraoperatively or postoperatively when pre-emptive analgesics are administered preoperatively. High intensity of pain is expected after surgical removal of the third molar which is associated with jaw swelling and limited opening of the jaw. We compared the pre-emptive analgesia effect of oral celecoxib and oral tramadol in elective ambulatory dental surgery under general anaesthesia. Informed consents were obtained from 84 patients with American Society of Anesthesiologists (ASA) physical status I or II and aged between 18 to 56 years. They were randomised to receive either oral celecoxib 200 mg (Group A) or oral tramadol 50 mg (Group B) one hour before induction of anaesthesia. Intraoperative and postoperative fentanyl consumption were compared. Numeric Rating Scale (NRS), ranging from 1 to 10, was used to assess postoperative pain scores. Group A showed a significant reduction in fentanyl consumption intraoperatively compared to Group B (p=0.047). Both groups of patients experienced mild pain at various times assessed postoperatively ranging between 0-2 NRS scores. Comparison between the groups did not detect significant reduction in pain scores and postoperative fentanyl consumption. We concluded that neither medication was found to be effective as pre-emptive analgesia, however, intraoperative fentanyl consumption was reduced by pre-emptive administration of oral celecoxib.

A retrospective cohort study: is COVID-19 BNT162b2 mRNA vaccination a trigger factor for cluster headache?

Patients with a history of CH and who had never experienced COVID-19 illness during the pandemic were included in this retrospective cohort analysis. The semi-structured survey was administered face to face to 24 CH patients (16 male). The headache features before and after vaccination were detailed in this survey. 18 patients got vaccinated twice, and 6 of them had no vaccination. After the first vaccination, 83.3% of them had CH bout; after the second vaccination, 72.2% of them had CH bout. We divided headache episodes into three groups: (1) before vaccination, (2) after the first vaccination, and (3) after the second vaccination. The third group had a higher pain intensity (9.30 ± 0.630, p=0.047) and remitting longer (20.00 ± 5.40days, p=0.019) than the other groups. The management of the 53.3% bouts after vaccinations was less effective than the usual episodes. Most ECH patients experienced new bouts more intense and longer duration after vaccinations than their previous bouts, the mechanism, and pathogenesis of the bouts are the subject of future research. The new studies can be a light for understanding the CH pathophysiology more deeply.

Quality of Life Assessment in Patients with Knee Osteoarthritis

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

My Catastrophizing and Your Catastrophizing: Dyadic Associations of Pain Catastrophizing and the Physical, Psychological, and Relational Well-being of Persons With Endometriosis and Their Partners.

Endometriosis, a painful chronic gynecologic condition, contributes to disruptions in multiple areas of life for both those affected and their partner. Pain catastrophizing has been associated with worse pain outcomes and quality of life for women with endometriosis and with more cognitive load for partners. Examining both partners' pain catastrophizing dyadically with our variables of interest will enhance understanding of its associations with the distressing nature of experiencing and responding to pain during sex for couples with endometriosis. Persons with endometriosis experiencing pain during sex and their partners (n=52 couples; 104 individuals) completed online self-report measures of pain catastrophizing, depressive symptoms, sexual satisfaction, and partner responses to pain. Persons with endometriosis reported on pain during sexual activity. Analyses were guided by the Actor-Partner Interdependence Model. Persons with endometriosis' pain catastrophizing was associated with their higher pain intensity and unpleasantness during sex. When persons with endometriosis reported more pain catastrophizing, they were less sexually satisfied and reported their partners responded more negatively to their pain. When partners reported higher catastrophizing, they were more depressed and responded more negatively to the pain. Consistent with the Communal Coping Model of pain catastrophizing, although meant to elicit support from the environment, the often-deleterious cognitive process of magnifying, ruminating, and feeling helpless about one's pain (or one's partner's pain) is associated with poorer outcomes for the individual with pain and their romantic partner. Implications for pain management include the relevance of involving the partner and attending to the pain cognitions of both members of the couple.

Predicting severe pain after cesarean section: prospective cohort study

BACKGROUND: Severe and unbearable pain after abdominal delivery is recorded in 20% of cases, indicating the limitations of the applied methods of postoperative pain relief and the need for a personalized approach. Tests assessing preoperative pain threshold and anxiety have the greatest sensitivity and specificity as predictors of intense postoperative pain. The informative value of these tests in the Russian obstetric population has not been assessed. OBJECTIVE: This study aimed to determine the optimal method for predicting severe pain after cesarean section (CS). MATERIALS AND METHODS: This prospective cohort study included 212 women who underwent elective CS under spinal anesthesia. The Hospital Anxiety and Depression Scale (HADS) anxiety rating scale, pressure algometry, and cutaneous infiltration anesthesia pain intensity assessment were used as predictors of high-intensity pain. Postoperative pain intensity was assessed using a 10-point Numeric Rating Scale (NRS). The maximum level of pain according to the central pain level at rest (NRSr) and during movement (NRSa) was recorded 24 hour postoperatively. The number of requests for “rescue analgesia” was recorded. The predictive value of the studied methods was determined based on ROC curve analysis. RESULTS: Median (interquartile range) NRSa was 5 [4–5]. Severe pain was recorded in 14% of the patients. The area under the ROC-curve (AUC), reflecting the relationship between severe postoperative pain and pressure-pain threshold, was 0.91±0.03 with 95% confidence interval (CI) of 0.84–0.97 (p 0.001). The relationship between pain intensity during infiltration anesthesia and postoperative pain severity had AUC=0.88 ± 0.04 with 95% CI of 0.81–0.96 (p 0.001). The HADS anxiety score demonstrated the lowest predictive ability (AUC=0.69±0.06; 95% CI, 0.81–0.96; p 0.001). When all three techniques were used together, the AUC was 0.924±0.024 with 95% CI 0.88–0.97 (p=0.001). CONCLUSION: Preoperative pressure-pain threshold and pain severity during infiltration anesthesia are reliable predictors of severe pain after CS. Assessment of preoperative anxiety using HADS has low sensitivity and specificity. However, its use in conjunction with methods for assessing the pain threshold increases the predictive value of the combined model compared with the results of using the methods separately.

Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study

BackgroundThe prevalence and risk factors of posttraumatic stress disorder (PTSD) after cesarean delivery, outside high-risk contexts, remain unclear ObjectiveTo assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery. Study designProspective 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 expected to undergo cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of PTSD symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a PTSD) were assessed by 2 self-administered questionnaires (Impact of Event Scale Revised (IESR) and Traumatic of Event Scale (TES)). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable. ResultsIn all, 2785 of 4431 women returned the IES-R questionnaire and 2792 the TES (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval (CI) 7.8-10.3%) and of provisional diagnosis 1.7% (95%CI 1.2-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors - young age, high BMI and Africa-born migrant – and cesarean-related obstetric factors - cesarean delivery after induced labor (adjusted odds ratio [aOR] 1.81, 95%CI 1.14-2.87), postpartum hemorrhage (aOR 1.61, 95%CI 1.04-2.46) and high intensity pain during the postpartum stay (aOR 1.90, 95%CI 1.17-3.11). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (aOR 0.66, 95%CI 0.46-0.98), and women with bad memories of delivery on day 2 postpartum at higher risk (aOR 3.20, 95%CI 1.97-5.12). The IES-R and the TES scales yielded consistent results ConclusionsAround one in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetric interventions and components of cesarean management may influence this risk

Variation of Pain Intensity with Smoking in Knee Osteoarthritis in Males

Background: Knee osteoarthritis is a significant cause of disability, affecting daily living activities predominantly in females but also impacting males. Various factors contribute to its development, including smoking, yet data on its effect on the male population is sparse. Objective: To explore the relationship between smoking and pain intensity in males with moderate-stage knee osteoarthritis. Methods: A cross-sectional study was conducted over six months, enrolling 71 male participants aged 30 to 75 years with grade 2 knee osteoarthritis, diagnosed according to the Kellgren and Lawrence scale. Participants were categorized into smokers and non-smokers. Data on smoking habits and pain severity, assessed using the numeric pain rating scale, were collected through questionnaires. The association between smoking and pain intensity was analyzed using the Pearson Chi-square test, with a significance level set at P&lt;0.05. Results: Out of 71 participants, 36 (50.7%) were smokers, and 35 (49.3%) were non-smokers. Severe pain was reported by 25 smokers, while 26 non-smokers experienced moderate pain. The analysis revealed a significant association between smoking and increased pain severity (P&lt;0.05), with a direct correlation between the number of cigarettes smoked and pain intensity. Conclusion: The study identified a significant association between smoking and higher pain intensity in male patients with knee osteoarthritis. These findings suggest that smoking cessation should be a key component of osteoarthritis management strategies to alleviate pain and improve quality of life in affected individuals.

Incidence of emergence delirium after homeostasis-guided pediatric anesthesia for ear-nose-throat surgery.

Emergence delirium is a complication of pediatric anesthesia during the early recovery period. Children undergoing ear, nose, and throat surgery are at high risk. The Pediatric Assessment of Emergence Delirium (PAED) scale is used for diagnosis and founded to specify the degree of emergence delirium. However, there is no consensus regarding a threshold value for emergence delirium diagnosis. Homeostasis-guided pediatric general anesthesia aims to maintain physiological parameters within normal ranges. In this prospective, observational study we evaluated the incidence of emergence delirium in children undergoing elective ear, nose, and throat surgery under standardized homeostasis-guided general anesthesia. Secondarily, we identified risk factors associated with an increased PAED score. In children aged 0-6 years, we collected data from standard monitoring, depth of anesthesia, and preoperative glucose and ketone body levels. These variables were studied as risk or protective factors for increased PAED >0 scores using multivariate logistic regression. Of the 105 children analyzed, only five children (4.7%) had emergence delirium according to a threshold PAED score ≥10, while 37 children (35%) had PAED scores >0. Statistical analysis of the PAED outcome identified two significant positive associations with pain (P<0.001) and preoperative blood glucose levels (P=0.006) and one negative association with preoperative ketone body levels (P<0.001). Our cohort observed a lower incidence of emergence delirium than in the literature. Higher pain intensity and lower blood glucose levels were risk factors for PAED > 0, whereas preoperative ketone body levels were protective.

Clinical and radiological efficacy of a new conservative treatment for fibrocystic disease

Background. Long-lasting dyshormonal breast diseases in women represent a risk factor for breast cancer, especially in patients with atypia. Clinical manifestations of fibrocystic breast disease (FBD) and mastopathy, including high-intensity pain cause psychoemotional discomfort and reduce the quality of life of women. The search for effective management strategies for mastopathy with an antiproliferative effect is highly relevant.Aim. To assess clinical and radiological efficacy of a new conservative treatment for FBD, “Evening primrose oil” administered orally for 6 months in women with symptomatic FBD.Materials and methods. This randomized, blind, placebo-controlled trial included 144 patients with clinical FBD manifestations (pain and tension in the breast). Patients were randomly assigned to one of the two treatment groups. Women in group I received “Evening primrose oil”, whereas women in group II received placebo (ascorbic acid) for 6 months. We measured the dynamics of radiological findings (at mammography and ultrasound examination) in the breast before and after treatment, as well as pain intensity using the visual-analog scale.Results. Patients in group I with all types of FBD (diffuse mastopathy, nodular, and mixed forms) demonstrated positive dynamics and BI-RADS category downgrading within 6 months. In the placebo group, the examination after 6 months demonstrated no significant changes in the breast and no BI-RADS category downgrading among women with diffuse mastopathy. Some patients with nodular and mixed FBD receiving placebo had negative dynamics after 6 months (as demonstrated by mammography and ultrasound examination; BI-RADS category upgraded from II to III, p&lt;0.01). Patients receiving “Evening primrose oil” also showed positive dynamics in their clinical manifestations, including decreased breast pain (from 7.8 to 1.8 on the visual analog scale). By contrast, patients receiving placebo had no changes in their breast pain intensity after 6 months (from 7.3 to 7.1 on the visual analog scale), which resulted in poorer psychoemotional state in 55.6 % of women.Conclusion. Our new treatment strategy for FBD patients with clinical and radiological manifestations in the breast demonstrated high efficiency and can be implemented into routine clinical practice.

Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain – findings from the BACE-N cohort

BackgroundBack pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes’ first point-of-contact.MethodsThe study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care.ResultsFour latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the “positive” class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the “fearful” class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the “distressed” class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the “hopeful” class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists.ConclusionsThe identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity.Trial registrationClinicaltrials.gov NCT04261309.

A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy.

Sleep quality is important during childhood and adolescence. Given the high prevalence of pain in children/youth with cerebral palsy, we aimed to measure the association between short-term pain trajectories and sleep disturbance in these individuals. We accrued the cohort between November 2019 and October 2020 and recruited children/youth who (1) were 8-18 years old; (2) had cerebral palsy with any Gross Motor Function Classification System level; and (3) could self-report pain and sleep disturbance. We collected self-reported baseline and weekly follow-up data using electronic questionnaires completed every week for 5 weeks. Sleep disturbance at 5 weeks was the primary outcome (pediatric Patient-Reported Outcomes Measurement Information System short form, v1.0-4a). We used general linear regression to assess the association between pain intensity trajectory group and sleep disturbance controlling for confounders. A total of 190 individuals were eligible; 102 were enrolled and 89 were included in our final analysis. Pain trajectory groups had estimated crude mean sleep disturbance scores at 5 weeks ranging from 56.0 (95% confidence interval, 51.8, 60.8) to 61.8 (55.7, 67.9). Compared to those with stable, no/very mild pain, those in the stable, high-pain group had the greatest sleep disturbance (adjusted β = 5.7; 95% confidence interval, 1.2, 10.2). Irrespective of pain trajectory, children and youth with cerebral palsy reported sleep disturbances. Those with a stable, high pain intensity in the previous 5 weeks reported the greatest sleep disturbance. The results highlight the importance of considering pain trajectories and their impact on sleep in children with cerebral palsy. Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med. 2024;20(5):719-726.

Exploring the outcome "days with bothersome pain" and its association with pain intensity, disability, and quality of life.

The aim of this study is to investigate the criterion validity, specifically the concurrent validity of the measure of days with bothersome pain, by investigating its association with measures of pain intensity, disability, and quality of life. We used two separate cohorts to study the concurrent validity of "days with bothersome pain," by investigating its association with pain intensity, disability, and quality of life: (1) 321 patients with low back pain (LBP), using follow-up data at 1 year, and (2) 170 pregnant women with pelvic girdle pain (PGP), using data at 12 and 30 weeks of their pregnancy. In both studies, weekly text messages asked for the number of days with bothersome pain the previous week. Pearson's correlation, univariable, and multivariable linear regression were used to assess the association between days with bothersome pain per week and pain intensity, disability, and quality of life. Non-linear associations were explored. Days with bothersome pain were moderately and inversely correlated with quality of life (r = -0.45, p < 0.001), and moderately correlated with pain intensity (r = 0.70, p < 0.001) and disability ( r = 0.51, p < 0.001), among patients with LBP, and to a lesser degree among pregnant women with PGP (corresponding values at 18 weeks of pregnancy for quality of life; r = -0.27, p = 0.005, for pain intensity r = 0.41, p < 0.001, and for disability r = 0.41, p < 0.001). Furthermore, it was best explained by pain intensity for LBP patients, and by pain intensity and disability for pregnant women with pelvic pain. For the latter cohort, non-linear analyses suggested that days with bothersome pain could not distinguish between individuals with different high pain intensities and disabilities and low quality of life. We consider the concurrent validity of "days with bothersome pain" to be moderate in the correlations with pain intensity, disability, and quality of life in patients with LBP and in pregnant women with PGP. Ceiling effects may be an issue in populations with high pain severity. The differences between the cohorts suggested that also other constructs are involved in the concept of days with bothersome pain.

The Relationship Between Pain, Daily Function, and Sleep Quality in Diabetic Neuropathy

Background and Aims: Poor sleep quality affects insulin sensitivity and glucose metabolism. There were limited information about sleep quality in individuals with diabetic peripheral neuropathy. The Pittsburgh Sleep Quality Index was used in this study to measure sleep quality and determine how sleep quality and pain were related in patients with diabetic peripheral neuropathy. Methods: This is a secondary analysis of an aerobic exercise research study in patients with diabetic peripheral neuropathy. Participants performed the Pain Inventory and the Pittsburgh Sleep Quality Index at baseline to measure clinical pain and sleep quality, respectively. Pain Inventory consists of two com¬ponents including The Pain Severity Index and the Pain Interference Index. The relationship between pain and sleep quality was evaluated using Pearson’s correlations. Results: The study showed that 77.8% of the subjects had low sleep quality (i.e., Pittsburgh Sleep Quality Index scores &gt; 5) (mean score of Pittsburgh Sleep Quality Index scores was 9.94±4.35). The mean scores of the Pain Interference Index and Pain Severity Index were 3.54±2.90 and 3.36±2.21, respectively. Both Pittsburgh Sleep Quality Index and Brief Pain Inventory-Pain severity index had positive relationship (r= 0.642, p = 0.004). In addition, there were positive relationship between Pittsburgh Sleep Quality Index and Brief Pain Inventory-Pain interference index (r= 0.591, p = 0.01). Conclusions: The majority of patient with diabetic peripheral neuropathy had low sleep quality. A higher pain intensity and more interference with daily activities were both strongly linked with poor sleep quality. The item of sleep discomfort in everyday activity was highly influenced in patients with diabetic peripheral neuropathy. Future studies are needed to determine if addressing poor sleep quality would impact perception of pain as well as diabetes management.

Comparing Remimazolam and Propofol for Postoperative Anesthesia Satisfaction in Outpatient Gynecological Surgery: A Randomized Clinical Trial.

This study aimed to compare the efficacy of remimazolam and propofol regarding postoperative anesthesia satisfaction in patients undergoing outpatient gynecological surgery. This was a single-center, open-label, non-inferiority, randomized clinical trial. Patients aged ≥ 18 years who underwent outpatient gynecological surgery with sedation were enrolled. Participants were randomly assigned to be sedated with remimazolam or propofol. The primary endpoint was the immediate postoperative anesthesia satisfaction score, evaluated through the Iowa Satisfaction with Anesthesia Scale (ISAS). 168 patients were randomly allocated to either the remimazolam group (n = 84) or the propofol group (n = 84). The mean (standard deviation) ISAS scores immediately after surgery were 1.7 (0.6) for the remimazolam group and 2.0 (0.7) for the propofol group (difference, -0.2; 97.5% confidence interval [CI]: -0.5 to -0.0; p = 0.02), indicating non-inferiority. The length of post-anesthesia care unit (PACU) stay was longer in the remimazolam group than in the propofol group (27.6 [9.1] min vs 22.4 [7.0] min; difference, 5.2 [95% CI: 2.7 to 7.6] min; p < 0.001). High-intensity injection pain was less frequently observed in the remimazolam group than in the propofol group (3.6% vs 45.2%; difference, -41.7% [95% CI: -54.2% to -29.1%]; p < 0.001). The nausea score was higher in the remimazolam group immediately after surgery than in the propofol group. Pain, nausea, sleep quality, anxiety, and depression scores were higher in the remimazolam group than in the propofol group on postoperative day 1. The incidence of adverse events and other secondary endpoints was comparable between the two groups. Remimazolam was non-inferior to propofol regarding postoperative anesthesia satisfaction in patients undergoing outpatient gynecological surgery. Therefore, it should be considered as a new sedation alternative in such procedures.

Clinical observation of perioperative negative emotional changes in patients with percutaneous balloon compression for primary trigeminal neuralgia: A prospective cohort study

ObjectiveTo investigate the prevalence of negative emotions in trigeminal neuralgia (TN) patients, to identify risk factors associated with anxiety and depression, and further to explore the impact of percutaneous balloon compression (PBC) on anxiety and depression in TN patients during the perioperative period. Methods400 patients with primary TN treated with PBC at our institution from November 2021 to April 2023 were included. We analyzed visual analogue scale (VAS) and the Hospital Anxiety and Depression Scale (HADS) scores. The patients’ clinical data and short-term clinical outcomes were gathered and subjected to statistical analysis. ResultsThis study included a total of 400 patients diagnosed with primary TN. Patients who had high pain intensity (OR 1.20, 95 % CI 1.02–1.41; p = 0.025) or a history of multiple previous TN procedures (OR 1.49, 95 % CI 1.03–2.16; p = 0.036), were more prone to anxiety. Patients who were female (OR 1.59, 95 % CI 1.03–2.44; p = 0.036), had high pain intensity (OR 1.28, 95 % CI 1.08–1.52; p = 0.004) or had a history of multiple previous TN procedures (OR 1.48, 95 % CI 1.11–1.98; p = 0.008), were more likely to have depression. Significant improvements in anxiety and depressive symptoms were observed in patients who experienced pain relief after PBC (p < 0.001). ConclusionsFemale gender, high pain intensity, and a history of multiple prior TN procedures are associated risk factors for anxiety and depression in TN patients. PBC can provide patients with a high pain relief rate and significantly improve their anxiety and depression symptoms during the perioperative period.