Mean Pain Research Articles

Work-related musculoskeletal disorders in Polish sonographers—A questionnaire study

PurposeThe ultrasound specialists face a substantial issue with work-related musculoskeletal disorders (WMSDs), characterized by occupation-related pain, reaching an estimated frequency of up to 90.5%. The type and location of pain vary depending on the sonographers specialty and the specific anatomical areas being examined. Our study aimed to assess the prevalence and intensity of pain among Polish doctors from various specialties conducting ultrasound examinations. Materials and methodsThe study has been performed between July and December 2023, involving 90 participants (51.9% women) actively practicing ultrasound diagnostics. The data collection process utilized a structured questionnaire developed by the researchers for this study. The questionnaire covered personal factors, including gender and age, and work-related aspects like workplace, specialty, sonography experience, and the types of examinations conducted. Statistical analysis involved both descriptive statistics and correlation analysis. ResultsThe age distribution ranged from 26 to 74 years, with mean (SD) of 43.1 (12.2) years. The leading specialties among physicians were radiology (22.2%) and internal medicine (22.2%). Among all physicians, 65.6% reported pain during or after ultrasound scans, with a mean (SD) pain intensity of 6.17 (2) in a 1–10 scale. The analysis indicated no correlation between age and gender and the occurrence of discomfort. ConclusionsWMSDs pose a significant risk to Polish sonographers, especially those specializing in vascular surgery, general surgery and obstetrics and gynecology specialties. The study underscores a notable deficit, with only 10% of the personnel reporting training in ergonomics for ultrasound work.

THE SMALLEST WORTHWHILE EFFECT OF EXERCISE THERAPY FOR PEOPLE WITH CHRONIC LOW BACK PAIN: A DISCRETE CHOICE EXPERIMENT STUDY

INTRODUCTION Understanding the magnitude of treatment effect patients need to see to consider a treatment worthwhile is of clear clinical and research importance. Current measures of clinical importance, such as the minimum clinical important difference, are limited as they are not determined by patients, and do not reflect specific costs, risks or inconveniences of individual treatments, i.e. you could have the same MCID for surgery as for exercise. We aimed to identify the smallest worthwhile effect (SWE), a new measure of clinical importance, of exercise therapy for people with non-specific chronic low back pain (CLBP) using discrete choice experiment. METHODS The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS 213 participants completed the survey. Mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. This means, for a baseline pain of 5, the SWE would be a 1/10 between-group reduction in pain. CONCLUSION This patient-informed threshold of clinical importance should guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.

The effect of a biofeedback-based virtual reality game on pain, fear and anxiety levels during port catheter needle insertion in pediatric oncology patients: A randomized controlled study

PurposeIt is essential to control pain, fear, and anxiety related to medical procedures to improve the well-being of the child and family trying to cope with the disease process. This study investigated the impact of the biofeedback-based virtual reality game (BioVirtualPed) on pain, fear, and anxiety levels during port needle insertion in pediatric oncology patients (POPs). MethodsThis randomized controlled study was conducted at a hospital between August and December 2023 involving 62 POPs aged 6–12 and their mothers. The intervention group wore a virtual reality headset and a respiratory sensor during the procedure. Data were collected using the Descriptive Information Form, Wong-Baker Pain Assessment Scale, Child Fear Scale, Children's State Anxiety, Satisfaction Scoring-Visual Analog Scale, and ADXL354 Sensor. Statistical analysis was performed using IBM SPSS for Windows Version 24.0. ResultsThe intervention group showed lower mean pain scores than the control group (p < 0.001). There was no difference in pre-procedure fear and anxiety scores between groups (p > 0.05 and p > 0.05, respectively). Post-procedure fear and anxiety scores were lower in the intervention group (p < 0.001 and p < 0.001, respectively). The intervention group's mean respiratory rates were lower (p < 0.001), and their satisfaction scores were higher (p < 0.001). Agreements between POPs and mothers on pain, fear, and anxiety scores were good and excellent across groups (p < 0.001). ConclusionsThe BioVirtualPed reduced procedure-related pain, anxiety, and fear, increased care satisfaction, and had a positive effect on the mean respiratory rate, hence it shows promising results, but these findings need further comfirmation.

Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review

BackgroundParenteral ketorolac and intravenous (IV) acetaminophen have been used for prehospital analgesia, yet limited data exist on their comparative effectiveness. Study ObjectivesTo evaluate the comparative effectiveness of IV acetaminophen and parenteral ketorolac for analgesia in the prehospital setting. MethodsWe conducted a retrospective cross-sectional evaluation of patients receiving IV acetaminophen or parenteral ketorolac for pain management in a large suburban EMS system between 1/1/2019 and 11/30/2021. The primary outcome was change in first to last pain score. Subgroup analysis was performed on patients with traumatic pain. We used inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) to estimate the treatment effect of acetaminophen versus ketorolac among all patients and the subgroup of those with traumatic pain. ResultsOf 2178 patients included, 856 (39.3%) received IV acetaminophen and 1322 (60.7%) received parenteral ketorolac. The unadjusted mean change in pain score was −1.9 (SD 2.4) for acetaminophen group and −2.4 (SD 2.4) for ketorolac. In the propensity score analyses, there was no statistically significant difference in pain score change for the acetaminophen group versus ketorolac among all patients (mean difference, IPTW: 0.11, 95% confidence interval [CI] −0.16, 0.37; PSM: 0.15, 95% CI −0.13, 0.43) and among those with traumatic pain (unadjusted: 0.18, 95% CI −0.35, 0.72; IPTW: 0.23, 95% CI −0.25, 0.71; PSM: −0.03, 95% CI −0.61, 0.54). ConclusionsWe found no statistically significant difference in mean pain reduction of IV acetaminophen and parenteral ketorolac for management of acute pain.

Rectal versus intravenous administration of acetaminophen; Clinical investigation of plasma level, analgesic, and antipyretic effects on 6-month to 6-year-old children in Zabol city, Iran

Acetaminophen is the most widely antipyretic analgesic medicine used in adults and children worldwide. Rectal acetaminophen is widely used in children who resist or cannot take oral medications. This study was designed to compare the efficacy of rectal and IV acetaminophen in children with fever and mild to moderate pain. Total 60 children aged six months to 6years, with fever and pain, that were treated with rectal or intravenous acetaminophen were selected and assigned in two groups. The IV group received 10mg/kg paracetamol as an IV infusion, and the rectal group received a 15mg/kg dose immediately after admission. Pain score was calculated using the FLACC method, and the axillary temperature was recorded at baseline and then 0.5, 1, 2, 4, and 6hours after drug administration. Blood samples were collected at baseline and then at 30min-intervals for the first 90minutes. The trend of changes in mean pain score at different time intervals was significantly different between the two groups. Body temperature decrease was more prominent in the IV group. The plasma concentration increased in both groups significantly with time. This increase was sharper in the IV group, just in the first 60minutes after drug administration. IV acetaminophen has more rapid onset of action, while rectal dosage form control fever and pain for longer duration. Considering its favorable effects with ease of administration and lower cost, rectal acetaminophen can be a reasonable option in selected patients with pain or fever.

Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial

BackgroundFear of pain associated with intrauterine device placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods. ObjectiveTo assess whether instillation of intrauterine mepivacaine before intrauterine device placement alleviates pain more effectively than a placebo. Study DesignWe conducted a multi-center, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing intrauterine device placement. An instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to intrauterine device placement. Pain scores were assessed using a 100 mm Visual Analog Scale at pre-specified time points. Primary outcome measured the difference in Visual Analog Scale pain scores between the intervention group and the placebo group during intrauterine device placement. Secondary outcomes included Visual Analog Scale pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method. ResultsWe enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% CI 5.75-20.87; P<.001): the mepivacaine group had a mean of 53.9 mm (SD 22.8), while the placebo group had a mean of 67.2 mm (SD 22.4). After adjusting for each individual provider’s impact, the difference in mean pain scores remained statistically significant (12.2 mm 95% CI 4.85-19.62; P<.001). A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group (P=.021). ConclusionThe intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during intrauterine device placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy.

Total Hip Replacement with a Fully Hydroxyapatite-Coated Shortened Stem: Five- to Thirteen-Year Follow-Up Results.

Background: Shortened femoral stems aim to mimic the biomechanical performance of traditional stems while preserving more bone and minimizing soft tissue damage. Our objective is to assess the outcomes of patients treated with a shortened stem (Furlong Evolution, JRI Orthopaedics, Sheffield, UK) to analyze the implant's efficacy and survivorship. Methods: This retrospective observational study included all patients aged 18 to 70 undergoing uncemented shortened stem total hip replacement at Hospital del Mar between 2010 and 2018. Hip function and pain were assessed with the Merle d'Aubigné-Postel scale and visual analog scale, respectively. A radiographic analysis measured stem and cup orientation, leg length discrepancy, stem subsidence, and radiolucencies around the cup. Perioperative complications, prosthetic failures, and reoperations were documented. Results: A total of 109 patients (74 male, 35 female) of a mean age of 51.8 ± 8.8 years were included. The average follow-up was 91 ± 17.4 months. Radiographically, 71 (65.1%) of the stems had been inserted at the appropriate angulation (±3°), and 102 (93.6%) of the cups had been placed in the Lewinnek safety zone. Leg length discrepancy was observed in 19 (17.4%) cases. The mean Merle d'Aubigné-Postel score improved from 13.1 ± 1.39 preoperatively to 17.8 ± 0.49 at 6 months postoperatively (p < 0.001). Merle d'Aubigné-Postel subscales also reflected a statistically significant improvement (p < 0.001). The mean pain score 12 months postoperatively was 0.52 ± 1.22, with 95.4% of patients declaring themselves satisfied or highly satisfied. The expected 13-year survival according to a Kaplan-Meier analysis was 100% in the absence of infection and 91.3% if revision for any cause is taken as a survival endpoint. Conclusions: The shortened stem under analysis provides excellent functional results and long-term survival rates.

Patient tolerance and complication rates of transperineal prostate biopsy with coaxial technique under local anesthesia: initial experience of a single institution.

Due to infectious complications of transrectal prostate biopsy (TRBx), the transperineal prostate biopsy (TPBx) technique is gaining popularity and is the first-line method in many institutions. We share our experience of the first 100 patients with TPBx, performed using the coaxial needle technique under local anesthesia. We retrospectively reviewed the records of the first 100 patients who had undergone TPBx between December 2022 and September 2023. Complication rates, cancer detection rates, patient tolerance, and pain response to the TPBx under local anesthesia at different steps of the procedure were collected. The mean age, total prostate-specific antigen (PSA), prostate volume, and PSA density were 64.5±7.5 years, 8.82±12 ng/mL, 58.4±26.4 mL, and 0.17±0.18 ng/mL2. Prostate cancer (PCa) was detected at histopathological evaluation in 51 patients. The mean positive core number and percentage of cancer involvement per core in patients who have PCa were 5.4±3.2 and 68.5±29.1, respectively. The mean pain score during the entire procedure was 2.85±1.48. When the steps are evaluated separately, the mean pain score during the probe placement step, local anesthetic, and sampling steps were 3.35±1.65, 2.54±1.45, and 0.9±0.82, respectively. Transperineal prostate biopsy with coaxial needle technique under local anesthesia is a well-tolerated procedure with feasible complication rates and patient discomfort.

Outcome after total knee arthroplasty with or without patellar resurfacing

Background: Anterior knee pain is one of the most important nagging factors following ‘total knee arthroplasty’. It requires adequate redressal to avoid patient dissatisfaction, undue psychological stresses and inflated costs due to readmission and reoperation. Aims: To assess the functional outcome prospectively in total knee arthroplasty with or without patellar resurfacing. Materials and Methods: A prospective randomised study involving 25 patients undergoing bilateral total knee arthroplasty (TKA) was carried out to study the outcome after TKA with patellar resurfacing (group I) and without patellar resurfacing (group II). The onlay surgical technique was used for patellar preparation, and a cemented all-polyethylene dome-shaped patellar button with three pegs was used for implantation. The Knee Society Score (KSS), Knee Functional Score (KFS) and visual analogue score were used for clinical assessment. Results: All outcomes were assessed after 1 year of follow-up in both the groups. There was a statistically significant difference between the group I and group II knees in the mean pain score (P &lt; 0.001), 47.8 and 41.2, respectively, in the visual analogue score (P = 0.002), 0.76 and 1.56, respectively, and the mean KSS (P &lt; 0.001), 90.28 and 84.16, respectively. However, there was no difference in the mean pre-operative and post-operative KFS between the two groups (P = 1.000), 45.00 (standard deviation [SD] ± 12.22) and 88.72 (SD ± 10.33), respectively. There was no statistical difference in the complication rates between the two groups. Conclusions: There is a significant improvement in anterior knee pain after patella resurfacing resulting in higher patient satisfaction.

A STUDY TO ASSESS THE EFFECT OF CRYOTHERAPY ON PAIN AND SELECTED BIOPHYSIOLOGICAL PARAMETERS DURING ARTERIOVENOUS FISTULA CANNULATION AMONG PATIENTS ON MAINTENANCE HAEMODIALYSIS

The current study entitled a study to assess the effect of Cryotherapy on pain and selected Biophysiological parameters during arteriovenous fistula cannulation among patients on maintenance Hemodialysis at KMCH, Coimbatore was undertaken, during the year 2010 - 2011 in partial fulfillment of the requirement for the degree of Master of Science in Nursing at KMCH College of Nursing, Coimbatore which is affiliated to Dr. M.G.R. Medical University, Chennai. Objectives: To assess the pain intensity during Xylocaine infiltration. To determine the effect of Cryotherapy on pain and Biophysiological parameters during AV fistula cannulation. To associate the level of pain with selected demographic variables. Design: Repeated Measures design. Setting: Hemodialysis unit of Kovai Medical Center and Hospital, Coimbatore. Sample: Sample size was 50. Conceptual framework: Modified Orlando‟s Nursing process model. Outcome measures: The demographic data was collected from the subjects. The pain intensity was measured during cannulation with Xylocaine and with Cryotherapy using Numerical Pain rating Scale. The investigator recorded the Biophysiological parameters during the procedure. Intervention: Cold application was done prior and during cannulation over on the web between the thumb and index finger of the hand which does not have the AV fistula. Results: The mean pain score with Xylocaine infiltration at arterial site was 4.81 and at the venous site was 4.86.There was a significant reduction in the pain score during cannulation with the application of Cryotherapy. The mean pain score during cannulation after Xylocaine at the arterial site was 1.59 and at the venous site was 1.51 whereas the mean pain score during cannulation after Cryotherapy was 0.96 and 0.92 correspondingly. But there was no statistically significant difference between the values of Biophysiological parameters such as BP, PR and RR during cannulation done with Xylocaine and with Cryotherapy. There was no significant association between pain score and age and gender of the subjects but there was significant association between pain and duration of illness and duration of treatment Conclusion: Cryotherapy is an effective nonpharmacological measure in reducing pain during AV fistula cannulation among Hemodialysis patients.

The Effect of Foot Massage on Comfort and Pain Intensity After Vaginal Delivery

Childbirth is a mother's subjective experience that is very memorable in her life. It is important to maintain maternal comfort so that the process of adapting to motherhood can run well. Pain during postpartum is one of the factors that prevents mothers from having difficulty adapting during the postpartum period, especially in primapara mothers. A pharmacological method that can be given to increase comfort and reduce the intensity of pain is foot massage. The aim of this study was to determine the effect of foot massage on the comfort and intensity of maternal pain after vaginal delivery during the postpartum period. This type of quasi-experimental research sample consisted of 38 respondents and the sampling technique used simple random sampling. This research was conducted at the Independent Early Midwife Practice in Lubuk Pakam. Respondents consisted of 2 groups, namely the intervention group and the control group. The instruments used were questionnaires, Visual Analog Scale (VAS), Post Partum Comfort Scale (PCS). Data analysis used chi-square/Fisher's exact test, independent-samples t test and one-way analysis of variance (ANOVA). The mean maternal comfort score in the intervention group was higher than the control group (143.45 ± 8.96, 119.00 ± 14.65, respectively) with a value of p = 0.000. The mean pain score in the intervention group was lower than the control group (1.36 ± 1.22, 4.95 ± 2.27) and the p value = 0.000. Foot massage is effective in increasing comfort and reducing the intensity of pain after vaginal delivery. The increase in maternal comfort after intervention was 18.34% and the reduction in pain intensity after vaginal delivery was 73%. In this way, midwives can apply foot massage to every mother after vaginal delivery.

Impact of Neck and Shoulder Pain on Health-Related Quality of Life in Adults in Saudi Arabia.

Musculoskeletal pain is widely recognized as a prevalent public health issue that affects individuals of various genders and age groups. This study aimed to assess the influence of neck and shoulderpain on the quality of life (QoL)of adult individuals living in Saudi Arabia. This is a cross-sectional study using an online-administered questionnaire that was distributed via online platforms in Saudi Arabia for the duration between January and June 2023. The 36-Item Short Form Health Survey (SF-36) questionnairewas used to estimate participants QoL. Binary logistic regression analysis was used to identify predictors of better QoL. A total of 6601 participants were involved in this study. The majority of the participants (76.8%, n = 4610) reported that they had muscle tension, stiffness, pressure, or dull pain in the neck and shoulder area. The mean pain score for the study participants was 4.0 (SD: 2.9), which indicates mild degree of pain. When the participants were asked about their health today, the mean score was 5.9 (SD: 3.9), which indicates moderate health status. The mean SF-36 score for the study participants was 58.16 (17.4), which demonstrates moderate quality of life. Binary logistic regression analysis showed that male gender, younger age, being married or divorced, and having lower BMI (less than 25.3 kg/cm2) were predictors of better QoL (p < 0.05). Notwithstanding the participants' moderate evaluations of their current health and quality of life, certain demographic attributes - such as being male, being younger in age, being married, and having a lower body mass index - showed a favorable association with quality of life. Strict interventions and preventative measures are essential for addressing musculoskeletal issues in the neck and shoulder region, as indicated by these findings. Further research should be dedicated to developing tailored interventions that specifically target different demographic cohorts, with the ultimate goal of improving the quality of life for all.

Examining the Prevalence of Musculoskeletal Problems Related to Mobile Phone Usage and Providing Corrective Solutions to Dental Students of Jundishapur University of Medical Sciences, Ahvaz

Objectives: The present study aimed to assess the prevalence of musculoskeletal problems related to mobile phone usage and provide corrective solutions for dental students of Jundishapur University of Medical Sciences, Ahvaz. Methods: The current study was conducted based on an analytical cross-sectional design. In order to collect relevant data, such as the presence of pain in the upper limbs, back, and neck, questionnaires and instrumental methods were used. Students were examined in two groups: the first group included 150 dental students up to the 4th semester, and the second group encompassed 150 dental students from the 5th semester onwards (3rd, 8th, 5th, and 6th year). Data collection instruments were demographic characteristic form, nomophobia questionnaire (NMP-Q), neck disability index (NDI), and Cornell hand discomfort questionnaire (CHDQ). Results: According to the results of the present study, the prevalence of nomophobia among dental students of Jundishapur University of Medical Sciences in Ahvaz was at an average level. The mean NDI score was 16.20, and the mean pain score among the students was 1.72. Moreover, 46.5% of students had pain in the hand area, and the highest amount of pain was reported in the F area. The mean score of Cornell's musculoskeletal disorders was reported as 2.72. Conclusion: Examining the relationship between the pain area and the year of entry to the university demonstrated a significant relationship between the year of entry to the university and the pain area. In this regard, the incoming students 2021-22 had the greatest amount of pain. According to the results of the corrective intervention on skeletal disorders in the wrist and neck region, the mean scores of the variables increased significantly after the intervention and corrective measures.

Costal margin reconstruction for slipping rib syndrome: Outcomes of more than 500 cases and advancements beyond earlier sutured repair technique

ObjectivesTo evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR). MethodsPatients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures. ResultsFour hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively (P < .001). Mean quality of life of 38% improved to 73%, 83%, 88%, 93%, and 95% at the same intervals (P < .001). Preoperatively, 29% of patients chronically used opioid medications. Opioid use dropped postoperatively to 11%, 4%, 4%, 0%, and 0% at the same intervals. Use of nonopioid medications followed a similar pattern. One CMR patient required full revision. ConclusionsSRS is a debilitating, but correctable disorder. Improved pain and quality of life, reduction in chronic opioid use, and freedom from revision surgery suggest that CMR should be considered the standard operation for SRS.

Analysis of Nurses' Pain Assessment Records in Colorectal Surgery: A Retrospective Study

Objective: The study aims to evaluate the effectiveness of pain management, establish a pain profile, and reveal the current state of pain assessment after colorectal surgery. Materials and Methods: A retrospective and descriptive design was used. The research population included the records of patients hospitalized in the general surgery ICU of a hospital between November 2020 and November 2021 after colorectal surgery. The measures were a Descriptive Information Form and a Pain Evaluation Follow-up Form. Results: Patients’ mean age was 61.32±14.21 years. Males were 64.2%. Colon (65.9%) and rectal (34.1%) surgeries had been performed. Postoperative mean pain values were 2.84±1.79 at the 0th-2nd hours and 1.68±1.44 (0-4) at the 37th-48th hours. The values were significantly higher in patients without chronic diseases. Of the nurses, 94.7% used scales with proven validity and reliability, but there were no records about the pain’s location, character, duration, and factors that increased or decreased. Conclusions: Nurses’ records about pain management after colorectal surgery were missing. The records analyzed were not enough to determine the pain profile after colorectal surgery. The role of pain and analgesia records in effective pain management should be considered, and the management of the electronic record system should be supported.

Unconscious Activation of Negative Emotional Memories Increases Pain Unpleasantness.

The influence of unconscious emotional processes on pain remains poorly understood. The present study tested whether cues to forgotten unpleasant images might amplify pain (i.e., in the absence of conscious recall). Seventy-two healthy female adults (19 to 34 years) performed an adapted Think/No-think paradigm (T/NT) using 72 combinations of neutral face images (cues) paired with 36 neutral and 36 unpleasant images. After completion of the T/NT task, cues associated with forgotten neutral or unpleasant images were identified. Cues to either neutral or unpleasant images from the NT condition were then presented in randomized order while participants received intermediate-level thermal pain stimulation on the left hand. Ratings of both pain intensity and unpleasantness were acquired after each trial. Mean pain unpleasantness ratings were greater during presentation of cues to forgotten negative versus neutral images (5.52 [SD = 2.06] versus 5.23 [SD = 2.10]; p = .02). This pattern was also present when comparing cues to remembered negative versus neutral images (5.62 [SD = 1.94] versus 5.04 [SD = 1.90]; p < .001). Mean pain intensity ratings were higher for cues to negative versus neutral images when remembered (5.48 [SD = 1.79] versus 5.00 [SD = 1.69]; p < .001), but not when forgotten (5.27 [SD = 1.96] versus 5.16 [SD = 1.93]; p = .30). Using an adapted T/NT-Pain paradigm, this study demonstrated that cues to nonrecallable (but potentially unconsciously activated) negative emotional memories amplify pain unpleasantness, similar to known effects of conscious negative emotions.

P099 Progression of psychological distress in inflammatory arthritis patients

Abstract Background/Aims Patients with inflammatory arthritis (IA) often present with mental health concerns at the time of diagnosis. Yet, the onset and progression of these psychological challenges throughout the disease’s trajectory remain unclear. Gaining insights into the evolution of mental health issues is crucial, as they can potentially lead to suboptimal disease management, amplified pain experiences, and a diminished quality of life. Our objective was to assess mental health co-morbidity and fibromyalgia severity status in patients with inflammatory arthritis before diagnosis, immediately after, and six months post-diagnosis in order to trace the natural progression of these conditions over time. Methods In this prospective observational study, we collected mental health (GAD7 for anxiety, PHQ8 for depression) and fibromyalgia criteria measures (WPI: Widespread pain index, SSS: symptom severity score) pre-diagnosis (via online form whilst awaiting initial appointment), immediately following diagnosis and six months post-diagnosis. Eligibility criteria were subsequent diagnosis of IA and pain rating ≥3/10 at Guy’s Hospital, London. In addition, demographic data and clinical assessment (DAS28, pain score) were collected immediately following diagnosis. Results 20 patients were recruited between April and November 2022. 50% were female, 65% had RA, and mean age was 51±14 years. Mean DAS 28 was 3.7 ± 1.1, mean fatigue score 39/100 ±31 and mean pain score was 5.3/10 ± 2.1. Mean MSK HQ was 31.2 ±12.7 and mean RAID was 3.9 ±2.5. The time from diagnosis to post-diagnosis assessment averaged 1.6 ±3.4 months, while from pre-screen to post-diagnosis assessment it was 2.9 ±3.7 months. Immediately following diagnosis, 10 patients (50%) screened positive for anxiety and 11 (55%) for depression. Anxiety significantly increased following diagnosis, and then returned to pre-diagnosis levels at six months. Depression and fibromyalgia severity remained similar to pre-screen following diagnosis, but at six months had significantly dropped from pre-screen levels (Table 1). Conclusion Rates of mental health comorbidity in IA at diagnosis are high. Receiving a diagnosis of IA may contribute to heightened anxiety, which reduces again by six months. Depression symptoms and fibromyalgia severity, including widespread pain, remain high following diagnosis but improve after six months, possibly as disease activity improves. Disclosure Z. Rutter-Locher: None. N. Arumalla: None. S. Norton: None. T. Garrood: None. L. Taams: None. K. Bannister: None. B. Kirkham: None.

Comparison of Two Types of Endometrial Scratch before Embryo Transfer and Patient-Reported Pain Scores: A Prospective Randomized Pilot Study

Background: The impact of various methods of endometrial scratch during assisted reproductive technology (ART) is not well established. Objective: To compare patient-reported pain scores and ART outcomes following two types of endometrial scratch prior to embryo transfer. Study design: In this prospective, non-blinded, randomized controlled trial, patients were assigned to either Pipelle or Shepard catheter. The primary outcome was mean pain score. Secondary outcomes included implantation rate (IR) and clinical pregnancy rate (CPR). Results: One hundred seventy transfers were included (Pipelle: n=78, Shepard: n=92). Mean pain scores were significantly lower in the Shepard group compared to the Pipelle group (3.0±2.4 vs. 3.9±2.2, respectively; p=0.01). There was no significant difference in IR (Shepard: 59.7%±52 and Pipelle: 56.5%±48; p=0.9) and CPR (Shepard: 67.6%±47 and Pipelle: 71.8%±45; p=0.6). Conclusions: In our study, the Shepard catheter was a less painful method of endometrial scratch without compromising ART outcomes.

Post-Tonsillectomy Pain:Is Cold Steel Dissection Method or Bipolar Diathermy Dissection Method is less Painful?

Background: Pain is one of the sequel of tonsillectomy, as reported in various studies. Tonsillectomy can be done by various methods, so aim of the present study is to evaluate pain of tonsillectomy comparing cold steel dissection method with bipolar diathermy method.Objective: To evaluate post-tonsillectomy pain comparing cold steel dissection method with bipolar diathermy method.Material and Methods: This prospective, randomized, controlled trial was conducted in ENT Department, from 18th January 2021 to January 30th 2022. Post tonsillectomy pain was measured by using visual analogue scale which consists of a 10 cm line with score of 10 means worse pain and score of zero means no pain. In this study a total sample size was 186 patients (i.e. 93 in each group), who were observed by taking the following parameters. Mean ± SD of group A (bipolar diathermy group) = 2.27 ± 1.25. Mean ± SD of group B (cold steel dissection group) = 1.59 ± 1.59. Confidence interval (2-sided) =95%. Power=90%. More over consecutive (nonprobability) sampling technique was used for sample collection.Results: In bipolar dissection group (38%) patients were male and (62%) patients were female. Where as in cold dissection group (40%) patients were male and (60%) patients were female. The mean pain score at 24 hours, 2ndpost operative day, 7th post operative day among two groups was analyzed. In bipolar dissection group, mean pain score at 24 hours was 3.5 ± 0.66, mean pain score at 2nd post operative day was 2.93 ± 0.73 and mean pain score at 7th post operative was 1.59 ± 1.02. Where as in cold dissection group, mean pain score at 24 hours was 3.33 ± 0.53 with a p value of 0.0543, mean pain score at 2ndpost operative day was 2.34 ± 0.60 with a p value of 0.0001and mean pain score at 7th post operative was 1.46 ± 0.82 with a p value of 0.3394.Conclusion: Our study concludes that mean pain score is less in cold steel dissection tonsillectomy as compared to bipolar diathermy tonsillectomy.Keywords: Analogue pain scale, Surgical Diathermy, Tonsillectomy.

Comparison of therapeutic effects of N-Acetylcysteine with pregabalin in improving the clinical symptoms of painful diabetic neuropathy: a randomized, double-blind clinical trial

ObjectivesPainful diabetic neuropathy (PDN) is highly prevalent and annoyingly in patients with diabetes. The aim of this study was to investigate the effects of oral N-acetylcysteine (NAC) compared to pregabalin in PDN.MethodsOne hundred two eligible patients with type 2 diabetes and PDN were randomly recievied pregabalin (150 mg/day) or N-Acetylcysteine (NAC) (600 mg/ twice a day) for 8 weeks. Mean pain score, Sleep interference score (SIS), Patient Global Impression of Change (PGIC), Clinical Global Impression of Change (CGIC), and also, serum levels of total antioxidant capacity (TAC), total thiol groups (TTG), catalase activity (CAT), nitric oxide (NO), and malondialdehyde (MDA) were assessed at baseline and at the end of the study.ResultsNAC was well tolerated in all patients. The decrease in mean pain scores and increase in SIS was similar between two groups. More improvement in PGIC and CGIC from the baseline was reported in NAC group. NAC, significantly, decreased serum levels of MDA, and NO, but increased TAC, TTG, and CAT. Pregabalin, significantly, decreased serum levels of MDA, and NO and increased TAC.DiscussionNAC is efficacious in alleviate symptoms of PDN which is probably related to its antioxidant effects.Trial registrationThe research protocol received approval from the Ethics Committee of Hamadan University of Medical Sciences (IR.UMSHA.REC.1397.137). The trial registry URL and number in Iranian Registry of Clinical Trials (IRCT): https://www.irct.ir/trial/33313, IRCT20180814040795N2 (Registration date: 2019-01-21, Retrospectively registered)