Median Pain Intensity Research Articles

A Single-Arm Phase 2 Trial of Trametinib in Patients with Locally Advanced or Metastatic Epithelioid Hemangioendothelioma.

Epithelioid hemangioendothelioma (EHE) is a rare vascular cancer with pathogenic TAZ-CAMTA1 (calmodulinbinding transcription activator 1) operating as an oncogenic driver through activation of the MAPK pathway. Trametinib is an inhibitor of MEK, a critical kinase in the MAPK pathway. We sought to evaluate the effect of trametinib in patients with EHE. A phase 2 trial of trametinib was conducted in patients with locally advanced or metastatic EHE. Eligibility requirements included evidence of tumor progression or presence of EHE-related pain requiring opiates for management before enrollment. The primary endpoint was objective response rate (ORR) as per RECIST1.1 in cases with TAZ- CAMTA1 confirmed by fusion-FISH. Secondary objectives were to estimate ORR for all patients, median progression-free survival (PFS), 2-year overall survival (OS) rate, patient safety, and change in patient-reported global health and pain scores per PROMIS questionnaires. 44 patients enrolled and 42 started trametinib. TAZ- CAMTA1 was detected in 27 tumor samples. TheORRwas 3.7%[95% confidence interval (CI), 0.094-19.0], median PFS was 10.4 months (95%CI, 7.1-NA), and 2-year OS rate was 33.3%(95%CI, 19.1-58.2) in the target population. Median pain intensity and interference scores improved significantly after 4 weeks of trametinib in patients using opiates. Common adverse events related to trametinib were rash, fatigue, nausea/vomiting, diarrhea/constipation, alopecia, and edema; one grade 5 ARDS/pneumonitis was related to trametinib. Trametinib was associated with reduction in EHE-related pain and median PFS of more than 6 months, providing palliative benefit in patients with advanced EHE, but the trial did not meet the ORR goal. See related commentary by Van Tine and Haarberg, p. 4552.

Could generative artificial intelligence replace fieldwork in pain research?

Generative artificial intelligence (AI) models offer potential assistance in pain research data acquisition, yet concerns persist regarding data accuracy and reliability. In a comparative study, we evaluated open generative AI models' capacity to acquire data on acute pain in rock climbers comparable to field research. Fifty-two rock climbers (33 m/19 f; age 29.0 [24.0-35.75] years) were asked to report pain location and intensity during a single climbing session. Five generative pretrained transformer models were tasked with responses to the same questions. Climbers identified the back of the forearm (19.2%) and toes (17.3%) as primary pain sites, with reported median pain intensity at 4 [3-5] and median maximum pain intensity at 7 [5-8]. Conversely, AI models yielded divergent findings, indicating fingers, hands, shoulders, legs, and feet as primary pain localizations with average and maximum pain intensity ranging from 3 to 4.4 and 5 to 10, respectively. Only two AI models provided references that were untraceable in PubMed and Google searches. Our findings reveal that, currently, open generative AI models cannot match the quality of field-collected data on acute pain in rock climbers. Moreover, the models generated nonexistent references, raising concerns about their reliability.

Self-reported characteristics of people seeking primary care physiotherapy in Denmark: A cross-sectional study.

Limited knowledge exists on the self-reported characteristics of patients seeking primary care physiotherapy in Denmark. To describe primary symptom site, co-occurrent pain sites, pain intensity, symptom duration, and number of symptom episodes in patients seeking primary care physiotherapy using patient-reported data. Cross-sectional study of patients seeking primary care physiotherapy within a nationwide network of clinics in Denmark (FysioDanmark® ). Data from the FysioDanmark® clinical database with patient-reported information obtained from questionnaires distributed to patients prior to their first consultation were used. This included primary symptom site, co-occurrent pain sites, pain intensity (0-10 numeric rating scale), symptom duration, and number of symptom episodes. Data from 61,097 patients (57% female) aged 42years (interquartile range 29-53) and 63,566 first visits were included. The most common reasons for seeking care were back- (22.9%), non-specific- (19.8%) and shoulder symptoms (15.9%). The majority of patients (89.4%) reported symptoms lasting longer than 7days, and many experienced recurrent episodes. Median pain intensity ranged from 3 to 5 across primary symptom sites and age groups. In general, females reported higher pain intensity than males. Danish patients seeking primary care physiotherapy most commonly presented with back, non-specific, and shoulder symptoms, with mild-to-moderate pain lasting longer than 7days, and many with recurrent episodes.

Treatment delay from onset of occipital neuralgia symptoms to treatment with nerve decompression surgery: a prospective cohort study.

The aims of this study were to (1) evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery, (2) perform a cost comparison analysis between surgical and nonsurgical treatment of occipital neuralgia, and (3) report postoperative results of nerve decompression for occipital neuralgia. Subjects (n = 1112) who underwent screening for nerve decompression surgery were evaluated for occipital neuralgia. Of those, 367 patients (33%) met the inclusion criteria. Timing of occipital neuralgia symptom onset and pain characteristics were prospectively collected. Cost associated with the nonsurgical treatment of occipital neuralgia was calculated for the period between onset of symptoms and surgery. A total of 226 patients (73%) underwent occipital nerve decompression. The average time between onset of occipital neuralgia and surgery was 19 years (7.1-32). Postoperatively, the median number of pain days per month decreased by 17 (0-26, 57%) (P < .001), the median pain intensity decreased by 4 (2-8, 44%) (P < .001), and median pain duration in hours was reduced by 12 (2-23, 50%) (P < .001). The annual mean cost of nonsurgical occipital neuralgia treatment was $28 728.82 ($16 419.42-$41 198.41) per patient. The mean cost during the 19-year time frame before surgery was $545 847.75($311 968.90-$782 769.82). This study demonstrates that patients suffer from occipital neuralgia for an average of 19 years before undergoing surgery. Nerve decompression reduces symptom severity significantly and should be considered earlier in the treatment course of occipital neuralgia that is refractory to conservative treatment to prevent patient morbidity and decrease direct and indirect health care costs.

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study

BackgroundAnalgesia is a core intervention in emergency medicine. Pain is subjective, so patient-reported experience with pain and analgesia is essential for healthcare professionals.The aim of this study was to evaluate patient-reported side effects and satisfaction associated with pre-hospital analgesia with low-dose esketamine.MethodsThis is an observational cross-sectional study conducted as part of quality assurance measures of the German Red Cross Emergency Medical Service, Reutlingen, Germany.The survey was administered to all patients who received prehospital esketamine analgesia from paramedics. Addresses were obtained from medical records and mailed 10 days after the event. Patient feedback was anonymous and could not be linked to operational documentation.ResultsA total of 201 patients were contacted, and 119 responses were received via the online questionnaire and postal mail (response rate 59%). The mean age of the patients was 68±13 years, with 64.7% (n=77) being female. The main diagnosis reported was fractures of the extremities in 69.7%. Patients reported initial median pain intensity on a Numeric Rating Scale (NRS) of 10 [8-10]. Pain was unbearable for 96.3% of patients. After administration of analgesia, 95.3% were satisfied or very satisfied. Patients reported no side effects in 78.5%, minor side effects in 10.0%, significant but well tolerable side effects in 11.3%, borderline tolerable side effects in 0.2%, and no unbearable side effects. Borderline tolerable nausea was reported in 2% of patients along with dreams in 0.8%. No nightmares were reported. Further analysis showed that patients older than 80 years reported significantly more side effects (p < 0.001) and were thus less satisfied with the analgesia.ConclusionsBoth patient perception and analgesia with few side effects were important for both safety and satisfaction. In the present study, low-dose esketamine analgesia was associated with low side effects and high patient satisfaction.

Treatment Delay in Patients Undergoing Headache Surgery (Nerve Decompression Surgery)

Although headache surgery has been shown to be an effective treatment option for refractory headache disorders, it has not been included as part of the headache disorder management algorithm by non-surgical providers. This study aims to evaluate the delay in surgical management of patients with headache disorders. In addition, a cost comparison analysis between conservative and operative treatment of headache disorders was performed, and the surgical outcomes of headache surgery were reported. Among 1112 patients who were screened, 271 (56%) patients underwent headache surgery. Data regarding the onset of headache disorder and pre- and postoperative pain characteristics were prospectively collected. To perform a cost comparison analysis, direct and indirect costs associated with the conservative treatment of headache disorders were calculated. The median duration between onset of headache disorder symptoms and headache surgery was 20 (8.2-32) years. The annual mean cost of conservative treatment of headache disorders was $49,463.78 ($30,933.87-$66,553.70) per patient. Over the 20-year time period before surgery, the mean cost was $989,275.65 ($618,677.31-$1,331,073.99). In comparison, the mean cost of headache surgery was $11,000. The median pain days per month decreased by 16 (0-25) (p<0.001), the median pain intensity reduced by 4 (2-7) (p<0.001), and the median pain duration decreased by 11 hours (0-22) (p<0.001). This study shows that patients experience symptoms of headache disorders for an average of 20 years prior to undergoing headache surgery. Surgical treatment not only significantly improves headache pain but also reduces healthcare costs and should be implemented in the management algorithm of headache disorders.

Effectiveness of single-dose 6 mg pegfilgrastim in mobilizing peripheral blood stem cells in allogeneic hematopoietic cell transplantation donors.

A single injection of 12 mg pegfilgrastim was used to mobilize peripheral blood progenitor cells (PBPCs) from healthy donors in some studies. The purpose of this study was to determine if 6 mg of pegfilgrastim was effective and safe for mobilizing CD34+ cells in donors for allogeneic hematopoietic stem cell transplantation. We conducted a retrospective case-matched design. A single dosage of 6 mg pegfilgrastim was used to mobilize PBPCs from 60 healthy donors. Granulocyte colony-stimulating factor (G-CSF, 10 μg/kg) was administered daily to the matched donors. Leukapheresis was scheduled to commence on day 4 of the mobilization regimen. The median yielded CD34+ cell in the pegfilgrastim group was higher than those in the G-CSF group, at 5.06 × 106/kg recipient weight. The 73.3% of donors mobilized with pegfilgrastim yielded >4 × 106 cells/kg CD34+ cells in a single apheresis procedure when compared to the 33.3% of donors mobilized with G-CSF (P < 0.001). The myeloid-derived suppressor cells (MDSC) proportion in the pegfilgrastim group was significantly higher than that in the G-CSF group (P < 0.001). The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) was higher in the G-CSF group than that in the pegfilgrastim group (26.7% vs. 11.7%), without statistical difference. In comparison to the G-CSF group, the pegfilgrastim group had a reduced median pain intensity numerical rating scale score (1 vs. 2). A single 6 mg dosage of pegfilgrastim is effective and safe for allogeneic PBPCs collection from healthy donors. Pegfilgrastim may decrease the incidence of aGVHD by boosting MDSCs, which need further investigation.

Topical capsaicin 8% patch in peripheral neuropathic pain: Efficacy and quality of life.

Peripheral neuropathic pain (PNP) is one of the most challenging diseases to treat with a significant negative impact on the patients' health-related quality of life (HRQoL). Capsaicin 8% patch has arisen in the last decades as an alternative to oral drugs in the treatment of PNP with fewer side effects and promising results in efficacy. This work aims to evaluate the effectiveness of the topical application of capsaicin in PNP and its impact on patients' HRQoL based on the use of capsaicin in a tertiary hospital of Oporto. This study included 100 patients with localized PNP with poor pain control and without improvement with previous treatments that were treated at least once with an 8% capsaicin patch. Effectiveness on pain relief, number of treatments needed, safety and impact on HRQoL were assessed through a set of questionnaires. Regarding the aetiology of PNP, 67.6% (N = 46) have post-surgery or trauma induced PNP with 64.7% (N = 44) of patients reporting pain in the lower limb. After the treatment, 30.9% (N = 21) felt minimally improved, 22.1 (N = 15) felt much improved and 13.2 (N = 9) felt very much improved. On a scale from 1 to 10, in the week prior to the survey, the median intensity of pain was 6 and the median interference in quality of life was 7. The majority of patients still report limitations in mobility and daily activities and moderate pain. Capsaicin 8% patch is effective in PNP treatment at least in the short term. Repeated applications may be important for long-term analgesia. The low systemic dose and few side effects mean that the treatment is generally well tolerated by patients. Due to the analgesic effect, capsaicin can improve the HRQoL of patients with PNP.

Neurocognitive Functioning in Patients with Painful Temporomandibular Disorders.

To investigate psychosocial factors in painful TMD (pTMD) which could have consequences for mastering chronic pain. Our study included 22 patients (20 women, 2 men) with pTMD, refractory to conservative treatment, and 19 healthy controls. The control group was matched for gender, age, and educational level, and IQ tested on the Wechsler Abbreviated Scale of Intelligence. Neurocognitive function was tested with the Color-Word Interference Test (CWIT). Pain intensity was reported according to the General Pain Intensity Questionnaire (GPI), using the Numeric Rating Scale (NRS). Self-perceived cognitive difficulties were reported by the Perceived Deficits Questionnaire-Depression 5-item (PDQ-5). Two measures of rumination were included: the Rumination-Reflection Questionnaire (RRQ) and the Ruminative Response Scale (RRS). The Montgomery Åsberg Depression Rating Scale Self-report (MADRS-S) was used to measure depressive symptoms, and the Oral Health Impact Profile-TMD (OHIP-TMD) to measure QoL related to oral health. There were no statistical differences in age (median pTMD: 55 years, median control: 53 years), educational level, and IQ between pTMD and controls. Median pain intensity in pTMD was NRS 8 at maximum and the median pain duration was 18 years. There were no significant differences in CWIT between pTMD and controls. Self-perceived cognitive function (PDQ) was significantly poorer in pTMD. Rumination scores from both measures, and the depression score from MADRS, were significantly higher in pTMD. The OHIP-TMD score revealed a significantly poorer QoL in pTMD. The group of pTMD patients have self-perceived cognitive difficulties that may make it more difficult to master chronic pain and common everyday tasks. They reported significantly more self-perceived cognitive difficulties, higher rumination, more depressive symptoms, and lower QoL compared to healthy controls, suggesting that these psychosocial factors could be targeted in treatment and interventions. However, the tested neurocognitive performance was equivalent to the control group.

(088) Fractional Area of Positive CD117 and PGP9.5 Immunostaining of Vestibular Tissue in Patients with Congenital and Acquired Neuroproliferative Vestibulodynia

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is a form of provoked vestibulodynia associated with an increased density of positive CD117 immunostaining (consistent with mast cells) and positive PGP9.5 immunostaining (consistent with nerves) in the vestibule. Genetic factors underlie the pathophysiology of NPV. Vestibular fibroblasts from NPV patients versus age matched controls produce higher proinflammatory cytokine levels of interleukins (IL) when provoked with Candida albicans in vitro that may lead to proliferation of C-afferent nociceptors. Two variants of NPV have been described. Congenital NPV (CNPV) is associated with a history of painful vaginal penetration by anything and positive umbilical hypersensitivity. Acquired NPV (ANPV) is associated with new onset entrance dyspareunia that persists, typically after an allergic reaction to a topical agent or after severe/recurrent candidiasis. A new computer-assisted approach using ImageJ can objectively assess both CD117 and PGP9.5 percent area of positive immunostaining (PAPI) in vestibular tissue. Objective This study compares for the first time immunohistochemical staining with CD117 and PGP9.5 in vestibular tissue from patients with CNPV and ANPV using ImageJ. This may help us better understand any fundamental pathophysiologic differences between the two variants. Methods Vestibular tissue samples from patients with CNPV (n=12) and ANPV (n=13) were formalin-fixed, paraffin-embedded, sectioned (10 μm) and subjected to immunostaining protocols with antibodies to CD117 or PGP9.5. Photomicrographs were obtained using 200x and 400x magnification and fractional area of positive immunostaining was determined using Image J; 3 measurements were performed for each photomicrograph. Pre-operative pain intensity (0 – 10) was assessed in both cohorts with cotton-tipped swab testing throughout the entire vestibule. Duration of symptoms, pain intensity scores, and PAPI between CNPV and ANPV patients were compared by Mann-Whitney test. Aggregate data are reported as median (interquartile range). Results At the time of complete vestibulectomy surgery, median ages of the CNPV and ANPV groups were 22 years (21 – 25) and 28 years (25 – 33), respectively. Median duration of symptoms in ANPV patients was 4.0 years (3.0 – 6.5), significantly shorter than CNPV patients (p&amp;lt;0.0001). Median pain intensity scores were 7.7 (6.5 – 8.2) and 5.4 (3.9 – 8.0) in the CNPV and ANPV groups, respectively (p = 0.0503). PAPI was similar for both PGP9.5 (0.314% vs 0.424%) and CD117 (0.680% vs 0.797%) in CNPV and ANPV patients, respectively. Conclusions In our patients, the density of immunostaining reflective of nerves and mast cells was similar in patients with congenital and acquired forms of NPV despite the median duration of symptoms being approximately 5 times longer in the congenital group. Self-reported pain intensity was nominally higher in CNPV patients but did not reach statistical significance. ANPV may occur later in life but the suspected underlying regional elevation in cytokines in the vestibule of these patients that leads to the increased density of mast cells and the proliferation of C-afferent nociceptors appears likely to be the same in both variants. Future studies should examine potential differences in pain perception between CNPV and ANPV patients. Disclosure No

Interscalene block in the context of enhanced recovery for shoulder: A case series.

The application of enhanced recovery in shoulder surgery has not had such a favorable acceptance, therefore, the objective of this study was to present and describe the use of interscalene block to promote enhanced recovery in a series of patients undergoing shoulder arthroscopic surgery. Thirty-five patients undergoing arthroscopic shoulder surgery were included, in whom interscalene blockade and sedation were administered. Subsequently, pain intensity, nausea, vomiting, dyspnea, presence of Horner's syndrome, blurred vision, hoarseness, time elapsed to discharge, unplanned readmissions, patient satisfaction, and compliance with hospital discharge criteria in the first 12 weeks were evaluated, hours following the criteria of an enhanced recovery. 27 patients (77,1%) had ASA I and 8 patients (22,8%) ASA II, 97,1% were rotator cuff repairs. Before discharge, two patients (5.7%) had nausea. At discharge, no patient had dyspnea or blurred vision, two patients (5.7%) developed hoarseness, and the median pain intensity was 1.0 (0.0-7.0). Between 24 and 48 hours only one patient (2.8%) presented nausea and the median pain intensity was 1.0 (0.0-8.0). All the patients were satisfied with their willingness to repeat the experience, 100% of the patients met the criteria for medical discharge after 12 hours, 30 patients (85.7%) were discharged the same day, the stay was 12 (11.5 to 12.5) hours, and no patient was readmitted. In selected patients with a committed, trained and experienced surgical-anesthetic team, there is a high possibility that the interscalene block will favor the performance of enhanced recovery programs in shoulder arthroscopic surgery.

45. Outcomes of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface in Oncologic Amputees: The MD Anderson Cancer Center Experience

PURPOSE: The outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in oncologic amputees have been limited to small series. Herein, we report the MD Anderson experience with the surgical and postamputation outcomes of TMR and RPNI in the oncologic population. METHODS: We conducted a retrospective cohort study of consecutive patients who underwent oncologic amputation followed by TMR or RPNI from November 2018 to May 2022. Patient-reported Outcomes Measurement System (PROMIS) and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained and compared with published benchmarked outcomes. RESULTS: We compared 68 patients with oncologic amputation at our institution with 727 patients with benchedmarked outcomes. Patients had mean follow-up period of 10.9±8.7 months. Oncologic amputees experienced significant reductions in pain intensity (-5.39; 95%CI,-4.28, -6.50; p<0.001), interference (-11.98; 95%CI, -8.19, -15.8; p<0.001), behavior (-32.95; 95%CI, -25.5,-40.4; p<0.001) and global health (-26.25; 95%CI, -22.09, -30.42; p<0.001) following TMR or RPNI from baseline to final follow-up. Delayed wound healing was the most common complication (14.7%) and tumor recurrence occurred in 36.8% of patients. Compared with benchedmarked outcomes, oncologic amputees who underwent TMR or RPNI demonstrated significantly lower median PLP (0.0 vs. 4.0, p<0.001), RLP (1.0 vs. 4, p<0.001), pain intensity (6.0 vs. 46.6, p<0.001), pain interference (9.5 vs. 55.9, p<0.001), and pain behavior (36.0 vs. 56.7, p<0.001) scores. CONCLUSION: Oncologic amputees who underwent TMR and RPNI demonstrated significant reductions in postamputation pain compared with their baseline and benchedmarked outcomes with relatively low postoperative complications rate.

INVESTIGATING THE EFFECTS OF FATIGUE PROTOCOL ON SPATIOTEMPORAL CHARACTERISTICS OF GAIT IN PATIENTS WITH CHRONIC NECK PAIN

Purpose: Chronic neck pain (CNP) may lead to problems, such as functional limitations, disability, and fatigue. Gait maintains postural orientation; It is important to investigate the effects of fatigue on walking in patients who subjectively define a certain level of fatigue, not for a certain period. This study aimed to investigate the effects of fatigue protocol on gait spatiotemporal characteristics in patients with CNP.&#x0D; Methods: Fifty-three patients with CNP, and twenty-six healthy controls were included. The groups were matched with Propensity Score Matching in terms of age and fatigue threshold as 26 individuals. Pain intensity and disability were evaluated with the Visual Analog Scale, and Neck Disability Index, respectively. Gait assessment was recorded with OptoGait (1.6.4.0, Microgate, Bolzano, Italy) for one minute while individuals walked at their preferred speed on the treadmill. Individuals keep walking on the treadmill and fatigue levels were asked for Modified Borg Scale. While fatigue reached 4 points, gait assessment was recorded for one minute. A two-way repeated-measures ANOVA was used for interaction time-by-group.&#x0D; Results: The median pain intensity was 7(4-9), and the disability was moderate in patients. Left step length, stride length, and cadence, showed significant, similar changes within the groups over time(p

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study.

This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy. A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05. Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up. Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up.

Efficacy of Cryotherapy in Comparison to Standard Oral Care to Prevent Oral Mucositis during Concurrent Chemoradiotherapy in Head and Neck Cancer Patients

A quasi-experimental study was conducted at Radiation Oncology Department of National Institute of Cancer Research &amp; Hospital (NICRH), Dhaka, Bangladesh, between November 2020 and October 2021, to determine the efficacy of cryotherapy in comparison to standard oral care to prevent oral mucositis in head and neck cancer patients during receiving CCRT. A total 100 Patients (50 patients in each arm) were included in this study according to inclusion and exclusion criteria by purposive sampling technique. All patients in Arm A and Arm B received total 66 Gray in 33 daily fractions, 1 fraction per day, 5 fractions per week and inj. Cisplatin 40mg/m² was given intravenously 2/3 hours before radiotherapy on 1st day and then weekly. Arm A received cryotherapy and Arm B received standard oral care. Intervention started from the 1st day of CCRT up to the end of CCRT. WHO oral mucositis grading and visual analogue scale (VAS) were employed to determine the effects. All the information was recorded in a pre-tested semi-structured questionnaire. Total 100 patients (50 patients in each arm) were enrolled. Mean age of the patients of Arm A and Arm B was 55.28±7.82 and 55.92±8.33 respectively. Male and female ratio was 6.14:1 in two Arms. Other demographic profile, baseline characteristics were statistically not significant in both arms (P&gt;0.05). The grade-3 mucositis appeared after 5th week in Arm B and after 6th week in Arm A. The incidence of grade- 3 mucositis after 5th week during CCRT to 4 weeks after completion of therapy was 6% vs 0%, 14% vs 6%, 22% vs 10%, 14% vs 6%, 8% vs 2%, respectively for arm B and Arm A (P&lt;0.05). Total number of patients suffering from grade 3 mucositis was 6 (12%) and 12 (24%) for Arm A and Arm B respectively (p value was &lt;0.05). The mean duration of grade-3 or more mucositis between Arm A and Arm B was 2.04±1.78 and 10±1.72 days respectively (P&lt;0.05). The difference of median pain intensity between two arms was not statistically significant for 1st and 2nd week (P&gt;0.05). However, it was significant after 3rd week during CCRT to 4 weeks after completion of CCRT (P&lt;0.05). Cryotherapy during CCRT may be beneficial to prevent oral mucositis and pain than maintaining standard oral care.&#x0D; CBMJ 2023 January: vol. 12 no. 01 P: 03-11

Determinants of satisfaction with acute pain therapy during and after childbirth.

An important task in obstetrics is to offer patients adequate pain management after vaginal delivery (VD) and after cesarean section (CS). The aim of the present analysis was to assess pain intensity at the day after childbirth, after 3 and 6 months in women after VD and after CS. Additionally, it was planned to identify determinants of maternal satisfaction with acute pain therapy following VD and CS. This secondary analysis of asingle-center prospective cohort study included 210 parturients. The women gave birth in the University Hospital of Wuerzburg. They completed asurvey before childbirth(P), on the first day (D1), 3and 6months after VD and CS. The survey included questions about the expected pain, the experienced pain, the birth, the pain afterwards and also psychological questionnaires. In addition, information was collected from the patient records. Women with planned CS received spinal anesthesia. Asecondary CS was performed with an epidural, spinal or general anesthesia. Pain therapy on the ward was standardized. The primary outcomes were acute and chronic pain intensity at rest, during movement, determinants of satisfaction with pain therapy and the wish to have received more pain medication during and after VD and CS (D1). A total of 175women completed the survey at all time points and were available for the analysis (drop-out 16.8%). The results confirmed high pain levels at D1 after CS (median pain intensity during movement: 8NRS points, interquartile range, IQR 6-9 points). After VD pain scores were much lower (median pain intensity during movement:4 points, IQR 2-5 points). Of the mothers 7.4% reported pain at rest at all time points after VD or CS but pain intensity was low after3 and 6months (median pain intensity at rest:2 points, IQR 0-3 points), 28% received extended-release opioids after CS and 33% of women (VD and CS) had an epidural. The most important influencing factor for lower satisfaction with pain therapy after CS or VD was inadequate pain relief. Women with VD who had an epidural, were more satisfied during delivery than women without but there was no difference at D1. This study confirmed high acute pain levels following CS and an incidence of chronic pain of around 7% but pain intensity was low and one third received strong opioids after CS. Around 11% of women after primary CS (8% epidural, 3% combined spinal/epidural) and around 55% of women after secondary CS had an epidural, which could be used for pain therapy after birth. Women without an epidural or without opioids may not have had good pain management. The received pain relief appeared to be the most relevant predictor for satisfaction and the wish to have received more pain medication. Mothers having aVD with an epidural catheter were more satisfied with pain therapy during birth than those without. Therefore, abetter multimodal pain management (including opioids, epidural and nonopioids) might provide better pain relief and might improve overall satisfaction with pain treatment following CS. Finally, the received pain relief might be abetter patient-related outcome measure for satisfaction with pain treatment after childbirth than pain intensity alone.

Chronic low back pain prevalence in Federal Highway Police Officers: A cross-sectional study.

Police officers are exposed to specific occupational tasks, which require lifting, trunk flexion and rotation, carrying weight, and frequent standing periods, which may be associated with an increased risk of experiencing low back pain (LBP). To describe the prevalence and intensity of chronic LBP (CLBP) in Brazilian Federal Highway Police officers (FHPO) from the Rio Grande do Sul state and evaluate its associated factors. A total of 208 FHPOs participated in this study. The participants answered an electronic questionnaire containing sociodemographic, behavioral, and occupational questions, and CLBP history. Data analysis comprises descriptive statistics and Poisson regression models. Most of the FHPO were male, aged 41 or more, lived with a partner and were physically active. Sixty-seven percent of FHPO had CLBP, and the median pain intensity was 3.0 (IQR = 0- 5). Participants who lived with a partner were less likely to report CLBP (PR = 0.80; 95% CI = 0.64; 0.99). On the other hand, those who worked as FHPO for more than 11 years were more likely to report CLPB (PR = 1.32; 95% CI = 1.06; 1.63), and high pain intensity (β= 0.95; 95% CI = 0.19; 1.71). The high CLBP prevalence among FHPO from Rio Grande do Sul state indicates a need to highlight the importance for police organizations to promote CLBP prevention and implement workplace management programs.

Differences in Pain Assessments Between Inpatients and Nurses Leads to Considerable Misestimated Pain

BACKGROUND: Pain assessments are an important aspect of health care quality because the high prevalence of pain in inpatients may contribute to complications. Several studies revealed a gap in the pain intensity evaluated by nurses (PEN) and patients (PEP). The aim of the present study was to analyze the correlation and agreement between pain assessments conducted by nurses and patients, and to determine patients at high risk of misestimated pain. OBJECTIVES: To compare the difference of pain intensity between the questionnaires conducted by additional assessors and electronic records by nursing staff. STUDY DESIGN: A retrospective study. SETTING: A medical center in Taichung, Taiwan. METHODS: We approached 1,034 patients admitted from January 1, 2018 to December 31, 2018 in our hospital. We compared the assessments of pain intensity using questionnaires conducted by additional assessors with those entered into electronic records by nursing staff. Continuous data were reported as the mean (± standard deviation). The analysis of agreement and correlation were performed by kappa statistics or weighted kappa statistics, and correlation (Spearman rank correlation method). RESULTS: Among the 1,034 patients, 307 patients were excluded. Thus, the final analysis included 686 patients. Patients’ median pain intensity was 5 in PEP and 1 in PEN. The patients’ pain intensity was underestimated (PEN &lt; PEP) in 539 patients (78.6%), matched (PEN = PEP) in 126 patients (18.3%), and overestimated (PEN &gt; PEP) in 21 patients (3.1%). The surgical interventions (chi squared = 7.996, and P = 0.018) and pain in the past 24 hours (chi squared = 17.776, and P &lt; 0.001) led to a significant difference. LIMITATIONS: The limitation of the study was the single-center and retrospective design. CONCLUSIONS: The gap in pain assessments between inpatients and nurses is an important issue in daily practice. The underestimations of pain were more common than overestimations (78.6% vs 3.1%). Surgical interventions and persistent pain lasting over 24 hours were high risk factors for underestimation, but patients’ gender, receiving anesthesia, type of anesthesia, and patient-controlled analgesia did not contribute significantly to differences in pain estimation. KEY WORDS: Pain, assessment, correlation, agreement

Lidocaine transdermal patches reduced pain intensity in neuropathic cancer patients already receiving opioid treatment

BackgroundLimited efficacy has been observed when using opioids to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in postherpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to investigate a treatment for cancer-related neuropathic pain.MethodsWe conducted a prospective, open-label, single-arm study to assess the efficacy and safety of lidocaine transdermal patches in patients experiencing localized, superficial, neuropathic cancer pain. Terminal cancer patients already receiving opioid treatment participated in the 3-day study. The primary endpoint was pain intensity evaluated by the numerical rating scale (NRS). The secondary endpoints were the pain relief score and the quality of analgesic treatment.ResultsThe results showed a significant difference in the median NRS over 3 days (Kruskal–Wallis test, p < 0.0001). The median NRS pain intensity from Day 1 to Day 3 was 4.0 with 95% C.I. (3.3, 5.0), 3.0 (2.5, 3.5), and 2.6 (2.0, 3.0), respectively. The difference between the median NRS pain intensities of any 2 days was significant (Wilcoxon signed-rank test, p < 0.0001). The generalized estimating equation (GEE) estimation model showed significant differences between the NRS pain intensities on any 2 days. There was no significant difference in the pain relief score or the quality of analgesic treatment.ConclusionsIn this study, the 5% lidocaine transdermal patch reduced the NRS pain intensity in neuropathic cancer patients already receiving opioid treatment. Treatment of localized and superficial neuropathic pain caused by cancer was well tolerated and effective.

Evaluating the Efficacy of Low Dose Radiotherapy in the Treatment of Painful, Benign Musculoskeletal Conditions

Introduction: Inflammatory diseases of the locomotor system are a very heterogeneous group of ailments, including enthesopathies. They arise as a result of long-term overload in the area of tendon attachments, which may lead to chronic inflammation and then, degeneration, which are the cause of chronic pain. The main methods of treatment are physiotherapy, physical agents treatment, pharmacological and orthopaedic treatment, i.e. manual therapy, the use of appropriate insoles correcting posture defects, cryotherapy, shock waves, iontophoresis, non-steroidal anti-inflammatory drugs, steroid injections, surgery and platelet-rich plasma therapy. Another, lesser-known method of treatment is low-dose radiation therapy (LDRT). Research objective: To evaluate the efficacy, time to improvement and analgesic effect duration after low dose radiotherapy (LDRT) in patients with enthesopathies. Materials and methods: A retrospective analysis included a group of 90 patients (51 women, 39 men) with a diagnosis of enthesopathy and treated with conformal radiotherapy using photon radiation at the NIO in Kraków from July 2018 to April 2021. The treated group included patients with heel, elbow, knee, shoulder and wrist problems. In each case, the total dose of radiation was 6 Gy, divided into 6 fractions administered on subsequent working days, given in a vacuum form to the patient immobilised. Pain was assessed with the use of an 11-point numerical rating scale (NRS). Pain was assessed by implementing the above mentioned scale prior to the commencement of radiotherapy, during the treatment, and then 1 month and 6 months following the completion of treatment. Results: In the vast majority of patients (92%), with a mean age of 51 years, at least temporary, partial improvement of pain has been demonstrated in the irradiated joints. The median time to treatment response was 30 days. Median pain intensity, as measured via the NRS scale, was 8.0 (IQR 7.0-10.0) before the treatment, 5.0 (IQR 3.0-7.0) after 1 month, and 2.0 (IQR 0-4.0) after 6 months from treatment completion. Persistent improvement in pain control after LDRT was shown in 85% of patients, with a mean follow-up period of 522 days (range: 55-952 days). The best response was observed in patients with heel spurs (a decrease of median NRS score by 7.0). Conclusions: Low dose RT is a very effective method of pain reduction in enthesopathies, particularly among patients with heel spurs. Most patients experienced pain reduction as early as 1 month after LDRT. Continuous pain reduction was observed during the follow-up period up to the 6th month and in most cases, the analgesic effect was long-lasting.