Moderate Levels Of Pain Research Articles

Trajectories of pain, physical function and physical activity components in patients with symptomatic knee and hip osteoarthritis: A group-based multi-trajectory approach

Introduction The aims of this study were to identify homogeneous subgroups with distinct trajectories of pain, physical function and physical activity (PA) components in patients with symptomatic knee and/or hip osteoarthritis (OA) and to identify the baseline predictive factors associated with these trajectories. Methods The KHOALA cohort is a French population-based multicenter cohort of 878 patients with symptomatic knee and/or hip OA, aged between 40 and 75 years old recruited between 2007 and 2009. Six outcomes assessed annually during a period of 5 years were modeled in the multi-trajectory model. Pain and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire while PA intensity [in metabolic equivalent of task (MET)], frequency (times per week), duration (hours per week) and type (weight-bearing exercises or not) were assessed by the Modifiable Activity Questionnaire (MAQ). At baseline, the radiological severity of OA was assessed using Kellgren and Lawrence (KL) grades, comorbidities by the Functional Comorbidity Index (FCI) and perceived vitality with the Short Form Health Survey (SF-36). Group-based multi-trajectory modeling was used to identify subgroups with distinct trajectories of pain, function and PA components. Patients with at least two available measures were included in the analyses. First, trajectory models were estimated with varying number of groups for each of the outcomes separately to clarify the types of distinct trajectories to be represented in the multi-trajectory model. The selection of the optimal models was based on maximization of the Bayesian information criterion, the proportion of patients in each trajectory group (> 5%) and the statistical significance of the equation modeled (intercept only, linear, quadratic or cubic). Then, each outcome trajectories characteristics were included in the multi-trajectory model and the optimal one was chosen according the same selection criteria. Multinomial logistic regressions were performed to identify the predictive baseline characteristics associated with each group and were adjusted for sociodemographic and clinical factors. Results Among the 878 patients, 609 (69.4%) were women, 222 (25.3%) had hip OA, 607 (69.1%) knee OA and 49 (5.6%) both hip and knee OA. Group-based multi-trajectory modeling revealed 3 distinct trajectories of pain, physical function and PA components over 5 years. The first (n = 187, 35.2%) included patients with low pain levels, no functional limitations and who practiced intense PA and weight-bearing exercises. The second (n = 218, 41.0%) included patients with moderate levels of pain and functional limitations and who practiced a less intense PA. Patients belonging to the third group (n = 127, 23.9%) had severe pain, severe functional limitations and a low-intensity practice with rare weight-bearing exercises. Overall, a decrease in intensity, frequency and duration of PA was observed in all groups over 5 years, even in the group of subjects with low pain levels and no functional limitations. In multivariate analyses, female sex (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.48–5.17), increasing age (OR = 1.05, 95% CI = 1.01–1.08), a high number of comorbidities (OR = 1.51, 95% CI = 1.21–1.90), a low vitality score (reflecting a high level of fatigue; OR = 0.94, 95% CI = 0.92–0.97) and a high KL grade (reflecting a high radiological severity; OR = 3.42, 95% CI = 1.53–7.65) were associated with the third group membership. Conclusion Based on the 5-year follow-up data, we identified 3 distinct trajectories of pain, physical function and PA components. A high number of comorbidities, a high level of fatigue and a high radiological severity were associated with the trajectories of severe pain and functional limitations. The management of these factors seems important to maintain physical function, limit pain and maintain PA practice in patients with symptomatic knee and/or hip OA.

Pain and severe sleep disturbance in the general population: Primary data and meta-analysis from 240,820 people across 45 low- and middle-income countries.

Pain and sleep disturbances are widespread, and are an important cause of a reduced quality of life. Despite this, there is a paucity of multinational population data assessing the association between pain and sleep problems, particularly among low- and middle-income countries (LMICs). Therefore, we investigated the relationship between pain and severe sleep disturbance across 45 LMICs. Community-based data on 240,820 people recruited via the World Health Survey were analyzed. Multivariable logistic regression analyses adjusted for multiple confounders were performed to quantify the association between pain and severe sleep problems in the last 30 days. A mediation analysis was conducted to explore potential mediators of the relationship between pain and severe sleep disturbance. The prevalence of mild, moderate, severe, and extreme levels of pain was 26.0%, 16.2%, 9.1%, and 2.2% respectively, whilst 7.8% of adults had severe sleep problems. Compared to those with no pain, the odds ratio (OR, 95% CI) for severe sleep problems was 3.65 (3.24-4.11), 9.35 (8.19-10.67) and 16.84 (13.91-20.39) for those with moderate, severe and extreme pain levels respectively. A country wide meta-analysis adjusted for age and sex demonstrated a significant increased OR across all 45 countries. Anxiety, depression and stress sensitivity explained 12.9%, 3.6%, and 5.2%, respectively, of the relationship between pain and severe sleep disturbances. Pain and sleep problems are highly co-morbid across LMICs. Future research is required to better understand this relationship. Moreover, future interventions are required to prevent and manage the pain and sleep disturbance comorbidity.

POSISI TIDUR MIRING EFEKTIF MENURUNKAN NYERI PUNGGUNG PADA IBU HAMIL TRIMESTER III DI POLI KIA RS RAHMAN RAHIM DESA SAIMBANG SUKODONO SIDOARJO

The relationship sleeping sim position with back pain in pregnant women at third trimester in Rahman Rahim Hospital Sukodono Sidoarjo. The purpose of this study was to find out the relationship sleeping sim position with back pain in pregnant women at third trimester in Rahman Rahim Hospital Sukodono Sidoarjo.Study design use analytic with cross sectional approach, the population were pregnant women at third trimester by 25 respondents, number of sample were of 24 respondents taken by simple random sampling technique. The independent variable is the sleeping sim position and the dependent variable was back pain. Instrument use questionnaire. Data were analyzed using the Mann Whitney with a level of significance (α = 0.05).Study results the majority (66.7%) of pregnant women do not perform sleeping sim position regularly and half of them (50%) had moderate pain level. Mann Whitney test obtained P = 0.000 means there is a relationship between the sleeping sim position with back pain in pregnant women at third trimester. Irregularities of sleeping sim position will cause back pain, so suggested to pregnant women to perform side sleeping position regularly to prevent and manage back pain.

Topical proparacaine vs combined topical-intracameral lidocaine anesthesia in phacoemulsification surgery with preoperative counseling about intraoperative visual fear

Background Phacoemulsication under topical anesthesia makes a quickest visual recovery and reduces surgical time. Topical anesthesia with supplementary intracameral lidocaine may reduce some pain during iris manipulation or iris diaphragm movement.Objective To study the anesthetic efficacy of topical 0.5% proparacaine hydrochloride versus combined topical - intracameral 1% lidocaine injection during phacoemulsification surgery.Method Total 80 patients divided into A and B, each group having 40 patients was enrolled in this study. Phacoemulsification was performed on group A under topical anesthesia with proparacaine hydrochloride 0.5% and on group B under combined topical - intracameral injection of 0.5cc 1% lidocaine. Preoperatively, all patients received counseling about the potential intraoperative visual fear. Each patient was shown visual analogue scale 10 minutes after completion of surgery and was recorded their pain score. Unco-operative patients and previous history of ocular trauma were excluded.Results According to visual analogue scale, on group A, 30% felt no pain, 50% felt mild pain and 20% felt tolerable moderate pain (level 4) and on group B, 80% felt no pain and 20% felt mild pain. The group A perceived pain higher than group B (P <0.001). Mean operation time was 10 minutes. Most of the patients in A and B groups had no eye movement (Group A: 88% and Group B: 95%).Conclusions The combined topical proparacaine - intracameral injection of lidocaine anesthesia is better than topical proparacaine during phacoemulsification ensuring patients and surgeons comfort. Preoperative counseling helps the patients to focus on operating microscope light during surgery.

Prevalence of Pain Diagnoses and Burden of Pain Among Active Duty Soldiers, FY2012.

Soldiers are at risk for acute and chronic pain due to the mental and physical challenges of military duties and ongoing training for force readiness. With the burden of pain on any individual attributable across pain sources, a broad perspective that goes beyond prior characterizations of pain is important. We aim to further the understanding of pain's effects among non-deployed active duty soldiers and the Military Health System (MHS), by describing prevalence of 10 painful conditions, reported pain levels, duration of pain and impact of pain on military duty limitations. Data are from the MHS Data Repository including outpatient MHS direct care encounters, claims for outpatient purchased care from civilian providers, and vital records, for all soldiers continuously enrolled in TRICARE and not deployed in FY 2012. Ten pain-related diagnostic categories were conceptually derived for this analysis and identified using ICD-9-CM diagnostic codes. We report the FY 2012 prevalence at the soldier-level (N = 297,120) for each pain category as a primary diagnosis, as well as in any diagnostic position, and at the soldier-level for reported pain level, duration, and military duty limitations. Institutional Review Board approval was obtained prior to analyses. Overall, 63% of soldiers had at least one pain diagnosis and 59% had a primary pain diagnosis during FY 2012. Back and neck pain (22%), non-traumatic joint disorders (28%), and other musculoskeletal pain (30%) were the most frequent categories for primary diagnosis. Nearly two-thirds of soldiers had a primary pain diagnosis in more than one category, and 23% in four or more categories. Moderate or severe pain levels were reported at least once during the year by 55% of soldiers who had a primary pain diagnosis. In the subsample of soldiers with primary pain in the first quarter, duration and chronicity of pain diagnoses varied by pain category: the back and neck pain category was the most common for both persistent pain occurring in each quarter of FY 2012 (23%) and chronic pain lasting for at least 3 mo (62%). In most pain categories, the majority of soldiers were released without duty limitations. These data provide a deeper understanding of pain diagnoses and burden of pain among active duty soldiers. A substantial proportion of soldiers with pain diagnoses were seen for pain self-reported as only mild, or that did not result in significant restrictions in military duty limitations. However, given the prevalence of multiple pain diagnoses and common reports of moderate or severe pain and long duration, complex interventions may be required to minimize the effect of pain on force readiness. This encounters-based analysis is likely an underestimate of presence of pain, and does not include contextual factors that could better describe the true effect of pain among this population.

Chronic scrotal pain may lead to reduced sexual function and interest, while sexual activity may worsen chronic scrotal pain: "double jeopardy".

BackgroundWhile it is recognized that chronic pain may adversely impact sexual function and activity in men and we also recognize that sexual activity may worsen the pain for men with chronic scrotal pain (CSP), the effect on sexual functioning and conversely the impact of sex on CSP has not previously been documented.MethodsRetrospective analysis of a prospectively collected database.ResultsFrom Feb 2014 to Sep 2015, a total of 128 men presenting for assessment of CSP completed all or parts of a standardized questionnaire. Overall 60% (69/116) of the men felt that the CSP had kept them either a “lot” or “some” of the time from sexual activity and 64% (27/43) had evidence of decreased erectile performance. Those with more severe pain (analog pain scores 7–10/10) had more significant sexual dysfunction than those with less severe pain, with 54% (45/83) vs. 0% (0/33, P<0.01: Fisher’s exact test) noting that the pain kept them from sexual activity “a lot” and 70% (23/33) vs. 40% (4/10, P<0.01) noting sexual dysfunction. Diminished libido was also common in the men [43% (55/128)] as were the symptoms of testosterone deficiency [76% (97/128)]. Conversely, sexual activity often exacerbated the pain, with 37% (47/128) finding that ejaculation aggravated their pain and another 38% (48/128) patients found sexual activity aggravated their pain.ConclusionsMen with severe CSP have significantly reduced sexual function and interest compared to men with moderate or minor levels of pain. The majority of men with CSP who were sexually active were faced with worsening pain with sex and ejaculation. Clinicians should be aware of the twin risks of sexual dysfunction occurring in men with CSP and sexual activity worsening the severity of the CSP.

Exercise-induced hypoalgesia in women with varying levels of menstrual pain.

Exercise-induced hypoalgesia (EIH) is a well-established phenomenon in pain-free individuals that describes a decrease in pain sensitivity after an acute bout of exercise. The EIH response has been demonstrated to be sub-optimal in the presence of persisting pain. Menstrual pain is a common recurrent painful problem with many women experiencing high levels of pain each cycle. However, the EIH response has not been examined in a cohort of women with high levels of menstrual pain. This research aimed to examine whether EIH manifests differently in women with varying levels of menstrual pain. The primary hypothesis was that women with high levels of menstrual pain would demonstrate compromised EIH. Secondary aims were to explore relationships between EIH and emotional state, sleep quality, body mass index (BMI) or physical activity levels. Pressure pain thresholds (PPT) were measured in 64 participants using a digital handheld algometer before and after a submaximal isometric-handgrip exercise. EIH index was compared between low (VAS 0-3), moderate (VAS 4-7) and high (VAS 8-10) pain groups, using a linear mixed model analysis with participant as a random effect, and site, menstrual pain category and the interaction between the two, as fixed effects. EIH was consistently induced in all groups. However, there was no statistically significant difference between the pain groups for EIH index (p=0.835) or for any co-variates (p>0.05). EIH was not found to differ between women who report regular low, moderate or high levels of menstrual pain, when measured at a point in their menstrual cycle when they are pain free. This study provides insight that EIH does not vary in women with differing levels of menstrual pain when they are not currently experiencing pain. The current findings indicate that, although menstrual pain can involve regular episodes of high pain levels, it may not be associated with the same central nervous system dysfunctions as seen in sustained chronic pain conditions.

Effects of Low-Intensity Contractions of Different Craniofacial Muscles in Healthy Participants - An Experimental Cross-Over Study.

Repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, ie, bruxism, is traditionally linked to pain and unpleasantness in the active muscles. The aim of this study was to investigate the effects of standardized craniofacial muscle contractions on self-reported symptoms. Sixteen healthy volunteers performed six 5-minute bouts of 20% maximal voluntary contraction task of the jaw-closing (Jaw), the orbicularis-oris (O-oris), and the orbicularis-oculi (O-oculi) muscles. Participants rated their perceived pain, unpleasantness, fatigue, and mental stress levels before, during, and after the contraction tasks on 0-10 Numeric Rating Scales (NRS). Each muscle contraction task (= 1 session) was separated by at least 1 week and the order of the sessions was randomized in each subject. All muscle contraction tasks evoked significant increases in NRS scores of pain (mean ± SD: Jaw; 3.8 ± 2.7, O-oris; 1.9 ± 2.2, O-oculi; 1.4 ± 1.3, P < .014), unpleasantness (Jaw; 4.1 ± 2.5, O-oris; 2.1 ± 1.9, O-oculi; 2.9 ± 1.8, P < .001), fatigue (Jaw; 5.8 ± 2.0, O-oris; 3.2 ± 2.3, O-oculi; 3.6 ± 1.9, P < .001), and mental stress (Jaw; 4.1 ± 2.1, O-oris; 2.2 ± 2.7, O-oculi; 2.9 ± 2.2, P < .001). The Jaw contractions were associated with higher NRS scores compared with the O-oris and the O-oculi contractions (P < .005) without differences between the O-oris and the O-oculi (P > .063). All symptoms disappeared within 1 day (P > .469). The results showed that submaximal static contractions of different craniofacial muscle groups could evoke transient, mild to moderate levels of muscle pain and fatigue and increased stress scores. The fatigue resistance may differ between different muscle groups. Further studies are warranted to better understand the contribution of specific craniofacial muscle groups for the characteristic presentation of musculoskeletal pain conditions in the head.

FREQUENCY OF SHOULDER PAIN AMONG WEIGHT LIFTERS IN ISLAMABAD and RAWALPINDI

Background: Shoulder pain is a very common complaint in population because of shoulder jointÂ’s extreme mobility and less stability. Weight lifting is considered as a sport in which weight lifters try to increment their muscular strength either for a competition or to maintain a healthy active life. Improper exercises or weight lifting not under the supervision of professional trainers or coaches may worsen or add to the development of glenohumeral joint hyper laxity, instability, or impingement. Moreover injuries to the shoulder are also regular among weight coaches and can be profession debilitating to those at the focused level. Objective of the study: Objective of the study is to determine the frequency of shoulder pain among weight lifters in Islamabad and Rawalpindi. Methodology: A descriptive cross sectional study was done in several different gyms of Rawalpindi and Islamabad. A sample of 291 male weight lifters (age 14-55year) was recruited through convenient sampling. Prevalence of shoulder pain was assessed by self-structured Questioner in which Pain assessment was done by Numeric Pain Rating Scale (NPRS), physical function and symptoms were measured by a standard DASH Questioner. Later the data was analyzed through SPSS 21. Results: The results showed that the mean age of the weight lifters was 24 and out of 291(100%) weight lifters 23% weight lifters had shoulder pain, among which majority had mild (46.3%) to moderate level (49.3%) pain. Results also showed that weight lifters with shoulder pain had more (82%) unilateral pain than (17.9%) bilateral pain. And mean of the DASH score was 40.96, indicates that shoulder Pain among weight lifters was causing mild disability. Conclusion: It is concluded that a valuable percentage of weight lifters have mild to moderate level of dull shoulder pain. Among which majority has unilateral pain and this pain is more evident in those weight lifters who spend one hour daily in gyms and fitness centers for their workouts and do repetitive activities and work in overhead positions in there occupational settings or in their daily livings. This pain was causing mild disability in their normal functioning.

Home-based intravenous analgesia with elastomeric pump as an outpatient procedure for pain control after anterior cruciate ligament repair

ObjectiveTo follow up pain in the immediate postoperative period, using an elastomeric pump in anterior cruciate ligament surgery. Material and methods309 patients who had undergone anterior cruciate ligament repair with bone-tendon-bone allograft. Pain control was assessed with a visual analogue scale (VAS) during the immediate postoperative period, in the postoperative care unit, in the recovery room, and after the first 24–48–72h following home discharge. The need for rescue medication, adverse effects observed and emergency visits were also registered. Results309 patients were assessed (264 males, 45 females), mean age 33 (range: 18–55). Postoperative pain was mild in 44.7% of patients, and 38.5% were pain-free. At discharge, 41.1% of patients reported mild pain and 57% were pain-free. At home, mild to moderate levels of pain were maintained and over 97% of patients presented VAS values ≤3. Fewer than 3% had adverse effects, 8.7% had to use analgesic medication at some point. Pruritus occurred in less than 1% of patients receiving intravenous analgesia at home, and fewer than 2% had device-related complications. DiscussionThere is no consensus regarding the postoperative management of anterior cruciate ligament lesions, although most surgeons use multimode anaesthesia and different combinations of analgesics to reduce postoperative pain. ConclusionsThe use of an intravenous elastomeric pump as postoperative analgesia for anterior cruciate ligamentoplasty has yielded good results.

Analgesia intravenosa domiciliaria mediante bomba elastomérica como procedimiento ambulatorio de control del dolor en la reparación del ligamento cruzado anterior

ObjectiveTo follow up pain in the immediate postoperative period, using an elastomeric pump in anterior cruciate ligament surgery. Material and methods309 patients who had undergone anterior cruciate ligament repair with bone-tendon-bone allograft. Pain control was assessed with a visual analogue scale (VAS) during the immediate postoperative period, in the postoperative care unit, in the recovery room, and after the first 24-48-72hours following home discharge. The need for rescue medication, adverse effects observed and emergency visits were also registered. Results309 patients were assessed (264 males, 45 females), mean age 33 (range: 18 - 55). Postoperative pain was mild in 44.7% of patients, and 38.5% were pain-free. At discharge, 41.1% of patients reported mild pain and 57% were pain-free. At home, mild to moderate levels of pain were maintained and over 97% of patients presented VAS values ≤ 3. Fewer than 3% had adverse effects, 8.7% had to use analgesic medication at some point. Pruritus occurred in less than 1% of patients receiving intravenous analgesia at home, and fewer than 2% had device-related complications. DiscussionThere is no consensus regarding the postoperative management of anterior cruciate ligament lesions, although most surgeons use multimode anaesthesia and different combinations of analgesics to reduce postoperative pain. ConclusionsThe use of an intravenous elastomeric pump as postoperative analgesia for anterior cruciate ligamentoplasty has yielded good results.

Looking beyond opioids for safer pain relief

Pain has been a part of Kate Mitchell’s life since she was 10 years old. What began as an ache in her ankle spread throughout her body until doctors eventually diagnosed her with a collection of disorders that cause chronic pain, including rheumatoid arthritis and fibromyalgia. Now in her 20s, Mitchell does her best to juggle life as a graduate student in literature with a schedule packed with medical appointments—sometimes as many as eight per week—and the routine that helps her keep chronic pain at bay. Her daily regimen to manage her illnesses and treat the accompanying pain consists of doing yoga, walking, and taking 40 pills, including two doses of acetaminophen mixed with the opioid hydrocodone. On her best days, she lives with a moderate level of pain she describes as dull and achy. On her worst, the pain is like a hot poker pressed against her joints. That’s

Trajectories of pain severity in juvenile idiopathic arthritis: results from the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort.

We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.0-37.1 months). Latent trajectory analysis of pain severity, measured in a 100-mm visual analogue scale, identified 5 distinct trajectories: (1) mild-decreasing pain (56.2% of the cohort); (2) moderate-decreasing pain (28.6%); (3) chronically moderate pain (7.4%); (4) minimal pain (4.0%); and (5) mild-increasing pain (3.7%). Mean disability and quality of life scores roughly paralleled the pain severity trajectories. At baseline, children with chronically moderate pain, compared to those with moderate-decreasing pain, were older (mean 10.0 vs 8.5 years, P = 0.01) and had higher active joint counts (mean 10.0 vs 7.2 joints, P = 0.06). Children with mild-increasing pain had lower joint counts than children with mild-decreasing pain (2.3 vs 5.2 joints, P < 0.001). Although most children with juvenile idiopathic arthritis in this cohort had mild or moderate initial levels of pain that decreased quickly, about 1 in 10 children had concerning pain trajectories (chronically moderate pain and mild-increasing pain). Systematic periodic assessment of pain severity in the months after diagnosis may help identify these concerning pain trajectories early and lay out appropriate pain management plans. Focused research into the factors leading to these concerning trajectories may help prevent them.

Perceptions of pain of laryngeal electromyography.

To evaluate pain associated with laryngeal electromyography (LEMG). A prospective case series. Adult patients scheduled for LEMG in a tertiary care laryngology practice were recruited between July 20, 2016, and March 1, 2017. Demographic and clinical data were extracted from the charts. Study participants reported their anticipated pain level using a visual analog scale (VAS) prior to the procedure. VAS was administered again within 10 minutes after the procedure, along with the validated McGill Pain Questionnaire, to gauge patient's pain perception after undergoing LEMG. Results were reviewed for 80 patients (mean age 48.2 ± 16.6 years, 37.5% male). Preprocedure VAS pain scores (4.59 ± 2.3 out of 10) were not significantly different than postprocedure VAS pain scores (4.61 ± 2.4) (P = 0.95). The McGill Pain Questionnaire reported a moderate pain level (32.1 ± 12.7 out of 78). Females anticipated a higher preprocedure VAS pain score (5.04 ± 2.3) than males (3.85 ± 2.2) (P = 0.02); however, postprocedure scores were not significantly different between genders. The following factors did not influence the pain scores: age, professional voice use, history of previous EMG, chronic pain diagnosis, psychiatric diagnosis, or current treatment with pain/psychiatric medications. All LEMGs were completed without any complications. Patients appropriately anticipated their pain levels for the LEMG, which may be attributed to proper patient education and counselling before the procedure. Overall pain levels were mild to moderate, and all LEMGs were completed; thus, LEMG was well tolerated. 4. Laryngoscope, 128:896-900, 2018.

Motivational Interviewing for Workers with Disabling Musculoskeletal Disorders: Results of a Cluster Randomized Control Trial

Purpose Although functional restoration programs appear effective in assisting injured workers to return-to-work (RTW) after a work related musculoskeletal (MSK) disorder, the addition of Motivational Interviewing (MI) to these programs may result in higher RTW. Methods We conducted a cluster randomized controlled trial with claimants attending an occupational rehabilitation facility from November 17, 2014 to June 30, 2015. Six clinicians provided MI in addition to the standard functional restoration program and formed an intervention group. Six clinicians continued to provide the standard functional restoration program based on graded activity, therapeutic exercise, and workplace accommodations. Independent t tests and chi square analysis were used to compare groups. Multivariable logistic regression was used to obtain the odds ratio of claimants’ confirmed RTW status at time of program discharge. Results 728 workers’ compensation claimants with MSK disorders were entered into 1 of 12 therapist clusters (MI group = 367, control group = 361). Claimants were predominantly employed (72.7%), males (63.2%), with moderate levels of pain and disability (mean pain VAS = 5.0/10 and mean Pain Disability Index = 48/70). Claimants were stratified based on job attachment status. The proportion of successful RTW at program discharge was 12.1% higher for unemployed workers in the intervention group (intervention group 21.6 vs. 9.5% in control, p = 0.03) and 3.0% higher for job attached workers compared to the control group (intervention group 97.1 vs. 94.1% in control, p = 0.10). Adherence to MI was mixed, but RTW was significantly higher among MI-adherent clinicians. The odds ratio for unemployed claimants was 2.64 (0.69–10.14) and 2.50 (0.68–9.14) for employed claimants after adjusting for age, sex, pain intensity, perceived disability, and therapist cluster. Conclusion MI in addition to routine functional restoration is more effective than routine functional restoration program alone in improving RTW among workers with disabling MSK disorders.

Applications of Rat Grimace Scale Method in Postoperative Pain Management in Rats

Introduction: Nowadays, 3R (replacement, reduction, refinement) concept lies in the core of laboratory animals science, one of the most important refinement strategies being the pain control. Rat Grimace Scale (RGS) is an actual and effective method used to assess pain in laboratory animals.Aims: The purpose of this study was to find the most effective post surgery analgesic protocol, by grading the changes in the animal’s facial expression.Materials and methods: In the present study we used 5 Wistar rats, as a pain model, ovariectomy was performed on 4 of the rats. Tramadol was administrated subcutaneously as it follows: 1 rat in pre-surgery dose of 25 mg/kg, 2 rats in post-surgery a dose of 25 mg/kg and respectively 50 mg/kg. The evaluation of pain was done across at the time 0, 2, 4 and 6 hours post-surgery using the scores of 0, 1 and 2, 0 representing the absence of pain, 1 a moderate level of pain and 2 a high level of pain.Results: The results of the study revealed that the spayed rat without Tramadol presented the highest level of pain (1.25 - 1.75). The pre-surgery analgesia enhanced the narcosis effect, but analgesia had a short term effect, with a moderate to high level of pain (1 - 1.5). To the animal treated with a dose of 25 mg/kg post-surgery, a moderate pain level was observed (0.5 - 1.25) and to the animal with the highest dose an optimal analgesia was determined (0.25).Conclusion: The expected analgesic effect was put forward by the 50 mg/kg dose of Tramadol and the RGS method was found to be suitable for the assessment of animal suffering in surgical experimental procedures.

Influence of Standardized Orientation on Patient Perception of Perioperative Care Following Alveolar Cleft Repair: A Survey Based Study of Patients Treated in a Large Academic Medical Center.

This study aims to better understand patient-reported outcomes for iliac bone grafting surgery for alveolar cleft repair and to determine how standardizing perioperative patient instruction affects patient-reported outcomes. Retrospective survey-based assessment of patients undergoing iliac bone grafting with and without hospital-based systems standardization. Academic tertiary care hospital. Of the 195 identified patients, 127 participated. Survey on pain and satisfaction regarding iliac bone grafting surgery. Survey answers measured patient opinions about the surgery. Answers of the pre- and poststandardization patients were compared to determine the effect of standardizing patient instructions. Patients rated their satisfaction with the surgery and recovery a 4.5 and 4.4 out of 5, respectively. They rated their overall pain in the hospital a 5.5 out of 10 (4.9 in the mouth, 5.7 in the hip). Patients were discharged an average of 1.2 days after surgery and could return to normal daily activity in 6.1 days. Poststandardization patients were more likely to adhere to instructions regarding use of an antibacterial mouthrinse and a protective oral splint. Patients were highly satisfied with the iliac bone grafting procedure and the recovery and reported only moderate levels of postoperative pain. Implementing standardized patient instructions may not affect patient satisfaction or pain severity, but it significantly increased patient adherence to physician instructions.

Clinical Phenotype of Diabetic Peripheral Neuropathy and Relation to Symptom Patterns: Cluster and Factor Analysis in Patients with Type 2 Diabetes in Korea.

Objectives Patients with diabetic peripheral neuropathy (DPN) is the most common complication. However, patients are usually suffering from not only diverse sensory deficit but also neuropathy-related discomforts. The aim of this study is to identify distinct groups of patients with DPN with respect to its clinical impacts on symptom patterns and comorbidities. Methods A hierarchical cluster analysis and factor analysis were performed to identify relevant subgroups of patients with DPN (n = 1338) and symptom patterns. Results Patients with DPN were divided into three clusters: asymptomatic (cluster 1, n = 448, 33.5%), moderate symptoms with disturbed sleep (cluster 2, n = 562, 42.0%), and severe symptoms with decreased quality of life (cluster 3, n = 328, 24.5%). Patients in cluster 3, compared with clusters 1 and 2, were characterized by higher levels of HbA1c and more severe pain and physical impairments. Patients in cluster 2 had moderate pain levels but disturbed sleep patterns comparable to those in cluster 3. The frequency of symptoms on each item of MNSI by “painful” symptom pattern showed a similar distribution pattern with increasing intensities along the three clusters. Conclusions Cluster and factor analysis endorsed the use of comprehensive and symptomatic subgrouping to individualize the evaluation of patients with DPN.

Effect of Experimental Periodontal Ligament Pain on Gingival Somatosensory Sensitivity.

To use a randomized, blinded, crossover design to evaluate the possible heterotopic effects of experimental periodontal ligament pain on adjacent gingival somatosensory sensitivity. A total of 12 healthy volunteers (8 female, 4 male; mean age ± standard error in means (SEM): 28 ± 1 years) participated in two randomized experimental quantitative sensory testing (QST) sessions, one in which capsaicin (experimental) was injected into the periodontal ligament and one in which isotonic saline (control) was injected. A total of 13 standardized QST measures were obtained on the buccal attached gingiva of a maxillary central incisor before, immediately after, and 30 minutes after injection of 30 μL of 5% capsaicin or isotonic saline into the periodontal ligament of the same incisor. The injection-evoked pain was evaluated on a 0-10 numeric rating scale (NRS). QST data were analyzed with two-way repeated measurement analysis of variance. Capsaicin injected into the periodontal ligament evoked moderate levels of pain (mean peak NRS ± SEM: capsaicin: 5.5 ± .7; control: 0.6 ± 0.5 [P < .001]). Capsaicin injected into the periodontal ligament significantly modulated gingival somatosensory sensitivity: increased sensitivity to warmth and painful heat stimuli occurred immediately and 30 minutes after the injection (P < .025), whereas decreased sensitivity to both tactile and painful mechanical stimuli (P < .011) occurred immediately after the injection and to painful mechanical stimuli only after 30 minutes (P = .016). No somatosensory changes were detected following the injection of isotonic saline (P > .050). Capsaicin injected into the periodontal ligament caused gain of heterotopic somatosensory sensitivity toward warmth and painful heat stimuli as well as reduction in mechanical sensitivity of the gingiva adjacent to the injected tooth. These findings may have implications for interpretation of somatosensory functions in patients with chronic intraoral pain, where gingival somatosensory profiles similar to those detected after capsaicin injection in the present study may be interpreted as signs of nerve damage.

Exercise induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash associated disorders

Background and aimsReduced pain sensitivity following exercise is termed exercise induced hypoalgesia (EIH). Preliminary evidence suggests that impairment of EIH is evident in individuals with whiplash associated disorders (WAD) following submaximal aerobic exercise. This study aimed to compare EIH responses to isometric and aerobic exercise in patients with chronic WAD and healthy controls and investigate relationships between EIH, conditioned pain modulation (CPM) and psychological factors in patients with chronic WAD. MethodsA cross sectional pre-post study investigated the effect of a single session of submaximal aerobic cycling exercise and a single session of isometric timed wall squat exercise on EIH in a group of participants with chronic WAD (n=21) and a group of asymptomatic control participants (n=19). Bivariate analyses between EIH and baseline measures of CPM and psychological features (fear of movement, pain catastrophization and posttraumatic stress symptoms) were also investigated. ResultsThe isometric wall squat exercise but not the aerobic cycling exercise resulted in EIH in both groups (P<.023) with no between-group differences (P>.55) demonstrated for either exercise. There were no significant associations measured between EIH (for either exercise performed), and CPM, or any of the psychological variables. ConclusionsThis study showed that individuals with chronic WAD and mild to moderate pain and disability, and no evidence of dysfunctional CPM, demonstrated reduced pain sensitivity, both in the cervical spine and over the tibialis anterior following an isometric, timed wall squat exercise. Cycling exercise did not increase pain sensitivity. ImplicationsIndividuals with chronic WAD and mild to moderate levels of neck pain and disability may experience less pain sensitivity both locally and remotely following an exercise program directed at non-painful muscles performing isometric exercises. Individuals cycling for 30min at 75% of age-predicted heart rate maximum do not experience increased pain sensitivity.