Higher Pain Ratings Research Articles

Hand Surgeon Posture: An Evaluation and Factors That Affect It

ObjectiveApproximately 68% of orthopaedic surgeons report occupational related musculoskeletal pain, with back pain being the most common. Poor posture while operating has been proven to contribute to these high rates of musculoskeletal pain. There is little research regarding intraoperative surgeon posture within the field of hand and upper extremity surgery. This prospective study aims to investigate and analyze hand surgeon posture in the operating room. MethodsPosture of three hand surgeons was recorded using the UPRIGHT GO posture tracking device while performing a prospective series of 223 hand and upper extremity surgeries. This device reports posture in terms of overall percentage of time spent slouched versus upright. For this cohort of 223 cases, data were collected including surgical procedure, whether the surgery was performed in a seated or standing position, whether or not loupes were worn during the procedure, and if the surgeon was the primary or assistant surgeon. These data were then analyzed to look for any contributing factors to poor posture. ResultsThe three hand surgeons in this study spent an average of 40.3% of their time slouched while operating. The average percentage of time slouched was significantly greater with the use of loupes versus no loupes. Additionally, mean time slouching was slightly increased when the surgeon was seated and also when the surgeon was acting as the assistant surgeon. ConclusionThe three orthopaedic hand surgeons in our study spent a significant portion of their operative time slouched. The main variable associated with a significant risk of poor surgical posture was wearing loupes. Slight increases in slouching were seen with operating while seated and as the assistant surgeon. Surgeon awareness of these variables, as well as techniques to improve surgeon posture, should be developed in order to help contribute to better surgeon posture within the field of hand surgery.

FamilyCoviDD19: results of a cross-sectional study—long-term outcomes of infected and uninfected household members

ObjectiveIn this study, we aimed to compare long-term physical and mental health outcome between SARS-CoV-2 infected and uninfected household members to differentiate between infection-related and pandemic-related outcomes after about two...

Patellar Resurfacing and Assessment of Total Knee Arthroplasty in Patients in King Abdullah Bin Abdulaziz University Hospital

The most effective surgical procedure for treating advanced knee osteoarthritis is total knee arthroplasty. On radiographs, knee osteoarthritis was present in about 37% of individuals over the age of 60. This study, a retrospective cohort study, compared the anterior knee pain, range of motion, and abnormal sound among patients who underwent total knee replacement surgery with or without postoperative patellar resurfacing. The King Abdullah bin Abdulaziz University Hospital in Riyadh, Saudi Arabia, has an orthopedic department where the study will be carried out. This study included 80 patients who had undergone total knee replacement surgery, either with or without patellar resurfacing.
 They were chosen in accordance with specific inclusion criteria, including being elderly patients (over 50) with knee osteoarthritis that was not responding to conservative treatment. Total knee arthroplasty is an effective treatment for advanced knee arthritis, particularly when the contentious patellar resurfacing procedure is used. Non-patellar resurfacing total knee arthroplasty demonstrated in compression a high rate of pain and an inability to achieve full range of motion. Our research supports our main goal, and numerous studies have agreed that patellar resurfacing provides painless treatment and better outcomes for people with knee arthritis.

Unilateral transtibial prosthesis users load their intact limb more than their prosthetic limb during sit-to-stand, squatting, and lifting

BackgroundLower limb prosthesis users exhibit high rates of joint pain and disease, such as osteoarthritis, in their intact limb. Overloading of their intact limb during daily activities may be a contributing factor. Limb loading biomechanics have been extensively studied during walking, but fewer investigations into limb loading during other functional movements exist. The purpose of this study was to characterize the lower limb loading of transtibial prosthesis users during three common daily tasks: sit-to-stand, squatting, and lifting. MethodsEight unilateral transtibial prosthesis users performed sit-to-stand (from three chair heights), squatting, and lifting a 10 kg box. Peak vertical ground reaction forces and peak knee flexion moments were computed for each limb (intact and prosthetic) to characterize limb loading and asymmetry. Ranges of motion of the intact and prosthetic ankles were also quantified. FindingsUsers had greater peak ground reaction forces and knee flexion moments in their intact limb for all tasks (p < 0.02). On average, the intact limb had 36–48% greater peak ground reaction forces and 168–343% greater peak knee flexion moments compared to the prosthetic limb. The prosthetic ankle provided <10° of ankle range of motion for all tasks, less than half the range of motion provided by the intact ankle. InterpretationProsthesis users overloaded their intact limb during all tasks. This asymmetric loading may lead to an accumulation of damage to the intact limb joints, such as the knee, and may contribute to the development of osteoarthritis. Prosthetic design and rehabilitation interventions that promote more symmetric loading should be investigated for these tasks.

Cadmium Toxicity: Insight into Sources, Toxicokinetics, and Effect on Vital Organs and Embryos

Background: Elemental cadmium, cadmium oxide, sulfide, and chloride are resurrected to the atmosphere from both natural and anthropogenic sources. cadmium concentrations in the blood, urine and kidney cortex are substantially higher in smokers compared to never smokers. Absorbed cadmium accumulates primly in the renal cortex and liver. The pancreas, thyroid, gall-bladder and testes can also include comparatively high concentrations. Objectives: The current review aimed to highlight on the effect of cadmium chloride on vital organs and embryos. Absorption of cadmium from the lungs is a major source of exposure between smokers and the occupationally exposed. Cadmium accumulates with age even a maximum level is arrived at about age 50. Metallothionein has been identified in the liver, kidneys, duodenum, urine and blood of animals. It has been postulated that metallothionein passes through the red cell membrane and is transformed to the kidney. Cadmium being a divalent cation is accumulated by transfers mechanisms developed for necessary metals. Cadmium may interact with zinc, iron, magnesium, manganese, calcium and selenium and cause their secondary disability and so break down metabolism, resulting in the final morphological and functional changes in many organs. Toxicity could result from cadmium (Cd2+) interacting with cellular ingredients until without get into the cell, but by interaction with receptors on their surface. Cadmium forms covalent and ionic bonds with atoms of sulfur, oxygen, and hydrogen present in the sulfhydryl groups, disulfide, carboxyl, imidazole or severally amino compounds present in the cells, causing significant disruption of their homeostasis. The principle target organelle of cadmium is the mitochondria. Symptoms of acute cadmium intoxicating usually appear after 24 hours are shortness of breath, general weakness, fever. It can also cause pulmonary edema, pneumonia and in acute cases, respiratory failure and death. Cadmium accumulates in the renal cortex and induces tubular damage. It may cause nephrotoxicity by procreating free radicals and/or by inducing necrosis, apoptosis and creatinine increase in plasma and urea increase in the serum. Exposure to cadmium can cause skeletal damage. Cadmium is attached to low bone mineralization, a high rate of fractures, increased osteoporosis and intense bone pain. It accumulates in the proximal tubular cells, it compresses cellular functions, which may result in reduced transformation among two forms of vitamin D3. This is probably to causes a decrease in calcium absorption and bone mineralization, which in turn may produce osteomalacia. The skeletal effects observed in young rats exposed to cadmium during the period of rapid skeletal growth and teratogenesis or skeletal effects recorded include sirenomelia (fused lower limbs), Amelia (absence of one or more limbs) and retard ossification of the sternum and ribs, dysplasia of facial bones and rear limbs and edema. Cadmium has been shown to be both embryotoxic and teratogenic in a different of animal species. It accumulates in human placenta and its concentration in cord blood increase with maternal exposure. Cadmium may be responsible for decreasing the volume of fetal capillaries in the terminal villi of the placenta. Furthermore, increasing the connective tissue about the fetal vessels changed synthesis of serum and amniotic fluid proteins and decreased expression of growth factors also may key a role in cadmium teratogenicity. Cadmium induces oxidative stress in many organisms at the cellular level, which may outcomes in physiological damage to various organs such as kidneys, liver, lung, pancreas, testes, placenta and bones Cadmium induces oxidative stress in many organisms at the cellular level, which may outcomes in physiological damage to various organs such as kidneys, liver, lung, pancreas, testes, placenta and bones. Reactive oxygen species reacting with polyunsaturated fatty acids of cell membranes initiate lipid peroxidation process that results in modulation of proteins, alteration in membrane components and this reason the loss of their impartiality and irrevocable damage. Conclusion: It can be concluded that symptoms of acute cadmium intoxicating are shortness of breath, general weakness, fever. pulmonary edema, and pneumonia. Cadmium accumulates with age in the different organs in the body and induces oxidative stress at the cellular level, which may outcomes in physiological damage to various organs such as kidneys, liver, lung, pancreas, testes, placenta and bones. Reactive oxygen species reacting with polyunsaturated fatty acids of cell membranes initiate lipid peroxidation process that results in modulation of proteins, alteration in membrane components and this reason the loss of their impartiality and irrevocable damage. Cadmium has been shown to be both embryotoxic and teratogenic in a different of animal species.

Spinal cord injury and prescribed opioids for pain: a scoping review.

Spinal cord injury (SCI) is a life-altering neurological condition affecting physical and psycho-social functioning and associated high rates of pain. Thus, individuals with SCI may be more likely to be exposed to prescription opioids. A scoping review was conducted to synthesize published research findings on post-acute SCI and prescription opioid use for pain, identify literature gaps, and propose recommendations for future research. We searched 6 electronic bibliographic databases (PubMed [MEDLINE], Ovid [MEDLINE], EMBASE, Cochrane Library, CINAHL, PsychNET) for articles published from 2014 through 2021. Terms for "spinal cord injury" and "prescription opioid use" were used. Included articles were in English and peer reviewed. Data were extracted using an electronic database by 2 independent reviewers. Opioid use risk factors for chronic SCI were identified and a gap analysis was performed. Of the 16 articles included in the scoping review, a majority were conducted in the United States (n = 9). Most articles lacked information on income (87.5%), ethnicity (87.5%), and race (75%). Prescription opioid use ranged from 35% to 64% in articles reporting this information (n = 7 articles, n = 3675 participants). Identified risk factors for opioid use included middle age, lower income, osteoarthritis diagnosis, prior opioid use, and lower-level spinal injury. Limited reporting of diversity in study populations, absence of risk of polypharmacy, and limited high quality methodology were identified gaps. Future research should report data on prescription opioid use in SCI populations, with additional demographics such as race, ethnicity, and income, given their importance to risk outcomes.

Neuroma Treatment With the Acellular Nerve Allograft Reconstruction Technique.

Treatment of a painful neuroma is a challenging problem for both the patient and the providers. Current surgical treatment options typically include excision of the neuroma and stump relation. However, with both treatment options, patients have high rates of persistent pain and rates of neuroma recurrence. We describe two patients with neuromas treated with our acellular nerve allograft reconstruction technique. This technique involves the excision of the neuroma and bridging the proximal nerve end to the surrounding tissue with an acellular nerve allograft. Both patients had immediate resolution of their neuropathic pain that was maintained at their final follow-up. Acellular nerve allograft reconstruction is a promising treatment option for the treatment of painful neuromas.

Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP)

In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.

Prevalence and Awareness of Musculoskeletal Injuries Associated With Competitive Video Gaming in Saudi Arabia.

Background In recent years, the use of electronic devices has become an important part of the lives of adolescents who regularly use computers for academic activities and leisure. The excessive use of these devices has been associated with several health problems, such as obesity, headaches, anxiety, stress, sleep disorders, and musculoskeletal pain. This study aimed to assess the prevalence and awareness of musculoskeletal injuries associated with competitive video gaming in Saudi Arabia. Methodology This descriptive, cross-sectional study targeted all individuals involved in competitive video gaming aged 18 years or older in Saudi Arabia.The data were collected using a researcher-initiated online questionnaire. The final electronic questionnaire contained questions on participants' data, frequency and pattern of playing competitive video gaming, the associated musculoskeletal injuries, the most reported sites, and the associated consequences. The final questionnaire was sent to the participants via social media platforms and no more answers were obtained. Results A total of 116 competitive video gaming participants were included. Participants' ages ranged from 18 to 48 years, with a mean age of 22.5. The majority of the participants were males (86.2%; 100). A total of 100 (86.2%) participants had at least one site-associated musculoskeletal injury, while only 16 (13.8%) had none. Regarding sites, the most reported sites included the lower back (63.8%), neck (50%), hand/wrist (44.8%), and shoulder (35.3%). A total of 58 (50.4%) thought that competing in electronic game tournaments negatively affects the musculoskeletal system, and 43 (37.1%) had an idea that competing in electronic gaming tournaments is linked to conditions such as tendinopathy, carpal tunnel syndrome, and repetitive stress injuries. Conclusions This study showed that the majority of competitive video gamers had musculoskeletal injuries mainly at the lower back, neck, hand/ wrist, and shoulder. A higher pain rate was reported among females and new gamers.

Mother's Knowledge and Attitudes About Diarrhea Management in Children

Diarrhoea is the leading cause of morbidity and mortality in children worldwide, including in Indonesia. The magnitude of the problem can be seen from the high rate of pain and death due to diarrhea. The study aims to determine mothers' knowledge and attitudes about treating diarrhea in children. Experimental quantitative research with a descriptive approach. The results showed that the level of knowledge was less than 25 people (62.5%), and the negative attitude category was 29 people (72.5%). It can be concluded that they suffer from diarrhea, while parents with good knowledge regarding managing diarrhea tend to have their children not suffer from diarrhea. Recommendations are expected to provide information for local health offices and puskesmas in overcoming diarrhea problems; this is valuable information to carry out programs to improve public health, especially diseases in children.

Functional neurological disorder: Clinical manifestations and comorbidities; an online survey

Functional Neurological Disorder (FND) is common and is often accompanied by multiple comorbid symptoms and conditions. There have been no large-scale studies exploring the change of its clinical manifestations and comorbidities.We used an online survey to assess FND patient characteristics, changes to fatigue, sleep and pain and comorbid symptoms and diagnoses, as well as treatment strategies. The survey was shared via the charities FND Action and FND Hope.527 participants were included in the analysis. Most (97.3%) reported experiencing more than one core FND symptom. Many respondents reported associated pain (78.1%), fatigue (78.0%) and sleep disturbances (46.7%) before FND diagnosis which often increased thereafter. Rates of obesity were higher (36.9%) than in the general population. Obesity was associated with increased pain, fatigue and sleep difficulties. There was frequent weight gain after diagnosis. 50.0% of participants reported having other diagnoses prior to FND, while in 43.3% new comorbidities arise after FND diagnosis. Many respondents reported being dissatisfied with their care, expressing a wish for further follow-up from mental health (32.7%) and/or neurological services (44.3%).This large online survey further supports the phenotypic complexity of FND. High rates of pain, fatigue and sleep disturbance exist before diagnosis but monitoring for change is worthwhile. Our study identified major gaps in service provision; we highlight the importance of an open mind regarding change in symptoms; this could aid the early identification and management of co-morbidities, including obesity and migraine, which possibly have a negative impact on FND.

Stress and pain regulation: Parallel processes among traumatized individuals

IntroductionThe human reaction to traumatic events is often marked by a dialectic alteration of two emotional states –a state characterized by intrusion, anxiety and hyperarousal, and a state of denial marked by dissociation and numbing. These two seemingly opposite states represent attempts to modulate stress, as gradual reduction of their intensity represents an adaptation to stress. Maladaptive reactions to trauma, however, reflect disrupted regulation capacities, manifested as persistent over-modulation or under-modulation of stress.ObjectivesTo demonstrate that these manifestations of disrupted regulation, as observed among individuals with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) are also reflected in patterns of pain modulation.MethodsThree studies using self-report questionnaires and psychophysical tests, assessing sensitivity to pain, as reflected by pain thresholds, and reactivity to suprathreshold noxious stimuli, as implicated in their ratingResultsStudy 1 Included 32 PTSD outpatients, 29 anxiety disorder outpatients, and 20 healthy controls. PTSD patients reported higher rates of chronic pain (83.3%) than anxiety patients (42.0%) and controls (5.0%). PTSD severity correlated with chronic pain severity (r = 0.61, p &lt; 0.01). PTSD patients displayed a unique paradoxical pain profile, according to which their pain thresholds were significantly higher than those of the anxiety patients and controls (p &lt; 0.01), but they perceived suprathreshold stimuli as being much more intense (p &lt; 0.01).Study 2 included 32 PTSD outpatients and 43 healthy controls. Findings replicated the paradoxical pain profile among PTSD patients. Pain thresholds were positively associated with dissociation level (b = 0.49; p &lt; 0.05) and negatively associated with anxiety level (b = -0.63, p &lt; 0.01). Pain ratings were positively associated with anxiety (b = 0.52, p &lt; 0.05) and negatively related to dissociation levels (b = -.51, p &lt; 0.05).Study 3 included 46 women diagnosed with BPD and 47 healthy controls. Women with BPD reported higher levels of childhood trauma (p &lt; 0.05) than the controls. They also demonstrated higher pain thresholds (p &lt; 0.05). Among subjects with high levels of body dissociation, implicated by reduced body awareness, those with BPD demonstrated hyposensitivity to pain, manifested in higher pain thresholds, lower suprathreshold pain ratings, and pain evoked by higher temperature, than the controls. Among those with low levels of body dissociation, BPD subjects demonstrated increased reactivity to pain as manifested in higher pain ratings and pain evoked by lower temperature.ConclusionsThese findings demonstrate the association between over-modulation and under-modulation of stress and over-modulation and under-modulation of pain, respectively, among PTSD and BPD patients. These findings point to parallel processes of disrupted regulation among traumatized individuals.Disclosure of InterestNone Declared

Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP)

In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.

Common Pediatric Otolaryngology Procedures: Ergonomic Considerations.

Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughouttheir otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.

Lumbopelvic pain and sick leave during pregnancy: A comparison of Italy and Norway.

Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries. Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire. Cross-sectional. Italian (n = 481) and Norwegian women (n = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women's experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters. In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway (p < 0.01), but not in Italy (p = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p = 0.06 and Norway: 53% versus 38%, p < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p = 0.02% and Norway: 27% versus 14%, p < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p < 0.01 and Norway: 31% versus 4%, p < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11-1.0, p = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29-1.0, p = 0.06). We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field.

LifeStyle and Exercise Relation to Neck and Back Pain in Saudi Arabia.

Personal anguish, incapacity, and a decline in work and life quality are all associated with neck and low back pain, making it a significant socioeconomic burden for individuals and society. It iswell knownthat engaging in regular physical exercise has considerable health benefits. The purpose of this research was to investigate the factors contributing to the high rates of musculoskeletal pain experienced by the Saudi Arabian population. This population-based, cross-sectional study was done in Saudi Arabia with 2,717 participants aged 18 to 60. A questionnaire was provided online to assess neck, shoulder, and lower back discomfort, time spent in general or aerobic physical activity, time spent sitting, sleep problems, general health, work satisfaction, and nutrition. Using logistic regression, weobserved potential risk factors for musculoskeletal pain. The prevalence of neck pain, shoulder pain, and lower back pain (LBP) were found to be 48.1%, 47.6%, and 63.8%, respectively. It was found that being a female (OR=1.78 [1.41-2.25], p<0.001), married (OR=1.58 [1.34-1.86], p<0.001), and having poor general health status (OR=3.78 [2.2-6.49], p<0.001), sleep disturbances (OR=2.46 [2.04-2.97], p<0.001) and poor job satisfaction (OR=1.29 [1.05-1.60], p=0.016) were independently associated with the prevalence of musculoskeletal pain. The diet of the individuals did not significantly influence the prevalence of MSPs. Good general health, good sleep, and good job satisfaction were associated with a reduced risk of experiencing neck or shoulder pain, but there was no association between physical activity and MSPs Longitudinal studies are required to acquire a better understanding of the relationship between MSP, aerobic activity, sleep, and diet.

Pancreatic intra-arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma: A pilot study.

To preliminarily evaluate the efficacy and safety of pancreatic intra-arterial infusion chemotherapy (PAIC) with nab-paclitaxel in patients with advanced pancreatic carcinoma. Fifteen patients with advanced pancreatic carcinoma received monthly, inpatient, 3-h, continuous PAIC of nab-paclitaxel at 180 mg/m2, combined with 60 mg oral tegafur gimeracil oteracil potassium capsule for 2 weeks. The therapeutic courses were repeated every 4 weeks. All patients had a preliminary diagnosis based on clinical symptoms, imaging data (computed tomography or magnetic resonance imaging or positron emission tomography/computed tomography), and tumor markers. The adverse effects, clinical benefit response (CBR), objective response rate (ORR), median progression free survival (mPFS), and median overall survival (mOS) were monitored. Fifteen patients with advanced pancreatic carcinoma were enrolled in this study, including 10 male and 5 female patients. The mean age at the time of treatment was 66.3 years (53-84 years). A total of 49 cycles of PAIC (mean = 3.27 cycles/patient) were performed. The most common treatment-related toxicities were alopecia, diarrhea, and nausea/vomiting. No procedure-related complications were observed. The longest overall survival observed was 22 months and the maximum number of treatments for the same patient was six cycles. PAIC contributed a high rate (13/15 [86.67%]) and fast (10/15 [66.67%]) easement of pain, with apparent symptom relief within 24 h, especially local pain symptom. The pain anesis rate was 13 (86.67%). CBR was achieved in 13 (86.67%) patients (95%CI [59.54,98.34]). ORR was achieved in four (26.67%) patients (95%CI [7.79,55.10]). Disease Control Rate was achieved in 14 (93.33%) patients. The mPFS was 5.22 months (interquartile range [IQR], 4.27-7.85 months). The mOS was 8.97 months (IQR, 5.65-13.70 months). In this study, the dose of the chemotherapeutics and the schedule of the transcatheter pancreatic arterial chemotherapy perfusion were shown to be safe, well-tolerated, and effective for the relief of clinical symptoms and CBR. These advantages can quickly establish the treatment belief and improve patient quality of life. This regimen requires further investigation in patients with advanced pancreatic carcinoma.

Prevalence and determinants of hip pain in non-ambulatory cerebral palsy children: a retrospective cohort study.

Hip pain is common in cerebral palsy children, particularly at Gross-Motor Function Classification System level IV-V. It is associated to hip displacement and relates to the migration percentage. Recent literature suggested early reconstructive bone surgery, as the best approach to prevent hip luxation, then hip pain. Still, high rates of hip pain are reported. To investigate prevalence and determinants of hip pain in an Italian cerebral palsy sample. Single-center retrospective cohort study. Inpatient and outpatient. Patients with spastic or dyskinetic cerebral palsy, Gross-Motor Function Classification System level IV or V, age 0-18. A chart review was implemented to report hip pain, as a dichotomous variable (pain/no pain), age, sex, cerebral palsy subtype, Gross-Motor Function level, lumbar scoliosis, migration percentage, previous orthopedic surgery, or botulinum injections, oral or intrathecal baclofen, drug-resistant epilepsy, assistive devices for standing or walking. Descriptive statistics and a multivariate logistic stepwise regression were performed. A total of 504 subjects were included: 302 level V, 209 females, 432 spastics. The mean length of follow-up was 6 years. The overall prevalence of hip pain was 8.9% (6.3% were at level V) and of hip dislocation was 19% (15.9% were at level V). Just 39% of dislocated hips were painful. Children at spastic subtype and level V were predominantly affected. Botulinum and soft tissue surgery related to lower rates of hip pain, without statistical significance. Age (OR 1.19, 95%CI 1.14-1.25, P value 0.000), sex (OR 1.72, 95%CI 1.18-2.52, P value 0.005), migration percentage (OR 1.02, 95%CI 1.02-1.03, P value 0.000) and lumbar scoliosis (OR 1.32, 95%CI 0.86-2.01, P value 0.200) resulted significant independent determinants of hip pain. Hip pain relates with the migration percentage, but not all dislocated hips become painful. Hip pain may be transient and requires a targeted and individualized approach. Children at spastic subtype and level V were predominantly affected. Age and sex are confirmed as determinants. Specific validated measures are to be implemented to assess hip pain. Considering severe non-ambulatory cerebral palsy patients, pain and quality of life should be considered as outcomes, in the management of hip luxation.

Design, methods, and recruitment outcomes of the Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study

The Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study is a 12-month pragmatic randomized comparative effectiveness trial conducted at ten United States Veterans Affairs (VA) health care sites. The overall goal was to test interventions to improve pain while reducing opioid use among VA patients with moderate-severe chronic pain despite treatment with long-term opioid therapy (LTOT). Aims were 1) to compare lower-intensity telecare collaborative pain management (TCM) versus higher-intensity integrated pain team management (IPT), and 2) to test the option of switching to buprenorphine (versus no option) in a high-dose subgroup. Recruitment challenges included secular trends in opioid prescribing and the COVID-19 pandemic. Participants were recruited over 3.5 years. Of 6966 potentially eligible patients, 4731 (67.9%) were contacted for telephone eligibility interview; of those contacted, 3398 (71.8%) declined participation, 359 (7.6%) were ineligible, 821 (24.2%) enrolled, and 820 (24.1%) were randomized. The most common reason for declining was satisfaction with pain care (n = 731). The most common reason for ineligibility was not having moderate-severe chronic pain (n = 110). Compared with the potentially eligible population, randomized participants were slightly younger, more often female, had similar prescribed opioids, and had similar or higher rates of pain and mental health diagnoses. The enrolled patient number was lower than the original target, but sufficient to power planned analyses. In conclusion, the VOICE trial enrolled a diverse sample similar to the population of VA patients receiving LTOT. Results will add substantially to limited existing evidence for interventions to improve pain while reducing opioid use.ClinicalTrials.gov identifier: NCT03026790

172 (PB-085) Poster - Developing an effective self-management web-based intervention using co-designed patient and multidisciplinary research: ePainQ

Background: Breast cancer is the most common cancer in terms of newly diagnosed cases. Surgery is the mainstay of treatment but confers comorbidities including high rates of persistent post-surgical pain. The James Lind Alliance breast surgery priority setting partnership (2022) identified the need to support patients around the time of diagnosis, during and after treatment, asking what are the best methods to individualise information and support given to patients. Web-based interventions providing real-time symptom reporting support patients and clinicians to make early and effective decisions regarding care.