Pain Expectations Research Articles

Transcranial random noise stimulation over the left dorsolateral prefrontal cortex attenuates pain expectation and perception

ObjectiveThe dorsolateral prefrontal cortex (DLPFC) has been increasingly used as a neuromodulatory target in pain management. Transcranial random noise stimulation (tRNS) was shown to effectively elevate cortical excitability. Hence, this study aimed to characterize how tRNS over the left DLPFC affects pain expectation and perception, as well as the efficacy of conditioned-pain modulation (CPM) that reflects the function of the endogenous pain-inhibitory pathway. MethodsUsing a randomized, double-blinded, and sham-controlled design, healthy participants were randomly recruited to receive tRNS with a direct current offset or sham stimulation. Their expectations and perceptions of painful electrocutaneous stimuli, as well as CPM efficacy were assessed before, immediately after, and 30 min after tRNS. ResultsCompared with sham stimulation, perceived-pain ratings to the painful stimuli, and expected-pain ratings before painful stimuli, attenuated immediately after tRNS, whereas this analgesic effect was ineffective 30 min after tRNS. Importantly, the immediate analgesia induced by tRNS could be accounted for by tRNS effect on attenuating expected-pain ratings before certain painful stimuli. However, CPM efficacy was not significantly affected by tRNS. ConclusionsThese results demonstrate analgesia immediately after applying tRNS over the left DLPFC. SignificanceThis study provides evidence for analgesia of DLPFC-tRNS on an experimental pain model.

Trends in Online Patient Perspectives of Neurosurgeons: A Sentiment Analysis

BACKGROUND: Patients increasingly rely on readily available physician reviews to inform their provider choices. Sentiment analysis and machine learning techniques quantitatively analyze written prose to understand patient desires from physician encounters. Patient perspectives on their medical care have been understudied in neurosurgery. OBJECTIVE: To analyze patient reviews of neurosurgeons to uncover trends between patient ratings of their encounters and content in their reviews. METHODS: Identification of neurosurgeons and demographic data were collected from 115 Accreditation Council for Graduate Medical Education–accredited programs using public data. Healthgrades.com was used to obtain online written and star rating reviews which were analyzed using a machine learning sentiment analysis package to generate a sentiment score. Student t tests compared differences between demographics and outcomes from the sentiment analysis. Multivariate regression was performed to examine associations between sentiment rating and word/word pair frequency. RESULTS: One thousand two hundred eighty-four neurosurgeons were found to have review profiles which consisted of 6815 reviews. Analysis revealed a direct correlation between sentiment score and star rating (r2 = 0.554, P < .0001). There were no differences in the sentiment score based on neurosurgeons' sex; however, younger surgeons had more positive reviews (P = .022). Word frequency analysis showed that reviews were less likely to be positive if they included “pain” (odds ratio [OR]: 0.28, CI: 0.24-0.32, P < .0001) or “rude” (OR: 0.03, CI: 0.01-0.06, P < .0001). Reviews were more likely to be positive when they included “kind” (OR: 3.7, CI: 2.6-5.3, P < .0001) or “pain-free” (OR: 3.1, CI: 2.1-4.7, P < .0001). CONCLUSION: Top-rated reviews demonstrate the importance of compassion in patient satisfaction. The word “pain” arose for both negative and positive reviews. Pain management seems to be a salient component of patients' evaluation of their neurosurgical care, thereby underscoring the importance of guiding patient pain expectations.

Does Minimally Invasive Mitral Valve Repair Mean Less Postoperative Pain?

BackgroundRapid recovery after minimally invasive mitral valve (MV) repair has been demonstrated in many studies, but the issue of postoperative pain has not been fully elucidated. We evaluated pain scores and medication use in patients undergoing MV repair by minimally invasive surgery (MIS) and open sternotomy (OS). MethodsBetween 2008 and 2019, 1332 patients underwent isolated MV repair by OS, and 913 underwent minimally invasive MV repair. After 1:1 propensity score matching, the study included 709 patients in each group. Opioid use was quantified as oral morphine equivalents in milligrams for each hospital day. The highest pain scores were collected from a visual analogue scale at 6-hour intervals. Predictive modeling was employed to compare pain medications and pain scores between the groups. ResultsThe postoperative median length of stay was 3 (3-4) and 5 (4-5) days for the MIS and OS groups, respectively (P < .001). The predicted geometric mean oral morphine equivalents demonstrated lower opioid use for the MIS group compared with the OS group for the first 4 days. However, the predicted mean pain score was higher in the first 24 hours for the MIS group compared with the OS group (4.7 [4.5-4.8] vs 4.4 [4.3-4.5], respectively, on a visual analogue scale of 0 to 10). ConclusionsMV repair by MIS methods was associated with decreased opioid use but not with decreased postoperative pain scores. Possible explanations include the difference in incision site pain and subjective differences in postoperative pain expectations.

Surgery for female dyspareunia after perineal trauma

Perineal trauma during labor and vulvo-vaginal surgery is common and entails pain, dyspareunia, and other quality of life issues. Herein we describe common pitfalls, reconstruction problems and considerations illustrated by two cases. Diagnosis: A thorough conversation with the woman about her history concerning trauma and present symptoms including sex life before the trauma. Examination: Visual traces of the trauma and palpation for persisting trigger points in accordance with the history. CASE 1: Had previously had two operations for Bartholinitis and two operations for vulvo-vaginal fistulas. She had severe external dyspareunia and not been able to engage in intercourse for 1 ½ year when referred. CASE 2: Suffered a total obstetric anal sphincter rupture during first delivery. Primary suturing was performed in the delivery room. The patient suffered from severe dysparunia and soiling during intercourse three months after the delivery. A low perineum and a low rectocele were seen. By 3D ultrasound a very short external anal sphincter was seen. The transverse perineal and bulbocavernose muscle were still torn. Surgery: Removal of scar tissue. Identifying affected anatomical structures. Usually, the superficial and deep transverse perineal muscle, the bulbocavernosus muscle and the rectovaginal fascia are traumatized. Examples of anatomical correct reconstruction are presented. Postoperative: Weekly Low Level Laser therapy (LLLT) for three weeks was applied, and pain killers were used. Scar tissue massage after four weeks. Recommendation of no intercourse for six weeks. After a longer period with dyspareunia, sex is usually connected with an expectation of pain even when the trigger is removed. This is partially caused by strong pelvic muscle contractions. Supportive consultations about sexual issues are usually necessary to obtain a complete recovery with a healed body and mind. Anatomical correct reconstructive surgery after long term dyspareunia is best treated in a bio-psycho-social frame. No conflict of interest

Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review.

To contextualize migraine as the most common primary headache disorder in relation to other chronic primary pain and non-pain functional somatic and mental conditions. Migraine is increasingly understood as a sensory processing disorder within a broader spectrum of symptom disorders. This has implications for diagnosis and treatment. Narrative review based on a search of the literature of the last 15 years on the overlap of migraine with other symptom disorders. Migraine as the prototypical primary headache disorder not only comprises many non-headache symptoms in itself, it also shows high comorbidity with other chronic pain and non-pain conditions (e.g., fibromyalgia syndrome, irritable bowel syndrome, functional non-epileptic seizures, depression, anxiety, and posttraumatic stress disorder). Such "symptom disorders" share several etiological factors (e.g., female preponderance, psychological vulnerability) and psychophysiological mechanisms (e.g., altered sensory processing, pain expectancy). These facts are acknowledged by several recent integrative conceptualizations such as chronic primary pain, chronic overlapping pain conditions, or functional somatic disorders. Accordingly, migraine management increasingly addresses the total symptom burden and individual contributors to symptom experience, and thus incorporates centrally acting pharmacological and non-pharmacological, that is, psychological and behavioral, treatment approaches. Migraine and also other primary headache disorders should be seen as particular phenotypes within a broader spectrum of symptom perception and processing disorders that require integrative diagnostics and treatment. A harmonization of classifications and better interdisciplinary collaboration are desirable.

Postoperative Pain in Outpatient Orthopedic Foot and Ankle Trauma Surgery Patients

Category: Trauma Introduction/Purpose: Opioid pain medications are frequently prescribed after orthopedic surgery as effective tools for pain relief, but with adverse consequences such as addiction and overdose. Postoperative pain control can vary depending on patient opioid prescription history and pain expectations. There are limited studies regarding pain and anxiety levels following orthopedic foot and ankle trauma surgery, with a lack of formal guidelines in prescribing opioid medications to this patient population. The overall purpose of this study was to gain an understanding of postoperative pain and anxiety in patients undergoing outpatient foot and ankle trauma surgery. This study additionally sought to identify any risk factors that may predispose a patient to increased postoperative pain and anxiety, resulting in a potentially increased pain medication requirement. Methods: A subanalysis of 50 patients from a prospective, observational study was performed, examining adult patients undergoing outpatient foot and ankle trauma surgery performed by trauma fellowship-trained senior investigators. Patients were enrolled and given pertinent reference materials including access to an automated texting survey platform to collect data regarding their postoperative pain, anxiety, and opioid medication use. Patients were stratified by procedure type (irrigation &amp; debridement/hardware removal, foot/syndesmosis ORIF, ankle ORIF, pilon ORIF) and by receiving perioperative regional anesthetic block versus local anesthetic. Pain and anxiety were measured with the Numeric Rating Scale for Pain (scale of 1-10) and the Visual Facial Anxiety Scale (scale of 1-5), respectively. The primary outcome measured was the number of days on average for a patient to discontinue opioid medication. Secondary endpoints consisted of pain level &lt; 4, anxiety level &lt; 2, patient-specific and surgery-related factors that may affect these variables. Results: Postoperatively, it took an average of 9.6 days until opioids were discontinued, 8.2 days for pain to subside below 4, and 6.6 days until anxiety reduced under 2. Foot/syndesmosis ORIF and older age were associated with prolonged pain medication use (p&lt;0.05). Drug use and older age limited the chance of obtaining a pain score under 4 (p&lt;0.05). Psychiatric history and older age decreased the odds of obtaining an anxiety score under 2 (p&lt;0.05). White race improved the chance of obtaining an anxiety score under 2 and tapering off pain medications (p&lt;0.05). When stratified by procedure type or analgesic adjuvants (regional block vs local), there were no significant differences in pain and anxiety scores. Conclusion: Our study shows that regardless of procedure type or analgesic adjuvant used, it takes approximately eight days for postoperative pain levels to decrease to 4 out of 10 and six days for anxiety levels to decrease to 2 out of 5, with patients requiring opioid pain medications for an average of 10 days. Risk factors such as older age, prior drug use, and psychiatric history increased postoperative pain, anxiety, and use of opioid pain medications. This data may be utilized by orthopedic surgeons in providing safe, effective, and evidence-based pain management prescribing practices in anticipating postoperative pain and anxiety.

Electrophysiological indices of pain expectation abnormalities in fibromyalgia patients

Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1–S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes.

Generalization of pain-related avoidance behavior based on de novo categorical knowledge.

People with chronic pain often fear and avoid movements and activities that were never paired with pain. Safe movements may be avoided if they share some semantic relationship with an actual pain-associated movement. This study investigated whether pain-associated operant responses (movements) can become categorically associated with perceptually dissimilar responses, thus motivating avoidance of new classes of safe movements-a phenomenon known as category-based avoidance generalization. Using a robotic arm, 2 groups were trained to categorize arm movements in different ways. Subsequently, the groups learned through operant conditioning that an arm movement from one of the categories was paired with a high probability of pain, whereas the others were paired with either a medium probability of pain or no pain (acquisition phase). Self-reported pain-related fear and pain expectancy were collected as indices of fear learning. During a final generalization test phase, the movements categorically related to those from the acquisition phase were made available but in the absence of pain. Results showed that the generalization of outcome measures depended on the categorical connections between arm movements, ie, the groups avoided and feared the novel generalization movement categorically related to the pain-associated acquisition movement, depending on how they had previously learned to categorize the movements. This suggests that operant pain-related avoidance can generalize to safe behaviors, which are not perceptually, but categorically, similar to a pain-associated behavior. This form of pain-related avoidance generalization is problematic because category-based relations can be extremely wide reaching and idiosyncratic. Thus, category-based generalization of operant pain-related avoidance merits further investigation.

How are Patients Describing You Online? A Natural Language Processing Driven Sentiment Analysis of Online Reviews on CSRS Surgeons.

A quantitative analysis of written, online reviews of Cervical Spine Research Society (CSRS) surgeons. This study quantitatively analyzes the written reviews of members of the CSRS to report biases associated with demographic factors and frequently used words in reviews to help aid physician practices. Physician review websites have influence on a patient's selection of a provider, but written reviews are subjective. Sentiment analysis of writing through artificial intelligence can quantify surgeon reviews to provide actionable feedback. Online written and star-rating reviews of CSRS surgeons were obtained from healthgrades.com. A sentiment analysis package was used to obtain compound scores of each physician's reviews. The relationship between demographic variables and average sentiment score of written reviews were evaluated through t -tests. Positive and negative word and bigram frequency analysis was performed to indicate trends in the reviews' language. In all, 2239 CSRS surgeon's reviews were analyzed. Analysis showed a positive correlation between the sentiment scores and overall average star-rated reviews ( r2 =0.60, P <0.01). There was no difference in review sentiment by provider sex. However, the age of surgeons showed a significant difference as those <55 had more positive reviews (mean=+0.50) than surgeons >=55 (mean=+0.37) ( P <0.01). The most positive reviews focused both on pain and behavioral factors, whereas the most negative focused mainly on pain. Behavioral attributes increased the odds of receiving positive reviews while pain decreased them. The top-rated surgeons were described as considerate providers and effective at managing pain in their most frequently used words and bigrams. However, the worst-rated ones were mainly described as unable to relieve pain. Through quantitative analysis of physician reviews, pain is a clear factor contributing to both positive and negative reviews of surgeons, reinforcing the need for proper pain expectation management. Level 4-retrospective case-control study.

Shared decision-making for postoperative opioid prescribing and preoperative pain management education decreases excess opioid burden.

Managing postoperative pain requires an individualized approach in order to balance adequate pain control with risk of persistent opioid use and narcotic abuse associated with inappropriately outsized narcotic prescriptions. Shared decision-making has been proposed to address individual pain management needs. We report here the results of a quality improvement initiative instituting prescribing guidelines using shared decision-making and preoperative pain expectation and management education to decrease excess opioid pills after surgery and improve patient satisfaction. Pre-intervention prescribing habits were obtained by retrospective review perioperative pharmacy records for patients undergoing general surgeries in the 24months prior to initiation of intervention. Patients scheduled to undergo General Surgery procedures were given a survey at their preoperative visit. Preoperative education was performed by the surgical team as a part of the Informed Consent process using a standardized handout and patients were asked to choose the number of narcotic pills they wished to obtain within prescribing recommendations. Postoperative surveys were administered during or after their 2-week postoperative visit. 131 patients completed pre-intervention and post-intervention surveys. The average prescription size decreased from 12.29 oxycodone pills per surgery prior to institution of pathway to 6.80 pills per surgery after institution of pathway (p < 0.001). The percentage of unused pills after surgery decreased from an estimated 70.5% pre-intervention to 48.5% (p < 0.001) post-intervention. 61.1% of patients with excess pills returned or planned to return medication to the pharmacy with 16.8% of patients reporting alternative disposal of excess medication. Patient-reported satisfaction was higher with current surgery compared to prior surgeries (p < 0.001). Institution of procedure-specific prescribing recommendations and preoperative pain management education using shared decision-making between patient and provider decreases opioid excess burden, resulting in fewer unused narcotic pills entering the community. Furthermore, allowing patients to participate in decision-making with their provider results in increased patient satisfaction.

Prospective analysis of pain expectancy and experience during MR-fusion prostate biopsy: does reality match patients’ expectancy?

PurposeMultiparametric magnetic resonance imaging fusion targeted prostate biopsy (MR-TB) has emerged to the biopsy technique of choice for evaluation of patients with suspected prostate cancer (PCA). The study aimed to determine expected and experienced pain during MR-TB depending on patients’ psychological state.MethodsWe prospectively enrolled 108 men with suspicion of PCA who underwent MR-TB. All patients completed self-reported validated questionnaires assessing pain, stress, self-efficacy, anxiety and study-specific questionnaires on expected and experienced pain before, during and after MR-TB. Patient characteristics and survey scores were obtained.ResultsOverall, pain levels during MR-TB were low (mean 2.8/10 ± 2.5 Numerical Rating Scale, NRS). 10/86 (11.6%) participants reported severe pain (≥ 7/10 NRS). Pain correlated significantly with anxiety (r = 0.42), stress (r = 0.22) and pain expectancy (r = 0.58). High self-efficacy did not show increased pain resilience. Participants anticipated more pain than experienced during each step of MR-TB with significant differences concerning local anesthesia and core sampling (both p < 0.001), among others. Expectancy and actual pain did not match regarding severity and impact of the total amount of cores taken (p < 0.05). Independent predictors of increased pain at biopsy were prostate volume > 50 ml (p = 0.0179) and expected pain during rectal manipulation (p < 0.001).ConclusionPain during MR-TB can be positively influenced by reducing men’s anxiety, stress and pain expectancy. To meet the needs of the audience, clinicians should address concrete pain levels of each procedural step and consider special treatment for patients with prostate volume > 50 ml and men reporting on increased rectal sensitivity.

Factors Related to Expectations in Individuals Waiting for Total Knee Arthroplasty.

There is no consensus on how age and expectations influence planning for total knee arthroplasty (TKA). This study developed and evaluated a new expectation questionnaire and assessed the relationship between preoperative expectations and patient characteristics. The questionnaire evaluated expectations for mobility, pain, participation, and rate of recovery after surgery. Fifty-five participants completed a 6-minute walk test and expectation questionnaire prior to TKA; 17 participants repeated the questionnaire one week later for reliability testing. Analysis of the questionnaire included intra-class correlation coefficient (ICC), homoscedasticity, skewness, kurtosis, multicollinearity, and descriptive measures. A four-step hierarchical linear regression was completed to determine the relationship of patient age, BMI, previous contralateral TKA, and 6-minute walk test scores to expectations. The questionnaire showed good/high test-retest reliability (ICC 0.84; 95% CI: 0.57, 0.94; p > 0.001). The final model was significant in predicting expectation scores R2 = 0.19 (p = 0.017). This questionnaire reliably measures patient expectations before TKA; however, further research is needed. Although we anticipated younger age to be related to higher expectations, higher function prior to TKA appears to be more strongly associated with higher expectations.

Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria.

Central sensitization (CS) involves dysfunctional central nervous system pain modulation resulting in heightened pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), despite the fact that pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use may produce opioid-induced hyperalgesia. Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested. Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of CS, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria, was administered using electronic survey. Participants also responded to questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items regarding pain beliefs and expectations of pain and addiction treatment. Descriptive analyses, Spearman rho correlations, and Mann-Whitney U tests were performed. Hypothesized relationships were confirmed between degree of CS, pain interference, and health-related quality of life. Degree of CS was also positively correlated with greater endorsement of pain as a reason for the onset, maintenance, and escalation of OUD; treatment delay; and OUD relapse. Participants with the American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly greater endorsement of pain as a reason for delaying OUD treatment, continuing and increasing opioid use, and precipitating OUD relapse. This study provides early evidence CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, potentially informing future mechanistic research and precision treatment.

Expectations and Experiences of Internet-Based Therapy for Adolescents with TMD Pain.

To investigate expectations and experiences of internet-based therapy (IBT) in adolescents with temporomandibular disorder (TMD) pain. Seven adolescents were strategically selected for this study. All patients had received IBT for their TMD pain in a previous randomized controlled trial. One-on-one interviews were conducted in a nonclinical setting. The interviews were semi-structured, following an interview guide with six domains. The recorded interviews were transcribed, and a qualitative inductive content analysis was then performed. Content analysis indicated that the expectations of the adolescents and their experiences of IBT as a treatment for TMD pain can be understood in light of three main categories: (1) To become better; (2) An ambivalent experience; and (3) A personal challenge. The adolescents expressed expectations of less TMD pain after treatment, but also of improvement in general well-being and everyday life. Although their experiences of IBT varied, adolescents described having mixed feelings about treatment and feeling that it was personally challenging. Gained understanding of expectations and experiences is a necessary basis for revising the IBT program to meet the demands of adolescents and to improve treatment adherence. Furthermore, the content of the three categories clarifies the values of adolescents, and this understanding can in turn contribute to the development of new patient-centered treatment programs.

Perception of pain and the oocyte donor experience: a retrospective analysis of commercial US donors

Research questionWhat is the relationship between oocyte donor characteristics and their pain perception, their expectation and experience of pain, and the interaction between pain and overall satisfaction with the donation process? DesignInstitutional Review Board approved, retrospective survey of commercial, US oocyte donors was emailed to recent donors recruited through Donor Egg Bank USA before 2020. ResultsOf the 503 opened emails, 246 individuals responded (48.9%). Most donors ranked their pain between minimal and moderate at all time points analysed. Altruistically motivated donors and parous donors were less likely to experience unexpected levels of pain. A high proportion (93.9%) of donors reported being informed of the risk of pain. Those who recalled being informed of the risk of pain were less likely to report higher levels of pain than expected. Although 94.2% of donors reported having an average to positive experience overall, 92.3% (12 out of 13 donors) in the group reporting a negative overall experience said they felt more pain than expected. ConclusionsDonors were well informed about the risk of pain. Altruistically motivated donors and parous donors were less likely to experience unexpected levels of pain. Report of unexpected levels of pain was highly related to low donor satisfaction.

Impact of the COVID-19 pandemic on patients with chronic pain in Germany: Associations with expectations and control beliefs.

BackgroundWhile the COVID‐19 pandemic is affecting people's well‐being worldwide, it may place a particularly high burden on people with chronic pain, as pain is known to be influenced by societal and psychological conditions.MethodsIn this observational study, we conducted telephone interviews with 196 patients with chronic pain to assess the impact of the pandemic on various aspects of their pain and everyday life. The initial interviews were conducted between April and May 2020 and were followed up by a second interview between August and December 2020.ResultsA substantial percentage of patients (39% at the first and 32% at the second interview) reported an increase in pain intensity due to the pandemic. Exploratory analyses revealed that patients who already suffered from greater pain and who experienced greater restrictions due to the pandemic were more likely to express pain worsening. Psychological factors such as negative expectations about the development of their pain and pain treatment and a high external locus of control were also associated with increases in pain.ConclusionsThese findings illustrate the complexity of chronic pain, suggesting that not only the impact of the pandemic on various areas of life but also the severity of the pain‐symptoms themselves and psychological factors influence the course of patients' symptoms during the pandemic.SignificanceThis study underlines the importance of psychosocial factors in chronic pain and demonstrates that the societal and psychological impact of the COVID‐19 pandemic can affect patients' pain and their ability to cope with it. The extent to which patients experience pain aggravation seems to interact with other psychological factors such as pain expectations and control beliefs.

Assessment of the psychological state of children with dental anomalies

Currently, a significant proportion of children have dental anomalies (DA) and require orthodontic treatment. The effectiveness of treatment is reduced due to the age-related characteristics of the child's psyche, which lengthens the time and affects the quality of the appointment.Objective: to assess the emotional state of children with DA aged 6–12 years.Patients and methods. To study the characteristics of the psychological state of children, 122 patients aged 6–12 years (44 boys and 78 girls, mean age 9 [7; 11] years) were examined and orthodontically treated. Children's complaints, the presence of tics and obsessive habits were assessed. The psychological state of the patients was assessed using the G.P. Lavrentieva and T.M. Titarenko anxiety level in children questionnaire. Causes and factors that increase anxiety at the reception were assessed using a questionnaire developed by the authors.Results and discussion. Aesthetic defect and speech disorders were the most frequent complaints among children aged 6–12 years with DA (58 and 23%, respectively), especially among older girls (r=0.72). 91.2% of children had obsessive habits, 48% had motor tics. Three groups were distinguished: with low (59.0%), medium (19.7%) and high (21.3%) levels of anxiety. No significant associations were found between the anxiety level and gender, age, presence of tics and obsessive habits. Factors that increased anxiety in children during an orthodontist's appointment were: past personal negative experience at a dental appointment (in 27.0%); office environment (23.8%); negative experience of parents or peers (16.4%); frequent visits to medical institutions in the past (21.3%); family relations (11.5%). The most common anxiety causes were pain expectation and inexplicable fear, a little less often - unpleasant manipulations in the oral cavity and comments from the parent. The rarest cause of anxiety was a disapproving remark from an orthodontist.Conclusion. Children with DA aged 6–12 years have an increased anxiety level, independent of gender and age. These children require a special approach from the orthodontist and, possibly, a consultation with a psychotherapist.

How expectancy violations facilitate learning to cope with pain – An experimental approach

BackgroundExpectations of painful sensations constitute a core feature of chronic pain. An important clinical question is whether such expectations are revised when disconfirming experiences are made (e.g., less pain than expected). This study examined how people adjust their pain expectations when the experience of decreasing pain is expected vs. unexpected. MethodsIn a novel randomized between-subjects design, a subclinical sample of people who frequently experience pain was provided with painful thermal stimulations. Unbeknownst to participants, the temperature applied was decreased from trial to trial. Based on the experimental instructions provided, this experience of decreasing pain was expected in one condition (expectation-confirmation; n = 34), whereas it was unexpected in another (expectation-disconfirmation; n = 39). ResultsPerceived pain intensity was lower in the expectation-confirmation condition than in the expectation-disconfirmation condition (p = .014, ηp2 = 0.083). The expectation-confirmation condition also showed a greater adjustment of their pain expectations than the expectation-disconfirmation condition (p = .046, ηp2 = 0.047). Across groups, large expectation violations (i.e., less pain than expected) were associated with increases in pain tolerance and the ability to cope with pain at a one-week follow-up. ConclusionsIn terms of assimilation, perceived pain intensity was shaped in the direction of pain expectations. The greater adjustment of expectations in the expectation-confirming condition is consistent with a confirmation bias in pain perception. Though participants who experienced large discrepancies between expected and experienced pain were hesitant to adjust their pain expectations immediately, expectation violations increased their ability to cope with pain one week later, suggesting some beneficial longer-term effects of expectation violations.

Preoperative Factors and Patient-Reported Outcomes After Total Hip Arthroplasty: Multivariable Prediction Modeling

Although total hip arthroplasty (THA) has been established as a cost-effective intervention, some patients experience ongoing pain and dissatisfaction. There is interest in predicting postoperative outcomes based on preoperative data, but the relative contribution of different preoperative factors is unclear. The study's aim was to develop multivariable prediction models for the assessment of patient-reported outcomes. Registry data on 1412 patients undergoing THA for osteoarthritis at two hospitals between 2013 and 2018 was used. Potential predictors included age, sex, body mass index, spoken language, education level, previous THA, American Society of Anaesthesiologists (ASA) score, lower back pain, depression/anxiety, other lower limb arthritis, number of other comorbidities, the preoperative expectation of pain and function, EuroQol Visual Analogue Scale (EQ-VAS) and preoperative OHS. Radiographic scores were also used: joint space narrowing (JSN), osteophytes, sclerosis, and an overall grade based on the Kellgren-Lawrence (KL) classification. Outcomes assessed were the patient-rated improvement, satisfaction, and OHS at six months. JSN or overall KL scores were the most important predictors (P < .001) for all outcomes, with better radiographic scores associated with worse outcomes. Other predictors associated with poorer outcomes were lower back pain and lower expectation (predicting poor improvement), lower education and higher ASA (predicting lower satisfaction) and younger age, female sex, non-English speakers, lower preoperative EQ-VAS, lower education, back pain, and anxiety/depression (predicting lower OHS). Preoperative radiological scores are an important predictor of patient-reported outcomes at six months postoperatively. Understanding the relative strengths and significance of different factors in predicting outcomes will help the clinician and patient decision-making for THA.

Comprendre la douleur chronique au spectre du genre : attentes de rôles de genre et pandémie

Chronic pain is a major health problem, afflicting one in four Canadians, with more women living with chronic pain. The study aims at documenting the impacts of the COVID-19 pandemic among individuals living with chronic pain depending on gender and at exploring gender role expectations of pain in relation to pain interference. Participants (N = 49) filled out questionnaires before, during and after the first wave of the COVID-19 pandemic, documenting their loneliness, distress, pandemic-related restrictions, pain and gender role expectations of pain. It was expected that women would be more affected by the pandemic. Results (p &gt; .05) do not indicate gender differences, nor associations between gender role expectations and pain interference. Further research is needed to broaden our knowledge regarding gender differences in chronic pain and to address health inequalities.