Higher Pain Research Articles

Patient experiences of outpatient hysteroscopy

ObjectivesPatient perspectives have an important role in improving the quality of outpatient hysteroscopy (OPH) services. Understanding women’s experiences can help provide important insights regarding the OPH journey. The purpose of this paper is to share perspectives and reflect on the experiences of women that participated in a national benchmarking OPH survey. In addition, we explore the correlation between women’s experience of OPH and reported pain scores. Material and methodsOver a two-month period, 5151 women took part in the national OPH survey. Free text comments relating to women’s OPH experience, collected as part of the survey, were subjected to qualitative analysis using NVivo 12 software to provide a better understanding of the OPH journey. In addition, correlations were drawn between the qualitative and quantitative data collected for pain scores and satisfaction using SPSS software. Results1720 (33.3%) women provided comments on their OPH experience. Qualitative thematic analysis generated themes that were divided into positive (82%) and negative (7%) experiences of care. Potential areas of improvement in relation to the OPH service were highlighted in 11% of themes. Most women regarded OPH as a safe, tolerable, and well delivered outpatient service. Quantitative analysis showed that 1829 (35.5%) women reported procedural pain between 70 and 100 mm. These women reported equivalent quality of care on a 10 cm visual analogue scale (9.71 [SD1.04] vs. 9.76 [0.73]; P = 0.06) but were more likely to decline having the procedure done in the same way again (19.4% vs. 3.1%; RR 6.30, 95% CI 5.06 to 7.83) compared to women with pain scores < 70 mm. ConclusionQualitative data supports the usefulness, safety, tolerability, and acceptance of hysteroscopy in an outpatient setting by most women. However, the reasons for high procedural pain, poor tolerability and negative experiences warrant review and exploration of both individual patient and relevant institutional factors including training, equipment, and local processes.

Is the traditional placement of stainless steel crowns in primary teeth more painful than the non-preparation Hall technique?

Is the anxiety level and pain experience in young children the same for the traditional method of stainless crowns placement that might require local anesthetic and excavation of decay compared to the Hall technique that requires no preparation and no anesthetic injections? A randomized controlled study of 2 groups (43 and 54) children 4-8 years old with proximal decay in primary first molars. Each child had one tooth restored with the Hall technique (HT) and the second tooth received a conventional stainless crown (CT) (with or without local anesthesia, as needed) and all crowns were cemented with a GIC resin type cement less than a month of each other. The order of the placement was reversed with the allocation randomly concealed. A visual Wong-Baker Pain Scale with six cartoon faces was used to record pain levels. Data were analyzed using SPSS (version 25). After computing univariate descriptive statistics, differences among proportions were examined using cross-tabulations and χ2 tests (α = 0.05). Analysis of variance was conducted for parametric analysis, and the Wilcoxon signed-rank test was used for within-group, and the Mann-Whitney U-test was used for between-group, nonparametric analysis. The pain scores did not differ by treatment type. The majority of children (58.3%) reported low procedural pain for both treatments leaving 47.7% reporting moderate to high procedural pain. Using local anesthetic with CT did not change the results. The pain scores were similar for both procedures. HT has been recommended as less traumatic and but this might not be true for all children.

Pengaruh Teknik Hypnobirthing terhadap Penurunan Tingkat Nyeri Pada Persalinan : Literatur Review

Childbirth is a natural process that occurs in women with pain caused by uterine contractions. The high pain rate reaches 90% of mothers who give birth. Various actions and efforts have been made to reduce and reduce the level of pain in mothers, one of which is the hypnobirthing method. The purpose of this literature is to identify the effect of hypnobirthing on reducing pain levels in labor. This writer uses the method used in searching for articles is a literature review using the Google Scholar database, Science Direct, and Mendeley. The results of the article search were 654 articles identified from the database. After the screening process left 13 articles that could be assessed for feasibility. 3 out of 13 articles were excluded for some reason, leaving 10 articles to be included. The conclusion from this literature is that hypnobirthing has an effect on reducing pain levels in labor.

PAIN THRESHOLD PARADOX IN SCHIZOPHRENIA: A NARRATIVE REVIEW BASED ON THE LASTEST NEUROSCIENCE.

Pain is one of the basic defense responses of living organisms. Although the threshold for pain perception varies from person to person, there is no doubt that pain reduces a person's quality of life. Assessing the subjective experience of pain is especially important in the treatment of patients with schizophrenia. In light of recent advances in neuroscience, we discuss pain thresholds in patients with schizophrenia. A narrative review of pain thresholds in patients with schizophrenia was conducted. We electronically searched the PubMed and Google Scholar databases for articles in English with "pain," "schizophrenia," "neural circuits," and "neurotransmitters" in the title or abstract, for the period January 2000 through June 2022. A seemingly contradictory phenomenon has been noted with regard to pain thresholds in patients with schizophrenia. One phenomenon is a high pain threshold for nociceptive stimuli, and the other is a low pain threshold in chronic pain. As a result, a pain threshold paradox has been observed. Many schizophrenia patients appear to have an excess of dopamine in the mesolimbic system, which stimulates both the descending pain inhibitory pathway and the salience network. As a result, a pain threshold paradox has been observed, in which the threshold for acute nociceptive pain is high and the threshold for chronic pain is low.

Post-traumatic osteoarthritis: the worst associated injuries and differences in patients' profile when compared with primary osteoarthritis

BackgroundThe estimated prevalence of post-traumatic osteoarthritis (PTOA) is 10–12% and in this study 12.4%. Different knee and hip injuries have been identified as risk factors for PTOA, but there is no consensus regarding the most painful and disabling injuries. Identifying these injuries might help in the prevention of PTOA. Additionally, patients with PTOA have a higher risk for complications after arthroplasty than patients with primary OA, perhaps due to differences in the profile and comorbidity that might help to explain the difference. This work aims 1) to identify the most common past injuries associated with the most painful and disabling PTOA cases in non-athlete patients and 2) to compare the comorbidities and characteristics between PTOA and primary OA.MethodsRetrospective hospital-based cohort study with 1290 participants with joint complaints or who received arthroplasty. Medical records included demographic information, diagnosis, medication, smoking, alcohol history and comorbidities. Data from January 2012 orthopaedic consults till December 2019 was reviewed and had the type and date of injury, pain score by the numerical rating scale and walking disability. Odds Ratio (OR) and 95% confidence intervals are presented.ResultsThere were 641 cases with primary OA (65% females) and 104 with PTOA (61% males). Patients with PTOA were 7.5 years younger (P < 0.001), reported more alcohol consumption (P = 0.01) and had higher odds of osteoporotic fractures (OP) and psychosis than patients with primary OA (OR = 2.0, CI = 1.06–3.78 and OR = 2.90, CI = -0.91–9.18, respectively). Knee fractures were most common in males and hip fractures in females (31% and 37.5%, respectively, P < 0.005). The PTOA-associated injuries with the highest pain and disability scores were meniscal injuries and hip fractures. Besides, in the group with primary OA, there were more diabetes, hypertension and hypothyroidism cases than in PTOA. However, after adjustment, differences were only significant for diabetes (ORadj = 1.78, CI = 1.0–3.2).ConclusionsPast meniscal injuries and hip fractures were the most relevant PTOA-associated injuries regarding pain and walking disability. This, together with differences in their profile when compared with primary OA, might help to decide the orthopaedic management of these injuries to prevent complications such as PTOA and recurrence, with appropriate preoperative planning, surgery choice and comorbidity treatment.

When knowledge hurts: humans are willing to receive pain for obtaining non-instrumental information

Humans and other animals value information that reduces uncertainty or leads to pleasurable anticipation, even if it cannot be used to gain tangible rewards or change outcomes. In exchange, they are willing to incur significant costs, sacrifice rewards or invest effort. We investigated whether human participants were also willing to endure pain—a highly salient and aversive cost—to obtain such information. Forty participants performed a computer-based task. On each trial, they observed a coin flip, with each side associated with different monetary rewards of varying magnitude. Participants could choose to endure a painful stimulus (low, moderate or high pain) to learn the outcome of the coin flip immediately. Importantly, regardless of their choice, winnings were always earned, rendering this information non-instrumental. Results showed that agents were willing to endure pain in exchange for information, with a lower likelihood of doing so as pain levels increased. Both higher average rewards and a larger variance between the two possible rewards independently increased the willingness to accept pain. Our results show that the intrinsic value of escaping uncertainty through non-instrumental information is sufficient to offset pain experiences, suggesting a shared mechanism through which these can be directly compared.

Preoperative Low Back Pain Affects Postoperative Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery.

A single-center retrospective study. To research the predictive factors associated with postoperative patient satisfaction 1 year after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), a minimally invasive procedure for lumbar degenerative disease. There have been reports of numerous variables influencing patient satisfaction with lumbar surgery; however, there have been few investigations on MIS are limited. This study included 229 patients (107 men and 122 women; mean age, 68.9 years) who received one or two levels of MISTLIF, and the patient's age, gender, disease, paralysis, preoperative physical functions, duration of symptom(s), and surgery-associated factors (waiting for surgery, number of surgical levels, surgical time, and intraoperative blood loss) were studied. Radiographic characteristics and clinical outcomes such as Oswestry Disability Index (ODI) scores and Visual Analog Scale (VAS; 0-100) ODI scores for low back pain, leg pain, and numbness were studied. One year following surgery, patient satisfaction (defined as satisfaction for surgery and for present condition; 0-100) was assessed using VAS and its relationships with investigation factors were examined. The mean VAS scores of satisfaction for surgery and for present condition were 88.6 and 84.2, respectively. The results of multiple regression analysis showed that preoperative adverse factors of satisfaction for surgery were being elderly (β =-0.17, p =0.023), high preoperative low back pain VAS scores (β =-0.15, p =0.020), and postoperative adverse factors were high postoperative ODI scores (β =-0.43, p <0.001). In addition, the preoperative adverse factor of satisfaction for present condition was high preoperative low back pain VAS scores (β =-0.21, p =0.002), and postoperative adverse factors were high postoperative ODI scores (β =-0.45, p <0.001) and high postoperative low back pain VAS scores (β =-0.26, p =0.001). According to this study, significant preoperative low back pain and high postoperative ODI score after surgery are linked to patient unhappiness.

Foot-related impairment in children with juvenile idiopathic arthritis.

Foot involvement is present in approximately 60%-90% of children with Juvenile idiopathic arthritis (JIA). It is a major cause of disability, which can lead to deterioration in daily activities and quality of life. However, it is often overlooked and can compromise patient management. Our objective was to describe the ankle and foot involvement in JIA and to appraise the functional impact of this damage on the child's performance and quality of life by using validated scores. The cross-sectional study included patients with JIA. Functional impairment was assessed through the Juvenile Arthritis Functionality Scale (JAFS) and the Oxford Ankle and Foot Questionnaire for children. Twenty-three patients aged 12.75±3.9 and with 41months of disease duration. After completing the Oxford score, the physical domain appeared to be the most altered. A long delay in diagnosis was associated with an alteration in the emotional domain of the Oxford score. Higher disease activity was significantly associated with impairment in both the physical activity and the footwear domains of the Oxford score. As regards clinical examination data, the presence of foot pain as well as the presence of tendinopathy were associated with an alteration of all Oxford score domains. The presence of flat feet significantly affected all domains of the Oxford score. The JAFS was reported to affect the child's performance ability and was associated with impairment in physical activity, school and play, and emotional domains. Ankle and foot involvement was common in our study. Functional ability was most impaired in the lower limbs. High disease activity, foot and ankle pain, tenosynovitis, and flat feet were associated with poorer quality of life and higher functional impact.

The overgeneralization of pain-related fear in individuals with higher pain sensitivity: A behavioral and event-related potential study

Fear generalization contributes to the development and maintenance of pain. Pain sensitivity has been proposed to predict the strength of fear responses to aversive stimuli. However, whether individual variation in pain sensitivity affects pain-related fear generalization and its underlying cognitive processing remains unclear. To address this gap, we recorded behavioral and event-related potential (ERP) data among 22 high pain sensitivity (HPS) and 22 low pain sensitivity (LPS) healthy adults when exposed to a fear generalization paradigm. The behavioral results indicate that the HPS group displayed higher unconditioned stimulus expectancy and greater fear, arousal, and anxiety ratings to conditioned stimulus and generalization stimulus than the LPS group (all p values < 0.05). The ERP results showed that the HPS group exhibited a larger late positive potential evoked by GS2, GS3 and CS- (all p < 0.005) but a smaller N1 evoked by all CS and GSs (all p values < 0.05) relative to the LPS group. These findings suggest that individuals with a high level of pain sensitivity allocate more attention resources to pain-related threatening stimuli, which contributes to an overgeneralization of pain-related fear.

Acupressure versus NSAID for relief of orthodontic pain : A randomized controlled clinical trial.

To compare ibuprofen and acupressure for pain relief after insertion of elastomeric orthodontic separators. Arandomized control clinical trial was conducted in an orthodontic clinic. Atotal of 75orthodontic patients aged 12-16years participating in the study were randomly allocated to receive either 400 mg of oral ibuprofen, applying acupressure therapy, or no pain-relief approach. Pain scores were recorded on visual analog scales (10 cm) over aweek at different times (4,10, 18, 24 h, and 1week). The margin of equivalence was defined as 10 mm. For all timepoints, the control group recorded the highest pain. For the ibuprofen and acupressure group, after 4 h, 18 h, and 1week, no significant difference was noted. However, after 10 h, no significant difference in pain between the control and acupressure groups was noted and the ibuprofen group showed significantly lower pain. In the acupressure group, the highest pain was noted at 10 h. After this timepoint, pain progressively decreased with time and the lowest pain was noted after 1week. In the control and ibuprofen groups, the highest pain was after 4 h, and then progressively decreased with time and the lowest pain was noted after 1week. There was no significant difference in pain perception between participants using ibuprofen or acupressure and both groups recorded significantly lower pain than the control group at most of the observed timepoints. Results support the analgesic effect of the acupressure approach.

Sleep disturbances in patients with psoriatic arthritis

Introduction/ObjectivesTo study quality of sleep in patients with psoriatic arthritis (PsA) and to investigate the association of sleep disturbances with other variables. Methodology and methodsPatients ≥18 years old with a diagnosis of PsA (CASPAR criteria). Sociodemographic and clinical data, physical exam. For each case, an age-sex matched control was included. The Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9) for depression were administered to both patients with PsA and controls. Statistical analysisDescriptive statistics. Univariate and multivariate analysis. Spearman correlation. Linear and multiple logistic regression. Results36 patients with PsA and 37 controls, 52.8% male, median age 57 years. Median PsA disease duration of 11 years. The ICSP was higher in patients with PsA than in controls (7.8±4.1 vs. 4.6±2.9, respectively, p<.001). A total of 27 patients (64.3%) presented sleep disturbances (ICSP≥5) vs. 15 controls (35.7%), p=.004. The presence of sleep disturbance in patients with PsA was associated with higher pain (6.5±2.4mm vs. 3.4±3.1mm, p=.01) and greater depression (PHQ-9 18 vs. 9, p=.05). The ICSP questionnaire correlated positively with PHQ-9, pain, night pain, MASES, PsAQoL, and DAPSA. In the linear regression analysis, both pain (β: .44, p=.01) and depression (β: .38, p=.03) were independently associated with sleep disorders. And in multiple logistic regression, the only variable independently associated with ICSP≥5 was pain (OR: 1.64, p=.023). ConclusionsMore than 60% of patients with PsA have sleep disturbance and the variables independently associated with it are pain and depression.

Work Adaptation Experience of Vietnamese Workers in Korean Workplaces: Constructivist Grounded Theory

Purpose: The purpose of this study is to find a nursing intervention plan by classifying the body pain areas of the Korean aged and analyzing related factors. Methods: This study performed the latent class analysis, cross-analysis, and one-way ANOVA using the SPSS 25.0, M-plus 7.0 program on 4,388 older adults aged 65 or over using the data from the 2020 Aging Research Panel. Results: As a result of the Latent Class Analysis, participants divided into four groups. Group 1 was the 'shoulder and low back pain group' with high shoulder and back pain, group 2 was the 'upper body pain group' with severe pain in the arms, wrists and fingers and chest, group 3 was the 'lower pain focused group' with high pain in the legs and knees, and finally, group 4 was the 'general low pain group' with low pain overall. The result of the study shows that the group that did not exercise regularly, the female group, and the low socioeconomic status group have more pain in general. The upper body central pain group showed a low level of life satisfaction. Conclusion: This study discusses various nursing interventions for the prevention of chronic pain, especially for the aged female group who has diverse body pain areas, the aged with low socioeconomic status, and the aged who do not exercise.

Potential benefits and therapeutic applications of "Panchgavya" therapy (Cowpathy) for human and animal health: Current scientific knowledge

Cow's milk, urine, dung, ghee, and curd (together known as "Panchgavya") have incomparable medicinal value in Ayurveda and ancient Indian clinical methods. Panchgavya is also known as Cowpathy in Ayurveda. In India, the cow is revered as a goddess known as "Gaumata" because of its nurturing qualities similar to those of a mother. Almost no adverse effects are associated with using Panchgavya, which is why it is recommended in Ayurveda for treating disorders affecting numerous body systems. Its possible antimicrobial effects have piqued the curiosity of medical researchers and practitioners. Cow milk is widely regarded as a nutritious diet and has been shown to effectively treat various medical conditions, including high body temperature, pain, cancer, diabetes, kidney diseases, and weakness. Milk can prevent the growth of microorganisms, has erotic qualities when combined with the leaves of medicinal herbs, and the fat in milk has anticancer characteristics. Toned and skim milk, lassi, yoghurt, cottage cheese, and khoa all come from milk and have important medicinal characteristics. Curd (dahi) is recommended as a blood purifier for conditions such as hemorrhoids, piles, and gastrointestinal issues. Ghee made from cows has been shown to boost immunity. It is important to highlight the use of cow dung as an antifungal and for treating malaria and tuberculosis. It has the potential to aid in the development of a populace free from disease, the creation of sustainable energy systems, the fulfilment of all nutritional needs, the elimination of poverty, the promotion of organic farming culture, and the like. Cow urine is a powerful remedy for numerous medical conditions, including but not limited to epileptic convulsions, diabetes, hepatitis, inflammation, fever, and anaemia. The current review article explores how the Panchgavya ingredients can be employed to safeguard human and animal health.

Evaluation Of Life Quality In Colorectal Cancer Patients

Introduction. The diagnostic period of cancer, the treatment process and the complications caused by the treatments negatively affect the quality of life of the patients and his relatives who support his care. The concept of quality of life has gained more importance in recent years due to reasons such as prolonged life expectancy and increased public awareness.&#x0D; Aim. Colorectal cancer affects the life quality of individuals negatively. In this study, life quality of colorectal cancer patients and the factors affecting their quality of life were examined.&#x0D; Materials and method. The sample of the study consisted of 110 patients who applied to the General Surgery Clinic/Service and Chemotherapy Unit in State Hospital and Training and Research Hospital between 01.05.2014 and 01.11.2015. Survey data were collected using the socio-demographic questionnaire, EORTC QLQ-C30 and EORTC QLQ-CR38 (European Organization for Research and Treatment of Cancer Core Questionnaire) and Beck Depression Scale. Number, percentage, mean distribution, variance analysis, Mann-Whitney U test and Kruskal-Wallis test were used with SPSS v.20.0 software in evaluating the data.&#x0D; Results. The mean age of the patients diagnosed with colorectal cancer was obtained 61.9 ± 10.92 years. It was determined that 61.8% of the patients were male, 87.3% were married, and 20.9% had cancer history in their family. It has been determined that, women suffered more from stoma-related problems than men and the perception of the body image of female patients were worser than men. Patients were found to have a high emotional function and high pain level; and have low constipation scores in the symptom subscale. Patients' scores related to stoma problems were high and sexual enjoyment scores were low. The age, number of children, marital status and educational status of the patients were found to have an influence on the quality of life.&#x0D; Conclusion.As a result, as the age of colorectal cancer patients progressed and as the number of children increased, the functional status was worse and the incidence of symptoms was higher. It was determined that gender did not affect the quality of life or depression.

An evaluation of a one-day pain science education event in a high school setting targeting pain related beliefs, knowledge, and behavioural intentions

BackgroundPersistent pain is a common condition affecting one in four UK adults. Public understanding of pain is limited. Delivering pain education within schools may improve public understanding in the longer term. ObjectiveTo evaluate the impact of a one-day Pain Science Education (PSE) event on sixth form/high school students’ pain beliefs, knowledge and behavioural intention. MethodsExploratory, single-site, mixed-methods, single-arm study involving secondary school students ≥16 years old attending a one-day PSE event. Outcome measures included the Pain Beliefs Questionnaire (PBQ), Concepts of Pain Inventory (COPI-ADULT), a vignette to assess pain behaviours; and thematic analysis of semi-structured interviews. ResultsNinety (mean age 16.5 years, 74% female) of the 114 attendees, agreed to participate in the evaluation. PBQ scores improved on the Organic beliefs subscale [mean difference −5.9 (95% CI -6.8, −5.0), P < 0.01] and Psychosocial Beliefs subscale [1.6 (1.0, 2.2) P < 0.01]. The COPI-Adult revealed an improvement [7.1 (6.0–8.1) points, P < 0.01] between baseline and post intervention. Pain behavioural intentions improved post education for work, exercise, and bed rest related activities (p < 0.05). Thematic analysis of interviews (n = 3) identified increased awareness of chronic pain and its underpinning biology, beliefs that pain education should be widely available, and that pain management should be holistic. ConclusionsA one-day PSE public health event can improve pain beliefs, knowledge and behavioural intentions in high school students and increase openness to holistic management. Future controlled studies are needed to confirm these results and investigate potential long-term impacts.

Pain sensitivity differs between dog breeds but not in the way veterinarians believe.

Veterinarians hold distinct breed-specific pain sensitivity beliefs that differ from the general public but are highly consistent with one another. This is remarkable as there is no current scientific evidence for biological differences in pain sensitivity across dog breeds. Therefore, the present study evaluated whether pain sensitivity thresholds differ across a set of dog breeds and, if so, whether veterinarians' pain sensitivity ratings explain these differences or whether these ratings are attributed to behavioral characteristics. Pain sensitivity thresholds [using quantitative sensory testing (QST) methods] and canine behaviors (using owner questionnaires and emotional reactivity tests) were prospectively measured across selected dog breeds. Adult, healthy dogs from 10 dog breeds/breed types were recruited, representing breeds subjectively rated by veterinarians as high (chihuahua, German shepherd, Maltese, Siberian husky), average (border collie, Boston terrier, Jack Russell terrier), or low (golden retriever, pitbull, Labrador retriever) pain sensitivity. A final sample of 149 dogs was included in statistical analyses. Veterinarians' pain sensitivity ratings provided a minimal explanation for pain sensitivity thresholds measured using QST in dogs; however, dog breeds did differ in their pain sensitivity thresholds across the QST methods evaluated. Breed differences were observed for some aspects of emotional reactivity tests; however, these behavioral differences did not explain the differences in pain sensitivity thresholds found. Veterinarians' pain sensitivity ratings were positively associated with dog approach scores for the disgruntled stranger test suggesting that the way dogs greet strangers may be a factor influencing veterinarians' ratings of pain sensitivity across dog breeds. Overall, these findings highlight a need to investigate biological mechanisms that may explain breed differences in pain sensitivity because this may inform pain management recommendations. Further, future research should focus on when and how these breed-specific pain sensitivity beliefs developed in veterinarians, as veterinarians' beliefs could impact the recognition and treatment of pain for canine patients.

Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy

BackgroundIn cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison.ObjectiveA retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers.SettingPaediatric Rehabilitation Hospital in Mexico City, from August to November 2018.Participants21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls).Characteristically dataSociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips.ResultsAll children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus.ConclusionThough possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.

Dysfunctional Activation of the Dorsolateral Prefrontal Cortex During Pain Anticipation Is Associated With Altered Subsequent Pain Experience in Fibromyalgia Patients

The ability to accurately predict pain is an adaptive feature in healthy individuals. However, in chronic pain, this mechanism may be selectively impaired and can lead to increased anxiety and excessive avoidance behavior. Recently, we reported the first data demonstrating brain activation in fibromyalgia (FM) patients during conditioned pain responses, in which FM patients revealed a tendency to form new pain-related associations rather than extinguishing irrelevant ones. The aim of the present study was to extend our previous analysis, to elucidate potential neural divergences between subjects with FM (n = 65) and healthy controls (HCs) (n = 33) during anticipatory information (ie, prior to painful stimulus onset). Using functional magnetic resonance imaging (fMRI), the current analyses include 1) a congruently cued paradigm of low and high pain predictive cues, followed by 2) an incongruently cued paradigm where low and high pain predictive cues were followed by an identical mid-intensity painful pressure. During incongruently cued high-pain associations, FM exhibited reduced left dorsolateral prefrontal cortex (dlPFC) activation compared to HCs, which was followed by an altered subsequent pain experience in FM, as patients continued to rate the following painful stimuli as high, even though the pressure had been lowered. During congruently cued low pain anticipation, FM exhibited decreased right dlPFC activation compared to HCs, as well as decreased brain connectivity between brain regions implicated in cognitive modulation of pain (dlPFC) and nociceptive processing (primary somatosensory cortex/postcentral gyrus [S1] and supplementary motor area [SMA]/midcingulate cortex [MCC]). These results may reflect an important feature of validating low pain expectations in HCs and help elucidate behavioral reports of impaired safety processing in FM patients. PerspectiveFM exhibited a stronger conditioned pain response for high-pain associations, which was associated with reduced dlPFC activation during the incongruent trial. During (congruent and incongruent) low pain associations, FM dlPFC brain activation remained indifferent. Imbalances in threat and safety pain perception may be an important target for psychotherapeutic interventions.

1703-P: Attitude and Perception of People with Type 2 DM about Obesity—A Western Indian Perspective

Introduction: Obesity is a major contributor to the T2DM epidemic. The Lifetime risk ofT2DM is highest (86.0% [76.6, 91.5]%) among Indian people with obesity.1 We present data on the attitude and perception of T2DM Indian general public toward obesity and its management. Methods: This cross-sectional survey was conducted between October to November 2022at 30 diabetes care clinics in western India. Data was collected from consenting male and female subjects in the age group of ≥18 years, using a structured questionnaire. Descriptive statistics were used to analyze the survey data. Results: A total of 1248 subjects (males: females = 592:658) with a mean (SD) age of44.6 (14.8) years participated in this survey. Out of which 596 (47.8%) were subjects with T2DM, with a mean (SD) BMI of 29.9 (5.7) kg/m2. Out of 596 subjects with T2DM, 203 (34.1%) perceived their weight as normal, 305 (51.2%) as overweight, and 88 (14.8%) as persons with obesity. However, when categorized as per Asia-Pacific guidelines for obesity classification of BMI, 544 (91.4%) subjects with T2DM were found to be, overweight/persons with obesity. Out of these 544 subjects, diet consultations for weight loss 374 (68.8%), followed by gym membership 269 (49.4%) were the top two weight management programs they were aware of and 396 (72.8%) believed that eating less and moving more is a simple formula for weight loss. Though 303 (55.7%) subjects were aware of doctors-prescribed weight loss drugs, only 291 (53.5%) subjects were considering weight management and only 228 (41.9%) were willing to try these medicines. High blood pressure (41.2%) and knee pain/ mobility (12.9%), were the top two co-morbid conditions in subjects with T2DM found to be, overweight/persons with obesity. Conclusion: This survey revealed that knowledge about of impact of obesity is unsatisfactory in Indian T2DM subjects with overweight/obesity. Educating people about the benefits of weight management interventions can assist subjects with T2DM for optimal outcomes. Disclosure S.A.Patange: None. R.M.Rohatgi: None. S.Bhojane: None. B.L.Gonsalves: None. I.S.Hafizi: None. R.R.Yadav: None. R.T.Mulani: None. K.M.Nayak: None. M.H.Patel: None. A.Rajput: None. V.Saboo: None. R.R.Kovil: None. P.Sanghavi: None. S.A.Bagri: None. A.N.Singh: None. S.N.Dbritto: None. A.A.Jadhav: None. D.H.Punatar: None. A.R.Kothari: None. S.A.Aversekar: None. M.H.Patel: None. R.M.Surya shaikh: None. S.R.Tanna: None. I.Kuberan: None. T.P.Shah: None. A.S.Patange: None. D.Padhye: None. S.A.Karkhanis: None. A.R.Sanghvi: None. A.P.Gandhi: None.

Multimodal physiological sensing for the assessment of acute pain.

Pain assessment is a challenging task encountered by clinicians. In clinical settings, patients' self-report is considered the gold standard in pain assessment. However, patients who are unable to self-report pain are at a higher risk of undiagnosed pain. In the present study, we explore the use of multiple sensing technologies to monitor physiological changes that can be used as a proxy for objective measurement of acute pain. Electrodermal activity (EDA), photoplethysmography (PPG), and respiration (RESP) signals were collected from 22 participants under two pain intensities (low and high) and on two different anatomical locations (forearm and hand). Three machine learning models were implemented, including support vector machines (SVM), decision trees (DT), and linear discriminant analysis (LDA) for the identification of pain. Various pain scenarios were investigated, identification of pain (no pain, pain), multiclass (no pain, low pain, high pain), and identification of pain location (forearm, hand). Reference classification results from individual sensors and from all sensors together were obtained. After feature selection, results showed that EDA was the most informative sensor in the three pain conditions, in identification of pain, in the multiclass problem, and for the identification of pain location. These results identify EDA as the superior sensor in our experimental conditions. Future work is required to validate the obtained features to improve its feasibility in more realistic scenarios. Finally, this study proposes EDA as a candidate to design a tool that can assist clinicians in the assessment of acute pain of nonverbal patients.