Pain Distress Research Articles

Abstract 4136277: The Lay Public Misconceives Characteristics of Acute Coronary Syndrome-Related Chest Pain

Introduction: The most common acute coronary syndrome (ACS) symptom is chest pain. Chest pain is an umbrella term more precisely described using words like pressure or tightness. Previous studies have not explored the lay public’s conceptions of ACS-related chest pain. Misconceptions about chest pain make it difficult for individuals to recognize this symptom if they were to experience it, delaying care seeking. Research Question: How does the lay public conceive of ACS-related chest pain? Methods: Participants from across the U.S. were recruited in May and June 2023. Participants completed an online survey including the Chest Pain Conception Questionnaire. Descriptive statistics were used to characterize conceptions of chest pain quality, timing, intensity, and distress. Conceptions of men and women were compared using the independent-samples t -test and Chi-square test. Results: Participants (n=597) were mostly women (n=355; 59.5%) with a mean age of 54.0 years (SD = 11.5). The sample was diverse: White (n=414, 69.2%), Black (n=101; 16.9%), Hispanic or Latina/o/e/x (n=96; 16.1%), and Asian (n=67; 11.2%). Participants often thought of pressure (78.9%), tightness (77.4%), squeezing (75.5%), gripping (72.9%), and heaviness (72.5%) as possible descriptors of ACS-related chest pain. They less often thought of discomfort (48.7%), fullness (16.8%), and indigestion (13.4%). Participants expected ACS-related chest pain to be “intense” and to bother them “a lot,” both with median scores of 4.0 on a 5-point Likert scale. Participants felt that ACS-related chest pain would “often” (median 4.0) occur with activity and “sometimes” (median 3.0) occur at rest. Women were more likely to rate specific descriptors of chest pain (i.e., pressure, tightness) and general descriptors of chest pain (i.e., discomfort, pain) as more likely ACS-related chest pain descriptors than men, (all ps ≤ .05). Women (n=58; 16.3%) were about twice as likely as men (n=22; 9.2%) to endorse indigestion as a possible descriptor of ACS-related chest pain, ( p = .013, OR = 0.52 [95% CI = 0.31-0.87]). Conclusions: As many as 1 in 5 participants did not endorse common descriptors such as pressure and tightness as potentially characterizing ACS-related chest pain. Most believed this symptom would be intense and bother them a lot. They also more often associated ACS-related chest pain with activity than with rest. Clinical and research interventions can target the misconceptions identified in this study.

Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.

To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes. One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures. VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury. Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.

Sleep Quality in Head and Neck Cancer

Background: Patients with head and neck cancer often experience impaired sleep. Moreover, the treatment may negatively affect sleep quality. The aim of this observational study was to evaluate the sleep quality after treatment for head and neck cancer, and its relationship with quality of life and psychological distress. Methods: A total of 151 patients who underwent treatment for head and neck cancer at our department were included in the study. Quality of life, sleep quality, risk of sleep apnea, sleepiness, pain, and psychological distress were assessed by means of specific questionnaires. Results: The median follow-up was 30 months. Poor sleep quality was observed in 55.6% of the cases. An association between PSQI global sleep quality and EORTC global health status was found. The DT, HADS anxiety, and HADS depression scores were associated to PSQI global score, sleep quality, sleep latency, sleep disturbances, and daytime dysfunction. Conclusions: Sleep disturbances, particularly OSA and insomnia, are frequent in HNC patients, and significantly impact their quality of life and psychological well-being. Given the effect of sleep on overall well-being, addressing sleep disorders should be a priority in the care of HNC patients.

Symptom management for people with advanced dementia who are receiving end of life care.

This review aims to synthesise contemporary research on symptom management for people with advanced dementia who are thought to be in the final year of life. It highlights the unique challenges faced by palliative care and dementia care specialists, offering insights into the clinical decision-making required to support those with advanced dementia in various care settings. Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Pain, breathlessness, and psychological distress are frequently mismanaged, which contributes to suboptimal care. Moreover, the unpredictable trajectory of dementia complicates the identification of end-of-life needs, which can result in fragmented care. Caregivers, both professional and family, struggle with managing complex symptoms, while family caregivers in home settings face added burdens in providing care without sufficient support. Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.

Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms

BackgroundUp to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM).MethodsThe MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement.DiscussionThe overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination.Trial registrationClinicalTrials.gov NCT06036147. Registered on September 13, 2023.

Comparison Between Dexmedetomidine and Midazolam-Fentanyl Combination in Flexible Bronchoscopy: A Prospective, Randomized, Double-blinded Study.

Dexmedetomidine has acceptable clinical utility for inducing sedation during flexible bronchoscopy. Reducing its dose may not only ameliorate its cardiovascular side effects, but also maintain its clinical usefulness. Patients between 18 and 65 years were randomized to either dexmedetomidine (0.75µg/kg) or the midazolam-fentanyl group (0.035mg/kg midazolam and 25mcg fentanyl). The primary outcome measure was the composite score. Other parameters noted were: oxygen saturation, hemodynamic variables, Modified Ramsay Sedation Score, Numerical Rating Scale (NRS) for pain intensity and distress, Visual Analog Scale score for cough, rescue medication doses, ease of doing bronchoscopy, and patient response 24 hours after bronchoscopy. In each arm, 31 patients were enrolled. The composite score at the nasopharynx was in the ideal category in 26 patients in dexmedetomidine and 21 in the midazolam-fentanyl group (P=0.007). At the tracheal level, the corresponding values were 24 and 16 (P=0.056). There was no significant difference between the 2 groups regarding the secondary outcome measures except hemodynamic parameters. The mean heart rate in the dexmedetomidine and midazolam-fentanyl groups, respectively, was as follows: at 10 minutes after start of FB (90.10±14.575, 104.35±18.48; P=0.001), at the end of FB (98.39±18.70, 105.94±17.45; P=0.016), and at 10 minutes after end of FB (89.84±12.02, 93.90±13.74; P=0.022). No patient developed bradycardia. Two patients (P=0.491) in the dexmedetomidine group developed hypotension. Low-dose dexmedetomidine (0.75μg/kg single dose) appears to lead to a better composite score compared with the midazolam-fentanyl combination.

Associations between acupuncture and uses of opioids and neuropsychiatric medication following chemotherapy-induced peripheral neuropathy among patients with breast cancer.

216 Background: Chemotherapy-induced peripheral neuropathy (CIPN) features debilitative neuropathic pain and neurologic deficits, commonly present in breast cancer population exposed to certain chemo-agents. Given suboptimal effects often rendered by limited therapeutic options, CIPN is associated to psychological distress and drug-seeking behaviors, which leads to heightened functional impairment and disease burden. Acupuncture has gained clinical recognitions for alleviating pain and mental distress, but its impact on medication uses for pain or psychiatric disorders in CIPN remains unclear. As such, this study aims to investigate the association between acupuncture and use of these medications among breast cancer patients experiencing CIPN. Methods: This survival analysis utilized data from the TriNetX Network comprising real-time electronic health records from over 60 healthcare organizations across the United States. Breast cancer patients over 18 at the index date within 01/01/1997 (inception of acupuncture practice in US) and 05/10/2023, diagnosed with CIPN after exposure to chemo-agents such as taxane, platinum, vinca alkaloids, thalidomide, or bortezomib, were identified as the baseline cohort. Patients who received at least three acupuncture sessions post CIPN diagnosis were compared to those without any acupuncture record. Endpoints included prescription of sedative/hypnotics, anti-depressants, anti-psychotics, anti-convulsant agents, and opioid analgesics, within a twelve-month follow-up period after index date. Antibiotics use was the negative control outcome. A 1:1 propensity-score-matching (PSM) method was applied for between-group balance of demographics, BMI, cancer treatment history, health comorbidities, and concurrent medications, followed by hazard ratios and 95% CI calculation using Cox regression model. Results: Among 398 PSM pairs, acupuncture group demonstrated significantly lower hazards of sedative/hypnotics (HR= 0.74, 95% CI 0.61-0.9), anti-depressants (HR= 0.75, 95% CI 0.61-0.93), anti-psychotics (HR= 0.74, 95% CI 0.58-0.96), anticonvulsants (HR= 0.48, 95% CI 0.27-0.87), and opioids (HR= 0.78, 95% CI 0.65-0.94) use, whereas antibiotics showed insignificant result (HR= 0.75, 95% CI 0.55-1.02). The significance sustained after sensitivity analyses, excluding patients with concurrent other cancers, and narrowing follow-up period down to the last nine months to concentrate on treatment effects. Conclusions: Our study suggests a decreased need of opioids and neuropsychiatric medication associated with acupuncture treatment among breast cancer patients endorsing CIPN. Rigorous clinical studies are warranted to validate the causal underpinnings.

Complimentary Role of Comprehensive Palliative Care Treatment to Intrathecal Therapy: Case Report

Intrathecal therapy with implanted devices is often reported in some recommendations.for the management of difficult cancer pain However, data is often biased by optimistic view and poor assessment.We report a case of patient in which a comprehensive and complex palliative care treatment was effective in managing a patient who was implanted a subcutaneous port for intrathecal analgesiaThis patient had many characteristics of a difficult pain, really defined as refractory due to various negative prognostic pain factors, such as neuropathic pain and psychological distress..A comprehensive pain management with a balanced approach including both interventional therapy and palliative care simultaneously, allowed to achieve optimal pain control. Terms such as intractable or refractory pain, have been ambiguously used in literature to select patients as candidates for implated pumps. A meaningful evaluation and a comprehensive treatment should be mandatory when using intrathecal anlgesia in patients with very difficult pain conditions.

Prevalence of concerns about falling in people with knee or hip osteoarthritis and the association with pain, function, and psychological factors-a cross-sectional study of 7442 patients treated in primary care.

Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA. This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression. In total, 7442 patients were included [mean age 67years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [β-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex. CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant.

AGING GRACEFULLY IN OSTEOARTHRITIS: IMPACT OF COMORBIDITIES

Background: Osteoarthritis (OA) is a prevalent musculoskeletal disorder, often complicated by comorbid conditions such as cardiovascular diseases, metabolic syndromes, and mental health issues. These comorbidities significantly impact the progression of OA and the effectiveness of its management, posing challenges for comprehensive patient care. Objectives: This review examines the relationship between OA and its common comorbidities, focusing on cardiovascular diseases, metabolic conditions, and mood disorders. We also explore the impact of pharmacological and non-pharmacological treatments in these patients, emphasizing the importance of integrated care strategies. Methods: Data from multiple studies were analyzed to assess the association between OA and comorbid conditions. The studies examined mortality risk, cardiovascular incidents, metabolic syndrome, diabetes, obesity, and mood disorders, while considering the effects of various OA treatment modalities, particularly non-steroidal anti-inflammatory drugs (NSAIDs). Results: Cardiovascular comorbidities, including coronary heart disease, are significantly linked to OA, with functional limitations such as impaired mobility being major contributors to increased cardiovascular risks and mortality. NSAIDs, commonly prescribed for OA, present substantial cardiovascular and renal risks, complicating their use in patients with pre-existing cardiovascular conditions. Metabolic comorbidities, particularly obesity and diabetes, are highly prevalent in OA patients and are associated with reduced quality of life and exacerbation of OA symptoms. Furthermore, mood disorders like depression and anxiety are common among OA patients, leading to a vicious cycle of pain and psychological distress that worsens functional outcomes. Conclusions: OA is closely related to various comorbidities, necessitating a holistic, multimodal approach to treatment. Beyond pharmacologic interventions, lifestyle changes, psychosocial support, and careful management of comorbid conditions are essential for improving outcomes in OA patients.

The Impact of Pain, Threat Perception and Emotional Distress on Suicide Risk in Individuals with Colorectal Cancer.

Colorectal cancer (CRC) can significantly impact mental health, increasing suicide risk. Variables such as pain and threat perception may be crucial. This study aims to identify predictors of suicide risk in individuals with CRC. A total of 71 participants (76.06% men) aged 27 to 88 years (M = 65.18, SD = 12.02) were assessed using the SF-36 for pain, the Brief Illness Perception Questionnaire (B-IPQ) for threat perception, the Hospital Anxiety and Depression Scale (HADS) for emotional distress, and the Plutchik suicide risk scale for suicide risk. Descriptive, comparative, and correlational analyses were performed, followed by a linear regression analysis. Nearly 20% of participants exhibited high suicide risk. There was a moderate-to-high association between suicide risk and the perception of threat, pain, and emotional distress. The linear regression model explained 39% of the variance in suicide risk, with threat perception, pain, and emotional distress as significant predictors. These results indicate the need for multidisciplinary care for individuals with CRC, including emotional support from health psychologists, and holistic, human-centered care from nursing and medical professionals. Future research is necessary to further explore these relationships and improve patient care strategies.

Measurement of Patients' Acceptable Symptom Levels and Priorities for Symptom Improvement in Advanced Prostate Cancer.

Limited research has evaluated the success criteria and priorities for symptom improvement of patients with cancer to inform patient-centered care. In this study, we adapted and tested a measure of these constructs, the Patient-Centered Outcomes Questionnaire (PCOQ), for patients with advanced prostate cancer. We compared acceptable symptom severity levels following symptom treatment across 10 symptoms and identified patient subgroups based on symptom importance. Patients with advanced prostate cancer (N = 99) participated in a one-time survey, which included a modified version of the PCOQ, standard symptom measures, and additional clinical characteristics. The modified PCOQ demonstrated construct validity through its correlations with related theoretical constructs. There was a moderate correlation between symptom severity and importance. Acceptable symptom severity levels were generally low, with sexual dysfunction having a higher acceptable severity than most other symptoms. Three patient subgroups were identified: (1) those who rated all symptoms as low in importance (n = 43); (2) those who rated all symptoms as moderately important (n = 33); and (3) those who rated all symptoms as highly important (n= 18). Subgroups were associated with functional status, fatigue, sleep problems, pain, and emotional distress. The modified PCOQ demonstrated preliminary evidence of construct validity. Patients generally considered low symptom severity to be acceptable, with variations across symptoms. Results suggest that symptom severity and importance are related but distinct aspects of the symptom experience in advanced prostate cancer. Patients' diverse priorities for symptom improvement point to the need for individualized treatment plans.

FSCIG 10% in pediatric primary immunodeficiency diseases: a European post-authorization safety study

BackgroundThe safety, tolerability, and immunogenicity of hyaluronidase-facilitated subcutaneous immunoglobulin (fSCIG) 10% (dual-vial unit of human immunoglobulin 10% and recombinant human hyaluronidase [rHuPH20]) were assessed in children with primary immunodeficiency diseases (PIDs).MethodsThis phase 4, post-authorization, prospective, interventional, multicenter study (NCT03116347) conducted in the European Economic Area, enrolled patients aged 2 to < 18 years with a documented PID diagnosis who had received immunoglobulin therapy for ≥ 3 months before enrollment. New fSCIG 10% starters underwent fSCIG 10% dose ramp-up for ≤ 6 weeks (epoch 1) before receiving fSCIG 10% for ≤ 3 years (epoch 2); patients pretreated with fSCIG 10% entered epoch 2 directly. The primary outcome was the number and rate (per infusion) of all noninfectious treatment-related serious and severe adverse events (AEs).ResultsIn total, 42 patients were enrolled and dosed (median [range] age: 11.5 [3–17] years; 81% male; 23 new starters; 19 pretreated). Overall, 49 related noninfectious, treatment-emergent AEs (TEAEs) were reported in 15 patients; most were mild in severity (87.8%). No treatment-related serious TEAEs were reported. Two TEAEs (infusion site pain and emotional distress) were reported as severe and treatment-related in a single new fSCIG 10% starter. The rate of local TEAEs was lower in pretreated patients (0.1 event/patient-year) versus new starters (1.3 events/patient-year). No patients tested positive for binding anti-rHuPH20 antibodies (titer of ≥ 1:160).ConclusionsNo safety signals were identified, and the incidence of local AEs declined over the duration of fSCIG 10% treatment. This study supports fSCIG 10% long-term safety in children with PIDs.Trial registration number (ClinicalTrials.gov)NCT03116347.

It's not all that bad: associations among pain characteristics and sexual well-being in people living with chronic pain.

Individuals experiencing chronic pain often report adverse effects on their sexual functioning. However, other important aspects of sexual well-being (SWB), such as sexual distress and sexual self-esteem, have received little attention. This is an important omission because a SWB involves more than just good sexual function. Similarly, past research has not examined how chronic pain characteristics affect the different aspects of SWB. The goal of this cross-sectional study was to examine the SWB of individuals living with chronic pain and to examine the extent to which SWB is associated with different chronic pain characteristics. A total of 310 individuals (28.1% men, 70.6% women, 1.3% transgender men) with ages between 21 and 50 (M = 31.96, SD = 6.13) who were in a romantic relationship and with self-reported chronic pain for three months or longer completed an online survey. The following indicators of SWB were included in the study: frequency of genital sexual activity, sexual satisfaction, sexual self-esteem, sexual desire, sexual function, genital pain, and sexual distress. The results show that most individuals with chronic pain maintain an active and satisfying sexual life and feel positive about themselves as a sexual partner. Slightly more than a fourth reported experiencing at least one sexual functioning difficulty and almost three-fourths of them found those difficulties sexually distressing. A first canonical correlation showed that more negative pain characteristics were associated with poorer SWB. The second canonical correlation showed that greater perceived partner support can offset the negative relationship between pain and some aspects of SWB. These findings show that individuals living with chronic pain can experience positive SWB. Furthermore, the buffering effect of partner support suggests it is important to involve romantic partners in interventions aimed at improving the SWB of people living with chronic pain. The study examined a large number of indicators of SWB using a sample of individuals with different types of chronic pain. Limitations include potential self-selection bias and a sample that was predominantly white and highly educated. The results paint a more positive picture of the SWB of individuals living with pain and show that individuals living with chronic pain can experience positive SWB. These findings can help for researchers, educators, and clinicians about how to conceptualize, understand, and improve the SWB of individuals living with chronic pain.

Open-label placebos reduce weight in obesity: a randomized controlled trial

Obesity is a major public health problem worldwide. Different approaches are known to face this problem, for example, dieting, surgery, or drug interventions. It has also been shown that placebos may help to reduce weight and hunger feelings, but the use of placebos is linked to problems with respect to the patient-healthcare-provider relationship. However, recent studies demonstrated that even placebos without deception (open-label placebos) affect symptoms such as pain, anxiety, or emotional distress. Here we aimed to examine whether an open-label placebo may help to lose weight in obesity. Our study included fifty-seven overweight and obese patients who aimed to lose weight using a combination of diet and sports. Patients were randomly divided into two groups. Participants in the open-label placebo group received two placebos each day. A treatment-as-usual group received no pills. Primary outcome included changes of body weight. Secondary outcomes were change of eating behavior and self-management abilities. After 4 weeks we found that participants in the open-label placebo condition lost more weight than the treatment-as-usual group. Furthermore, OLP treatment affected eating behavior. No effects for self-management abilities were found. Although further research is necessary, open-label placebos might help individuals to lose weight.

The non-haemorrhagic vagal response to trauma: a review of hypotensive and bradycardic responses to injury in the absence of bleeding.

Trauma has the potential to cause haemorrhage, tissue damage, pain, visceral manipulation and psychological distress. Each of these consequences of trauma can cause changes in autonomic outflow, which dictates a patient's vital signs. Patients who are hypotensive and bradycardic due to a vagally mediated parasympathetic response to pain, psychological distress and visceral manipulation may be confused with those who exhibit bradycardia and hypotension following significant blood volume loss. This review summarises literature that describes specific stimuli, patterns of injury and patient characteristics that are associated with a non-haemorrhagic vagal response to trauma. Twenty-six records described predominantly parasympathetic responses to trauma (both blunt and penetrating) and surgery ("iatrogenic trauma"). Such a non-haemorrhagic vagal response occurs following a wide variety of injury patterns. Patient age and sex are poor predictors of the likelihood of a non-haemorrhagic vagal response. The development and resolution of a non-haemorrhagic vagal response occurs over a heterogenous time period. It is unclear whether speed of onset and resolution is linked to the pattern of injury or other factors causing a predominantly parasympathetic response following non-haemorrhagic trauma. The pattern of injury, patient demographic and speed of onset / resolution associated with the non-haemorrhagic vagal response to trauma may is heterogenous. It is therefore challenging to clinically distinguish between the hypotensive bradycardia due to hypovolaemia secondary to haemorrhage, or a parasympathetic response to trauma in the absence of bleeding.

Virtual Reality to Reduce Pain, Fatigue, and Emotional Distress in People With Cancer: A Scoping Review.

Cancer and its treatments cause symptoms such as pain, fatigue, and emotional distress, which affect the quality of life of patients at different stages of cancer. Virtual reality (VR) has emerged as a promising alternative for addressing these symptoms by immersing patients in a virtual environment that isolates them from reality. To describe the existing evidence on the use of VR to improve pain, fatigue, and emotional distress in people with cancer at different stages of the cancer trajectory. A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Search was conducted in PubMed and CINAHL until October 2023. Twenty-three primary studies related to the study topic were identified, and the following information was collected: type of VR (immersive vs nonimmersive) used in oncology services, purpose (distraction, training, or relaxation), devices used (head-mounted display, headset, or virtual controller), and the environment simulated (natural environment, skill games, or educational environment). The effects of VR on pain, fatigue, and emotional distress are described, highlighting its ability to mitigate these symptoms in the short term. Virtual reality has been shown to be an effective technique for reducing pain, fatigue, and emotional distress in people with cancer in the short term. Nurses can use VR as a complementary tool to promote virtual environments that improve the care for and therefore the quality of life of people with cancer.

Splenic rupture in dairy cattle: Report of 24 cases.

Splenic rupture in cattle is scarcely described in the literature. The aim of this work was to report the occurrence of splenic rupture in cattle in southern Brazil as well as to describe the causes of the condition. Between 2013 and 2022, 24 of the 1769 bovine necropsies performed in southern Brazil were due to splenic rupture, accounting for 1.36% of the diagnoses. Animals died due to hemoperitoneum caused by a rupture in the splenic capsule, typically associated with marked splenomegaly and a large hematoma between the capsule and the parenchyma. Clinical signs were described in a subset of cases (11 of 24 cases, 46%) and included apathy, abdominal pain, mucosal pallor, tachycardia, and respiratory distress. However, the majority (13 of 24 cases, 54%) presented as sudden death. The underlying cause of splenic rupture was established as follows: 16 cases (67%) secondary to babesiosis, 4 cases (17%) due to lymphoma, 1 case (4%) due to a thrombus, 1 case (4%) due to external trauma, 1 case due to a ruptured nodular lymphoid hyperplasia (4%), and 1 case of undetermined cause (4%). Hypovolemic shock caused by splenic rupture is an important cause of death of dairy cattle, and babesiosis and bovine leukemia virus-associated lymphoma are among the most common etiologic diagnoses (84% of cases). The description of the causes of this condition is important to clarify the pathogenesis and occurrence of splenic rupture in dairy cattle.

TEMPOROMANDIBULAR DISORDER, BODY PAIN, AND OTOLOGIC AND PSYCHOLOGIC SYMPTOMS: THEIR INTERRELATIONSHIPS IN ASIAN YOUTHS.

To establish the interrelationships between temporomandibular disorders (TMDs), pain, and otologic and psychologic comorbidities in Asian youths. Youths from a local polytechnic, aged 17 to 24 years old, were enrolled and an electronic survey encompassing demographic variables-the DC/TMD TMD pain screener (TPS), Short- form Fonseca Anamnestic Index (SFAI), modified Maciel's Otologic/Pain Symptom Inventory, and Patient Health Questionnaire-4-was administered. Par.cipants were subsequently categorized into groups: no TMD pain (NP), with TMD pain (WP), no TMDs (NT), and with any TMDs (WT). Data were evaluated with chi-square test, nonparametric, and logistic regression analyses (α &#61; .05). Among the 198 participants (mean age 18.8 ± 1.7 years), 11.1% had painful TMDs and 18.2% experienced TMD pain or dysfunction. Significant differences in total-otologic symptoms (total-OS), vertigo, and dizziness plus otalgia, tinnitus, and hearing loss scores were observed between the WP-NP and WT-NT groups correspondingly. While total-comorbid pain (total-CP) and psychologic distress (total-PD) scores varied substanally between the WT-NT group, only a significant difference in total-PD scores was discerned between the WP-NP group. Total-OS scores were moderately correlated to TPS/SFAI, total-CP, and total-PD scores, and psychologic distress was a risk factor for painful TMDs. Otologic and pain comorbidities were prevalent among Asian youths with TMDs and appear to be interrelated. The complex interaction of TMDs with pain, otologic, and psychologic comorbidities must be considered when caring for youths with multiple somatic complaints.

Symptom experience and symptom distress in patients with malignant brain tumor treated with proton therapy: A five-year follow-up study

Background and purposeSince patients with primary brain tumor are expected to become long-term survivors, the prevention of long-term treatment-induced side effects is particularly important. This study aimed to explore whether symptom experience and symptom distress change over five years in adults with primary brain tumors treated with proton therapy. An additional aim was to explore whether symptom experience and symptom distress correlate. Materials and methodsThe study had a longitudinal observational design. Adult (≥18 years) patients (n = 170) with primary brain tumors treated with proton therapy were followed over five years. Symptom experience and symptom distress were evaluated using the patient-reported Radiotherapy-Related Symptom Assessment Scale. Data from baseline, 1, 12, and 60 months were analyzed using non-parametric tests. ResultsOf the 170 patients, the levels of symptoms and symptom distress were low. Fatigue increased at 1 (p=0.005) and 12 months (p=0.025) and was the most frequent symptom from baseline to 60 months’ follow-up. Cognitive impairment increased at 12 (p=0.027) and 60 months (p<0.001) and was the most distressing symptom at 60 months’ follow-up. There were significant, moderate to strong, correlations at all time points between symptom experience and symptom distress of fatigue, insomnia, pain, dyspnea, cognitive impairment, worry, anxiety, nausea, sadness, constipation, and skin reactions. ConclusionSymptom experience and symptom distress changed in intensity over time with cognitive impairment as the most distressing symptom at 60 months. Future research should focus on identifying effective interventions aimed at alleviating these symptoms and reducing symptom distress for this vulnerable group of patients.