Non-pain Group Research Articles

Gut Microbiomics of Sustained Knee Pain in Knee Osteoarthritis Patients.

To examine whether gut microbes were associated with post-surgery sustained knee pain in knee osteoarthritis (OA) patients by a gut microbiomics approach. Total knee replacement (TKR) patients due to primary knee OA were recruited. Sustained knee pain status at least one year after TKR was defined by the Western Ontario and McMaster University Arthritis Index (WOMAC). Fasting plasma sample and fecal sample were collected. Metabolomic profiling was performed on fasting plasma. 16S rRNA sequencing was performed on fecal samples to determine microbial composition. Twenty TKR patients due to primary knee OA were included in the study with 10 experiencing sustained post-surgery pain and 10 without such pain. Age, sex, and BMI were matched. Linear discriminant analysis of microbiome data identified 13 bacterial taxa that were highly abundant in the pain group, and 5 that were highly abundant in the non-pain group (all P < 0.05). Plasma metabolomic profiling measured 622 metabolites. The correlation analysis indicated that the 18 taxa were significantly correlated with 231 metabolites (all P < 0.05). sPLS-DA analysis showed that 30 out of the 231 metabolites explained 29% of total variance and can be used to clearly separate sustained knee pain patients from non-pain patients. Pathway enrichment analysis showed that these significant metabolites were enriched in arachidonic acid metabolic pathway, bile acid biosynthesis, and linoleic acid metabolism. The gut microbes may play a significant role in sustained knee pain in knee OA patients after TKR potentially through their activation of inflammatory pathways, lipid metabolism, and central sensitization.

Model of quality of life in a group of people with chronic low back pain.

BackgroundChronic low back pain (CLBP) is one of the leading causes of a reduction in the quality of life (QoL). Various methods effec-tively improve patients’ performance and coping with their symptoms in the short term. The lack of focus on psychological factors, thus overlooking an important element of the holistic model, may result in the modest long-term improvement. The present study aimed to test the relationships between the variables in Wilson and Cleary’s QoL model in a CLBP group and to compare them to a nonpain group.Participants and procedureData were obtained from 177 people with CLBP and 160 nonpain participants. We conducted a cross-sectional study in which a multi-module self-administered questionnaire examining biological factors, personality traits, personal values, body as-sessment, symptoms of depression and anxiety, functional status, general perception of health, life satisfaction, received social support, economic support, satisfaction of health care and sociodemographic factors was adopted.ResultsMultiple regression models were able to explain 48.4% of the variance of QoL in the CLBP group and 30.9% in the nonpain group. Statistically significant predictors in the CLBP model were the severity of anxiety, emotional stability, receiving social support, and general health assessment and emotional stability in the nonpain group.ConclusionsThe study has enabled an initial exploratory analysis of the Wilson and Cleary model in a CLBP group. The list of factors de-termining the QoL should be extended to include emotional stability, social and economic support. Further research is needed to explain the relationships between variables in the model.

Is malocclusion a predictor of pain in patients suffering from TMD pain?

Temporomandibular disorders (TMD) affect the masticatory muscles, temporomandibular joints (TMJs) and associated structures. The relationship between occlusion and TMD is a contentious issue in the dental field. Although there is a strong argument against invasive and irreversible therapeutic TMD procedures, the TMD biopsychosocial model is still not accepted by some clinicians. Hence, this study aimed to verify whether malocclusions are related to TMD pain. The study included 49 adult patients with one or multiple TMD diagnoses and without any other diseases that could mimic TMD. A reliable investigator diagnosed the patients using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) protocol. The sample was divided into pain and non-pain TMD groups, and the predictor of malocclusion was categorized as the dependent variable. There were 33 patients in the TMD pain group and 16 patients in the non-pain TMD group. Analyses were conducted at a significance level of 0.05. The χ2 test (with Yates' correction for 2 × 2 matrix) was used to compare qualitative variables between the groups. Malocclusion was present in 13 patients in the pain group and 7 patients in the non-pain group. According to our study, there is no correlation between malocclusion and TMD pain.

The role of traditional social determinants of health in referral patterns, timing of surgery, and Chiari Health Index for Pediatrics-determined quality of life in children with symptomatic Chiari type I malformation.

Understanding the impact of the social determinants of health on the utilization of healthcare resources is an important step in eliminating inequalities. The goal of this study was to determine the role of social determinants of health in referral patterns, timing of consultation/intervention, and quality of life in children with Chiari malformation type I (CM-I). A retrospective study was conducted of children aged 0 to 18 years who underwent surgical treatment for CM-I at a single pediatric facility from 2015 to 2019. The variables included demographic and socioeconomic characteristics, referral patterns, timing, and quality of life data based on the Chiari Health Index for Pediatrics (CHIP). The cohort consisted of 103 surgically treated CM-I patients. No differences were seen in race, sex, insurance, or household income when evaluating referral source (community, specialist, or emergency department) or when comparing patients with incidental versus symptomatic findings. In the evaluation of timing from initial evaluation to surgery, no statistical differences were seen between racial, sex, insurance status, or income groups. Children from households of lower median family income were significantly more likely to report pain at the time of consultation (pain group median [interquartile range] $46,660 [$41,004-$50,367] vs nonpain group $53,604 [$41,427-$59,828], p = 0.004). Those in the lower-income group also reported lower CHIP scores corresponding to increased symptomatology in the nonpain physical symptoms (p = 0.004) and psychosocial domains (p = 0.018). There was no evidence of a difference in referral patterns or a delay in time from clinic presentation to surgery based on the traditional social determinants of health categories. Children from households in the lower-income group were associated with increased severity of pain and nonpain symptoms.

Construction of pain prediction model for patients undergoing hepatic arterial chemoembolization

ObjectiveTo construct a predictive model for pain in patients undergoing hepatic arterial chemoembolization (TACE) in interventional operating room.MethodsThrough literature review and expert interviews, a questionnaire was prepared for the assessment of pain factors in patients with hepatic arterial chemoembolization. A prospective cohort study was used to select 228 patients with hepatic arterial chemoembolization in a tertiary and first-class hospital. The data of the patients in the pain group and the non-pain group were compared, and a rapid screening prediction model was constructed by univariate analysis and logistic regression analysis, and its prediction effect was tested.ResultsTumor size, liver cancer stage, and chemoembolization with drug-loaded microspheres and pirarubicin hydrochloride (THP) mixed with lipiodol were independent predictors of pain in patients after hepatic arterial chemoembolization. Finally, the pain prediction model after TACE was obtained. The results of Hosmer–Lemeshow test showed that the model fit was good (χ2 = 13.540, p = 0.095). The area under the receiver operating characteristic curve was 0.798, p < 0.001.ConclusionThe rapid screening and prediction model of pain in patients undergoing hepatic arterial chemoembolization has certain efficacy, which is helpful for clinical screening of patients with high risk of pain, and can provide reference for predictive pain management decision-making.

Elasticity evaluation of the plantar fascia: A shear wave elastography study involving 33 early-stage plantar fasciopathy subjects.

Background: Plantar fasciopathy, the most common foot condition seen in elderly and athletic populations, can be diagnosed and differentially diagnosed with imaging modalities such as ultrasound shear wave elastography (SWE). However, standard guidelines for ultrasound elastography of the plantar fascia are lacking. The purpose of this study was to determine the impact of the region of interest (ROI) on the evaluation of the plantar fascia elasticity and confirm the screening accuracy of SWE in the early-stage of plantar fasciopathy. Methods: This was an observational case‒control study involving 50 feet of 33 early-stage plantar fasciopathy subjects (the plantar fasciopathy group) and 96 asymptomatic feet of 48 healthy volunteers (the non-pain group). Clinical information, including age, gender, height, weight, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Scale score (AOFAS), and the symptom duration, were recorded. All participants underwent both conventional ultrasound and SWE evaluation. The plantar fascia elastic parameters included SWEsingle-point, calculated with a single-point ROI set at the greatest thickness of the plantar fascia, and SWEmulti-point, calculated by multipoint ROIs set continuously from the origin at the calcaneus to about 2cm from the calcaneal origin. Results: The plantar fasciopathy group presented a higher VAS score (median [IQR), 4.00 (3.00) vs. 0.00 (0.00), p < 0.001] and lower AOFAS score [median (IQR), 79.50 (3.00) vs. 100.00 (10.00), p < 0.001] than the non-pain group. The median plantar fascia thickness of the plantar fasciopathy group was significantly greater than that of the non-pain group [median (IQR), 3.95 (1.37)mm vs 2.40 (0.60)mm, p < 0.001]. Abnormal ultrasound features, including echogenicity, border irregularities, and blood flow signals, were more prominent in the plantar fasciopathy group than in the non-pain group (29% vs. 0%, p < 0.001; 26% vs. 1%, p < 0.001; 12% vs. 0%, p < 0.001, respectively). Quantitative analysis of the plantar fascia elasticity revealed that the difference between the value of SWEsingle-point and SWEmultipoint was significant [median (IQR), 65.76 (58.58) vs. 57.42 (35.52)kPa, p = 0.02). There was a moderate and significant correlation between the value of SWEsingle-point and heel pain. However, there was no correlation between the value of SWEmultipoint and heel pain. Finally, we utilized the results of SWEsingle-point as the best elastic parameter reflecting clinical heel pain and found that SWEsingle-point could provide additional value in screening early-stage plantar fasciopathy, with an increase in sensitivity from 76% to 92% over conventional ultrasound alone. Additionally, compared with conventional ultrasound and SWE, the use of both improved the accuracy of screening for plantar fasciopathy. Although there were no significant differences in the negative predictive value of conventional ultrasound, SWE, and their combination, the positive predictive value when using both (90.20%) was significantly greater than that when using conventional ultrasound (74.50%) or SWE alone (76.50%). Conclusion: The plantar fascia elastic parameter calculated with single-point ROIs set at the greatest thickness of the plantar fascia is positively correlated with fascia feel pain. Single-point analysis is sufficient for the screening of the early-stage plantar fasciopathy using SWE. SWEsingle-point may provide additional valuable information for assessing the severity of plantar fasciopathy.

27 Pain Medication Use at Follow up Is Associated with Long-term Outcomes

IntroductionUse of prescription pain medication after burn injury is commonly required. However, little is known about long-term pain medication use and its association with outcomes. Therefore, the purpose of this study is to assess patterns of prescription pain medication use after discharge and the association between these medications and quality of life outcomes.MethodsData from the Burn Model System National Longitudinal Database (2015-2021) were analyzed. Pain medication use was assessed at pre-injury (recall at discharge), discharge (medical record) and follow-up (self-report at 6, 12, and 24 months after injury). Outcome measures included: VR-12 Physical and Mental Component Summary scores (PCS and MCS), Community Integration Questionnaire (CIQ), Posttraumatic Stress Disorder Checklist (PCL), Satisfaction with Life Scale (SWLS), and NeuroQOL Stigma. The population was divided into two groups, those taking and not taking prescription pain medications at one year. Regression analyses examined associations between prescription pain medication use and outcomes at 12 months, controlling for age, gender, race, ethnicity and burn size.ResultsOf the 645 participants, 15% reported prescription pain medication use prior to their burn. At discharge, 81% reported use of an opioid and 46% reported use of a neuropathic pain medication. At 12 months, 32% of individuals indicated prescription pain medication use. The pain medication group exhibited larger burn size (24.0% vs 15.2%) and longer hospital stays (40.4 vs 25.0 days) than the non-pain medication group (p< 0.0001 for all). Additionally, 25% of individuals who reported pre-injury pain medication use also reported use at 12 months. Regression analyses demonstrated that pain medication use was associated with worse physical health (PCS: coefficient 8.69, p< 0.0001) mental health (MCS: 6.31, p< 0.0001), stigma (NeuroQOL Stigma: 3.91, p< 0.0001), and satisfaction with life (SWLS: -3.66, p< 0.0001) at one year. Additionally, pain medication use was associated with 45% decreased odds of being employed (coefficient 0.55, p=0.029) and approximately 3 times greater odds of having post-traumatic stress disorder at 12 months (coefficient 3.25, p< 0.0001).ConclusionsThere are significant associations between prescription pain medication use and worse physical, mental and employment outcomes at twelve months. This information may be used to trigger screening and manage long-term recovery outcomes.

Plasma inflammatory cytokines and treatment-resistant depression with comorbid pain: improvement by ketamine

BackgroundTreatment-resistant depression (TRD) and pain frequently coexist clinically. Ketamine has analgesic and antidepressant effects, but few studies have evaluated individual differences in antidepressant outcomes to repeated ketamine in TRD patients with comorbid pain. Our aims were to determine the difference in ketamine’s antidepressant effects in TRD patients with or without pain and then to examine whether inflammatory cytokines might contribute to ketamine’s effect.MethodsSixty-six patients with TRD received six infusions of ketamine. Plasma levels of 19 inflammatory cytokines were assessed at baseline and post-infusion (day 13 and day 26) using the Luminex assay. Plasma inflammatory cytokines of sixty healthy controls (HCs) were also examined.ResultsTRD patients with pain had a higher antidepressant response rate (χ2 = 4.062, P = 0.044) and remission rate (χ2 = 4.062, P = 0.044) than patients without pain. Before ketamine treatment, GM-CSF and IL-6 levels were higher in the pain group than in the non-pain and HC groups. In the pain group, levels of TNF-α and IL-6 at day 13 and GM-CSF, fractalkine, IFN-γ, IL-10, MIP-3α, IL-12P70, IL-17α, IL-1β, IL-2, IL-4, IL-23, IL-5, IL-6, IL-7, MIP-1β, and TNF-α at day 26 were lower than those at baseline; in the non-pain group, TNF-α levels at day 13 and day 26 were lower than those at baseline. In the pain group, the changes of IL-6 were associated with improvement in pain intensity (β = 0.333, P = 0.001) and depressive symptoms (β = 0.478, P = 0.005) at day 13. Path analysis showed the direct (β = 2.995, P = 0.028) and indirect (β = 0.867, P = 0.042) effects of changes of IL-6 on improvement in depressive symptoms both were statistically significant.ConclusionThis study suggested that an elevated inflammatory response plays a critical role in individual differences in TRD patients with or without pain. Ketamine showed great antidepressant and analgesic effects in TRD patients with pain, which may be related to its effects on modulating inflammation.Trial registrationChiCTR, ChiCTR-OOC-17012239. Registered on 26 May 2017

Multifidus Cross-Sectional Area in Health Care Workers: Does It Correlate With Pain?

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. OTs and other health care professionals frequently experience low back pain. This has been associated with multifidus cross-sectional area in various populations, but not previously in health care workers. This project observed multifidus cross-sectional area in OTs and other health care personnel. A pain group was compared with a nonpain group to assess differences between them. At the S1 level (with a trend at L5), those with more pain had smaller multifidus. Primary Author and Speaker: Robert E. Larson Contributing Authors: Ulrike H. Mitchell, A. Wayne Johnson

The Relationship Between Dynamic Balance Ability and Shoulder Pain in High School Baseball Pitchers.

Dynamic balance is essential for pitching motion because pitching kinematics requires whole body coordination. The Star Excursion Balance Test (SEBT) and the Y balance test (YBT) evaluate dynamic balance quantitatively. There are some reports that investigated the relationship between SEBT/YBT and pain in upper and lower extremities, but there is no study among high school baseball pitchers. Dynamic balance deficiency is associated with shoulder pain among high school baseball pitchers. Cross-sectional study. Level 4. A total of 259 male high school pitchers who participated in the preseason medical checkups were included in the study. YBT was used to measure their dynamic balance. The participants completed a questionnaire which asked if they were currently experiencing shoulder pain. Twenty-two pitchers had shoulder pain during the preseason medical checkups. In the YBT, the posterolateral balance while standing with the axis leg as well as the posteromedial and posterolateral balance while standing with the step leg were significantly lower in the pain group than in the nonpain group (P = 0.05, 0.04, and 0.001, respectively). A logistic regression analysis showed that posterolateral balance when standing with the step leg was an independent risk factor for current shoulder pain (P = 0.04, odds ratio 0.942, 95% CI 0.892-0.996). The dynamic balance of high school baseball pitchers with shoulder pain was lower than that of participants without shoulder pain. In particular, posterolateral direction with the step leg standing was significantly related to shoulder pain. Among high school baseball pitchers, decreased dynamic balance was related to current shoulder pain. YBT maybe recommended in preseason medical checkups for high school baseball pitchers.

Relationship between Nonspecific Low Back Pain and Physical Function among Japanese High School Long-distance Runners

Background: For long-distance runners, low back pain as well as lower extremity disorders are becoming more common. This study analyzed the relationship between regular physical assessment results and nonspecific low back pain among long-distance runners. Methods: Subjects included 105 high school long-distance runners, who were divided into the low back pain group (n = 20; LP) and non-pain group (n = 85; NP). All subjects underwent regular chronic pain and physical assessments every six months. Differences in each measurement between both groups were analyzed using an unpaired t-test for comparison.Results: The LP had a shorter history of athletics (LP=3.2 years, NP=4.6 years, 95% confidence interval (95%CI): -2.55, -0.28, r=0.45), a greater hip extension angle (LP=32.7°, NP=28.4°, 95% CI: 2.85, 5.61, r=0.67), a lower hip extension muscle strength (LP=3.1 kgf/kg, NP=4.0 kgf/kg, 95% CI; 0.19, 0.61, r=0.45), and a greater number of times during the stand-up test (LP=11.1, NP=8.1, 95% CI; 0.40, 5.56, r=0.45) than the NP.Conclusion: An excessive hip extension angle and insufficient hip extension muscle strength were considered as risk factors. It is possible that the excessive movement of the hip joint and the biarticular muscles may have caused the low back pain in the inexperienced runners.

Uji Validitas Dan Reliabilitas Kuesioner Fonseca Anamnestic Index Versi Bahasa Indonesia Populasi Usia 19-21 Tahun (Penelitian)

Background: Temporomandibular disorders are disorders that can involve masticatory muscles, temporomandibular joints, or both. The main symptoms and signs of temporomandibular disorders can be pain in the mastication muscle, pain in the temporomandibular joint area, limited movement of the jaw, and sounds in the temporomandibular joint, such as clicks or crepitus. Objective: To know the validity and reliability test of the Indonesian version of the Fonseca Anamnestic Index questionnaire in population ages 19-21 years in temporomandibular disorders. Methods: Observational analytic with cross-sectional study design. This study used a questionnaire with ten questions distributed via Google forms to 354 respondents (213 women and 141 men) aged 19-21 years in Jabodetabek. Validity test data were analyzed using correlation, and reliability test data were analyzed using Cronbach’s alpha. Results: The correlation test showed that the Indonesian version of the FAI questionnaire was valid with r &gt; 0.1 and the results of the reliability test on the pain group were reliable with Cronbach's alpha &gt; 0.6, but the results were unreliable in the non-pain group with Cronbach's alpha &lt; 0.6. Conclusion: The Indonesian version of the FAI questionnaire was valid with a high correlation. Based on the pain group, the Indonesian version of the FAI questionnaire is reliable, while based on the non-pain group, the Indonesian version of the FAI questionnaire is not reliable.

Age-related changes in muscle elasticity around the shoulder joint in young male baseball players: A prospective longitudinal study

BackgroundLongitudinal changes of elasticity in the muscle tissues around the shoulder joint during the growth period have not been assessed using shear wave elastography. MethodsThis study enrolled male students aged 13–18 years who played baseball or rubber baseball as an extra-curricular activity during junior high or high school or on a baseball team outside of school. The exclusion criterion was a history of surgery for athletic injury. One hundred and twenty-one boys were included in the study. The elasticity of the superior part of the trapezius, the supraspinatus, and the infraspinatus were measured by ultrasound. The shear elastic modulus (SEM), which is the ratio of the strain ratio (SR) in the acoustic coupler to the SR of each muscle, was calculated as a representative value. Six months after the baseline assessment, subjects were evaluated regarding any newly developed pain in the joint of the throwing shoulder, and categorized into either the non-pain group or the pain group. ResultsAlthough all muscle SEMs tended to increase in both the throwing and non-throwing shoulders, no significant difference was observed in the prevalence of shoulder joint pain between ages (p = 0.541). The results of a binominal logistic regression analysis, adjusted for age, body mass index, playing position in baseball, frequency of baseball practice, shoulder range of motion, and muscle strength showed that a decrease in SEM values of the supraspinatus was a risk factor for the development of new pain (odds ratio: 0.056; 95% confidence interval 0.011–0.299; p = 0.001). ConclusionsThe elasticity of muscle tissues around the throwing shoulder increased with age, and low tissue elasticity of the supraspinatus of the throwing shoulder was a factor that triggered pain during throwing motions.

Correlation analysis between the surface electromyography and muscle fiber types of the core muscle group in the patients with myofascial pain syndromes

To detect the core muscle group in the patients with myofascial pain syndromes(MPS) by using the surface electromyography; to detect the distribution of muscle fiber type by the analysis of the median frequency and the slope of the median frequency. From October 2017 to March 2018, there were 100 patients with the MPS, including 45 males and 55 females; the average age was 48.5 years old, ranging from 29 to 76 years old. There were 40 cases of left back pain and 60 cases of right back pain. The course of illness was more than 6 months. Another 40 healthy patients without pain in the waist were included in the control group, 20 males and 20 females; the average age was 47.3 years old, ranging from 29 to 76 years old. All the patients had different degrees of back pain and muscle stiffness, which were diagnosed as lumbar fasciitis by clinical and imaging examination. Surface electromyography was used to measure the characteristics of the lumbar core muscles (multifissions, iliocostal muscles, and longest muscle) of the three groups in the Biering-Sorensen testing, such as median frequency(MF) and absolute slope of median frequency (MFs). The MF values of the multifidus muscle in the three groups were as follows:the left side of the non-pain group was 133.88±26.61, and the right side was 131.39±29.81; left side of lift side pain group 117.29±10.93, right side 133.70±17.81; in the right pain group, the left side was 131.36±17.37, and the right side was 118.28±13.57. The MF values of the iliocostal muscle in the three groups were:106.94±28.01 on the left side of the non-pain group, 114.68±18.96 on the right side; left side of lift side pain group 93.95±11.17, right side 107.60±27.86; in the right pain group, the left side was 105.93±15.52, and the right side was 97.27±19.27. The MF values of the longest muscle in the three groups were:109.24±26.20 on the left side of the non-pain group, 112.58±17.70 on the right side. Left side of left side pain group 95.58±10.83, right side 108.79±26.39; in the right pain group, the left side was 106.50±17.98, and the right side was 98.20±11.16. The MFs values of the multifidus muscle in the three groups were:0.221±0.109 on the left side of the non-pain group, and 0.259±0.169 on the right side; left side of left side pain group 0.318±0.184, right side 0.210±0.159; in the right pain group, the left side was 0.258±0.169, and the right side was 0.386±0.166. The MFs values of the iliocostal muscles in the three groups were:0.241±0.158 for the left side of the non-pain group, and 0.238±0.128 for the right side. Left side of left side pain group 0.330±0.208, right side 0.252±0.171; in the right side pain group, left side 0.249±0.150, right side 0.343± 0.144. The MFs values of the longest muscle of the three groups were:0.244±0.252 on the left side of the non-pain group, and 0.210±0.128 on the right side; left side of left side pain group 0.348±0.255, right side 0.241±0.224; in the right pain group, the left side was 0.239±0.155, and the right side was 0.334±0.233. There were no statistically significant differences in MF and MFs values of the left and right lumbar multifidus muscle, iliocostal muscle and longest muscle in the non-pain group(P>0.05). MF values of the pain side multifidus muscle, iliocostal muscle and longest muscle in the lumbago group were lower than those in the non-pain group(P<0.05). MFs values of the painful side multifidus muscle, iliocostal muscle and longest muscle in the low back pain group were higher than those in the non-pain group(P<0.05). The muscle fatigue degree of the back muscle in the pain side of patients with MPs is decreased, and the muscle fiber type is dominated by II muscle fiber.

Over-triage occurs when considering the patient's pain in Korean Triage and Acuity Scale (KTAS).

BackgroundThe Korean Triage and Acuity Scale (KTAS) was developed based on the Canadian Emergency Department Triage and Acuity Scale. In patients with pain, to determine the KTAS level, the pain scale is considered; however, since the degree of pain is subjective, this may affect the accuracy of KTAS. The purpose of this study was to evaluate the accuracy of KTAS in predicting patient's severity with the degree of pain used as a modifier.MethodA retrospective observational cohort study was conducted in an urban tertiary hospital emergency department (ED). We investigated patients over 16 years old from January to June 2016. The patients were divided into the pain and non-pain groups according to whether the degree of pain was used as a modifier or not. We compared the predictive power of KTAS on the urgency of patients between the two groups. Acute area registration in the ED, emergency procedure, emergency operation, hospitalization, intensive care unit admission, and 7-day mortality were used as markers to determine urgent patients.ResultsOverall, 24,253 patients were included in the study, with 9,175 (37.8%) in the pain group. The proportions of patients with KTAS 1–3 were 61.4% in the pain and 75.6% in the non-pain groups. Among patients with KTAS 2–3, the proportion of urgent patients was higher in the non-pain group than the pain group (p<0.001). The odds ratios for urgent patients at each KTAS level revealed a more evident discriminatory power of KTAS for urgent patients in the non-pain group. The predictability of KTAS for urgent patients was higher in the non-pain group than the pain group (area under the curve; 0.736 vs. 0.765, p-value <0.001).ConclusionsConsidering the degree of pain with KTAS led to overestimation of patient severity and had a negative impact on the predictability of KTAS for urgent patients.

Effects of Omega‐3 Polyunsaturated Fatty‐Acid Supplementation on Neuropathic Pain Symptoms and Sphingosine Levels in Mexican‐Americans with Type 2 Diabetes

PurposeTo determine whether dietary supplementation with omega‐3 polyunsaturated fatty acids (PUFAs) reduces neuropathic pain symptoms in Mexican‐Americans with type 2 diabetes.MethodsForty volunteers with type 2 diabetes enrolled in the “En Balance‐PLUS” program, which provided weekly nutrition–diabetes education and daily supplementation with 1,000 mg docosahexaenoic acid (DHA)–200 mg eicosapentaenoic acid over 3 months. The study assessed self‐reported neuropathic pain symptoms pre/postintervention using the short‐form McGill Pain Questionnaire (SF‐MPQ), monitored clinical laboratory values at baseline and 3 months, and performed baseline and 3‐month metabolomic analysis of plasma samples.ResultsA total of 26 participants self‐reported neuropathic pain symptoms at baseline. After 3 months of omega‐3 PUFA supplementation, participants reported significant improvement in SF‐MPQ scores (sensory, affective, and visual analogue scale; P&lt;0.001, P=0.012, and P&lt;0.001, respectively). Untargeted metabolomic analysis revealed that participants in the moderate–high SF‐MPQ group had the highest relative plasma sphingosine levels at baseline compared to the low SF‐MPQ group (P=0.0127) and the nonpain group (P=0.0444). Omega‐3 PUFA supplementation increased plasma DHA and reduced plasma sphingosine levels in participants reporting neuropathic pain symptoms (P&lt;0.001 and P&lt;0.001, respectively). Increased plasma DHA levels significantly correlated with improved SF‐MPQ sensory scores (r=0.425, P=0.030). Improved SF‐MPQ scores, however, did not correlate with clinical/laboratory parameters.ConclusionThe data suggest that omega‐3 PUFAs dietary supplementation may reduce neuropathic pain symptoms in individuals with type 2 diabetes and correlates with sphingosine levels in the plasma.Support or Funding InformationThis study was funded by NIH grants 5P20MD006988 and 5R25GM060507. The content of this article is solely the responsibility of the authors, and does not necessarily represent the official views of the National Institutes of Health.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effects of omega-3 polyunsaturated fatty-acid supplementation on neuropathic pain symptoms and sphingosine levels in Mexican-Americans with type 2 diabetes.

PurposeTo determine whether dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) reduces neuropathic pain symptoms in Mexican-Americans with type 2 diabetes.MethodsForty volunteers with type 2 diabetes enrolled in the “En Balance-PLUS” program, which provided weekly nutrition–diabetes education and daily supplementation with 1,000 mg docosahexaenoic acid (DHA)–200 mg eicosapentaenoic acid over 3 months. The study assessed self-reported neuropathic pain symptoms pre/postintervention using the short-form McGill Pain Questionnaire (SF-MPQ), monitored clinical laboratory values at baseline and 3 months, and performed baseline and 3-month metabolomic analysis of plasma samples.ResultsA total of 26 participants self-reported neuropathic pain symptoms at baseline. After 3 months of omega-3 PUFA supplementation, participants reported significant improvement in SF-MPQ scores (sensory, affective, and visual analogue scale; P<0.001, P=0.012, and P<0.001, respectively). Untargeted metabolomic analysis revealed that participants in the moderate–high SF-MPQ group had the highest relative plasma sphingosine levels at baseline compared to the low SF-MPQ group (P=0.0127) and the nonpain group (P=0.0444). Omega-3 PUFA supplementation increased plasma DHA and reduced plasma sphingosine levels in participants reporting neuropathic pain symptoms (P<0.001 and P<0.001, respectively). Increased plasma DHA levels significantly correlated with improved SF-MPQ sensory scores (r=0.425, P=0.030). Improved SF-MPQ scores, however, did not correlate with clinical/laboratory parameters.ConclusionThe data suggest that omega-3 PUFAs dietary supplementation may reduce neuropathic pain symptoms in individuals with type 2 diabetes and correlates with sphingosine levels in the plasma.

Characteristics and relative factors of headache caused by cervicocerebral artery dissection.

To analyze the characteristics and relative factors of headache and neck pain due to cervicocerebral artery dissection (CAD). A total of 146 consecutive patients with CAD in Zhengzhou, China (2010-2017) were observed and registered prospectively. There were 60 (60/146) cases who complained of headache and neck pain, and we analyzed the characteristics of pain according to their clinical features. For the 130 (130/146) patients with complete clinical laboratory data, they were divided into two groups according to pain, and the relative factors of pain were analyzed. The headache and neck pain in 60 CAD patients was mostly acute onset (98.3%), 70.6% (12/17) of patients with anterior circulation dissection and 88.4% (38/43) of patients with posterior circulation dissection complained of moderate to severe pain. 41.2% (7/17) of patients with anterior circulation dissection had temporal pain, while 46.5% (20/43) of the patients with posterior circulation dissection had occipital pain. There were 23.5% (4/17) and 32.6% (14/43) of patients with anterior and posterior circulation dissection complained of throbbing pain, respectively, 23.5% (4/17) and 20.9% (9/43) of patients with anterior and posterior circulation dissection complained of pulsating pain. The pain could occur in the ipsilateral (40.0%), bilateral (52.7%), or contralateral (7.3%) sites of the dissection. In the 130 patients, there were 56 cases (43.1%) in the pain group, and 74 cases (56.9%) in the non-pain group. Multivariate logistic regression analysis showed that female gender (OR 4.01, 95% CI 1.63-9.85, P = 0.002), posterior circulation (OR 3.18, 95% CI 1.39-7.28, P = 0.006), history of headache (OR 4.72, 95% CI 1.08-20.52, P = 0.039), and low-density lipoprotein less than 1.8mmol/L (OR 2.90, 95% CI 1.15-7.34, P = 0.025) were risk factors of the occurrence of the pain related to CAD. The headache and neck pain caused by CAD is a moderate to severe pain occurring suddenly. The pain nature may be diverse but mostly like throbbing and pulsating. When the dissected artery is located in the posterior circulation, the pain is mostly in the occipital region, and mostly in the temporal region when the dissected artery is located in the anterior circulation. The pain can occur in ipsilateral, bilateral, or contralateral of the dissection. In addition, several factors might contribute to the occurrence of headache and neck pain.

The relationship between pain psychological factors and job stress in rehabilitation workers with or without chronic pain.

Pain is affected by pain psychological factors (PPFs), whereas relationship between PPFs and job stress are unclear. This study aimed to elucidate the relationship between PPFs and job stress in workers. The study participants were the staff of the rehabilitation department of a core hospital. After undergoing a preliminary survey (38/43, 88% response rate), the rehabilitation workers were divided into the chronic pain group (CPG, n = 18) and the nonpain group (NPG, n = 13). Depression, anxiety, and magnification in the CPG were significantly associated with depressed mood and total stress response. Anxiety in the NPG was also significantly associated with all stress responses, except irritability and feelings of anxiety. Furthermore, all subscales of the Pain Catastrophizing Scale in the NPG were significantly and negatively associated with the vigor of stress responses. Chronic pain in workers was associated with severe job stress, and increased job stress worsened the state of chronic pain. Pain catastrophizing may be associated with early job stress in a person with no pain. This finding revealed a difference between the CPG and NPG and may be important for managing workers with job stress or pain.

MP13: Accuracy of Korean triage and acuity scale when pain severity is used as a modifier

Introduction: Accurate triage is important because under-triage may delay critical care for emergent patients and over-triage may inhibit efficient management of emergency department (ED) resources. In Korea, the Korean Triage and Acuity Scale (KTAS) was developed based on the CTAS in 2015. The purpose of this study was to evaluate the accuracy of KTAS in predicting patient’s severity when degree of pain was used as a modifier. Methods: This was a retrospective observational cohort study, conducted in an ED of urban tertiary university hospital with more than 90,000 visits per year. We studied adult patients who visited the ED from January 2016 to June 2016. Patients were devided into pain group and non-pain group according to whether the degree of pain was used as a modifier in the KTAS evaluation. We used acute area registration, emergency procedure, emergency operation, hospitalization, intensive care unit admission, and hospital mortality as markers to determine urgent patients. To evaluate discriminative ability of KTAS, the odds ratios of each KTAS values compared to KTAS 3 for the urgent patients were calculated. And to compare the predictive power of KTAS for urgent patients between the two groups, the area under the receiver operating characteristic (ROC) curves were compared by DeLongs method. Results: There were 9,175 (37.8%) patients in the pain group and 15,078 (62.2%) patients in the non-pain group. When KTAS was assessed as 2, only 20.3% of the patients in the pain group were registered to the acute area, while 71.2% of the patients in the non-pain group were registered to the acute area (p&lt;0.001). And the proportion of emergency procedure, admission, ICU admission, and mortality was also higher in patients with pain group. Similarly, in the patients of KTAS 3, the proportion of urgent patients was higher in the non-pain group except emergency operation. The odds ratio for the occurrence of urgent patients decreased as the KTAS value increased in both groups, however, the difference between the odds ratios of each KTAS was more evident in the non-pain group. In pain group, compared to patients with KTAS 3, the odds ratio (95% CI) for acute area registration were 2.32 (1.92-2.80), 0.61 (0.51-0.73), and 0.35 (0.23-0.53) for patients with KTAS 2, 4, 5, respectively; in non-pain group, odds ratio were 5.59 (5.09-6.13), 0.28 (0.25-0.32), and 0.13 (0.10-0.16). The non-pain group showed better predictive power of KTAS for acute area registration than pain group; AUC (95% CI), 0.864 (0.861-0.867) vs. 0.810 (0.802-0.818), p&lt;0.0001). The predictability of KTAS was also higher in non-pain group for emergency procedure, emergency operation, admission, and ICU admission. Conclusion: We have confirmed that the use of pain severity as a modifier in KTAS is a factor affecting accuracy. The acuity level is overestimated when pain severity is used as modifier in KTAS evaluation.