Number Of Pain Sites Research Articles

Site, frequency, and duration of pain in young children with spina bifida.

PURPOSE:To investigate the: (1) percent of children with spina bifida (SB) complaining of pain, (2) frequency, duration, and cause of pain by sex, level of lesion type of SB, and ambulation status, (3) body sites reported to hurt, by variables in objective 2, and (4) associations between physical and mental/emotional health between caregiver and child.METHODS:Cross-sectional study of 101 caregivers of children (3 to 6 years old) with SB. Survey data and information from medical records were included. Pearson chi-square, one-way ANOVA, Fisher’s exact test, logistic regressions, and bivariate correlations were used.RESULTS:Seventy percent reported that their child complained of pain, which did not significantly differ by sex, level of lesion, type of SB, or ambulation status. Most (86%) were reported to have experienced pain for less than 24 hours. The most frequently reported pain site was the head, followed by the abdomen and the lower body. Number of pain sites was moderately correlated with frequency of pain complaints. Correlations between how caregivers reported their own physical/mental/emotional health and how they rated that of their children ranged from weak (r = 0.22) to moderate (r = 0.55).CONCLUSION:Almost seven of ten children reportedly complained of pain ranging from at least once a month to everyday. Pain needs to be routinely assessed and treated in this population.

Epidemiology of pain in back and extremities in rural population: A community-based estimation of age- and sex-specific prevalence, distribution, duration and intensity of pain, number of painful sites and seasonality of pain during twelve months in rural Gadchiroli, India.

BackgroundPopulation-based estimates of the burden of pain in back and extremities (PBE) by sex, age, intensity, seasonality and site are lacking from rural India.MethodsTwo villages were randomly selected from a cluster of 39 villages in Gadchiroli district in India. All residents’≥20 years of age were surveyed in January 2010 by trained surveyors by making household visits. Information on PBE in the 12 months prior to survey was obtained using a structured, pretested questionnaire.ResultsThe 12-month period prevalence of PBE was 75% (95% confidence interval CI = 72.54-77.73) in men and 91% (95% CI = 88.66-92.13) in women. The prevalence of PBE in the participants >50 years was 94% while that in the age group 20 to 50 years was 79% (P < 0.05). The site with the highest prevalence of pain was low back (women 80%, men 59%). The mean number of painful sites per person was 5.42 (95% CI = 5.17-5.67) in women, 3.68 (95% CI = 3.45-3.90) in men, 3.89 (95% CI = 3.71-4.07) in participants aged 20 to 50 years and 6.48 (95% CI = 6.11-6.85) in those >50 years. Among participants across the age and sex groups, the prevalence of mild pain was higher than severe pain at all the anatomical sites. Among various seasons, the highest prevalence of pain was in the rainy season (14%).ConclusionThe prevalence and the number of painful sites were higher among women and in those >50 years of age. The public health interventions for PBE need to focus on these two high risk groups.

Pain drawing as a screening tool for anxiety, depression and reduced health-related quality of life in back pain patients: A cohort study.

Back pain patients are more likely to suffer from depression, anxiety and reduced quality of life. Pain drawing is a simple, frequently used anamnesis tool that facilitates communication between physicians and patients. This study analysed pain drawings to examine whether pain drawing is suitable as a screening tool for signs of anxiety, depression or reduced quality of life, as the detection of these symptoms is essential for successful treatment. Pain drawings of 219 patients with lower back pain were evaluated retrospectively. Pain drawings are a schematic drawing of a human being. Six variables of the pain drawing were analysed. Subscales of the Hospital Anxiety and Depression Scale (HADS) and the Mental Component Summary (MCS) of the Short Form 12 (SF-12) were used to measure anxiety, depression and quality of life, respectively. Descriptive statistics, uni- and multivariate linear regression analyses and analysis of variance were performed. Logistic regression analyses were conducted for suitable variables. We revealed significant positive correlations between the variables "filled body surface" and "number of pain sites" and the anxiety (HADS-A) and depression subscales (HADS-D) of the HADS (p<0.01). The same predictors had significant negative correlations with the MCS (p<0.01). However, the sensitivity and specificity of the variable "number of pain sites" were too low compared to those for existing screening tests to consider it as a screening tool for anxiety, depression and quality of life (HADS-A: sensitivity: 45.2%, specificity: 83.3%; HADS-D: sensitivity: 61.1%, specificity: 51%; MCS: sensitivity: 21.2%, specificity: 85.7%). There were significant correlations between the amount of filled body surface and the number of pain sites in the pain drawing and anxiety, depression and quality of life. Although useful in routine clinical practice, pain drawing cannot be used as a screening tool based on our results.

Patterns and Correlates of Self-Management Strategies for Osteoarthritis-Related Pain Among Older Non-Hispanic Black and Non-Hispanic White Adults.

Knee osteoarthritis (OA) is a leading source of pain and disability among older adults. Self-management (SM) strategies are recommended to manage OA symptoms. Sociodemographic and clinical characteristics, along with other factors, may influence SM utilization rate. This study sought to examine the prevalence and correlates of SM use for pain among non-Hispanic Black patients (NHB) and non-Hispanic White patients (NHW) older adults with or at risk for knee OA. A secondary data analysis was conducted on the Understanding Pain and Limitations in Osteoarthritic Disease multisite observational study, which included NHB (n = 104) and NHW (n = 98) community-dwelling older adults with or at risk for knee OA. Participants completed measures of sociodemographics, pain SM use, coping, and clinical and experimental pain. Clinical and experimental pain were significantly greater among NHBs compared to NHWs. There were no significant differences in use of total SM by ethnicity/race. Interestingly, multiple linear regression revealed that clinical and experimental pain indices, as well as coping, number of pain sites, age, and sex were differentially associated with total SM use between NHBs and NHWs. There were significant ethnicity/race by type of pain management interaction effects for pain measures. SM is common among older adults with or at risk for knee OA pain, and the prevalence of SM does not differ by ethnicity/race, but many guideline-recommended interventions for OA are underutilized. Importantly, different factors were associated with the use of SM, highlighting distinct biopsychosocial mechanisms contributing to SM use in NHBs and NHWs.

Recurrent pain in adolescents with cerebral palsy: a longitudinal population-based study.

To investigate the pain characteristics, pain interference with activities of daily living, and use of analgesics in adolescents with cerebral palsy (CP) and compare the results with previous findings. Sixty-seven adolescents (median age 14y 4mo, range 12y 2mo-17y, 28 females, 39 males) classified in Gross Motor Function Classification System (GMFCS) levels III to V, who participated in a CP surveillance programme, were assessed on pain measures twice, 5 years apart. Primary caregivers marked recurrent pain sites and graded pain interference with activities of daily living and sleep. Information on pain severity was obtained through two questions from the Child Health Questionnaire (CHQ) and were transformed into a pain score scaled from 0 to 100, where 100 represented no pain. The use of short-acting analgesics was recorded. Over 5 years, the prevalence of recurrent pain, number of pain sites, pain intensity, and pain frequency all increased significantly. The most frequent pain sites were the hip/thigh in GMFCS level V and knee in GMFCS level III. The median CHQ pain score decreased from 60 to 40 (p<0.001). Pain interference with activities of daily living increased (p=0.011) but not for sleep. Twenty-eight of 54 participants with moderate or severe pain (CHQ pain score ≤60) received no short-acting analgesics. In adolescents with CP, pain increased over 5 years despite follow-up in a surveillance programme. For enhanced management of pain, we propose that an algorithm on pain should be included in surveillance programmes.

Differences in Pain Characteristics and Functional Associations between Nursing Home Residents and Community-Dwelling Older Adults: A Cross-Sectional Study.

BackgroundPain is one of the most critical issues in older adults, and the place of residence may play an important role in pain characteristics and related factors. However, it is an understudied subject. This study investigated differences in pain characteristics and functional associations between nursing home residents and community-dwelling older adults.MethodsOlder adult participants were recruited from nursing homes (n=73) and the community (n=73). Pain characteristics, including type, intensity, and number of pain sites, were evaluated. Other outcome measures were functional mobility, walking speed, functional independence, physical activity, anxiety, depression, and health-related quality of life.ResultsNursing home residents experienced musculoskeletal pain more frequently and had a greater number of pain sites than community-dwelling older adults (p<0.05). Walking speed and mobility were significantly lower and anxiety and depression were significantly higher in nursing home residents (p<0.05). While higher pain intensity was significantly correlated with low scores on physical measures, low health-related quality of life, and higher depression and anxiety symptoms in both groups (p<0.05), the magnitudes of the correlations were much higher in nursing home residents. The number of pain sites was significantly correlated with low scores on physical measures, low health-related quality of life, and higher depression and anxiety symptoms mainly in nursing home residents (p<0.05).ConclusionCompared to community-dwelling older adults, nursing home residents experienced musculoskeletal pain more frequently and at more sites in the body. Higher pain intensity and number of pain sites were associated with worse clinical variables, mainly in nursing home residents. This study highlights the importance of regular pain assessment, especially in nursing home care settings.

Modeling the Multidimensional Predictors of Multisite Musculoskeletal Pain Across Adulthood-A Generalized Estimating Equations Approach.

Background: Multisite pain is commonly chronic and often lacks its initial role as a potential tissue damage signal. Chronic pain among working-age individuals is a risk for disability and imposes a major burden on health care systems and society. As effective treatments for chronic pain are largely lacking, better identification of the factors associated with pain over working years is needed.Methods: Members of the Northern Finland Birth Cohort 1966 participated in data collection at the ages of 31 (n = 4,028) and 46 (n = 3,429). Using these two time points, we performed a multivariable analysis of the association of socioeconomic, occupational, psychological and lifestyle factors (i.e., low education, living alone, low household income, unemployment, occupational physical exposures [hard physical labor, leaning forward, back twisting, constant moving, lifting loads of ≥ 1 kg], physical inactivity, regular smoking, regular drinking, overweight, and psychiatric symptoms) with the number of musculoskeletal pain sites (i.e., upper extremity, lower extremity, lower back, and the neck-shoulder region; totalling 0–4 pain sites). The data were analyzed using generalized estimating equations.Results: At the age of 31, multisite pain was reported by 72.5% of men and 78.6% of women. At the age of 46, the prevalence of multisite pain was 75.7% among men and 82.7% among women. Among men, the number of pain sites was positively associated with age (rate ratio 1.05, 95% confidence interval 1.01–1.08), low household income (1.05, 1.01–1.08), unemployment (1.13, 1.06–1.19), any occupational exposure (1.17, 1.12–1.22), regular smoking (1.06, 1.02–1.11), and psychiatric symptoms (1.21, 1.17–1.26). Among women, the number of pain sites was positively associated with age (1.06, 1.04–1.10), unemployment (1.10, 1.05–1.15), any occupational exposure (1.10, 1.06–1.13), regular smoking (1.06, 1.02–1.10), overweight (1.08, 1.05–1.11), and psychiatric symptoms (1.19, 1.15–1.22); living alone was negatively associated with the number of pain sites (0.95, 0.91–0.99).Conclusion: Of the studied predictors, psychiatric symptoms, occupational physical exposures and unemployment were most strongly associated with multisite pain among both sexes. The results of this study deepen the understanding of the underlying factors of and comorbidities behind multisite pain, and help develop pain relief and rehabilitation strategies for working-age individuals with multisite pain.

Investigating Specialized Chronic Pain Care Among Emerging Adults

AIMS: To investigate characteristics of emerging adults accessing a specialized chronic non-cancer pain clinic and describe interventions offered and utilized by this group. A retrospective chart review was conducted of emerging adults and middle-aged adults with chronic pain receiving care over a six-month period. A chronic pain clinic in Southeastern Ontario. 82 participants comprised of 41 emerging adults (aged 18-29) and 41 middle-aged adults (aged 30-64) METHODS: Groups were matched on sex and number of pain sites. Demographic and pain characteristics, interventions, referrals, and clinic utilization were examined using bivariate and multivariate analysis. Emerging adults reported lower pain severity scores (t(80)=-2.15, p=.035), were more likely to receive referrals for additional consultation and/or diagnostic investigations (X2(1, n=82)=4.97, p=.026) and to have at least one psychology visit (X2=7.29, p=.007). Moreover, emerging adults with higher depression scores were more likely to see a psychologist (OR 1.23, 95% CI 1.014-1.492). Pain presentation and care patterns differed between emerging adults and middle-aged adults. Increased use of non-pharmacologic interventions in emerging adults may reflect differences in pain presentations as well as clinician's sensitivity to emerging adult's particular developmental needs but further research is needed. Further research is needed to contribute to nurses' understanding of the quality and efficacy of pain management approaches.

Effect of central sensitization inventory on the number of painful sites and pain severity in a Japanese regional population cohort

BackgroundTo investigate the association between the central sensitization inventory (CSI), a screening tool for central sensitization, and the number of painful sites and the severity of pain in locomotive organs in an epidemiological study in the elderly. MethodsA total of 379 individuals who underwent musculoskeletal disease screening were enrolled in this study. The CSI was used to assess symptoms of central sensitization. The number and location of painful sites and the severity of pain were evaluated using pain mapping and a numerical rating scale (NRS) at 37 sites. We investigated the association between the number of painful sites and CSI score, and the association between the severity of low back pain or knee pain and CSI score. ResultsThere was a positive correlation between CSI score and the number of painful sites. The CSI score was significantly higher in those with significant low back pain than in those without pain, and the high-CSI group tended to have a greater number of painful sites. Comparison of CSI scores between participants with low back pain alone and those with low back pain and posterior lower leg pain showed that the latter group had a significantly higher CSI score than the former group. The CSI score in participants with radiographic evidence of knee osteoarthritis was significantly higher in those with knee pain than in those without pain. ConclusionsThe results of this study suggest that participants with significant low back pain and a higher number of painful sites are more susceptible to the influence of central sensitization. In addition, CSI score was higher in participants with low back pain and posterior lower leg pain than in those with low back pain alone, suggesting that the spread of pain may be due to central sensitization.

Pressure pain thresholds in individuals with knee pain: a cross-sectional study

BackgroundKnee osteoarthritis (KOA), chronic widespread pain (CWP) and overweight/obesity are public health problems that often coincide, and there is a multifactorial and unclear relationship between them. The study aimed to (1) investigate pain sensitivity, assessed by pressure pain thresholds (PPTs), among women and men with knee pain and (2) associations with, respectively, radiographic KOA (rKOA), CWP, and overweight/obesity.MethodsBaseline data from an ongoing longitudinal study involving 280 individuals with knee pain in the 30–60 age group. Pain sensitivity was assessed by PPTs on eight different tender points using a pressure algometer. The participants’ knees were x-rayed. Self-reported CWP and number of pain sites were assessed with a pain figure, and overweight/obesity was measured using body mass index (BMI), visceral fat area (VFA), and body fat percentage, assessed with a bioimpedance. Associations were analysed using regression analyses.ResultsWomen reported lower PPTs than men (p < 0.001), but no PPTs differences were found between those with and without rKOA. Low PPTs was associated with female sex, more pain sites, CWP, and a higher VFA and body fat percentage. The tender points second rib and the knees were most affected. The prevalence of CWP was 38 %.ConclusionsThe modifiable factors, increased VFA, and body fat could be associated with increased pain sensitivity among individuals with knee pain. Longitudinal studies are needed to further investigate the associations.

Association of asthma with low serum vitamin D and its related musculoskeletal and psychological symptoms in adults: a case-control study

There are complex potential inter-relationships between the chronic inflammation of asthma and poor control, vitamin D deficiency, musculoskeletal pain and anxiety and depression. The aim was to investigate associations between vitamin D and these possible co-morbidities. This case-controlled study involved 75 adults with asthma and 75 controls. Serum 25-hydroxyvitamin D (25(OH)D) was measured, levels of anxiety, depression, musculoskeletal pain, and asthma control were assessed. Participants with asthma had lower 25(OH)D and higher anxiety scores and higher measures of musculoskeletal pain compared to controls. Binary logistic regression showed that asthma was associated with decreased 25(OH)D (Odds ratio (OR) = 0.86), general weakness (OR = 13.29), complaint of musculoskeletal pain (OR = 13.73), and increased intensity of musculoskeletal pain (OR = 0.61) and number of painful sites (OR = 2.58). Asthma was not associated with anxiety or depression. Further studies are required to investigate if vitamin D supplementation can improve asthma symptoms and musculoskeletal pain.

Associations Between Dysmenorrhea Symptom-Based Phenotypes and Vaginal Microbiome: A Pilot Study.

Dysmenorrhea is highly prevalent; it places women at risk for other chronic pain conditions. There is a high degree of individual variability in menstrual pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Distinct dysmenorrhea symptom-based phenotypes were previously identified, but the biological underpinnings of these phenotypes are less known. One underexplored contributor is the vaginal microbiome. The vaginal microbiota differs significantly among reproductive-age women and may modulate as well as amplify reproductive tract inflammation, which may contribute to dysmenorrhea symptoms. The objective of this study was to examine associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome compositions on- and off-menses. We conducted a prospective, longitudinal, pilot study of 20 women (aged 15-24 years) grouped into three dysmenorrhea symptom-based phenotypes: "mild localized pain," "severe localized pain," and "severe multiple pain and gastrointestinal symptoms." Over one menstrual cycle, participants provided vaginal swabs when they were on- and off-menses. We assayed the vaginal microbiome using 16S rRNA gene sequencing. Permutational multivariate analysis of variance tests were used to compare microbiome compositions across phenotypes, with heat maps generated to visualize the relative abundance of bacterial taxa. The vaginal microbiome compositions (n = 40) were different across the three phenotypes. After separating the on-menses (n = 20) and off-menses (n = 20) specimens, the statistically significant difference was seen on-menses, but not off-menses. Compared to the "mild localized pain" phenotype, participants in the "multiple severe symptoms" phenotype had a lower lactobacilli level and a higher abundance of Prevotella, Atopobium, and Gardnerella when on-menses. We also observed trends of differences across phenotypes in vaginal microbiome change from off- to on-menses. The study provides proof-of-concept data to support larger studies on associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome that might lead to new intervention targets and/or biomarkers for dysmenorrhea. This line of research has the potential to inform precision dysmenorrhea treatment that can improve women's quality of life.

Associations of Pain Characteristics with Long-term Trajectories of Physical Capacity among Older Adults in the United States

Bothersome and multisite pain are common and strongly associated with low physical functioning in older adults. Although these associations are well established in cross-sectional studies, few population-based studies have examined the impact of pain on physical functioning over time. Accordingly, we sought to determine the associations of pain characteristics with longitudinal trajectories of performance-based measures of physical capacity in older adults. Data on 6,783 community-dwelling adults aged ≥65 years who participated in the 2011-2017 National Health and Aging Trends Study were analyzed. Physical capacity was measured annually using the Short Physical Performance Battery. Group-based trajectory modeling was used to identify groups with similar longitudinal patterns of physical capacity. Baseline pain characteristics included report of bothersome pain in the past month, activity-limiting pain, location of pain, and pain medication use. Multinomial logistic regression was used to examine associations of pain characteristics with trajectories of physical capacity, adjusting for demographic and health characteristics. The cohort was 57% female, 68% white, and 58% were ≥75 years. Four distinct physical capacity trajectories were identified: “persistently low” (12% of cohort), “low, declining” (16%), “moderate, declining” (29%), and “persistently high” (43%). Participants who reported bothersome pain, activity-limiting pain, greater number of pain sites, and more frequent pain medication use at baseline were significantly more likely to demonstrate either “persistently low” or a declining physical capacity trajectory. For example, compared to those not reporting bothersome pain participants who reported bothersome pain were 79% (adjusted relative risk [RR]=1.79 [95%CI:1.26-2.55]), 75% (RR=1.75 [95%CI:1.42-2.16]), and 24% (RR=1.24 [95%CI:1.01-1.51]) more likely to have a “persistently low”, “low declining”, and “moderate declining” physical capacity trajectory, respectively. Among older adults in the US, bothersome pain and other pain characteristics were significantly associated with poor and worsening trajectories of physical capacity over a 6-year period. National Institute on Aging/NIH U01AG032947 and Scan Design Foundation.

The Affordable Care Act's young adult mandate was associated with a reduction in pain prevalence.

Pain is a major health problem among U.S. young adults. The passage of the Affordable Care Act's young adult mandate in 2010 allowed individuals to remain on their parents' health insurance until age 26. Although studies have documented the positive effects of this mandate on various health outcomes, less is known about its association with self-reported pain among young adults. Using the 2002 to 2018 National Health Interview Survey (N = 48,053) and a difference-in-differences approach, we compared the probabilities of reporting pain at 5 sites (low back, joint, neck, headache/migraine, and facial/jaw) and the number of pain sites between mandate eligible (ages 20-25) and ineligible (ages 26-30) adults before and after the mandate. In fully adjusted models, the mandate was associated with a decline of 2 percentage points in the probability of reporting pain at any site (marginal effect, -0.02; 95% confidence interval [CI], -0.05 to -0.002; weighted sample proportion, 0.37) and in the number of pain sites (coefficient, -0.07; 95% CI, -0.11 to -0.01; weighted sample average, 0.62). These results were primarily driven by the association between the mandate and the probability of reporting low back pain (marginal effect, -0.03; 95% CI, -0.05 to -0.01; weighted sample proportion, 0.20). Additional analyses revealed that the mandate was associated with improvements in access to care and reductions in risk factors for pain-including chronic conditions and risky health behaviors. To the extent that the results are generalizable to other health insurance programs, removing financial barriers to medical care may help reduce pain prevalence.

Pediatric recurring pain in the community: the role of children's sleep and internalizing symptoms.

Associations between poor sleep and pain may be amplified for children who also have depressive or anxious symptoms. This study examined associations between child sleep at eight years and recurrent pain at nine years along with the moderating role of internalizing symptoms. Families were from a community-based, ongoing longitudinal study (N = 632 children). At eight and nine years, twins (49.2% female, 56.7% non-Latinx European American, 28.8% Latinx) and caregivers participated in assessments focused on child sleep and pain, respectively. Approximately 53% of children had pain in at least one location at least monthly. Internalizing symptoms at age eight were positively associated with number of pain sites at age nine. Lower sleep efficiencies wereassociated with more pain sites for children with higher levels of internalizing symptoms. Later midpoint times were associated with more pain sites for children with lower levels of internalizing symptoms.Interventions focused on improving children's pain outcomes may consider targeting sleep behaviors and mental health.

Neuropathic pain and symptoms of potential small-fiber neuropathy in fibromyalgic patients: A national on-line survey.

Recent studies have highlighted that about 50% of fibromyalgic patients has a neuropathy of small- and/or large-fibers which could partially explain the puzzling symptoms of fibromyalgia (FM). Our aim was to investigate the estimated prevalence of self-reported neuropathic pain and small-fiber neuropathic symptoms (SFNS) indicative for the presence of small-fiber pathology in FM patients. A nationwide sample of patients was recruited to participate in an on-line survey. Two groups of patients were considered in post-hoc analysis: those positive (FM+) to the Fibromyalgia Research Criteria (FRC) and those complaining typical symptoms of fibromyalgia without fulfilling the FRC (FM-). We collected data from 854 patients (749 FM+ and 105 FM-). Patients that scored=50/100 at the Neuropathic Pain Symptoms Inventory (NPSI), indicating severe neuropathic pain, were 57.3% (62.4% in FM+ and 21.0% in FM-). Around 46% of patients presented three or more SFNS that could be suggestive of small fiber pathology, the most frequent being dry eyes/mouth, allodynia, and dyshidrosis. The NPSI score showed significant moderate/strong associations with disability (Spearman's rho=0.61), pain (rho=0.66), stiffness level (rho=0.46), number of painful sites (rho=0.40), and SFNS (rho=0.44). Despite the high prevalence of neuropathic pain and other symptoms attributable to potential small and/or large fibers pathology, neurophysiologic investigations were performed in 43.6% of cases and skin punch biopsy only in 1.9% of patients enrolled, as well as the assumption of anti-neuropathic pain drugs (13.2%). Our findings underscore the high estimated prevalence of neuropathic pain and SFNS in FM patients.

Abstract PO-111: Postoperative lung cancer pain over 4 days: Changes in painful body surface area

Abstract Introduction: It is unknown if the body surface area measure is sensitive to the change in pain over the first four days after lung cancer surgery. Known for cancer health disparities, improving pain outcomes for patients with lung cancer could have implications for reducing disparities. The purpose of this study was to compare body surface area over the first four days post thoracotomy for lung cancer. Methodology: In a repeated measures observational study, 41 lung cancer patients (mean age 60±12 years, 80% male, 100% Turkish) who had thoracotomy surgery reported pain postoperatively for four days. Patients were asked to mark on a body outline the location of the area where they had pain each day using PAINReportIt, a valid and reliable electronic version of the McGill Pain Questionnaire, on an Internet-enabled Surface Pro tablet. The number of sites that the patient marked was counted automatically by PAINReportIt. Then the body surface area percentage (BSA%) was calculated using ImageJ software. Each day patients were asked to rate on a 0-10 scale the pain intensity they were currently having and the least and worst that the pain was in the past 24 hours. These 3 values were used to create the average of pain intensity (API) the patient experienced for each of the four days. Analyses included scatter plots, descriptive statistics, longitudinal analysis of BSA% using linear mixed effects model, and Pearson correlations of BSA% and API. Results: The mean number of pain sites recorded by PAINReportIt for each postop day 1 to 4 was 2.1±0.7, 2.2±0.7, 2.1±0.9, and 1.9±0.7, respectively (p=.152). The mean BSA% on postop days 1 to 4 was 2.1%±1.9%, 2.4%±2.2%, 2.5%±2.7%, and 2.2%±2.4%, respectively. The correlations between postop day 1-4 values were high (r=.68 to r=.86). Longitudinal analysis shows that the time trend was not statistically significant: b=0.023, Std Err=0.094, 5=0.242, p=.81. The API significantly decreased over the 4 postop days: 7.3±1.8, 5.6±1.8, 4.2±1.9, and 3±2.1, respectively (p=.000). The correlations between BSA% and API on each of the 4 postop days were: r=-.56, p&amp;lt;.001, r=-.15, p=.36, r=-.03, p=.85, and r=-.05, p=.78. The negative relationship between BSA% and API was unexpected and scatter plots show that at very high pain and very low pain, BSA%s were low. High BSA% values were mostly observed at moderate pain. This inverse U shape relationship explains the correlations between BSA% and API at different time points. Conclusions: In a sample of patients who had thoracotomy for lung cancer, the BSA% was not sensitive to recovery over the first 4 days after surgery, but the API was. This finding is likely due to the few pain sites and small areas marked on the body outline to represent the pain of the surgical incision and chest tubes. In the post thoracotomy lung cancer population, BSA% is not likely to be a measure that will help reduce cancer health disparities. Citation Format: Mecca M. James, Sevgi D. Dogan, Seda K. Yedir, Rishabh Garg, Yingwei Yao, Sevily Erden, Diana J. Wilkie. Postoperative lung cancer pain over 4 days: Changes in painful body surface area [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-111.

Sleep Disturbance and Its Association with Pain Severity and Multisite Pain: A Prospective 10.7-Year Study.

IntroductionSleep disturbance is often comorbid with chronic pain disorders, with emerging evidence suggesting a stronger effect of sleep disturbance on pain than vice versa; however, few studies have evaluated the long-term associations between sleep disturbance and pain. This study was to examine the associations of sleep disturbance with knee pain severity, number of painful sites (NPS) and persistent pain in a 10.7-year cohort study.MethodsA total of 1099 community-dwelling older adults (age mean ± SD, 63 ± 7.5 years; 51% female) were recruited and followed up at 2.6, 5.1 and 10.7 years later. Data on demographics, body mass index, physical activity and comorbidities were collected. At each time point, sleep disturbance, knee pain severity and NPS were assessed by using questionnaires. Multisite pain (MSP) was defined as NPS ≥ 2. Persistent knee pain or MSP was defined as having knee pain or MSP at all time points, respectively. Multivariable mixed-effects models and log-binomial regression were applied.ResultsIn multivariable analyses, sleep disturbance was associated with greater knee pain severity (β 0.91/unit, 95% CI 0.70–1.11) and more NPS [(relative risk (RR) 1.10/unit, 95% CI 1.07–1.14] in a dose–response manner. Persistent sleep disturbance was associated with persistent knee pain (RR 1.90, 1.26–2.87) and MSP (RR 1.29, 1.07–1.56). Persistent knee pain and MSP were also associated with persistent sleep disturbance (knee pain: RR = 1.99; MSP: RR = 2.71, both P < 0.05).ConclusionsSleep disturbance was independently associated with greater pain severity and NPS in a dose–response manner. A reciprocal relationship between persistent sleep disturbance and persistent pain suggests treating either problem could help the other.Electronic Supplementary MaterialThe online version of this article (10.1007/s40122-020-00208-x) contains supplementary material, which is available to authorized users.

High individual pain variability in people living with HIV: A graphical analysis.

People living with HIV (PLWH) frequently experience pain. Following calls to analyse individual-level data in addition to group-level data in pain studies, we compared individual and group-level changes in pain prevalence, intensity and number of pain sites over 48weeks in a large cohort of PLWH. This is the largest ever cohort study of pain in PLWH, and is the first to report pain at the level of the individual. Participants included all participants with complete pain records from a randomized clinical trial (RCT) for the treatment of HIV (n=787/1053). At weeks 0, 12, 24, 36 and 48 we assessed participants' pain in the last week; presence of pain, and if present, the intensity and locations of the pain. We used standard averaging methods to describe data at the group level, and unique graphical reporting methods to analyse data at the level of the individual. Group-level data demonstrated a trend for pain prevalence to decline over time (19% week 0, 12% week 48). Worst pain intensity remained stable (median between 4/10 and 5/10), as did the number (median=1) and common sites of pain across the 48weeks. In contrast, individual-level data demonstrated high intra-individual variability with regards to the presence of pain, and the intensity and location of the pain. While our group-level data were similar to previous longitudinal studies, an apparent reduction in pain over 48weeks, the individual-level data showed large variability within individuals in that same time frame. This graphical analysis highlights the high variability in pain (pain prevalence, intensity and body sites) across time in people living with HIV, and how presenting averaged data hides this important variability. Our data support the reporting of individual-level data in human experimental and observational studies.

Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study.

Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment. The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals' phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics. This cross-sectional survey study included 678 women (aged 14-42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals' phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics. We reproduced three dysmenorrhea symptom-based phenotypes: the "mild localized pain" phenotype (characterized by mild abdominal cramps), the "severe localized pain" phenotype (characterized by severe abdominal cramps), and the "multiple severe symptoms" phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals' phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes. Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.