Mild Chronic Pain Research Articles

Patterns and predictors of recurrent acute care use among Medicaid beneficiaries with systemic lupus erythematosus

ObjectivesWe aimed to identify longitudinal patterns and predictors of acute care use (emergency department [ED] visits and hospitalizations) among individuals with SLE enrolled in Medicaid, the largest U.S. public insurance. MethodsUsing Medicaid data (29 states, 2000–2010) we identified 18–65-year-olds with SLE (≥3 SLE ICD-9 codes, 3rd code=index date), ≥12 months of enrollment prior to the index date and ≥24 months post. For each 90-day interval post index date, patients were assigned binary indicators (1=≥1 ED visit or hospitalization, 0=none). We used group-based trajectory models to graph patterns of overall and SLE-specific acute care use, and multinomial logistic regression models to examine predictors. ResultsAmong 40,381 SLE patients, the mean age was 40.8 (SD 11.9). Using a three-group trajectory model, 2,342 (6%) were recurrent all-cause high acute care utilizers, 12,932 (32%) moderate, 25,107 (62%) infrequent; 25% were moderate or high utilizers for SLE. There were higher odds of all-cause, recurrent acute care use (vs. infrequent) among patients with severe vs. mild SLE (OR 3.37, 95% CI 3.0–3.78), chronic pain (odds ratio [OR] 1.63, 95% CI 1.15–2.32), depression (OR 1.90 95% CI 1.74–2.09), and cardiovascular disease (OR 2.29, 95% CI 2.08–2.52). Older age, male sex and hydroxychloroquine use were associated with lower odds of recurrent overall and SLE-specific acute care use. ConclusionNearly 40% of Medicaid beneficiaries with SLE are recurrent all-cause acute care utilizers; 25% have recurrent use for SLE. Modifiable factors, including outpatient management of SLE and comorbidities, may reduce avoidable acute care use.

Development and evaluation of an 1-day Acceptance and Commitment Therapy workshop for Veterans with comorbid chronic pain, TBI, and psychological distress: Outcomes from a pilot study

ObjectivesTo 1) develop and refine a 1-day trans-diagnostic psychotherapeutic “ACT on Life” workshop tailored for Veterans with mild traumatic brain injury, stress-based psychopathology, and pain; 2) examine the feasibility, acceptability, and preliminary effects of this intervention. SettingA Veterans Health Administration medical center. ParticipantsVeterans returning from Operations Iraqi Freedom, Enduring Freedom, and New Dawn with mild TBI, stress-based psychopathology, and chronic pain. DesignPhase I involved development of the intervention by experts and subsequent refinement based on Veteran feedback (N = 11). Phase II was a pilot randomized controlled trial comparing the effects of the revised intervention (N = 20) to treatment as usual (TAU; N = 12). Main measuresFor phase I, qualitative feedback at 2 weeks and 3 months post-workshop was obtained from Veterans. For phase II, quantitative measures included the PTSD Checklist, Depression Anxiety and Stress Scale, Military-to-Civilian Questionnaire, WHO-Disability Assessment Schedule, Brief Pain Inventory, Acceptance and Action Questionnaire. ResultsVeterans found the workshop acceptable, innovative and useful. Quantitative data from phase II suggested that participants in the ACT group, relative to TAU, showed improvement in psychiatric symptoms, functioning, and reintegration 3 months post-workshop. Unexpectedly, pain interference was lower in the TAU group at follow-up. ConclusionsPreliminary results support the feasibility, acceptability, and promising effects on psychological distress and community reintegration of this 1-day, transdiagnostic workshop for Veterans. Future research examining the effectiveness of this workshop with a larger sample size is necessary.

The impact of factor infusion frequency on health-related quality of life in people with haemophilia

Abstract Background Some studies suggest that people with haemophilia (PwH) who use prophylaxis value low frequency of clotting factor administration more than a lower risk of bleeding. However, more frequent infusions offer the potential of reducing joint disease and pain, which in turn may improve functioning and quality of life. Aims To explore the impact on health-related quality of life (HRQoL) aspects of haemophilia associated with adherence and annual infusion rate in the context of factors influencing treatment that are important to patients, including prophylaxis, chronic pain, concomitant conditions and hospital admission. Materials and methods HRQoL was assessed in participants with severe haemophilia in the ‘Cost of Haemophilia in Europe: a Socioeconomic Survey’ (CHESS) study who were using prophylaxis. Patients using on-demand treatment were excluded. This multivariate analysis examined the interaction between factors potentially influencing treatment and HRQoL, and minor and major bleeds. Results From the total CHESS population (n=1,285), 338 (26%) participants provided responses for major and minor bleeds and target joints, and 145 (11%) provided EQ-5D-3L responses. Major and minor bleeds were associated with pain. Patients with severe chronic pain reported a substantial negative impact on HRQoL; but this was significantly improved by increases in the annual infusion rate. This was not apparent in participants with mild or moderate pain. Conclusion Increasing the frequency of prophylaxis infusions is associated with improved quality of life in PwH who have severe chronic pain. However, increasing the number of infusions per week in those with mild or moderate chronic pain with the intention of improving prophylactic effect may not have the same effect.

A Novel Use of Fully Absorbable PhasixTM Mesh for Laparoscopic Inguinal Hernia Repair

Background and Objectives:An inguinal hernia is usually repaired with synthetic nonabsorbable mesh, resulting in collagen formation, chronic inflammation, and fibrosis, with significantly reduced hernia recurrence. However, chronic pain may affect the quality of life. Poly-4-hydroxybutyrate (P4HB) mesh was introduced to minimize complications, and starts to degrade in 12–18 months. This study assesses the consequences and results of patients undergoing transabdominal preperitoneal (TAPP) inguinal hernia repair using P4HB mesh (PhasixTM, C.R. Bard Inc., Murray Hill, NJ, USA).Methods:We performed a pilot study of laparoscopic TAPP repair for inguinal hernias using P4HB mesh in 15 patients (14 male and one female) with an average age of 55.8 y, and an average body mass index of 27.4 kg/m2. We assessed the recurrence rate and patients' chronic pain for 30 months, with institutional review board approval (E-19–3735). The study was conducted from January 2016 to July 2017 in Medical City, King Saud University. We measured postoperative pain, reactions, mesh sensation, discomfort, and recurrence.Results:In 15 patients, we encountered no recurrence or mesh sensation, except in one patient, who experienced mild chronic inguinal pain for one year, without activity restrictions.Conclusion:Laparoscopic TAPP inguinal hernia repair using P4HB mesh is safe for combined, direct (medial), and indirect (lateral) inguinal hernia, with no recurrence. P4HB absorbable mesh caused less chronic pain and discomfort. Longer follow-up, more patients and 15 patients repaired using synthetic mesh are necessary to assess the utility of P4HB for inguinal hernia repair globally.

Association between severity of depressive symptoms and chronic knee pain in Korean adults aged over 50 years: a cross-sectional study using nationally representative data

ObjectivesTo identify the association between the presence and severity of depressive symptoms and those of chronic knee pain.DesignA retrospective cross-sectional study.ParticipantsWe used data from the sixth Korea National Health and...

An Approach to the Management of Bilateral Posterior Shoulder Dislocations Following Seizure: Case Report, Literature Review, and Proposed Treatment Algorithm

Bilateral posterior shoulder dislocations in patients with seizure disorders are an uncommon injury that is difficult to treat. Surgery is typically required and impaction lesions often require bone reconstruction procedures. Seizures in the early postoperative period can have disastrous consequences when bone restoration procedures are disrupted. However, delaying treatment of persistent instability can cause further joint damage and bone loss potentially leading to the need for humeral head replacement. Our purpose is to introduce an approach to treating the young patient who presents with bilateral posterior dislocations related to a seizure. We report a case, describe the surgical techniques used, and propose an algorithm for managing the treatment of a young patient who presents with bilateral posterior dislocations related to a seizure. At her most recent follow-up (57 mo postoperative for the left shoulder and 41 mo postoperative for the right shoulder), she denied any apprehension or instability in either shoulder and had no further dislocations. She reported mild chronic pain in both shoulders, worse in the right than the left. She has a smooth passive range of motion with no crepitus in either shoulder. Her range of motion in forward elevation/external rotation/internal rotation is 150/45/L3 on the left and 50/150/L3 on the right. Strength is 5/5 in all planes and her subscapularis is clinically intact bilaterally. Our case illustrates the importance of early surgical intervention, resulting in functional, stable shoulders even in the face of medically and surgically intractable epilepsy. This algorithm highlights the importance of multidisciplinary cooperation and early surgical intervention to minimize bone loss and avoid joint replacement.

Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain.

Drawing on advances in chronic pain metrics, a simplified Graded Chronic Pain Scale-Revised was developed to differentiate mild, bothersome, and high-impact chronic pain. Graded Chronic Pain Scale-Revised was validated among adult enrollees of 2 health plans (N = 2021). In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 40.5%: 15.4% with mild chronic pain (lower pain intensity and interference); 10.1% bothersome chronic pain (moderate to severe pain intensity with lower interference with life activities); and 15.0% high-impact chronic pain (sustained pain-related activity limitations). Persons with mild chronic pain vs those without chronic pain showed small differences on 10 health status indicators (unfavorable health perceptions, activity limitations, and receiving long-term opioid therapy), with nonsignificant differences for 7 of 10 indicators. Persons with bothersome vs mild chronic pain differed significantly on 6 of 10 indicators (eg, negative pain coping beliefs, psychological distress, unfavorable health perceptions, and pain-related interference with overall activities). Persons with high-impact chronic pain differed significantly from those with mild chronic pain on all 10 indicators. Persons with high-impact chronic pain, relative to those with bothersome chronic pain, were more likely to have substantial activity limitations (significant differences for 4 of 5 disability indicators) and more often received long-term opioid therapy. Graded Chronic Pain Scale-Revised strongly predicted 5 activity-limitation indicators with area under receiver operating characteristic curve coefficients of 0.76 to 0.89. We conclude that the 5-item Graded Chronic Pain Scale-Revised and its scoring rules provide a brief, simple, and valid method for assessing chronic pain.

Integrating Mind Body Skills and Physical Activity in Older Adults With Mild Cognitive Impairment (MCI) and Chronic Pain

Integrating Mind Body Skills and Physical Activity in Older Adults With Mild Cognitive Impairment (MCI) and Chronic Pain

Auricular acupressure therapy for mild or moderate chronic non-cancer pain: a systematic review

Objective To evaluate the effects of auricular acupressure therapy (AAT) on mild or moderate chronic non-cancer pain and the implementation measures so as to provide a basis for implementing and spreading AAT standardly. Methods Randomized controlled trials (RCTs) on AAT for mild or moderate chronic non-cancer pain were retrieved in Chinese National Knowledge Infrastructure (CNKI) , Wanfang database, VIP database, PubMed, Web of Science and Embase. Two researchers independently screened literatures based on the inclusion and exclusion criteria, extracted data, evaluated literature quality and carried out descriptive analysis on effects and implementation measures of AAT for pain. Results A total of 12 RCTs were included which showed that AAT could ease pain. Most researches selected nervous system and pain area auricular points in the meantime, took vaccaria segetalis seeds as AAT material, carried out acupressure by adult patients with the appropriate strength when feeling sour, numbness, swelling and hot. There were no unified results in the times of auricular acupressure per day, pressing time each time, bean-pressing in both or single ears, but the three aspects presented a certain trend. Conclusions In most cases, the application of AAT for mild or moderate chronic non-cancer pain can ease pain. Nurses should pay attention to auricular point selection, AAT material, AAT duration, times of auricular acupressure per day, pressing time each time, bean-pressing in both or single ears, pressure strength and patient education so as to achieve the best treatment effects. Key words: Pain; Auricular acupressure therapy; Mild pain; Moderate pain; Chronic non-cancer pain; Systematic review

Surgical treatments for women with stress urinary incontinence: the ESTER systematic review and economic evaluation.

Urinary incontinence in women is a distressing condition that restricts quality of life and results in a large economic burden to both the NHS and women themselves. To evaluate the clinical effectiveness, safety and cost-effectiveness of surgical treatment for stress urinary incontinence (SUI) in women and explore women's preferences. An evidence synthesis, a discrete choice experiment (DCE) and an economic decision model, with a value-of-information (VOI) analysis. Nine surgical interventions were compared. Previous Cochrane reviews for each were identified and updated to include additional studies. Systematic review methods were applied. The outcomes of interest were 'cure' and 'improvement'. Both a pairwise and a network meta-analysis (NMA) were conducted for all available surgical comparisons. A DCE was undertaken to assess the preferences of women for treatment outcomes. An economic model assessed the cost-effectiveness of alternative surgeries and a VOI analysis was undertaken. Data from 175 studies were included in the effectiveness review. The majority of included studies were rated as being at high or unclear risk of bias across all risk-of-bias domains. The NMA, which included 120 studies that reported data on 'cure' or 'improvement', showed that retropubic mid-urethral sling (MUS), transobturator MUS, traditional sling and open colposuspension were more effective than other surgical procedures for both primary outcomes. The results for other interventions were variable. In general, rate of tape and mesh exposure was higher after transobturator MUS than after retropubic MUS or single-incision sling, whereas the rate of tape or mesh erosion/extrusion was similar between transobturator MUS and retropubic MUS. The results of the DCE, in which 789 women completed an anonymous online questionnaire, indicate that women tend to prefer surgical treatments associated with no pain or mild chronic pain and shorter length of hospital stay as well as those treatments that have a smaller risk for urinary symptoms to reoccur after surgery. The cost-effectiveness results suggest that, over a lifetime, retropubic MUS is, on average, the least costly and most effective surgery. However, the high level of uncertainty makes robust estimates difficult to ascertain. The VOI analysis highlighted that further research around the incidence rates of complications would be of most value. Overall, the quality of the clinical evidence was low, with limited data available for the assessment of complications. Furthermore, there is a lack of robust evidence and significant uncertainty around some parameters in the economic modelling. To our knowledge, this is the most comprehensive assessment of published evidence for the treatment of SUI. There is some evidence that retropubic MUS, transobturator MUS and traditional sling are effective in the short to medium term and that retropubic MUS is cost-effective in the medium to long term. The VOI analysis highlights the value of further research to reduce the uncertainty around the incidence rates of complications. There is a need to obtain robust clinical data in future work, particularly around long-term complication rates. This study is registered as PROSPERO CRD42016049339. The National Institute for Health Research Health Technology Assessment programme.

A 12-year experience of using the Kugel procedure for adult inguinal hernias via the internal ring approach.

Kugel procedure is a classic preperitoneal herniorrhaphy via the posterior approach for inguinal hernias but it has a steep learning curve. The aim of the study is to evaluate the efficacy of the Kugel procedure via the internal ring approach. Kugel procedures via the internal ring approach were performed on 3673 patients with inguinal hernias between September, 2005 and August, 2017. Demographic data, peri-operative data and postoperative data were collected to evaluate of the efficacy of this technique. None of the patients with inguinal hernias who underwent the Kugel procedure via the internal ring approach was converted to other procedures. The mean operation time for a unilateral hernia was 46.3 ± 15.2min, with a mean blood loss of 28.9 ± 10.5mL. The mean visual analogue scale score on postoperative day 1 was 3.1 ± 0.9. Drainage tubes were placed in 266 patients and were removed after a mean duration of 2.8 ± 0.5days. The mean postoperative hospital stay was 1.2 ± 0.8days. There were no serious intra-operative complications. Postoperative complications included seroma (n = 84), haematoma (n = 28), ecchymosis (n = 33), superficial incision infection (n = 1), recurrence (n = 1) and mild chronic pain (n = 11). The Kugel procedure via the internal ring approach is a safe, feasible and cost-effective technique for inguinal hernias that retains the benefits of the standard Kugel procedure and is easier to master.

Untangling chronic pain and post-concussion symptoms: the significance of depression

ABSTRACTObjectives: Post-concussion-like symptoms (PCS) are common in patients without a history of brain injury, such as those with chronic pain (CP). This exploratory study examined neuro-cognitive and psychological functioning in patients with PCS following mild traumatic brain injury (mTBI) or CP, to assess unique and overlapping phenomenology.Methods: In this case-control study, participants (n = 102) with chronic symptoms after mTBI (n = 45) were matched with mTBI recovered (n = 31) and CP groups (n = 26), on age, gender, ethnicity and education. Psychological status, cognitive functioning, health symptoms, beliefs and behaviours were examined.Results: Participants who had not recovered from an mTBI and participants with CP did not differ in terms of PCS symptoms, quality of life, distress or illness behaviours, however, the CP group endorsed fewer subjective cognitive problems, more negative expectations about recovery and more distress (p < 0.05). On cognitive testing participants who had not recovered from an mTBI demonstrated greater difficulties with attention (p < 0.01) although differences disappeared when depression was controlled in the analyses.Conclusions: Unique patterns associated with each condition were evident though caution is required in attributing PCS and cognitive symptoms to a brain injury in people with mTBI presenting with chronic pain and/or depression. Psychological constructs such as illness and recovery beliefs appear to be important to consider in the development of treatment interventions.

Effect of high-frequency repetitive transcranial magnetic stimulation on chronic central pain after mild traumatic brain injury: A pilot study.

Central pain can occur following traumatic brain injury, leading to poor functional recovery, limitation of activities of daily living, and decreased quality of life. The aim of this study was to determine whether high-frequency (10 Hz) repetitive transcranial magnetic stimulation, applied over the primary motor cortex of the affected hemisphere, can be used to manage chronic central pain after mild traumatic brain injury. Prospective randomized feasibility study. Twelve patients with mild traumatic brain injury and chronic central pain were randomly assigned to transcranial magnetic stimulation (high-frequency stimulation, 10 sessions) or sham groups. Diffuse tensor tractography revealed partially injured spinothalamocortical tracts in all recruited patients. A numerical rating scale (NRS) was used to evaluate pain intensity during pre-treatment and immediately after the 5th transcranial magnetic stimulation session (post1), 10th transcranial magnetic stimulation session (post2), and 1 (post3), 2 (post4), and 4 weeks (post 5) after finishing treatment. Physical and mental health status were evaluated using the Short Form 36 Health Survey (SF-36), including physical and mental component scores (PCS, MCS). The NRS score of the repetitive transcranial magnetic stimulation group was significantly lower than the sham group score at all clinical evaluation time-points during and after transcranial magnetic stimulation sessions. The transcranial magnetic stimulation group's SF-36 PCS score was significantly higher at post2, post3, post4, and post5 compared with the sham group. High-frequency transcranial magnetic stimulation may be used to manage chronic central pain and improve quality of life in patients with mild traumatic brain injury. However, this is a pilot study and further research is needed.

Pain experiences of adults with osteogenesis imperfecta: An integrative review

ABSTRACT Background: Pain is a common symptom of osteogenesis imperfecta (OI) among children and adolescents. However, little is currently known of the pain experiences of adults with OI. Aims: The aims of this study were to critically appraise the studies assessing OI pain, to synthesize the pain experiences of adults with OI, and to compare the adult OI pain experiences to childhood. Methods: An integrative review was conducted. Five electronic bibliographic databases were searched. Published quantitative, qualitative, and/or mixed-method studies assessing pain in adults with OI were screened, reviewed, and appraised. Descriptive statistics were used to calculate quality scores, summarize sample characteristics, and synthesize findings. Extracted pain data were analyzed using constant comparison and consolidated into meaningful themes. Results: From the 832 titles identified, 14 studies including seven case reports met the inclusion criteria. Study appraisal scores ranged from low to moderate using the Quality Assessment Tool and the Case Report Checklist. The majority of studies assessed pain as a secondary outcome (71.4%) using well-established tools (64.2%). Adults with OI experience pain of mild to moderate intensity, which may interfere with completion of daily activities. Two themes emerged from analysis of the data: mild chronic pain persists despite surgical, pharmacological, or nonpharmacological interventions and past fractures and structural deformities may trigger onset of chronic pain in adulthood. Conclusion: Limited attention has been given to exploring the pain experience of adults diagnosed with OI. Pain is a long-term symptom of OI requiring further in-depth investigation to better understand and manage pain in adults with OI.

Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia

Background: The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. Objective: The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Study Design: Cross-sectional study. Setting: Department of Rehabilitation Sciences, Ghent University, Belgium. Methods: Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computercontrolled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Results: Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. Limitations: No psychosocial issues were taken into account for this study. Conclusion: The present results suggest normal pain sensitivity in RLBP, but future research is needed. In mild and severe CLBP some findings of altered pain processing are evident, although to a lesser extent compared to FM patients. In conclusion, mild and severe CLBP presents within a spectrum, somewhere between completely healthy persons and FM patients, characterized by pain augmentation. Key words: Low back pain, fibromyalgia, pain assessment, quantitative sensory testing, central sensitization, hypersensitivity, temporal summation, spatial summation, conditioned pain modulation

When Is It Safe to Run? Applying Four Pain Rules to Running Participation.

Musculoskeletal pain and injury impacts 19% to 79% of novice and elite distance runners (1,3,4). Runners may disregard pain to achieve personal distance goals or participate in competitive events (3). Later, these same runners may seek medical care for worsening pain. While the presence of mild chronic pain may be a sign of a long-term preexisting condition, such as osteoarthritis, changes in pain symptoms with running may indicate significant biomechanical stresses and a brewing injury. A complete description of the pain symptoms from the patient should be obtained with respect to the severity and type of pain (using anchors of 0 to 10 in a numerical pain rating scale and verbal descriptors, such as “achy,” “sharp,” or “throbbing”) (2), anatomic location of the pain, and onset of pain (before, during, or after the run). Clinicians can educate patients on the following rules to guide running participation: Pain that increases during a running session should be avoided, and the activity should be reduced or stopped immediately. If the pain quality changes from dull to intense (achy to sharp), the activity should be stopped. Joint pain should not persist or increase by 24 h after exercise, because this indicates that the musculoskeletal system was not prepared for the running volume of that session. If preexisting mild joint pain is present (<3 points out of a 10-point scale), the pain should not worsen during the exercise session or last into the next day. If the pain causes a limp or a compensatory gait change, the exercise volume must be reduced or the exercise must stop until a normal gait pattern occurs. Persistence of asymmetric gait due to pain interferes with normal tissue healing and may increase the risk for more injuries (5). These rules can be applied to any runner, irrespective of age, body habitus, and experience. Moreover, these rules can help runners self-regulate progression of running programs and determine whether additional rest is needed before reengaging. If pain persists even when these rules are followed, clinical work-up for injuries is needed.

Predictors of quality of life among adolescents and young adults with a bleeding disorder

BackgroundHealth-related quality of life (HRQoL) in adolescents and young adults with bleeding disorders is under-researched. We aimed to describe factors related to HRQoL in adolescents and young adults with hemophilia A or B or von Willebrand disease.MethodsA convenience sample of volunteers aged 13 to 25 years with hemophilia or von Willebrand disease completed a cross-sectional survey that assessed Physical (PCS) and Mental (MCS) Component Summary scores on the SF-36 questionnaire. Quantile regression models were used to assess factors associated with HRQoL.ResultsOf 108 respondents, 79, 7, and 14% had hemophilia A, hemophilia B, and von Willebrand disease, respectively. Most had severe disease (71%), had never developed an inhibitor (65%), and were treated prophylactically (68%). Half of patients were aged 13 to 17 years and most were white (80%) and non-Hispanic (89%). Chronic pain was reported as moderate to severe by 31% of respondents. Median PCS and MCS were 81.3 and 75.5, respectively. Quantile regression showed that the median PCS for women (61% with von Willebrand disease) was 13.1 (95% CI: 2.4, 23.8; p = 0.02) points lower than men. Ever developing an inhibitor (vs never) was associated with a 13.1-point (95% CI: 4.7, 21.5; p < 0.01) PCS reduction. MCS was 10.0 points (95% CI: 0.7, 19.3; p = 0.04) higher for prophylactic infusers versus those using on-demand treatment. Compared with patients with no to mild chronic pain, those with moderate to severe chronic pain had 25.5-point (95% CI: 17.2, 33.8; p < 0.001) and 10.0-point (95% CI: 0.8, 19.2; p = 0.03) reductions in median PCS and MCS, respectively.ConclusionsEfforts should be made to prevent and manage chronic pain, which was strongly related to physical and mental HRQoL, in adolescents and young adults with hemophilia and von Willebrand disease. Previous research suggests that better clotting factor adherence may be associated with less chronic pain.

Mild Traumatic Brain Injury and Chronic Pain: Using Mixed Methods to Explore Unique and Overlapping Phenomenology

To assess unique and overlapping phenomenology using neuro-imaging (Magnetic Resonance Imaging/ Diffusion Tensor Imaging), neuro-cognitive testing, health questionnaires and interviews in participants with mild traumatic brain injury (MTBI) and chronic pain (CP).

Life stories of people on sick leave from work because of mild mental illness, pain and fatigue.

Many people experience some form of mild mental illness, chronic pain and fatigue feelings that lead to long-term absences from the workplace. The article examines narrations about developmental experiences and adult life of people in need of back to work rehabilitation. Narrative interviews were analyzed within a qualitative content analyses design. The sample was purposive, with 16 working-age adults at rehabilitation because of mild mental illnesses, chronic pain, and fatigue feelings. Ethical approval, was obtained from The Regional Committee for Medical Research Ethics, Health Region Central Norway. Reference no.: 2010/1323. There were stories about more or less stressful childhoods. In adult life, there were turns at various ages from meaningful work engagement, to struggle in private life from long lasting strain, stressful family situations or crises. Illness may develop when experiencing crises or strain over time in private situations, this in combination with expectations and requirements in working life. Not only working environments, but also the private situations, life history events, and self-esteem of individuals, should be taken into consideration in the rehabilitation program. There is a need of research on working life that support the employee's positive self-image, and on effective rehabilitation when needed.

Chronic Pain in HIV-Infected Patients: Relationship to Depression, Substance Use, and Mental Health and Pain Treatment.

As the advent of highly active antiretroviral therapy, HIV has become a chronic disease for most individuals in developed countries. Chronic pain is a common occurrence for HIV-infected patients and has an impact on quality of life and antiretroviral adherence. The objective of this study was to examine relationships between chronic pain and depression, substance use, mental health treatment, and pain treatment in HIV-infected patients. Cross-sectional study. Three primary care sites where HIV+ patients receive treatment. Two hundred and thirty eight HIV-infected primary care patients. We collected self-report and chart-review information on demographics, HIV clinical status, chronic pain, depression, substance use, mental health treatment, and pain treatment. We collected data between October 2012 and November 2013. Of the patients enrolled in this study, 107 reported no chronic pain, 24 reported mild chronic pain, and 107 reported moderate-severe chronic pain. Participants in the moderate-severe pain group were more likely to have high levels of depressive symptoms than those in the no chronic pain group. Similarly, there was a significant relationship between chronic pain status and interference with life activities due to pain. Participants with moderate-severe chronic pain were more likely to be taking an antidepressant medication than those with mild chronic pain, and more likely to be taking a prescription opioid than the other two groups. We did not find a significant relationship between problematic substance use and chronic pain status. Despite pharmacologic treatment, moderate-severe chronic pain and elevated depression symptoms are common among HIV-infected patients and frequently co-occur.