Magnitude Of Pain Research Articles

Multidimensional Analysis of Quality of Life in Patients with Chronic Non-Cancer Pain and Short- and Long-Term Intrathecal Analgesic Therapy.

Background: Intrathecal drug delivery (IDD) is part of the fourth analgesic step. Evidence on the quality of life of patients with refractory chronic non-cancer pain (CNCP) using these devices and their long-term outcomes is scarce. This study aims to evaluate patients with IDD to assess their HRQoL. Additionally, the study seeks to understand the patients' satisfaction with the treatment and changes in pain magnitude over time. Methods: Adult patients with CNCP and intrathecal drug delivery systems (IDDS) were included. The study population was divided into two groups: less than and more than 15 years of treatment. HRQoL was analyzed using validated questionnaires. Pain reduction was assessed using the visual analog scale (VAS), and treatment satisfaction was evaluated using the Patient Global Impression of Improvement scale. Results: The results indicate a poor HRQoL in IDD patients, with better scores in the group with ≥15 years of treatment. Pain reduction was similar in both groups, and patients reported a positive satisfaction level with the treatment. Conclusions: HRQoL in CNCP patients is severely affected. Long-term IDD patients have a similar or even better HRQoL in some respects compared to those with shorter follow-ups. IDD patients experienced pain reduction, with most feeling better or much better.

Knee Osteoarthritis.

Knee osteoarthritis (OA) typically presents with joint pain that is exacerbated by use and alleviated with rest. There is relatively brief, self-limited morning stiffness and absence of constitutional symptoms. Overweight and obesity are the most important modifiable risk factors. Although pharmacologic and nonpharmacologic interventions are generally effective at alleviating pain and improving physical function, they do not fundamentally reverse the pathologic and radiographic process of knee OA. As the severity of disease increases, the magnitude of pain and functional impairment intensifies. Surgical intervention should be pursued to relieve pain and restore functionality only when nonpharmacologic approaches and pharmacologic agents fail to control pain.

Microbiome-driven IBS metabotypes influence response to the low FODMAP diet: insights from the faecal volatome

Irritable bowel syndrome (IBS) is a common and debilitating disorder manifesting with abdominal pain and bowel dysfunction. A mainstay of treatment is dietary modification, including restriction of FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). A greater response to a low FODMAP diet has been reported in those with a distinct IBS microbiome termed IBS-P. We investigated whether this is linked to specific changes in the metabolome in IBS-P. Solid phase microextraction gas chromatography-mass spectrometry was used to examine the faecal headspace of 56 IBS cases (each paired with a non-IBS household control) at baseline, and after four-weeks of a low FODMAP diet (39 pairs). 50% cases had the IBS-P microbial subtype, while the others had a microbiome that more resembled healthy controls (termed IBS-H). Clinical response to restriction of FODMAPs was measured with the IBS-symptom severity scale, from which a pain sub score was calculated. Two distinct metabotypes were identified and mapped onto the microbial subtypes. IBS-P was characterised by a fermentative metabolic profile rich in short chain fatty acids (SCFAs). After FODMAP restriction significant reductions in SCFAs were observed in IBS-P. SCFA levels did not change significantly in the IBS-H group. The magnitude of pain and overall symptom improvement were significantly greater in IBS-P compared to IBS-H (p=0.016 and p=0.026, respectively). Using just five metabolites, a biomarker model could predict microbial subtype with accuracy (AUROC 0.797, sensitivity 78.6% (95% CI: 0.78-0.94), specificity 71.4% (95% CI: 0.55-0.88). A metabotype high in SCFAs can be manipulated by restricting fermentable carbohydrate, and is associated with an enhanced clinical response to this dietary restriction. This implies that SCFAs harbour pro-nociceptive potential when produced in a specific IBS niche. By ascertaining metabotype, microbial subtype can be predicted with accuracy. This could allow targeted FODMAP restriction in those seemingly primed to respond best. This research was co-funded by Addenbrooke's Charitable Trust, Cambridge University Hospitals and the Wellcome Sanger Institute, and supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).

Prevalence and characterization of pain in radiation oncology: the PREDORT multicenter cross-sectional study.

Pain in cancer patients has enormous impact on their quality-of-life. Radiation therapy (RT) is a cornerstone in cancer treatment. The objective of the PREDORT study is to estimate the prevalence of pain in patients attending at Radiation Oncology (RO) Services. A prospective, multicenter study was designed for patients treated at the RO Services of reference hospitals. Patients were seen in their initial Nursing consultation, during which key data was collected, including demographic and comorbidities data, medical history, and oncological and pain characteristics. The study has received approval from the Ethics Committee of Navarra, and all patients signed the Informed Consent. Of the 860 participating patients, 306 reported some type of pain, which implies a prevalence of 35.6%. Of them, 213 identified a cause of oncological origin. The proportion of pain was similar among sexes, but the proportion of non-cancer pain was higher among women (p < 0.05). Regarding pain intensity, the magnitude of breakthrough pain in patients with oncological pain is nearly 1 point greater than in patients with non-oncological pain (7.53 vs 6.81; p = 0.064). Cancer pain is more likely to be limiting of normal life than non-cancer pain (59% versus 38%, p < 0.001). Regarding analgesic treatment, only 60/306 patients (19.6%) were receiving strong opioids. There were 68 patients with pain without any treatment (22.2%). The prevalence of pain in cancer patients referred to RO services is 35.6%, with the prevalence of exclusively oncological pain being 24.8%. Understanding and addressing oncological pain is essential to provide comprehensive care to patients.

Exploring the relationship between condition severity and health-related quality of life in people with haemophilia A across Europe: a multivariable analysis of data from the CHESS II study

BackgroundHaemophilia A (HA; Factor VIII deficiency) is a congenital X-linked bleeding disorder characterized by trauma-related or spontaneous bleeding events, most notably arising within the intraarticular space and resulting in chronic inflammation and degeneration of affected joints. Endogenous clotting factor activity relative to normal levels determines the severity of HA symptoms, as mild (> 5–40%), moderate (1–5%), or severe (< 1%). Within the current environment of rapid evolution in HA management, we seek to understand the interplay of condition severity and health-related quality of life (HRQoL) to characterise and differentiate unmet needs among people with HA (PwHA).MethodsA generalised linear regression model (GLM) was developed to explore the relationship between HA severity and EQ-5D-5 L index score from adult HA patients sampled in the “Cost of Haemophilia across Europe – a Socioeconomic Survey II” (CHESS II) cross-sectional, retrospective burden of illness study among adults with hereditary haemophilia A or B from eight European countries. HA patients of any severity with no active inhibitors during the 12 months prior to data capture and a completeEQ-5D-5 L response were included. A base GLM model was specified with covariates for demographic and clinical characteristics (age, body mass index, country, employment, HA severity, annual bleeding rate, problem joints, and chronic pain).ResultsOf 381 evaluable patients, 221 (58.0%) had severe HA, 96 (25.2%) had moderate HA, and 64 (16.8%) had mild HA. Among the covariates included in the GLM model and after controlling for haemophilia-related outcomes, a significant association was observed between mild HA and higher EQ-5D-5 L index score (average marginal effects, 0.084; p = 0.016) relative to severe HA. Patient country of residence and magnitude of HA-related chronic pain were also associated with significant differences in index scores, with the latter showing a negative relationship with HRQoL outcomes.ConclusionsCondition severity and chronic pain are significant predictors of HRQoL in PwHA. Durable bleeding protection and effective management of chronic pain have the potential to address unmet treatment needs in this population.

Changes in Widespread Pain After Surgical Weight Loss in Racialized Adults: A Secondary Analysis From a 2-Year Longitudinal Study

Widespread pain (WP) is associated with reduced function and disability. Importantly, three-fourths of the approximately 42% of U.S. adults with obesity have WP. Moreover, rates of adult obesity are higher, and WP outcomes are worse in racialized non-Hispanic Black and Hispanic/Latino/a/X groups, potentially exacerbating existing pain disparities. Bariatric surgery significantly reduces weight and improves pain. However, recurrent or unresolved pain after bariatric surgery can hinder weight loss or facilitate weight regain. The current study conducted a secondary analysis of a longitudinal study of predictors and mechanisms of weight loss after bariatric surgery to examine the point prevalence of WP and pain trajectories 24 months post surgery. Our secondary aim was to examine the association between weight loss and pain characteristics. Our exploratory aim was to longitudinally examine racial differences in pain trajectories after bariatric surgery. Our results showed that point prevalence decreased after bariatric surgery. Additionally, significant improvements in pain trajectories occurred within the first 3 months post surgery with a pattern of pain reemergence beginning at 12 months post surgery. Hispanic/Latino/a/X participants reported a higher number of painful anatomical sites before bariatric surgery, and the rate of change in this domain for this group was faster compared with the racialized non-Hispanic Black participants. These findings suggest that pain improvements are most evident during the early stages of surgical weight loss in racialized populations of adults with WP. Thus, clinicians should routinely monitor patients’ weight changes after bariatric surgery as they are likely to correspond to changes in their pain experiences. PerspectiveThis article presents the prevalence and pain trajectories of racialized adults with WP after surgical weight loss. Clinicians should evaluate changes in the magnitude and spatial distribution of pain after significant weight change in these populations so that pain interventions can be prescribed with greater precision.

Prevalence of low back pain and associated factors among bank workers at Hawassa city, Northern Zone, Sidama Region, Southern Ethiopia

BackgroundLower back pain (LBP) is a public health threat that affects people who frequently experience sedentary working conditions. Few studies reported on low back pain among bank workers in Ethiopia, particularly in the study area. Therefore, this study aimed to determine the magnitude and associated factors of low back pain among bank workers in Hawassa City, Sidama Region, Ethiopia.MethodsThis institutional-based cross-sectional study was conducted from April 20, 2023, to June 30, 2023. A multistage sampling technique was employed to select participants, and data were collected using a structured self-administered questionnaire, entered into Epidata version 4.6, and transferred to SPSS version 25 for further analysis. Bivariate and multivariate logistic regression analyses were performed to identify the independent predictors of lower back pain.ResultsOf the 627 total study participants, six hundred seven bank workers participated in the study, with a response rate of 96.8%. The overall magnitude of lower back pain among the study population was 55.2%, with a 95% confidence interval (CI 51.1–59). Based on the multivariate binary logistic regression analysis, being in a manager position (AOR = 3.85; 95% CI = (1.2,12), a level 2 banker (AOR = 3.8; 95% CI = (1.9,8.9), age 30–39 years (AOR = 4; 95% CI = (2,12.4), an age ≥ 40 years (AOR = 5.4; 95% CI= (3.04,16.3), working in sufficient space (AOR = 0.4; 95% CI = (0.3,0.9), and physical activity (AOR = 0.2; 95% CI = (0.1,0.8)) were significantly associated with low back pain.ConclusionThe prevalence of low back pain among the bank workers was high in the study area. Being in a managerial position, being a level two banker, being aged 30–39 years, being aged ≥ 40 years, working in sufficient space, and engaging in physical activity were significantly associated. Therefore, it is essential to establish a health screening team, create awareness programs for the benefit of physical activity, provide sufficient working space, and give special attention to elderly and senior bankers and bank managers to reduce the risk of developing low back pain.

An Innovative EEG-Based Pain Identification and Quantification: A Pilot Study.

The present pilot study aimed to propose an innovative scale-independent measure based on electroencephalographic (EEG) signals for the identification and quantification of the magnitude of chronic pain. EEG data were collected from three groups of participants at rest: seven healthy participants with pain, 15 healthy participants submitted to thermal pain, and 66 participants living with chronic pain. Every 30 s, the pain intensity score felt by the participant was also recorded. Electrodes positioned in the contralateral motor region were of interest. After EEG preprocessing, a complex analytical signal was obtained using Hilbert transform, and the upper envelope of the EEG signal was extracted. The average coefficient of variation of the upper envelope of the signal was then calculated for the beta (13-30 Hz) band and proposed as a new EEG-based indicator, namely Piqβ, to identify and quantify pain. The main results are as follows: (1) A Piqβ threshold at 10%, that is, Piqβ ≥ 10%, indicates the presence of pain, and (2) the higher the Piqβ (%), the higher the extent of pain. This finding indicates that Piqβ can objectively identify and quantify pain in a population living with chronic pain. This new EEG-based indicator can be used for objective pain assessment based on the neurophysiological body response to pain. Objective pain assessment is a valuable decision-making aid and an important contribution to pain management and monitoring.

Multi-dimensional evaluation of pain response in low day-age calves to two types of dehorning.

Dehorning calves is necessary to minimize injury because intensive raising circumstances make horned cows more aggressive. However, acute pain is commonly perceived by farm animals when undergoing painful practices such as dehorning, affecting their health status and quality of life. By quantifying the magnitude of pain and discomfort associated with dehorning, we aim to contribute to a more humane and sustainable cattle farming industry. The objective of this study was to evaluate the behavioral, physiological, and emotional effects of acute dehorning pain in calves using two methods: dehorning cream and dehorning hot-iron.30 Holstein calves aged 4 days were selected for the study. These calves were randomly assigned to two experimental groups based on the method of disbudding: dehorning cream (n = 15) and hot-iron dehorning (n = 15). Before and after dehorning, we evaluated their physiological indicators of infrared eye temperature, concentrations of substance P, IL-6, cortisol, haptoglobin, as well as emotional state, and pain-related behavioral reactions. Post-dehorning, the duration of lying down decreased significantly in both groups (DI and DC: 0-4 h) after dehorning (p < 0.05). Both groups exhibited increased frequencies of pain-related behaviors such as head shaking (DI: 1-7 h, DC: 1-6 h), ear flicking (DI: 2-7 h, DC: 2-7 h), head scratching (DI: 2-3 h, DC: 1-7 h), and top scuffing (DI: 2 h, DC: 2-7 h) compared to pre-dehorning (p < 0.05). The DC group demonstrated a higher frequency of head-shaking, ear-flicking, head-scratching, and top-rubbing behaviors, along with a longer duration of lying down (0-4 h), compared to the DI group (p < 0.05). Post-dehorning, play behavior reduced significantly in both groups (6-8 h) (p < 0.05), whereas judgment bias and fear levels showed no significant change (p > 0.05). Physiological measures including eye temperature, and blood levels of substance P and IL-6, did not differ significantly between the groups before and after dehorning (p > 0.05). However, 48 h after dehorning, calves in the DC group had significantly higher haptoglobin levels compared to the DI group (p = 0.015). Additionally, salivary cortisol levels in the DC group increased significantly at 3.5 h and 7 h post-dehorning (p = 0.018, p = 0.043). Both hot-iron and cream dehorning induced pain in calves, as evidenced by increased pain-related behaviors, elevated salivary cortisol, and higher haptoglobin levels, alongside reduced positive behaviors. Notably, these effects were more pronounced in the DC group than in the DI group, suggesting that dehorning hot-iron may be a comparatively less stressful dehorning method for young calves. Moreover, the brief duration of pain response and weaker response to dehorning observed in 13-day-age calves in this study suggests that dehorning at younger ages may be more advisable and warrants further research.

Asymmetric changes in foot anthropometry with pregnancy may be related to onset of lower limb and low back pain.

Fifty percent of pregnant females experience pain with 20% reporting long-term pain post-partum. Pregnant females undergo changes in foot anthropometry, lower extremity alignment, and joint laxity. It is unknown if asymmetric alterations may be related to development of pain. The purpose of this study was twofold: 1) to compare asymmetric alignment in pregnant females with and without pain during pregnancy and in nulliparous controls and 2) to assess the relationship between asymmetric alignment and pain severity in all participants. Ten pregnant females in their third trimester and nine nulliparous controls participated. Bilateral asymmetry of foot length, width, arch index, arch height index, arch rigidity index, arch drop, rearfoot angle, and pelvic obliquity were determined. Joint laxity and musculoskeletal pain were also assessed. ANOVAs were utilized to compare asymmetries between pregnant females reporting pain (n = 5), those not reporting pain (n = 5), and controls. Spearman's Rho correlations were used to relate asymmetry to pain magnitude (α = 0.05). No statistical differences (p>0.05) were found between pregnant females with or without pain and controls for any of the metrics. Negative correlations were found between arch index asymmetry and low back pain (p = 0.005), foot length asymmetry and lower leg pain (p = 0.008), and pelvic obliquity and lower leg pain (p = 0.020). Positive correlations were found between foot width asymmetry and knee pain (p = 0.028), as well as arch drop asymmetry and upper leg (p = 0.024), knee (p = 0.005), and lower leg pain (p = 0.019). This study was successful in identifying potential targets for prevention and treatment of pain in pregnancy. Furthermore, because pain during pregnancy may be predictive of pain post-partum, it is important to conduct future research to determine both if interventions such as footwear or exercise can prevent or treat these asymmetries and prevent post-partum pain.

The Prevalence and Risk Factors of Low Back Pain Among Healthcare Workers in Asia

Intorduction: Low Back Pain is a musculoskeletal disorder and not a disease. Among healthcare workers (HCw), this is the disorder they experience most often, and knowledge about the prevalence of of low back pain (LBP) and its risk factors among healthcare workers is important to determine appropriate training for them The purpose of this study was to identify the magnitude of low back pain (LBP) problems in HCw as well as to determine which risk factors are determinants. Method: This study used a systematic review via meta-analysis guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Through a search of 13 articles from several countries in Asia, which analyzed 5753 respondents (1080 or 18.8% were males and 4673 or 81.2% were females), the average prevalence of LBP was 58.1%. This value was calculated without estimating the time span of its occurrence. If this range was calculated, of the 11 articles that calculated the lifetime incidence of LBP, the average was 60%. The risk factors were manual patient removal, heavy object lifting, sex, age, stress, type of work, workplace environment, and work duration. Conclusion: This study found a high prevalence, and there are still many risk factors for LBP that require special attention. Healthcare workers are advised to pay attention to ergonomics and working behavior, while hospital leaders are advised to conduct training on the risk factors of LBP.

Postoperative Evaluation of Pain and Disability in Patients Undergoing Spinal Discectomy.

A spinal discectomy surgery (SDS) is a common surgical procedure performed to treat lumbosacral radiculopathy. To evaluate postoperative patterns of pain and disability in patients undergoing spinal discectomy. This investigation was a retrospective longitudinal review of prospective information gathered from 543 enrolled patients for lumbar radiculoplasty. The study participants were divided into two categories: Category 1 (SDS) comprising patients of lumbar radiculoplasty managed with SDS (n=270) and Category 2 (non-SDS) comprising patients of lumbar radiculoplasty managed with therapy other than SDS (n=273). It included study participants taking medication for pain control including opioids and non-opioids and physiotherapy for strengthening lower back muscles. At baseline, three months, 12 months, and 24 months after surgery, patient-reported information was gathered. Leg pain magnitude, back pain magnitude, and pain-related impairment were the key outcome metrics of interest. The mean postoperative visual analog scale (VAS) score for leg pain at three-month follow-up was 4.3±1.2in study participants in SDSand 8.1±1.3 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 12-month follow-up was 2.8±1.1 in study participants in SDS and 7.9±1.5in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 24-month follow-up was 1.7±1.2 in study participants in SDS and 7.1±1.1 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). It was observed that after discectomy, patients suffering from lumbar radiculopathy have significant pain and disability recovery. According to these results, only a small percentage of individuals exhibit negative results at the level of impairment.

Daily Pain Experiences in Chronic Pancreatitis: Identifying Pain Phenotypes.

Pain, the hallmark symptom of chronic pancreatitis (CP), remains difficult to assess. To capture the variability of pain that patients can experience day to day, this study used pain diaries to describe daily pain experiences and identify pain phenotypes. This study is a secondary data analysis from a pilot trial examining cognitive behavioral therapy for pain treatment in CP. Before treatment, patients completed an online daily pain diary using the Brief Pain Inventory for 7 days. Using indicators of pain magnitude, pain variability, pain synchrony along with least, worst, and average pain intensity levels, we identified pain patterns using K-means clustering. Of 30 patients in the pilot trial, a total of 27 patients (mean age of 49.8 years, 80% women) had complete data to include in this report. Four clusters were identified: cluster 1, lowest pain magnitude (n = 3); cluster 2, moderate pain magnitude and high pain variability (n = 4); cluster 3, moderate pain magnitude and low pain variability (n = 9); and cluster 4, highest pain magnitude and lowest pain variability (n = 11). Daily pain diaries offer a novel way of evaluating the dynamic pain experiences in CP. Although 4 distinct pain patterns were identified, further studies are needed to validate these findings.

Central sensitization negatively influences the level of disability in female patients with anterior knee pain.

To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment. The data of a total of 44 AKP female patients with a mean age of 27.7years (15-50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1years (16-46). CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS). Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96). AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients. Level III.

Prevalence of low back pain and its associated factors among traditional cloth weavers in Gulele sub-city, Addis Ababa, Ethiopia.

The prevalence of work-related musculoskeletal disorders particularly low back pain is significantly high among common informal or small-scale enterprises within developing countries like weaving. However, there is little information on risk factors for low back pain in the informal sector such as the weaving sector in the areas of Addis Ababa as well as in Ethiopia. Therefore this study was aimed to assess the magnitude of low back pain and its associated factors among traditional cloth weavers in the Gulele sub-city, Addis Ababa, Ethiopia. A cross-sectional study with internal comparison was conducted from June 1, 2022, and August 30, 2022. A total of 660 traditional cloth weavers were included in the study by using a systematic random sampling method to select participants in each of cooperatives as well as individual households in 5 woredas in Gulele sub-city. The data was analyzed and managed using SPSS version 20. A multivariate logistic regression analysis was used to control potential confounding factors and to determine the association. Among 660 (100%) respondents, 330 (50%) of them experienced low back pain after starting weaving. Out of the respondents with low back pain through their job career, 291 (44.1%) of them experienced low back pain during the last 12 months. Working greater than 8 h per day (AOR = 4.60, 95%CI: 2.35, 8.87), working with frequent bending (AOR = 3.32, 95%CI: 1.49, 7.40), job stress (AOR = 1.68, 95%CI: 1.18, 2.40) were among factors significantly associated with the occurrence of low back pain. This study has shown a high prevalence of low back pain among traditional cloth weavers which indicates the need for immediate public health action. However, very small improvements in the working condition, weaving tools design, working methods can potentially lead to large benefits.

Medial and dorsal lateral septum involving social disruption stress-primed escalation in acid-induced writhes.

Stress may cause prospective escalations in abdominal pain magnitude and accumbal TRPV1 expression, while central neural circuits mediating these stress effects remain unclear. Using retrograde tracing methods, we first demonstrated the existence of a medial septal-dorsal lateral septal -accumbal circuit very likely involving social disruption stress-primed escalations in acid-induced writhes and accumbal TRPV1 level. An intersectional viral strategy and virus-carrying hM3Dq and hM4Di DREADDs were, then, employed to selectively modulate GABAergic and cholinergic neuronal activity in medial and dorsal lateral septum. Exciting medial septal GABAergic neuron was found to prevent social disruption stress-primed escalations in acid-induced writhes and accumbal TRPV1 and PKCε expressions. Likewise, inactivating dorsal lateral septal cholinergic neurons was also effective in abolishing these stress-primed escalations. Inactivating GABAergic neuron in non-stressed animals' medial septum was found to reproduce the stress-primed effects in causing heightened acid-induced writhes and accumbal TRPV1 and PKCε levels. These results, taken together, prompt us to conclude that social disruption stress may produce plastic changes in a newly-identified medial septal-dorsal lateral septal-accumbal circuit. Moreover, medial septal GABAergic hypoactivity and dorsal lateral septal cholinergic hyperactivity are, at least, two likely causes reflecting such stress-produced escalations in abdominal pain magnitude and pain transduction-related protein over-expression in nucleus accumbens.

Duration of Electro-Dry Needling Does Not Change the Pain Response After Repeated Nociceptive Thermal Stimuli in Asymptomatic Individuals: A Randomized Intervention Study

ObjectiveTo assess the effects of 5 different durations of electro-dry needling (EDN) on asymptomatic individuals’ pain response after repeated noxious thermal stimuli. DesignRandomized, non-controlled intervention trial. SettingUniversity laboratory. ParticipantsAsymptomatic participants (N=50) were recruited for the study and randomized into 5 groups. There were 33 women with an average age of 26.8 (±4.8) years. To participate in the study, individuals had to be between the ages of 18 and 40, free of any musculoskeletal injury which prevented participation of daily activities, and not pregnant or trying to become pregnant. InterventionsParticipants were randomly assigned to receive 5 different durations of EDN: 10, 15, 20, 25, and 30 minutes. To perform the EDN, 2 monofilament needles were inserted lateral to the lumbar spinous processes of L3 and L5 on the right. Needles were left in situ with electrical stimulation at a frequency of 2 Hz and an amplitude which resulted in a 3 to 6 out of 10 intensity pain rating by the participant. Main Outcome MeasuresThe change in the magnitude of pain in response to repetitive heat-pulses before and after the EDN procedure. ResultsThere was a significant reduction in the magnitude of pain in response across the groups after EDN (F(1,42)=94.12, P<.001, ƞp2=.691). However, the interaction between time and group was not significant (F(4,42)=1.019, P=.409, ƞp2=.088), indicating that no duration of EDN was superior to another in reducing temporal summation. ConclusionsThis study suggests that in asymptomatic individuals, performing EDN beyond 10 minutes does not provide any additional benefits in the reduction of the magnitude of pain in response to thermal nociceptive stimuli. Additional study in symptomatic populations is required for generalizability in clinical settings.

PD34-04 PREDICTIVE MODELS FOR SEVERE PAIN AND URINARY SYMPTOMS AFTER URETEROSCOPY WITH URETERAL STENT PLACEMENT FROM THE USDRN STENTS STUDY

You have accessJournal of UrologyCME1 Apr 2023PD34-04 PREDICTIVE MODELS FOR SEVERE PAIN AND URINARY SYMPTOMS AFTER URETEROSCOPY WITH URETERAL STENT PLACEMENT FROM THE USDRN STENTS STUDY Gregory Tasian, Hongqiu Yang, Hussein Al-Khalidi, Michele Curatolo, Naim Maalouf, Jodi Antonelli, Alana Desai, Henry Lai, Peter Reese, Hunter Wessells, Justin Ziemba, Ziya Kirkali, Charles Scales, and Jonathan Harper Gregory TasianGregory Tasian More articles by this author , Hongqiu YangHongqiu Yang More articles by this author , Hussein Al-KhalidiHussein Al-Khalidi More articles by this author , Michele CuratoloMichele Curatolo More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , Alana DesaiAlana Desai More articles by this author , Henry LaiHenry Lai More articles by this author , Peter ReesePeter Reese More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Justin ZiembaJustin Ziemba More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Charles ScalesCharles Scales More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In order to identify patients most likely to benefit from strategies to improve post-operative experiences, the Urinary Stone Disease Research Network developed models to predict severe pain and urinary symptoms after ureteroscopy (URS) for urinary stones. METHODS: The cohort included participants who underwent URS with ureteral stent placement for ureteral and/or kidney stones at 4 centers in the United States as part of the prospective STENTS study. We fit multivariable logistic regression models with generalized estimating equations for three outcomes: severe pain intensity (i.e., magnitude of pain), pain interference (i.e., pain disrupting daily activities), and urinary symptoms. Each outcome was defined as the top quartile of symptoms reported on post-operative days 1, 3, 5, and 7 after URS. In the model building process, we tested the following variables that were all measured before URS and stent placement: age, sex, BMI, number of body regions affected by pain, current depression, ureteral stone location, prior URS, opioid use, hypersensitivity to mechanical pain (pressure pain threshold), and pain facilitation (temporal summation). RESULTS: The study included 424 participants, of whom 6.6% were adolescents, 93.4% were adults, and 47% were female. Two-hundred twelve participants (50%) had kidney stones and 203 (48%) had ureteral stones as the indication for URS. Models that included sex, number of body regions affected by pain, and depression successfully predicted all three outcomes (Figure). CONCLUSIONS: Pre-operative patient characteristics, particularly sex and psychosocial health, have good performance for predicting individuals who will experience severe pain and severe urinary symptoms after URS with ureteral stent placement. If validated in external cohorts, these models could be integrated into bedside practice to implement individualized pre-emptive strategies to improve post-surgical outcomes. Source of Funding: NIH/NIDDK © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e921 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Tasian More articles by this author Hongqiu Yang More articles by this author Hussein Al-Khalidi More articles by this author Michele Curatolo More articles by this author Naim Maalouf More articles by this author Jodi Antonelli More articles by this author Alana Desai More articles by this author Henry Lai More articles by this author Peter Reese More articles by this author Hunter Wessells More articles by this author Justin Ziemba More articles by this author Ziya Kirkali More articles by this author Charles Scales More articles by this author Jonathan Harper More articles by this author Expand All Advertisement PDF downloadLoading ...

Adaptive coding of pain prediction error in the anterior insula.

Understanding the mechanisms behind the influence of expectation and context on pain perception is crucial for improving analgesic treatments. Prediction error (PE) signals how much a noxious stimulus deviates from expectation and is therefore crucial for our understanding of pain perception. It is thought that the brain engages in 'adaptive coding' of pain PE, such that sensitivity to unexpected outcomes is modulated by contextual information. While there is behavioural evidence that pain is coded adaptively, and evidence that reward PE signals are coded adaptively, controversy remains regarding the underlying neural mechanism of adaptively-coded pain PEs. A cued-pain task was performed by 19 healthy adults while undergoing FMRI scanning. BOLD responses to the task were tested using an axiomatic approach to identify areas that may code pain PE adaptively. The left dorsal anterior insula demonstrated a pattern of response consistent with adaptively-coded pain PE. Signals from this area were sensitive to both predicted pain magnitudes on the instigation of expectation, and the unexpectedness of pain delivery. Crucially however, the response at pain delivery was consistent with the local context of the pain stimulation, rather than the absolute magnitude of delivered pain, a pattern suggestive of an adaptively-coded PE signal. The study advances our understanding of the neural basis of pain prediction. Alongside existing evidence that the periaqueductal grey codes pain PE and the posterior insula codes pain magnitude, the results highlight a distinct contribution of the left dorsal anterior insula in the processing of pain. Although there is behavioural evidence that pain is coded adaptively, the neural mechanisms serving this process are not well understood. This study used functional MRI to provide the first evidence that the left dorsal anterior insula, an area associated with aversive learning, responds to pain in a manner consistent with the adaptive coding of pain prediction error. This study aids our understanding of the neural basis of subjective pain representation, and thus can contribute to the advancement of analgesic treatments.

Pattern and predictors of musculoskeletal pain among bakery workers in Abeokuta, Nigeria

IntroductionThe magnitude of musculoskeletal pain (MSP) and its risk factors among bakery workers are not well known in Nigeria. Therefore, this study investigated the pattern and predictors of musculoskeletal pain (MSP) seen in Nigerian bakery workers.MethodsThe analytical cross-sectional survey used a proforma and the standard Nordic questionnaire in assessing demographic characteristics, relevant work-related/ergonomic hazards and MSP information. Participants were selected using a multistage sampling technique with simple random sampling at stage one (25 bakeries) and a consecutive sampling technique at stage two (7 employees from each bakery). Statistics like chi-square and logistic regression were used in analysing the data.ResultsOne hundred and seventy-seven participants (77.4% males) with a mean age of 29.7 ± 6.7 years, and the average length of working in the bakery was 9.3 ± 5.2 years. Bending for prolonged periods (93.2%) and repetitive hand movements (92.1%) were the most prevalent ergonomic work hazards. In the past year, 72.3% reported MSP with the lower back region most prevalent (80.2%) followed by pain in the neck region (63.8%). Age, gender and educational attainments were significantly associated with the presence of MSP while ergonomic factors such as repetitive bending, overstretching and use of vibration-generating movement were also significantly associated with the presence of MSP among the bakery workers. Inadequate staffing, using vibration movement handling and education are the main predictors of the presence of MSP (&lt;i&gt;χ&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 29.09, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; &lt;i&gt;R&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 0.219).ConclusionsHigh prevalence of musculoskeletal pain in the past one year among Nigerian bakery workers predicted by education level, inadequate staffing, and vibration movement handling.