Chronic Pain Intensity Research Articles

Evaluation of the quality of life after implantation of light or standard polypropylene hernia meshes.

Abstract.

Effectiveness of Norethisterone Acetate alone Versus in Combination with Letrozole for treatment of Chronic Pelvic Chronic Pain and Dyspareunia in Patients with Endometriosis

Aim: To compare mean chronic pelvic pain (CPP) and deep dyspareunia intensity after 6 month treatment of using norethisterone acetate alone and combination with letrozole in patients with endometriosis. Study design & duration: This randomized controlled trail was conducted from February 1st, 2020 to January 31st, 2021. Setting: Department of Obs. &Gynecology, Nishtar hospital Multan. Materials and methods: Seventy two women with age range 18-60 years regardless of parity, having endometriosis with baseline pain > 5 at visual analogue scale were included in study. Pain was measured on VAS at baseline and after 6 months of treatment. All data was entered in a pre-designed proforma. Results: Mean age of cases was 39.83 ± 12.61 years in group-A and 41.58 ± 12.66 years in group-B. At baseline the mean chronic pelvic pain in group-A was 7.17 ± 1.28 and in group-B was 7.00 ± 1.39. The mean chronic pelvic pain at 6th month was statistically lower in group-A (1.72 ± 0.74) when compared with group-B (4.39 ± 0.64) with a p-value < 0.001. Similarly, deep dyspareunia was markedly reduced follow-up in both group A and group B at 6 months. Conclusion: CPP and deep dyspareunia are significantly reduced after 6 month of treatment with combined oral letrozole (2.5 mg/day) and norethisterone acetate (2.5 mg/day). Keywords: Endometriosis, aromatase inhibitor, letrozole, norethisterone acetate.

Mindfulness in pain self-control of people with chronic pain: a cross-sectional study

IntroductionChronic pain has a significant impact on individuals’ daily lives, and its control is essential for improving quality of life. In this sense, the practice of Mindfulness is a useful non-pharmacological technique for self-management of chronic pain.ObjectivesThis study aims to identify the level of knowledge regarding the effectiveness of Mindfulness for self-control of pain by people with chronic pain.MethodsA cross-sectional study was conducted on a sample of 23 adults with chronic pain. The online survey assessed sociodemographic characterization, Brief Pain Inventory, and knowledge/opinion about the effectiveness of mindfulness strategies.ResultsThe sample consisted mostly of middle-aged women, with family support, employed and with higher academic qualifications. 47.8% of the sample had experienced pain for over 20 years with the most prevalent diagnosis being fibromyalgia. The average intensity of chronic pain corresponded to moderate pain and the level of acceptance of it was low, interfering in instrumental activities of daily life. Although they had never tried the technique, most of the sample knew what mindfulness consisted of, considering it as a viable option for self-management of chronic pain. Moderate and positive correlations were found between the level of acceptance of pain and greater availability for the practice of mindfulness (rho=.137; p<.001), the same happened between satisfaction with the practice of mindfulness and self-control of pain (rho=.259; p<.001).ConclusionsOur findings outline the need to include non-pharmacological measures such as mindfulness in therapeutic schemes for chronic pain management, given the manifest interest of this population.DisclosureNo significant relationships.

Lower Prevalence of Chronic Pain in Manifest Huntington's Disease: A Pilot Observational Study.

Pain is a minor problem compared with other Huntington Disease (HD) symptoms. Nevertheless, in HD it is poorly recognized and underestimated. So far, no study evaluated the presence of chronic pain in HD. The aim of this pilot study was to evaluate the presence and features of chronic pain in a cohort of HD gene carriers. An observational cross-sectional study was conducted in a cohort of HD gene carriers compared to not gene carriers (n.134 HD subjects, n.74 not gene mutation carriers). A specific pain interview, alongside a neurological, cognitive and behavioural examination, was performed in order to classify the type of pain, subjective intensity. A significant prevalence of “no Pain” in HD was found, which tended to increase with HD progression and a reduced frequency of pain in the last 3 months. A clear difference was found between manifest and premanifest HD in terms of intensity of pain, which did not change significantly with HD progression; however, a tendency emerges to a progressive reduction. No significant group difference was present in analgesic use, type and the site of pain. These findings could support a lower prevalence of chronic pain in manifest HD. Prevalence and intensity of chronic pain seem directly influenced by the process of neurodegeneration rather than by an incorrect cognitive and emotional functioning.

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis.

Aberrant functional connectivity and temporal variability of the dynamic pain connectome in patients with low back related leg pain

Neuroimaging studies have suggested a link between the intensity of chronic low back pain intensity and structural and functional brain alterations. However, chronic pain results from the coordination and dynamics among several brain networks that comprise the dynamic pain connectome. Here, we use resting-state functional magnetic resonance imaging and measures of static (sFC) and dynamic functional connectivity (dFC) variability in the typical (0.01–0.1 Hz) and five specific (slow-6 to slow-2) frequency bands to test hypotheses regarding disruption in this variability in low back-related leg pain (LBLP) patients who experience chronic pain and numbness. Twenty-four LBLP patients and 23 healthy controls completed clinical assessments, and partial correlational analyses between altered sFC and dFC variability and clinical measures were conducted. We found a lower within-network sFC in the ascending nociceptive pathway (Asc) and a lower cross-network sFC between nodes of the salience network and the Asc in the typical frequency band. In the slow-5 frequency band, a lower within-network sFC was found in the Asc. Abnormal cross-network sFC was found between nodes of the salience network-Asc (slow-5 and slow-6) and the default mode network-Asc (slow-4 and slow-6). Furthermore, cross-network abnormalities in the typical and certain specific frequency bands were linked to clinical assessments. These findings indicate that frequency-related within- and cross-network communication among the nodes in the dynamic pain connectome is dysfunctional in LBLP patients and that selecting specific frequencies may be potentially useful for detecting LBLP-related brain activity.

Chronic Lumbar Pain and Insomnia in College-Aged Students.

Insomnia in college students has a significant impact on academic performance and mental health (e.g., depression). Although the mechanisms underlying insomnia and chronic pain are becoming clearer, only a few studies on college students have examined these factors by their location in the body. The purpose of the present study was to identify the location of chronic pain in the body most associated with insomnia in college students. A web-based survey was used to collect information pertaining to nine questions from 494 university students: sex, age, presence of chronic pain, intensity of chronic pain, location of chronic pain, and duration of chronic pain, as well as scores from the Athens Insomnia Scale (AIS), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. To examine the association between insomnia and the site of chronic pain, stepwise logistic regression analysis was conducted with AIS as the target variable. The results showed a significant positive correlation between chronic pain in the lumbar region and AIS scores. Future longitudinal studies including multiple factors are necessary to clarify the causal relationship between insomnia and chronic lower back pain.

Comparison of the effect of psychosocial skills training on acute and chronic musculoskeletal pain intensity: The effectiveness of early intervention in the reduction of acute musculoskeletal pain.

Pain, as a psychological experience, is caused by complex interactions among sensory-discriminative, motivational-affective, and cognitive-evaluative dimensions. The psychosocial approach is one of the important approaches in managing musculoskeletal pain in patients. Therefore, this study aimed to determine and compare the effects of psychosocial skills training on pain intensity in patients with acute and chronic musculoskeletal pain. In this quasi-experimental study, 64 patients with acute and chronic musculoskeletal pain were selected using convenience sampling. Both groups received psychosocial training in pain management in groups of 8-10 people over six 1-h sessions. The data were collected at baseline, after the intervention, and 3months later using a numerical rating scale (NRS). Then, the data were entered into the SPSS 22 software and were analysed using descriptive and inferential statistics. In this study, the mean age of the participants was 50.10±10.63years and 60.9% of them were female. Based on the results, time had a significant effect on pain intensity (p<0.001), but the effect of group on pain intensity was not statistically significant (p=0.07). The group×time effect on pain intensity was also statistically significant (p<0.001). Psychosocial training had a positive impact on the reduction of pain among the patients with acute and chronic musculoskeletal pain. Additionally, the training was more effective in patients with acute pain due to early training. These findings can help healthcare providers in the field of musculoskeletal pain management, especially in patients with acute pain.

Effects of hypnosis vs mindfulness meditation vs education on chronic pain intensity and secondary outcomes in veterans: a randomized clinical trial.

Effective, rigorously evaluated nonpharmacological treatments for chronic pain are needed. This study compared the effectiveness of training in hypnosis (HYP) and mindfulness meditation (MM) with an active education control (ED). Veterans (N = 328) were randomly assigned to 8 manualized, group-based, in-person sessions of HYP (n = 110), MM (n = 108), or ED (n = 110). Primary (average pain intensity [API]) and secondary outcomes were assessed at pretreatment, posttreatment, and 3 and 6 months posttreatment. Treatment effects were evaluated using linear regression, a generalized estimating equation approach, or a Fisher exact test, depending on the variable. There were no significant omnibus between-group differences in pretreatment to posttreatment change in API; however, pretreatment to posttreatment improvements in API and several secondary variables were seen for participants in all 3 conditions. Participation in MM resulted in greater decreases in API and pain interference at 6 months posttreatment relative to ED. Participation in HYP resulted in greater decreases in API, pain interference, and depressive symptoms at 3 and 6 months posttreatment compared with ED. No significant differences on outcomes between HYP and MM were detected at any time point. This study suggests that all 3 interventions provide posttreatment benefits on a range of outcomes, but the benefits of HYP and MM continue beyond the end of treatment, while the improvements associated with ED dissipate over time. Future research is needed to determine whether the between-group differences that emerged posttreatment are reliable, whether there are benefits of combining treatments, and to explore moderating and mediating factors.

Individually unique dynamics of cortical connectivity reflect the ongoing intensity of chronic pain.

Chronic pain diseases are characterised by an ongoing and fluctuating endogenous pain, yet it remains to be elucidated how this is reflected by the dynamics of ongoing functional cortical connections. In this study, we investigated the cortical encoding of 20 patients with chronic back pain and 20 chronic migraineurs in 4 repeated fMRI sessions. A brain parcellation approach subdivided the whole brain into 408 regions. Linear mixed-effects models were fitted for each pair of brain regions to explore the relationship between the dynamic cortical connectivity and the observed trajectory of the patients' ratings of fluctuating endogenous pain. Overall, we found that periods of high and increasing pain were predominantly related to low cortical connectivity. The change of pain intensity in chronic back pain was subserved by connections in left parietal opercular regions, right insular regions, as well as large parts of the parietal, cingular, and motor cortices. The change of pain intensity direction in chronic migraine was reflected by decreasing connectivity between the anterior insular cortex and orbitofrontal areas, as well as between the PCC and frontal and anterior cingulate cortex regions. Of interest, the group results were not mirrored by the individual patterns of pain-related connectivity, which rejects the idea of a common neuronal core problem for chronic pain diseases. The diversity of the individual cortical signatures of chronic pain encoding results adds to the understanding of chronic pain as a complex and multifaceted disease. The present findings support recent developments for more personalised medicine.

Variations in Chronic Pain Intensity and Physical Function by Age and Sex for Patients with Knee Osteoarthritis

Treatment-seeking behaviour, evaluation and management approach, as well as responsiveness to management by individuals with knee osteoarthritis (OA) could be hampered by variations of common confounding (constant) factors of knee OA; age and sex. Studies that integrate age and sex variations in clinical factors such as pain intensity and physical function are limited. The aim of this study was to determine age and sex variations in pain intensity and physical function among individuals with knee OA in Nigeria.

Acupuncture Enhances Dorsal Raphe Functional Connectivity in Knee Osteoarthritis With Chronic Pain.

IntroductionKnee osteoarthritis is a common disease in the elderly. Patients suffer from long-term chronic pain and reduced life quality. Acupuncture has been proven to be an effective treatment for KOA. However, the neural mechanism of acupuncture is unclear, so far. Periaqueductal gray (PAG) and raphe nuclei (RPN) are essential structures associated with chronic pain in human brains. This study aims to investigate functional connectivity (FC) changes of PAG and RPN in KOA to interpret the neural mechanism of acupuncture.MethodsIn 15 patients with KOA and 15 healthy controls (HC), we acquired Visual Analog Scale (VAS) scores and resting-state fMRI images of each participant before and after acupuncture stimulation on EX-LE5 acupoint. Then, PAG and RPN were selected as seeds to perform FC analysis based on resting-state fMRI images. Finally, we compared FC patterns of PAG and RPN between patients with KOA and HC, then between pre-acupuncture and post-acupuncture. Correlations between FC values and VAS scores were calculated as well.ResultsFor PAG, FC of patients with KOA was lower in the right lingual gyrus at post-acupuncture compared with HC (p <0.001, uncorrected). For dorsal RPN, FC of patients with KOA was significantly higher in right putamen at post-acupuncture compared with HC (p <0.001, corrected with FDR), and FC changes were significant between pre-acupuncture and post-acupuncture in patients with KOA. Post-acupuncture FC values between dorsal RPN and right putamen were correlated with VAS scores. For medial RPN, FC of patients with KOA was lower in the right cerebellum at post-acupuncture compared with HC (p <0.001, uncorrected), but no significant FC changes were found between pre-acupuncture and post-acupuncture in patients with KOA. FC values between medial RPN and right cerebellum were not correlated with VAS scores at pre-acupuncture and post-acupuncture.DiscussionOur study demonstrated that acupuncture enhanced FC between dorsal RPN and the right putamen in patients with KOA, which was associated with chronic pain intensity. This result suggests that acupuncture stimulation can enhance FC between dorsal raphe and striatum, illustrating a neural mechanism that acupuncture can drive the patients' brain, with KOA, to perceive pain.

The effects of different analgesic methods on chronic pain in patients undergoing video-assisted thoracoscopic surgery.

Thoracic epidural block, paravertebral block, and intercostal nerve block have been confirmed to alleviate acute pain after video-assisted thoracoscopic surgery (VATS). In contrast, little is known about the effects of these methods on chronic post-surgical pain (CPSP). To investigate the effects of epidural block, paravertebral block, and intercostal nerve block on postoperative chronic pain in patients undergoing VATS. A total of 240 patients undergoing VATS were randomly divided into 4 groups: an epidural group, paravertebral group, intercostal group, and a control group. All patients were interviewed after 1, 3, 6, and 12 months to investigate the incidence and severity of CPSP. The epidural group had lower incidence of chronic pain within 6 months and it was less severe within 3 months compared with the control group. The incidence and intensity of chronic pain within 3 months were lower in the intercostal group than in the control group. The incidence and intensity of pain within 1 month of surgery were lower in the paravertebral group than in the control group. Of the 122 patients who developed pain after 1 month, 93 (76.2%) reported chronic pain after 12 months, and only 9 (11.7%) had chronic pain after 12 months despite reporting no pain at 1 month. The prevalence of CPSP after VATS is high. Epidural block, paravertebral block, and intercostal nerve block can all reduce the incidence and severity of CPSP, with epidural block showing the best effect. In addition to acute pain, 1-month postoperative pain also exerts a warning effect on CPSP.

Night-time cardiac metrics from a wearable sensor predict intensity of next-day chronic pain

Chronic pain is devastating and its measurement is elusive, making intervention difficult for sufferers and practitioners alike. The present study explores the possibility of tracking fluctuations in pain over time with wearable sensors of heart-based metrics. We measured mean heart rate and heart rate variability with a wrist-worn sensor in persons with and without chronic pain for one month. Mixed model regressions were used to test the associations, revealing that heart rate measured at night was predictive of pain intensity on the next day in participants with chronic pain (p < .05), but not in healthy controls (p > .05). The results suggest that cardiac biometrics can predict pain intensity in primary chronic pain conditions.

The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross-sectional study.

Pain is a major characteristic in haemophilic arthropathy. Identifying the psychosocial variables affected by pain can help when addressing these patients. To assess the relationship between perceived intensity of chronic pain and joint damage, kinesiophobia, catastrophism, anxiety and perceived quality of life in adult patients with haemophilic arthropathy. Multicentre cross-sectional descriptive study. Seventy-seven adult patients with haemophilic arthropathy were recruited. The usual and maximum pain intensity (Visual Analog Scale), joint status (Haemophilia Joint Health Score), Kinesiophobia (Tampa Scale of Kinesiophobia), catastrophism (Pain catastrophizing scale), anxiety (State-Trait Anxiety inventory) and perceived quality of life (36-Item Short Form Health Survey) were evaluated. The correlation between usual and maximum pain intensity with quantitative variables was obtained with Spearman`s correlation test. Kruskal-Wallis one-way ANOVA analysed differences in perceived pain according to the severity and type of treatment, and development of inhibitors. The usual intensity of perceived pain correlated positively with catastrophism, kinesiophobia, and state and trait anxiety. The same results were obtained when analysing the maximum perception of pain. We found an inverse correlation between the physical component of perceived quality of life and usual and maximum pain intensity perceived by patients. Psychosocial factors affect the painful experience of patients with haemophilic arthropathy. Pain intensity affects the quality of life of these patients.

Pain intensity and depression level in chronic temporomandibular disorders patients

Aim: The aim of this study was to assess the correlation between pain intensity and the level of depression in patients with chronic temporomandibular disorders (TMD). Materials and methods: Fifty-five volunteers diagnosed by the Research Diagnostic Criteria (RDC/TMD) were assessed for pain intensity and level of depression. Pain intensity and level of depression were assessed using a visual analysis scale and Beck depression inventory, respectively. Data analysis was conducted using confidence intervals and Pearson’s chi-square test (p&lt; 0.05). Results: The results demonstrated that non-depressed individuals (43.6%) showed a mean pain intensity of 28.27mm, those with mild depression (38.2%) 34.24mm, and those moderate depression (18.2%) 50.7mm. Statistical analysis showed that there was a positive and significant correlation between pain intensity and level of depression (p=0.004). Discussion: This study found a positive correlation between pain intensity and depression level in chronic TMD patients. However, it has not been elucidated yet how TMD are correlated to depression and in which way depression can influence its onset and perpetuation. Conclusion: The level of depression may play an important role in the intensity of chronic pain, therefore, a multidisciplinary intervention seems to be important for the treatment success.

The association between sleep quality, preoperative risk factors for chronic postoperative pain and postoperative pain intensity 12 months after knee and hip arthroplasty.

Chronic postoperative pain following total joint replacement (TJA) is a substantial clinical problem, and poor sleep may affect predictive factors for postoperative pain, such as pain catastrophizing. However, the magnitude of these associations is currently unknown. This exploratory study investigated (1) the relationship between preoperative sleep quality, clinical pain intensity, pain catastrophizing, anxiety, and depression and (2) their associations with chronic postoperative pain following TJA. This secondary analysis from a larger randomized controlled trial included rest pain intensity (preoperative and 12 months postoperative; visual analogue scale, VAS), preoperative Pittsburgh Sleep Quality Index (PSQI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) data from 74 knee and 89 hip osteoarthritis (OA) patients scheduled for TJA. Poor sleepers were identified based on preoperative PSQI scores higher than 5. Poor sleepers demonstrated higher preoperative VAS, pain catastrophizing, anxiety, and depression compared with good sleepers (all p < 0.003). Preoperative PSQI (β = 0.23, p = 0.006), PCS (β = 0.44, p < 0.005), and anxiety (β = 0.18, p = 0.036) were independent factors for preoperative VAS. Preoperative VAS (β = 0.32, p < 0.005), but not preoperative sleep quality (β = -0.06, p = 0.5), was an independent factor for postoperative VAS. The OA patients reporting poor preoperative sleep quality show higher preoperative pain, pain catastrophizing, anxiety, and depression. High preoperative pain intensity, but not poor sleep quality, was associated with higher chronic postoperative pain intensity. Future studies are encouraged to explore associations between sleep and chronic postoperative pain.

EP.WE.501The Role of Nerve Sheath Catheters after Major Lower Limb Amputations in Post-operative Pain Control

Abstract Aim Pain is a common post-operative complication after limb amputation. Though the evidence is mixed, current literature suggests nerve sheath catheters (NSC) have no effect on chronic stump pain, phantom limb pain or post-operative pain score but reduces opioid use. This study aims to compare pain outcomes in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA). Method This retrospective study collected information from 32 patients after lower-limb amputation from April 2014 - March 2017. Information regarding indication, anaesthetic and morphine requirement at 72 hours were collected from medical records and standardised questions used to assess phantom limb pain, chronic limb pain and pain intensity (1-10) at 24, 48 and 72 hours. Results Of the 11 patients who received a NSC catheter for pain control, 33% experienced no post-operative pain, 18% experienced phantom limb pain, 18% reported chronic limb pain and 62% required higher dosages of morphine at 72 hours. However, two patients used large amounts of morphine potentially giving spurious results. In comparison, of those patients without NCS, 43% experienced no pain, 9% experienced phantom limb pain, 33% reported chronic limb pain and only 47% required morphine at 72 hours and at lower doses compared to with NSC. The incidence of phantom limb pain was higher in those who had AKA regardless of the analgesic technique used. Conclusion Patients with NSC were less likely to experience chronic limb pain thus proving their role in post-operative pain control despite having higher morphine requirements.

Updates on the Role of Spinal Cord Stimulation in the Management of Non-Surgical Chronic Lower Back Pain.

Studies have shown that spinal cord stimulation (SCS) therapy is effective in the management of chronic low back pain. It plays a role by minimizing the intensity of chronic pain, improving the quality of life index, reducing the intake of narcotic analgesics, and increasing the functional improvement in the working environment. However, spinal cord stimulation therapy is not universal because of the complications in the procedure itself, the invasive nature of the treatment, and cost-effectiveness. Therefore, the proper selection of the patients is necessary to get the maximum benefit from the treatment. The study's main objective is to determine the role of spinal cord stimulation in treating non-surgical patients with chronic low back pain. The article will review the mechanism, outcomes, efficacy, predisposing factors in the success and failure of the treatment and indications, contraindications, and selection of patients undergoing spinal cord stimulation therapy. A manual search of the literature was done using databases like Google Scholar and PubMed using the keywords: spinal cord, stimulation, chronic, and low back pain. A total of 37 articles were included in the study after considering the inclusion and exclusion criteria. Spinal cord stimulation therapy effectively treats refractory lower back pain, considering the technology and mechanism of action. The authors conclude that spinal cord stimulation therapy can be used to manage chronic low back pain, other neuropathic pain, and ischemic pain when other standard treatment methods have failed and the pain persisted for more than six months.

Long-Term Pain Characteristics and Management Following Minimally Invasive Spinal Decompression and Open Laminectomy and Fusion for Spinal Stenosis.

Background and Objectives: To compare the long-term pain characteristics and its chronic management following minimally invasive spinal (MIS) decompression and open laminectomy with fusion for lumbar stenosis. Materials and Methods: The study cohort included patients with a minimum 5-year postoperative follow-up after undergoing either MIS decompression or laminectomy with fusion for spinal claudication. The primary outcome of interest was chronic back and leg pain intensity. Secondary outcome measures included pain frequency during the day, chronic use of non-opioid analgesics, narcotic medications, medical cannabinoids, and continuous interventional pain treatments. Results: A total of 95 patients with lumbar spinal stenosis underwent one- or two-level surgery for lumbar spinal stenosis between April 2009 and July 2013. Of these, 50 patients underwent MIS decompression and 45 patients underwent open laminectomy with instrumented fusion. In the fusion group, a higher percentage of patients experienced moderate-to-severe back pain with 48% compared to 21.8% of patients in the MIS decompression group (p < 0.01). In contrast, we found no significant difference in the reported leg pain in both groups. In the fusion group, 20% of the patients described their back and leg pain as persistent throughout the day compared to only 2.2% in the MIS decompression group (p < 0.05). A trend toward higher chronic dependence on analgesic medication and repetitive pain clinic treatments was found in the fusion group. Conclusions: MIS decompression for the treatment of degenerative spinal stenosis resulted in decreased long-term back pain and similar leg pain outcomes compared to open laminectomy and instrumented fusion surgery.