Magnitude Of Pain Research Articles

Comparing patient-reported outcomes and experiences among static, dynamic computer-aided, and conventional freehand dental implant placement: A randomized clinical trial.

The purpose of this study was to compare patient-reported outcomes and experiences (PROs and PREs) among three techniques of dental implant placement, including (a) conventional freehand, (b) dynamic, and (c) static computer-aided implant surgery (CAIS). Ninety patients were randomly assigned to have dental implant placed with one of the three protocols. Participants were asked to fill in a series of self-administered questionnaires assessing (1) preoperative expectations, (2) postoperative healing events during the first week after surgery, and (3) experiences and overall satisfaction with the procedures at 2 weeks. Differences within the groups were analyzed by Wilcoxson signed-rank test. Kruskal-Wallis test was used for comparisons among the three groups. Eighty-eight patients completed the study. Patients' expectations on chewing difficulty, the postoperative experience of duration of pain, speaking limitations, and impact on routine activities were significantly different among groups (p=0.04, 0.01, 0.038, and 0.046, respectively). Overall, patients appeared to significantly underestimate the duration of postoperative pain (p=0.035) and swelling (p=0.001). No significant difference in magnitude of postoperative pain, swelling, and painkiller consumption was found among the groups. The short-term functional limitations after surgery were deemed acceptable by most participants and 89% were satisfied by the overall procedure. Surgical placement of dental implant with conventional freehand, static, and dynamic CAIS techniques did not result in any difference in the level of postoperative pain and swelling, and appeared to lead to equal levels of satisfaction as expressed by the patients postoperatively.

Sex-related differences in response to masseteric injections of glutamate and nerve growth factor in healthy human participants

The neurophysiological mechanisms underlying NGF-induced masseter muscle sensitization and sex-related differences in its effect are not well understood in humans. Therefore, this longitudinal cohort study aimed to investigate the effect of NGF injection on the density and expression of substance P, NMDA-receptors and NGF by the nerve fibers in the human masseter muscle, to correlate expression with pain characteristics, and to determine any possible sex-related differences in these effects of NGF. The magnitude of NGF-induced mechanical sensitization and pain during oral function was significantly greater in women than in men (P < 0.050). Significant positive correlations were found between nerve fiber expression of NMDA-receptors and peak pain intensity (rs = 0.620, P = 0.048), and expression of NMDA-receptors by putative nociceptors and change in temporal summation pain after glutamate injection (rs = 0.561, P = 0.003). In women, there was a significant inverse relationship between the degree of NGF-induced mechanical sensitization and the change in nerve fiber expression of NMDA-receptors alone (rs = − 0.659, P = 0.013), and in combination with NGF (rs = − 0.764, P = 0.001). In conclusion, women displayed a greater magnitude of NGF-induced mechanical sensitization that also was associated with nerve fibers expression of NMDA-receptors, when compared to men. The present findings suggest that, in women, increased peripheral NMDA-receptor expression could be associated with masseter muscle pain sensitivity.

Comparison of effect of intraperitoneal instillation of additional dexmedetomidine or clonidine along with bupivacaine for post-operative analgesia following laparoscopic cholecystectomy.

Background and Aims:Despite advances in minimally invasive surgery, postoperative pain remains a concern after laparoscopic cholecystectomy. This study aims to compare the effect of intraperitoneal instillation of bupivacaine with alpha-2 agonists (dexmedetomidine and clonidine) for postoperative analgesia.Methods:One hundred and eight patients scheduled for elective laparoscopic cholecystectomy were randomised to receive either 20 mL of 0.5% bupivacaine (Group B), 20 mL of 0.5% bupivacaine with dexmedetomidine 1 μg/kg (Group BD) or 20 mL of 0.5% bupivacaine with clonidine 1 μg/kg (Group BC). Study drug made to equal volume (40 mL) was instilled before the removal of trocar at the end of surgery. Standard general endotracheal anaesthesia with intra-abdominal pressure of 12–14 mm Hg during laparoscopy was followed uniformly. The primary objective of our study was the magnitude of pain. One way analysis of variance (ANOVA) for continuous variables and Chi-square test for categorical variables was used.Results:The Numerical Rating Scale (NRS) scores for pain intensity did not show any statistical significance at any of the pre-defined time points. Time to first request for analgesia was shortest in group BC (64.0 ± 60.6 min) when compared to the other groups (B, 78.8 ± 83.4 min; BD, 112.2 ± 93.4 min; P < 0.05). Total amount of rescue fentanyl given in groups BD (16.8 ± 29.0 μg) and BC (15 ± 26.4 μg) was significantly less than B (35.7 ± 40.0 μg); P < 0.05).Conclusion:The addition of alpha-2 agonists to bupivacaine reduces the post-operative opioid consumption, and dexmedetomidine appears to be superior to clonidine in prolonging time to first analgesic request.

Assessment of pain control among patients with cancer in hospitals of the Gaza Strip: a cross-sectional study

BackgroundPoor control of cancer pain is a major public health problem worldwide. Many potential barriers can lead to suboptimal treatment of cancer pain. One such barrier is inadequate measurement and assessment of cancer-related pain control. This study aimed to assess current pain control and management for hospitalized adult patients with cancer in the Gaza Strip. MethodsA cross-sectional study was conducted from Dec 10, 2017, to April 25, 2018, in the Gaza Strip. The validated Brief Pain Inventory (BPI) questionnaire was translated into Arabic for data collection. The first section of the questionnaire described the patients’ sociodemographic characteristics, the second evaluated the severity of cancer, and the third assessed the interference of pain with daily activities. A ten-point Likert scale was used to evaluate the magnitude of cancer pain and its impact on the patients’ lifestyle. Participants were 12 years of age and older, and were patients with cancer who had been admitted to Al-Rantisi Hospital or European Gaza Hospital (the two cancer institutes available in the Gaza Strip), and who had no mental illness or disorder affecting pain perception. Convenience sampling was used to recruit eligible patients for face-to-face interviews to complete the questionnaire. The primary outcome was the median score of cancer pain control. Ethical approval was obtained from the Palestinian Ministry of Health and informed verbal consent was obtained from patients. Data were analysed with SPSS version 22. Findings97 patients were assessed, of whom 75% (73 of 97) were eligible and were recruited. The sample size was decided based on the available cases in the included centres during study period. The median age was 49 years (IQR 37–60), 56% (41 of 73) were females, and 86% (63 of 73) were married. Most (81%; 59 of 73) had an educational level of high school or below, and 52% (38 of 73) were unemployed. 90% of patients (66 of 73) had cancer pain as a presenting symptom at diagnosis. 93% (68 of 73) had received painkillers (analgesics) within the past week, 74% (54 of 73) were using analgesics daily, and 43% (31 of 73) reported that they needed potent analgesics. 15% (11 of 73) reported concerns about analgesic addiction. The level of functional impairment owing to pain, as reported using the ten-point Likert scale, was highest for daily activities and routines (median 9·0, IQR 7·0–10·0) and least for social relationships (5·0, 0·0–9·0). There was no statistically significantly association between cancer-related pain and gender, educational level, or occupation. InterpretationMost patients were taking analgesics but a large proportion reported the need for more potent or frequent doses of painkillers. In addition, pain had a significant effect on the patients’ lifestyle. These findings indicate poor control of cancer pain. There is an urgent need to address the reasons for this, to alleviate pain and to improve quality of life. FundingNone.

Multiple imputation to quantify misclassification in observational studies of the cognitively impaired: an application for pain assessment in nursing home residents

BackgroundDespite experimental evidence suggesting that pain sensitivity is not impaired by cognitive impairment, observational studies in nursing home residents have observed an inverse association between cognitive impairment and resident-reported or staff-assessed pain. Under the hypothesis that the inverse association may be partially attributable to differential misclassification due to recall and communication limitations, this study implemented a missing data approach to quantify the absolute magnitude of misclassification of pain, pain frequency, and pain intensity by level of cognitive impairment.MethodsUsing the 2016 Minimum Data Set 3.0, we conducted a cross-sectional study among newly admitted US nursing home residents. Pain presence, severity, and frequency is assessed via resident-reported measures. For residents unable to communicate their pain, nursing home staff document pain based on direct resident observation and record review. We estimate a counterfactual expected level of pain in the absence of cognitive impairment by multiply imputing modified pain indicators for which the values were retained for residents with no/mild cognitive impairment and set to missing for residents with moderate/severe cognitive impairment. Absolute differences (∆) in the presence and magnitude of pain were calculated as the difference between documented pain and the expected level of pain.ResultsThe difference between observed and expected resident reported pain was greater in residents with severe cognitive impairment (∆ = -10.2%, 95% Confidence Interval (CI): -10.9% to -9.4%) than those with moderate cognitive impairment (∆ = -4.5%, 95% CI: -5.4% to -3.6%). For staff-assessed pain, the magnitude of apparent underreporting was similar between residents with moderate impairment (∆ = -7.2%, 95% CI: -8.3% to -6.0%) and residents with severe impairment (∆ = -7.2%, 95% CI: -8.0% to -6.3%). Pain characterized as “mild” had the highest magnitude of apparent underreporting.ConclusionsIn residents with moderate to severe cognitive impairment, documentation of any pain was lower than expected in the absence of cognitive impairment. This finding supports the hypothesis that an inverse association between pain and cognitive impairment may be explained by differential misclassification. This study highlights the need to develop analytic and/or procedural solutions to correct for recall/reporter bias resulting from cognitive impairment.

Comparative Study of Ultrasound Guided Abdominal Field Blocks Versus Port Infiltration in Laparoscopic Cholecystectomies for Post-operative Pain Relief

Background and Aims: Effective post-operative analgesia after laparoscopic cholecystectomy is important because it facilitates early amelioration, ambulation and short hospital stay. Aim: To compare the postoperative analgesic efficacy of ultrasound guided abdominal field blocks with port site infiltration with ropivacaine in laparoscopic cholecystectomy. Methods: An observational study was conducted in the Postgraduate Department of Anaesthesiology and Critical Care Medicine in collaboration with the Department of General Surgery, Government Medical College, and Srinagar from October 2017–December 2018. Patients were randomised into two groups to receive either local anaesthetic infiltration of the laparoscopy port sites (n = 40, Group A/standard group) and USAFBs (n = 40, Group B/study group) using a total dose of 30 ml of ropivacaine 0.2% with sterile technique. Randomisation was done by flipping of coin method. The primary objective was to measure magnitude of pain in first 24 hours using numeric rating scores (NRS). To estimate opioid consumption in first 24 hours postoperatively. To assess the quality of pain relief and patient satisfaction on a four point Patient satisfaction scale. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students’ t-test. Results: Duration of analgesia was significantly longer in Group B than group A. Upon inter group comparison of A vs. B the results were statistically significant (p value &lt;0.001). At all time in 24 hrs. Postoperative period (1, 2, 4, 6, 12 and 24 hrs.) NRS score was least in group B then group A with statistically significant difference (p value &lt;0.001). The overall tramadol consumption in Group A was approximately twice (107.5 ± 61.55 mg) as compared to Group B (56.3 ± 39.53mg). Conclusion: STA block in addition with rectus abdominis sheath block is a good alternative for providing perioperative analgesia for upper abdominal surgery such as laparoscopic chole

A Two Question Screen for Mental Health Opportunities.

Shortened versions of validated PRO measures of coping strategies e.g. PSEQ-2, may facilitate screening and monitoring of psychological conditions such as depression and anxiety. The primary research question in this study assesses the sensitivity and specificity of a PSEQ-2 score of less than 10 for important symptoms of depression (a PHQ-2 score greater than 2), anxiety (GAD-2 score greater than 2), any impactful prior episode of psychological trauma, and QuickDASH greater than 49. Secondarily we assess the associations between self-efficacy and other demographic and psychological factors on the magnitude of limitations and pain intensity. We performed a retrospective PRO evaluation in 926 adult patients attending an upper extremity clinic between 1st January 2018 and 31st January 2019. Demographic factors were assessed using electronic medical records and PRO data using an online platform. Patients included 556 (60%) women, 370 (40%) men (mean 51 years ± 14 (range, 19-88), mostly (n=584, 63%) with safety net insurance. A PSEQ-2 scoring threshold of less than 10 was 81% sensitive for a PHQ-2 score of 3 or greater, 84% sensitive for a GAD-2 score of 3 or greater, 84% sensitive for one or more important psychological traumas, and 82% sensitive for a QuickDASH of 50 or greater. PSEQ-2 less than 10 was independently associated with greater upper extremity limitations (β=11 [6.3 to 17, 95% Confidence interval [C.I], P<0.001) and pain intensity (β=0.92 (0.31 to 1.5, 95% C.I) P=0.003) amongst other psychological and demographic factors. A PSEQ-2 score of less than 10 might, along with verbal and non-verbal signs of distress, be a useful way to introduce the use of more sensitive screening questionnaires about anxiety or depression, or open up the option of speaking directly to mental or social health professionals. Future studies are required to test this hypothesis.

Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

Summary Chronic pain is a leading cause of disability globally and associated with enormous health-care costs. The discrepancy between the extent of tissue damage and the magnitude of pain, disability, and associated symptoms represents a diagnostic challenge for rheumatology specialists. Central sensitisation, defined as an amplification of neural signalling within the CNS that elicits pain hypersensitivity, has been investigated as a reason for this discrepancy. Features of central sensitisation have been documented in various pain conditions common in rheumatology practice, including fibromyalgia, osteoarthritis, rheumatoid arthritis, Ehlers-Danlos syndrome, upper extremity tendinopathies, headache, and spinal pain. Within individual pain conditions, there is substantial variation among patients in terms of presence and magnitude of central sensitisation, stressing the importance of individual assessment. Central sensitisation predicts poor treatment outcomes in multiple patient populations. The available evidence supports various pharmacological and non-pharmacological strategies to reduce central sensitisation and to improve patient outcomes in several conditions commonly seen in rheumatology practice. These data open up new treatment perspectives, with the possibility for precision pain medicine treatment according to pain phenotyping as a logical next step. With this view, studies suggest the possibility of matching non-pharmacological approaches, or medications, or both to the central sensitisation pain phenotypes.

An exploratory investigation into the effects of mental defeat on pain threshold, pain rating, pain anticipation, and mood

In chronic pain, mental defeat is considered as a disabling type of self-evaluation triggered by repeated episodes of debilitating pain. This exploratory study experimentally tested the effect of an activated sense of defeat, as well as its interaction with pain catastrophizing, on pain and mood. Participants (N = 71) were allocated to either high or low pain catastrophizing groups and then randomly assigned to receive either defeat or neutral manipulations. A cold pressor task administered before and after the thought manipulation measured pain threshold, alongside visual analogue scales for mental defeat, attention, pain intensity, pain anticipation as well as mood. Thought manipulation checks supported successful defeat activation. Defeat activation was associated with increased negative mood and attentional disengagement from the nociceptive stimuli, irrespective of pain catastrophizing tendency. There were no changes in pain threshold, pain or pain anticipation ratings. The results suggest that mental defeat can be experimentally activated using an autobiographical memory task and that an activated sense of defeat appears to operate independently from pain catastrophizing in influencing mood and attentional disengagement from the nociceptive stimuli. Future research can utilize our experimental approach to evaluate the effect of an activated sense of mental defeat in people with chronic pain, for whom the magnitude of pain, mood and attentional responses may be stronger and broader.

Prevalence and Contributing Factors Associated With Postoperative Pain in Pediatric Patients: A Cross-Sectional Follow-up Study

Background: Pain is a stressful condition considered to be a global health problem, and children are the most vulnerable and under-served population. Moderate to severe postoperative pain in pediatric population is associated with physiological, psychological and emotional adverse effects. This study aimed to assess the prevalence and contributing factors associated with postoperative pain in pediatric patients. Methods: Institution-based, cross sectional follow-up study was conducted from February 1 to April 30, 2020. Data were entered into Epi-info version 7 and analyzed by SPSS version 20. The strength of association of dependent and independent variables was presented by crude and adjusted odds ratio and 95% confidence interval. Binary logistic regression analysis was used and variables with a p-value of < 0.05 were considered statistically significant. The Face, Leg, Activity, Cry and Consolability (FLACC) scale was used to measure pain severity. Results: A total of 153 pediatric patients aged 2 to 12 years were included. The prevalence of moderate to severe pain after pediatric surgery was 40.5% (95% CI: 32.7, 48.4). Preoperative anxiety (AOR: 2.24, 95% CI: 1.02, 4.88), history of preoperative pain (AOR: 3.97, 95% CI: 1.55, 10.19), neurologic surgery [AOR: 8.32, 95% CI: 1.77, 39.12) and incision size greater than 10 cm (AOR: 3.41, 95% CI: 1.08, 10.77) were significantly associated with postoperative pain. Conclusion: The prevalence of moderate to severe post-operative pain was high. Preoperative anxiety, history of preoperative pain, type of surgery and incision length were significantly associated with postoperative pain. The magnitude of postoperative pain remains high and a plan for adequate pain management and preoperative anxiety reduction needs to be developed.

Lower Back Pain Among Neurological and Neurosurgical Adult Patients at an Armed Forces Hospital Addis Ababa, Ethiopia

Lower back pain differs in prevalence with respect to gender, time, occupation and nations and little is known about it on military professionals in Ethiopia who are exposed to more workload, psychological disorders and regular physical exercise hence we aimed in this study to assess the magnitude of lower back pain and its determinants among neurological and neurosurgical adult patients at Armed Forces Comprehensive Specialized Hospital Addis Ababa, Ethiopia from December 16, 2017 to March 23, 2018. For this aim a comparative crossectional study was carried out, and using single and two population proportion formulas, sample size of 585 was calculated. Every third participants aged more than or equal to 18 years were included in the study. Descriptive statics and bivariate and multivariable logistic regression was done for variables. The study results showed response rate of the study is 99.7% and the median age is 42 years with interquartile range of 14 years, 447 (76.7%) of them are male and 441 (75.6%) are military. The magnitude of low back pain is 65.9% with 95% Confidence Interval (62.1, 69.8); and previous recommended spinal surgery, tender point, comorbidities, and numbness and tingling sensation have significant association in multivariable logistic regression with adjusted odds ratio (95% Confidence Interval) 2.18 (1.06, 4.45), 4.36 (2.17, 8.77), 0.57 (0.35, 0.95), and 2.92 (1.71, 4.96); respectively. Finally, we concluded that the magnitude of lower back pain is high neurological and neurosurgical adult military patients at study settings and determinants are recommended spinal surgery, and numbness and tingling sensation, tender point and comorbidities; and strengthening neurological and neurosurgical services are recommended.

Comparative study ultrasound guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief

Background and Aims: Effective post‑operative analgesia after laparoscopic cholecystectomy is important because it facilitates early amelioration, ambulation and short hospital stay. Aim: To compare the postoperative analgesic efficacy of ultrasound guided abdominal field blocks with port site infiltration with ropivacaine in laparoscopic cholecystectomy. Methods: An observational study was conducted in the Postgraduate Department of Anaesthesiology and Critical Care Medicine in collaboration with the Department of General Surgery, Government Medical College, Srinagar from October 2017 – December 2018. Patients were randomised into two groups to receive either local anaesthetic infiltration of the laparoscopy port sites (n = 40, Group A/standard group) and USAFBs (n = 40, Group B/study group) using a total dose of 30 ml of ropivacaine 0.2% with sterile technique. Randomisation was done by flipping of coin method. The primary objective was to measure magnitude of pain in first 24 hours using numeric rating scores (NRS). To estimate opioid consumption in first 24 hours postoperatively. To assess the quality of pain relief and patient satisfaction on a four point Patient satisfaction scale. Statistical analysis was done using SPSS version 21. Data were compared using the Chi‑square test and students’ t‑test. Results: Duration of analgesia was significantly longer in Group B than group A. Upon inter group comparison of A vs. B the results were statistically significant (p value <0.001). At all time in 24 hrs. Postoperative period (1, 2, 4, 6, 12 and 24 hrs.) NRS score was least in group B then group A with statistically significant difference (p value <0.001). The overall tramadol consumption in Group A was approximately twice (107.5 ± 61.55 mg) as compared to Group B (56.3 ± 39.53mg). Conclusion: STA block in addition with rectus abdominis sheath block is a good alternative for providing perioperative analgesia for upper abdominal surgery such as laparoscopic cholecystectomy and can cover the conventional anatomical port sites as well.

Associations Among Nitric Oxide and Enkephalinases With Fibromyalgia Symptoms.

Fibromyalgia (FM) is a complex syndrome of uncertain etiology, characterized by the presence of widespread pain. Both nitric oxide and enkephalinases modulate pain perception. The aim of this study was to evaluate the relationships among serum nitric oxide levels, oxytocinase activity, and enkephalin-degrading aminopeptidase (EDA) activity with pain-related clinical manifestations in women with FM. We performed an observational case study in a population of 58 women diagnosed with FM. Serum nitric oxide levels were analyzed by an ozone chemiluminescence-based assay. Both serum oxytocinase and EDA activities were fluorometrically determined. Pain threshold and pain magnitude were evaluated using the PainMatcher. The pressure pain thresholds were measured using a digital pressure algometer. We used a visual analog scale, the Central Sensitization Inventory, the Revised Fibromyalgia Impact Questionnaire, and the Beck Anxiety Inventory to assess the global level of pain, the symptoms associated with the central sensitization syndrome, the severity of FM, and the anxiety level, respectively. Multiple linear regression analysis adjusted by age, body mass index, and menopause status revealed significant associations between nitric oxide levels and dominant occiput pressure pain thresholds, nondominant occiput pressure pain thresholds, and FM effects. Significant associations of oxytocinase activity with the visual analog scale and dominant knee pressure pain thresholds were also found. Moreover, results showed a significant association between high EDA activity levels and dominant second-rib pressure pain thresholds. Our data have shown significant relationships of serum nitric oxide levels and oxytocinase and EDA activities with some body pressure pain thresholds, the daily activity level, and the global intensity of pain in women with FM. These results suggest that pain, which is the main symptom of this syndrome, may be related to alterations in nitric oxide levels and in oxytocinase and EDA activities in patients with FM.

CONSISTENCY OF DYNAMIC KNEE VALGUS KINEMATICS AND PAIN ACROSS FUNCTIONAL TASKS IN FEMALES WITH PATELLOFEMORAL PAIN: A CROSS-SECTIONAL STUDY.

Dynamic knee valgus has been associated with patellofemoral pain (PFP) during high-level tasks, however, repeated lower-level stresses may be an alternative pain mechanism. The primary purpose of the current study was to examine the consistency of dynamic knee valgus and task-elicited pain demonstrated by females with PFP across four common functional tasks (stair ascent, stair descent, sit-to-stand, and stand-to-sit). A secondary purpose was to assess the correlation between the clinical test of single-limb squat and functional tasks. Females with patellofemoral pain will demonstrate a positive relationship in magnitude of dynamic knee valgus and task-elicited pain across functional tasks. Individuals who demonstrated greater dynamic knee valgus and task-elicited pain during the clinical test of single-limb squat would demonstrate greater dynamic knee valgus and task elicited pain during stair ascent/descent and sit-to-stand/stand-to-sit tasks. Cross-sectional study; secondary analysis of a feasibility intervention study. Twenty-three women with patellofemoral pain (age: 21.8 SD 3.7 years; BMI: 22.2 SD 2.0 kg/m2) participated. Three-dimensional kinematic data were captured during task completion. Hip and knee frontal and transverse plane angles at 45 ° of knee flexion, and pain using a visual analog scale, were assessed during single-limb squat, stair ascent/descent, and sit-to-stand. Pearson product-moment correlation coefficients were calculated to examine between-task relationships for each variable at the pre-intervention assessment. Correlation coefficients between tasks ranged from 0.23-0.76 for hip frontal plane measures (7/10 significant relationships, p<0.02), 0.31-0.90 for hip transverse plane measures (7/10 significant, p<0.01), 0.87-0.95 for knee frontal plane measures (10/10 significant, p<0.01), and 0.54-0.86 for knee transverse plane measures (10/10 significant, p<0.01). Correlations spanned 0.59-0.85 for pain during tasks (10/10 significant, p<0.01). Females with patellofemoral pain demonstrated positive correlations in dynamic knee valgus kinematics and task-elicited pain across five tasks. Movement and pain during the clinical test of single-limb squat test also was correlated with movement and pain during the functional tasks of stair ascent/descent and sit-to-stand. Level 2b.

Neuropathic Pain after Adolescent Idiopathic Scoliosis Correction Surgery.

Study DesignProspective study.PurposeTo investigate the prevalence and the associated risk factors of chronic neuropathic pain symptoms using painDETECT questionnaire in adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) surgery.Overview of LiteraturePost-lumbar surgery syndrome is a disease entity that describes neuropathic pain following spinal surgery. However, few studies have investigated the prevalence and risk factors for neuropathic pain in pediatric population undergoing corrective spinal surgery.MethodsForty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors.ResultsBased on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022).ConclusionsChronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.

'Reinventing the wheel' to advance the development of pain therapeutics.

Chronic pain affects approximately one-third of the population worldwide. The primary goal of animal research is to understand the neural mechanisms underlying pain so better treatments can be developed. Despite an enormous investment in time and money, almost no novel treatments for pain have been developed. There are many factors that contribute to this lack of translation in drug development. The mismatch between the goals of drug development in animals (inhibition of pain-evoked responses) and treatment in humans (restoration of function) is a major problem. To solve this problem, a number of pain-depressed behavioral tests have been developed to assess changes in normal behavior in laboratory animals. The use of home cage wheel running as a pain assessment tool is especially useful in that it is easy to use, provides an objective measurement of the magnitude and duration of pain, and is a clinically relevant method to screen novel drugs. Pain depresses activity in humans and animals, and effective analgesic treatments restore activity. Unlike traditional pain-evoked tests (e.g., hot plate, tail flick, von Frey test), restoration of home cage wheel running evaluates treatments for both antinociceptive efficacy and the absence of disruptive side effects (e.g., sedation, paralysis, nausea). This article reviews the literature using wheel running to assess pain and makes the case for home cage wheel running as an effective and clinically relevant method to screen novel analgesics for therapeutic potential.

Decreased Initial Peak Pain Sensation with Aging: A Psychophysical Study.

Background and PurposeAging is associated with an impairment of diverse physiological functions, including nociception. For example, older adults in comparison to young adults, show an overall increase in pain thresholds, reflecting a decline in pain sensitivity and changes in the nociceptive pathways. These results are, however, debated as they were not always replicated depending on the stimulus modality, duration, and location. The aim of the current study was to determine how the temporal evolution of pain intensity during a continuous tonic heat pain test is influenced by aging. More specifically, we wanted to 1) assess the effect of age on initial peak and late-phase pain and 2) determine whether potential age effects depend on the stimulation site.Participants and Methods13 young adults (average of 27.9 years old) and 13 older adults (average of 67.5 years old) participated in this study. Experimental heat pain was evoked on an appendicular (forearm) and axial (lower-back) body region, using a thermode (2-minute stimulation at a constant, individually-adjusted temperature). During the nociceptive stimulation, participants used a computerized visual analogue scale to continuously rate their pain.ResultsWe show that initial peak (0–30 seconds) pain sensation was significantly lower in older adults compared to young adults, while late-phase (30–120 seconds) pain sensation was similar across the two age groups. These results hold true for both stimulation sites, suggesting the existence of an age effect on both appendicular and axial body regions.ConclusionThe lower magnitude of initial peak pain observed in older adults, which affects both appendicular and axial body regions, could reflect generalized peripheral or central alterations of the nociceptive system in older adults. These alterations in older adults could have significant clinical impacts, such as an increased vulnerability to injury or an underestimation of the severity of their pain condition.

Modality-specific facilitation of noninjurious sharp mechanical pain by topical capsaicin.

We had previously shown that a "blunt blade" stimulator can mimic the noninjurious strain phase of incisional pain, but not its sustained duration. Here, we tested whether acute sensitization of the skin with topical capsaicin can add the sustained phase to this noninvasive surrogate model of intraoperative pain. Altogether, 110 healthy volunteers (55 male and 55 female; 26 ± 5 years) participated in several experiments using the "blunt blade" (0.25 × 4 mm) on normal skin (n = 36) and on skin pretreated by a high-concentration capsaicin patch (8%, Qutenza; n = 36). These data were compared with an experimental incision (n = 40) using quantitative and qualitative pain ratings by numerical rating scale and SES Pain Perception Scale descriptors. Capsaicin sensitization increased blade-induced pain magnitude and duration significantly (both P < 0.05), but it failed to fully match the sustained duration of incisional pain. In normal skin, the SES pattern of pain qualities elicited by the blade matched incision in pain magnitude and pattern of pain descriptors. In capsaicin-treated skin, the blade acquired a significant facilitation only of the perceived heat pain component (P < 0.001), but not of mechanical pain components. Thus, capsaicin morphed the descriptor pattern of the blade to become more capsaicin-like, which is probably explained best by peripheral sensitization of the TRPV1 receptor. Quantitative sensory testing in capsaicin-sensitized skin revealed hyperalgesia to heat and pressure stimuli, and loss of cold and cold pain sensitivity. These findings support our hypothesis that the blade models the early tissue-strain-related mechanical pain phase of surgical incisions.

Effectiveness, Safety, and Predictive Potential in Ultrasound-Guided Stellate Ganglion Blockades for the Treatment of Sympathetically Maintained Pain.

Evaluating the effectiveness of stellate ganglion blockades (SGBs) proves challenging, since the criteria defining a successful blockade are controversial. This may be one reason for the scarcity of studies on this topic, thus forcing clinical guidelines to remain conservative in recommending SGBs. Moreover, factors to predict which patients will benefit from blockade series are not yet available. The objectives of this study were to evaluate through a clinical approach SGBs' effectiveness performed under ultrasound guidance (us-SGB) and to identify factors to predict effectiveness. We retrospectively analyzed 809 us-SGBs in 105 patients with complex regional pain syndrome (CRPS) and neuropathic pain syndromes (all potentially including sympathetically maintained pain) regarding pain reduction. Volume and type of local anesthetics, magnitude of pain, temperature of the dorsal hands, heart rate, blood pressure, and occurrence of Horner's syndrome or complications were assessed. Pain reduction after a blockade series was highly significant and showed no significant correlation with change of temperature, vital signs, or Horner's syndrome. For patients with neuropathic pain, the predictive potential for pain reduction following a blockade series lies within the range of pain reduction after the first blockade. In a literature comparison, incidences of complications (hoarseness 3.9%, dysphagia 3.4%, hematoma 0.6%) were lower than in non-ultrasound-guided techniques. Data indicate that us-SGBs are safe and effective in reducing sympathetically maintained pain in patients with CRPS and neuropathic pain syndromes. Pain reduction after the first blockade may predict total pain reduction after a blockade series. Other clinical measures seem unsuitable to predict effectiveness.

Possible steps on preventing rape as a war crime

The Japanese military’s history of wanton rape during war continues to dog its diplomacy and economic relations, particularly with South Korea. Although Japan is not alone in its military having committed such war crimes, it does stand out as a developed nation that denies full accountability and seeks to diminish the import of its actions. Japan has an opportunity to make amends and help reduce the likelihood of such heinous crimes in the future worldwide. It should seize the chance to lead rather than obfuscate, to promote healing rather than deny the magnitude of pain that it caused.