Pain Group Research Articles

Efficacy of acupuncture for lumbar disc herniation: changes in paravertebral muscle and fat infiltration – a multicenter retrospective cohort study

ObjectiveThis study seeks to elucidate the dynamic alterations in the multifidus, erector spinae, and psoas major muscles, along with their fatty infiltration, in patients diagnosed with lumbar disc herniation treated through acupuncture. Concurrently, the Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores are employed to evaluate modifications in lumbar and leg pain and the enhancement in lumbar functionality.MethodsA retrospective multi-center cohort study enrolled 332 adult LDH patients. Participants were divided into acupuncture and rehabilitation therapy groups. The acupuncture cohort received targeted treatments at specific acupuncture points, while the rehabilitation group received traditional rehabilitative therapy. Magnetic Resonance Imaging (MRI) gauged muscle cross-sectional areas (Sm, Se, Sp) and their ratios to vertebral area (Sm/Sv, Se/Sv, Sp/Sv), and fatty infiltration areas (Sfm, Sfe, Sfp) and their ratios (Sfm/Sv, Sfe/Sv, Sfp/Sv). Pain and function were assessed using Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores pre-treatment, 2-weeks, and 3-months post-intervention.ResultsA total of 332 patients were enrolled for analysis. Post-treatment, the acupuncture group exhibited increased Sm, Se, Sp and their ratios and reduced fatty infiltration areas and their ratios (P<0.05) compared to rehabilitation. Both treatments decreased VAS scores and enhanced JOA scores at both intervals (P<0.05). Intriguingly, no significant disparities were observed between the acupuncture and rehabilitation groups concerning pain and JOA scores at the 2-week follow-up (p>0.05); however, 3 months post-treatment, the acupuncture group significantly outperformed the rehabilitation group in both pain and JOA scores (p<0.05).ConclusionThis study demonstrates that acupuncture treatment is significantly more effective than traditional rehabilitation therapy in improving paraspinal muscle function, reducing muscle fat infiltration, and alleviating lumbar and leg pain in patients with lumbar disc herniation (LDH). Specifically, acupuncture significantly increases the cross-sectional areas (Sm, Se, Sp) of the paraspinal muscles and reduces muscle fat infiltration, showing superior long-term results in pain relief and functional improvement. Future research should further explore the long-term effects of acupuncture on the function and structure of paraspinal muscles, assess its potential in preventing the recurrence of LDH, and delve deeper into how acupuncture affects paraspinal muscles at the molecular level, to better understand its therapeutic mechanisms and enhance its clinical application.

Reduction of neck pain severity in patients with medication-overuse headache

BackgroundNeck pain and primary headache disorders are highly prevalent in populations and clinical cohorts. Medication-overuse headache (MOH) is a treatable secondary headache, mainly developing in migraine sufferers, that accounts for the majority of patients presenting to headache clinics. Nevertheless, the association between neck pain and MOH has not been reported. This study evaluated the prevalence and clinical course of neck pain in patients with MOH before and after MOH treatment.MethodsWe analyzed 635 MOH patients enrolled in a nationwide, prospective, multicenter MOH registry. Demographics and clinical data were collected at baseline and 3 months to evaluate changes in the status and severity of neck pain and headache. Severity of neck pain was graded into 4 groups, and severe neck pain was defined as grade 3 or 4.ResultsAmong 635 patients with MOH, 366 (57.6%) reported neck pain at baseline. MOH patients with neck pain had an earlier onset of their primary headache disorder (23.4 ± 12.7 vs. 26.2 ± 13.3 years, p = 0.007). Although monthly headache days were comparable between the patients with neck pain and those without neck pain, the neck pain group had higher levels of anxiety (7.4 ± 5.8 vs. 6.4 ± 5.4, p = 0.017), more severe cutaneous allodynia (2.4 ± 3.3 vs. 1.8 ± 3.0, p = 0.038), and poorer quality of life (171.7 ± 70.4 vs. 184.0 ± 68.9, p = 0.029). At 3 months, 456 (71.8%) were followed-up, and 257 (56.4%) were recovered from MOH. Compared to the baseline, the proportion of severe neck pain (40.4% vs. 19.4%, p < 0.001) was decreased. The proportion of severe neck pain was much lower in patients with recovery from MOH compared to those without (4.7% vs. 15.1%, p < 0.001).ConclusionsNeck pain in MOH patients was associated with earlier onset of headache, higher levels of anxiety and allodynia, and poorer quality of life. Improvement in neck pain improvement was linked to recovery from MOH. These findings suggest the potential importance of integrating and management of neck pain into clinical practice for MOH.

Microfracture Versus a Porcine-Derived Collagen-Augmented Chondrogenesis Technique for Treating Knee Cartilage Defects: Results at Midterm Follow-up.

Damaged cartilage can be treated using the creation of microfractures (MFxs) or the porcine-derived collagen-augmented chondrogenesis technique (C-ACT). To provide the midterm results of a multicenter randomized controlled trial comparing MFx and C-ACT for knee cartilage defects. Randomized controlled trial; Level of evidence, 1. The study cohort comprised 36 patients with medial femoral condyle cartilage defects who were followed up for 6 years with clinical and magnetic resonance imaging data (n = 14 treated with MFx alone, n = 22 treated with C-ACT). Clinical outcomes were assessed preoperatively and at 1, 2, and 6 years postoperatively using a visual analog scale (VAS) for pain, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the International Knee Documentation Committee (IKDC) subjective score. Magnetic resonance imaging scans were performed preoperatively and at 1 and 6 years postoperatively, and the repaired cartilage tissue was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score. The repaired tissue/reference cartilage ratio was quantified using T2 mapping. Adverse events during follow-up were also evaluated. In both groups, the VAS pain score improved and was maintained for 1, 2, and 6 years postoperatively compared with preoperatively (P < .05 for all). Although there were no significant differences between groups in the VAS pain, KOOS, or IKDC scores at any time point, the change in the IKDC-Activities of Daily Living subscore from preoperatively to 6 years postoperatively was better in the C-ACT group than the MFx group (P = .0423). At 6 years postoperatively, the MOCART assessment showed superior results regarding the surface of the repair tissue in the C-ACT group compared with the MFx group (P = .0288). There were no differences between the groups in the total MOCART score or other subscores. The study results suggest that C-ACT has similar effects to MFx in improving pain, joint function, and imaging findings and may be superior to MFx in improving daily life function and improving the quality of the surface of the cartilage tissue. ClinicalTrials.gov identifier: NCT02539030.

Attitudes and Beliefs Regarding Pain and Discrimination Among Black Adults with Sickle Cell Disease: A Mixed Methods Evaluation of an Adapted Chronic Pain Intervention.

This study sought to adapt a chronic pain group curriculum for adults with sickle cell disease (SCD). Given the association of experiences of racism and discrimination with health outcomes, this study also explored how such experiences for patients with SCD impact their interactions with clinicians and health-care systems. This mixed methods study recruited patients (aged ≥18 years) in a sickle cell treatment program; all self-identified as Black or African American. Key informant interviews evaluated a chronic pain program curriculum and rated the curriculum sessions' importance for SCD pain management. A survey containing six validated instruments then measured experiences of pain and discrimination, level of emotional expressivity, and trust in physicians and health insurers. Of the 19 adult patients approached, 12 (63%) completed the interview and survey. Interview data analysis resulted in five themes comprising pain, treatment, mental/emotional, health-care clinicians, and differences in SCD versus other chronic conditions. Each curriculum session was rated as "very important" or "important" by participants. Most described at least one experience of racism or discrimination in the medical setting and identified clinicians' lack of knowledge as a barrier to appropriate SCD care. Participants identified the importance of non-pharmacological treatments for SCD pain and appropriately managing pain caused by comorbid chronic conditions. Conversely, survey responses reported moderate levels of pain, infrequent discriminatory experiences in the medical setting, and moderate trust in medical professionals, whereas most reported experiences of discrimination in general settings. Many participants reported they either accepted it or did nothing in response to discriminatory experiences. Study findings emphasize the need to address experiences of racism and stigma in addition to experiences of emotional and physical pain among patients with SCD in the context of pain management. Findings from this study will inform the development of a SCD pain group curriculum for adult patients.

Delayed Recovery After Exercise-Induced Pain in People with Chronic Widespread Muscle Pain Related to Cortical Connectivity

Background/Objectives: There is a subset of patients with pain who become worse after exercise. To explore this, we examined the responses of people with chronic primary pain to a standardized high intensity exercise protocol used to induce delayed onset muscle soreness (DOMS). Methods: Ten participants with a diagnosis of chronic widespread muscle pain (CWMP) were matched by age and reported gender to ten participants without muscle pain (i.e., no pain (NP)). Participants completed a standardized DOMS protocol. Pain intensity in the arm at rest and with movement was assessed using daily electronic diaries. Peak pain, the timing of peak pain, and the time to recovery were compared between groups. Associations of pain variables with the functional connectivity of the sensorimotor (SMN), cerebellum, frontoparietal control (FPN), and default mode network (DMN) both within network nodes and the rest of the brain was assessed. Results: Significant differences in peak pain, the time to peak pain, and the time to recovery were noted between groups for both pain at rest and pain with movement after controlling for catastrophizing and pain resilience. Connectivity across the SMN, FPN, and DMN was associated with all pain-related variables. Significant group differences were identified between groups. Conclusions: A standardized muscle “injury” protocol resulted in more pain, a longer time to peak pain, and a longer time to resolve pain in the patient group compared to the NP group. These differences were associated with differences in connectivity across brain regions related to sensorimotor integration and appraisal. These findings provide preliminary evidence of the dysregulation of responses to muscle (micro)trauma in people with chronic pain.

Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery.

Purpose: This study investigates the anxiety levels of patients who have undergone surgery for degenerative lumbar spinal stenosis (DLSS) and the impact of this condition on their post-operative recovery process. Materials and methods: The study group consisted of 71 patients and the control group consisted of 65 healthy individuals. The study assessed the patients' pain, disability and anxiety levels. The results show that the patients' anxiety levels are higher than those of the general population, and that anxiety levels increase even more in patients with high pain and disability scores. Postoperative State Anxiety (SA) and Trait Anxiety (TA) scores were compared between DLSS patients and healthy individuals. The anxiety scores of the patient group were analyzed in relation to age, gender, pain, physical disability and postoperative period. Results: It was found that the SA scores were statistically significantly higher in the pain group. It was found that the SA scores of patients were statistically significantly different according to their physical disability status. It was also found that both the painful early postoperative group and the painful late postoperative group had higher SA scores than the painless early postoperative group and the painless late postoperative group. Conclusion: These findings highlight the importance of considering pain, physical activity, and anxiety together in supporting the postoperative recovery process. It is suggested that holistic approaches that focus on pain, physical disability and anxiety may have a positive impact on recovery. More extensive and prospective studies are needed to clarify the causal relationship between these concepts

Impact of Experimentally Induced Pain on Logical Reasoning and Underlying Attention-Related Psychophysiological Mechanisms

Background. Pain is known to negatively impact attention, but its influence on more complex cognitive abilities, such as logical reasoning, remains inconsistent. This may be due to compensatory mechanisms (e.g., investing additional resources), which might not be detectable at the behavioral level but can be observed through psychophysiological measures. In this study, we investigated whether experimentally induced pain affects logical reasoning and underlying attentional mechanisms, using both behavioral and electroencephalographic (EEG) measures. Methods. A total of 98 female participants were divided into a pain-free control group (N = 47) and a pain group (N = 51). Both groups completed the Advanced Progressive Matrices (APM) task, with EEG recordings capturing task-related power (TRP) changes in the upper alpha frequency band (10–12 Hz). We used a mixed design where all participants completed half of the APM task in a pain-free state (control condition); the second half was completed under pain induction by the pain group but not the pain-free group (experimental condition). Results. Logical reasoning performance, as measured by APM scores and response times, declined during the experimental condition, compared to the control condition for both groups, indicating that the second part of the APM was more difficult than the first part. However, no significant differences were found between the pain and pain-free groups, suggesting that pain did not impair cognitive performance at the behavioral level. In contrast, EEG measures revealed significant differences in upper alpha band power, particularly at fronto-central sites. In the pain group, the decrease in TRP during the experimental condition was significantly smaller compared to both the control condition and the pain-free group. Conclusions. Pain did not impair task performance at the behavioral level but reduced attentional resources, as reflected by changes in upper alpha band activity. This underscores the importance of incorporating more sensitive psychophysiological measures alongside behavioral measures to better understand the impact of pain on cognitive processes.

Identifying Risk Factors for Disease Progression in Developmental Dysplasia of the Hip Using a Contralateral Hip Model

Background: Developmental dysplasia of the hip (DDH) can cause pain and premature osteoarthritis. The risk factors and timing for disease progression in adolescents and young adults have not been fully defined. This study aimed to determine the prevalence of and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on a dysplastic hip. Methods: Patients undergoing unilateral PAO for DDH were followed for at least 2 years and categorized into contralateral pain and no-pain groups and contralateral surgery and no-surgery groups. Pain was defined with the modified Harris hip score. Univariate analysis tested group differences in demographics, radiographic measures, and range of motion. Kaplan-Meier survival analysis was used to assess pain development and surgery in the contralateral hip over time. Multivariable regression identified risk factors for contralateral pain and surgery. Contralateral pain and surgery predictors were secondarily assessed after categorization of the contralateral hips as dysplastic, borderline, and non-dysplastic and in subgroups based on the lateral center-edge angle (LCEA) and acetabular inclination (AI) in 5° increments. Results: One hundred and eighty-four patients were followed for a mean of 4.6 ± 1.6 years (range, 2.0 to 8.8 years), during which 51% (93) reported contralateral hip pain and 33% (60) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% with contralateral pain development as the end point and 66% with contralateral surgery as the end point. Painful hips exhibited more severe dysplasia compared with no-pain hips (LCEA = 16.5° versus 20.3°, p &lt; 0.001; AI = 13.2° versus 10.0°, p &lt; 0.001). AI was the sole predictor of pain, with every 1° increase in the AI raising the risk by 11%. Surgically treated hips also had more severe dysplasia (LCEA = 14.9° versus 20.0°, p &lt; 0.001; AI = 14.7° versus 10.2°, p &lt; 0.001) and were in younger patients (21.6 versus 24.1 years, p = 0.022). AI and a maximum alpha angle of ≥55° were predictors of contralateral surgery. Conclusions: At 5 years after hip PAO, approximately 50% of contralateral hips will have pain and approximately 35% can be expected to need surgery. More severe dysplasia, based on the LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Association between type III collagen degradation and local tissue damage of a single joint

ObjectiveThe development of disease-modifying drugs is limited by OA's heterogeneity and the challenge of defining clinical endpoints. Serological biomarkers are considered potential surrogate endpoints, but their contribution from single joints to systemic levels in OA patients is unclear. In this exploratory study we longitudinally assessed systemic biomarker levels' response to tissue damage and healing before and after surgery in patients undergoing knee or hip joint replacement revision for aseptic failure. Patients with chronic pain associated with a prior hip or knee arthroplasty, but not receiving revision surgery were included as control. MethodThe serological biomarker of MMP mediated type III collagen degradation C3M, associated with synovial tissue degradation, was measured at baseline before revision surgery, after revision surgery and at a 6-month follow-up in 48 patients with aseptic loosening of a knee or hip prosthesis and in 18 patients with chronic pain from a hip or knee prosthesis. Longitudinal changes in biomarkers were modeled using linear mixed models. ResultsNo differences between the aseptic loosening and chronic pain groups were observed at baseline. Revision surgery in the aseptic loosening group led to a swift increase in C3M, which normalized within 2–3 months. No changes in biomarker level were observed in chronic pain patients over three months. ConclusionThese findings suggest that tissue damage in a single joint significantly impacts systemic biomarker levels and underscores the relevance of systemic biomarkers in assessing local tissue remodeling.

Investigating the effects of artificial baroreflex stimulation on pain perception: A comparative study in no-pain and chronic low back pain individuals.

The autonomic nervous system (ANS) and pain exhibit a reciprocal relationship, where acute pain triggers ANS responses, whereas resting ANS activity can influence pain perception. Nociceptive signalling can also be altered by 'top-down' processes occurring in the brain, brainstem and spinal cord, known as 'descending modulation'. By employing the conditioned pain modulation (CPM) paradigm, we previously revealed a connection between reduced low-frequency heart rate variability and CPM. Individuals with chronic pain often experience both ANS dysregulation and impaired CPM. Baroreceptors, which contribute to blood pressure and heart rate variability regulation, may play a significant role in this relationship, although their involvement in pain perception and their functioning in chronic pain have not been sufficiently explored. In the present study, we combined artificial 'baroreceptor stimulation' in both pressure pain and CPM paradigms, seeking to explore the role of baroreceptors in pain perception and descending modulation. In total, 22 individuals with chronic low back pain (CLBP) and 29 individuals with no-pain (NP) took part in the present study. We identified a differential modulation of baroreceptor stimulation on pressure pain between the groups of NP and CLBP participants. Specifically, NP participants perceived less pain in response to baroreflex activation, whereas CLBP participants exhibited increased pain sensitivity. CPM scores were associated with baseline measures of baroreflex sensitivity in both CLBP and NP participants. Our data support the importance of the baroreflex in chronic pain and a possible mechanism of dysregulation involving the interaction between the ANS and descending pain modulation. KEY POINTS: Baroreflex stimulation has different effects on pressure pain in participants with chronic pain compared to matched individuals with no-pain. Baroreceptor activation decreases pain in participants with no-pain but increases pain perception in participants with chronic pain. Baroreflex sensitivity is associated with conditioned pain modulation in both groups of chronic pain and no-pain participants. The reactivity of the baroreflex during autonomic stress demonstrated a positive correlation with Pain Trait scores in participants with chronic back pain.

Peak alpha frequency differs between chronic back pain and chronic widespread pain.

Low peak alpha frequency (PAF) is an electroencephalography (EEG) outcome associated reliably with high acute pain sensitivity. However, existing research suggests that the relationship between PAF and chronic pain is more variable. This variability could be attributable to chronic pain groups typically being examined as homogenous populations, without consideration being given to potential diagnosis-specific differences. Indeed, while emerging work has compared individuals with chronic pain to healthy controls, no previous studies have examined differences in PAF between diagnoses or across chronic pain subtypes. To address this gap, we reanalysed a dataset of resting state EEG previously used to demonstrate a lack of difference in PAF between individuals with chronic pain and healthy controls. In this new analysis, we separated patients by diagnosis before comparing PAF across three subgroups: chronic widespread pain (n = 30), chronic back pain (n = 38), and healthy controls (n = 87). We replicate the original finding of no significant difference between chronic pain groups and controls, but also find that individuals with widespread pain had significantly higher global average PAF values than those of people with chronic back pain [p = 0.028, β = 0.25 Hz] after controlling for age, sex, and depression. These novel findings reveal PAF values in individuals with chronic pain may be diagnosis-specific and not uniformly shifted from the values of healthy controls. Future studies should account for diagnosis and be cautious with exploring homogenous 'chronic pain' classifications during investigations of PAF. Our work suggests that, contrary to previous hypotheses, inter-individual differences in PAF reflect diagnosis-specific mechanisms rather than the general presence of chronic pain, and therefore may have important implications for future work regarding individually-tailored pain management strategies.

Long-Term Efficacy of Posterior Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome.

To analyze long-term treatment outcomes of a posterior neurectomy in a large cohort of patients with anterior cutaneous nerve entrapment syndrome (ACNES). The current step-up treatment approach for ACNES involves abdominal wall tender point injections, pulsed radiofrequency, and neurectomy. If an anterior neurectomy fails or pain reoccurs, a posterior neurectomy is considered as a final surgical option. Data on posterior neurectomy treatment outcomes are scarce. ACNES patients who underwent a unilateral posterior neurectomy between 2012 and 2022 in a single institution completed a questionnaire regarding their current pain status. Primary outcomes were short- and long-term treatment success, defined as ≥50% pain relief. Patients were stratified whether the operative indication was recurrent pain (>3months) after an initially successful anterior neurectomy or ongoing pain after an anterior neurectomy. Data from 260 of 379 patients (77% female, mean age 42years) were analyzed (68.6% response rate). Sensitivity analysis found that short-term outcomes were similar between responders and non-responders. The recurrent pain group demonstrated significantly better treatment outcomes compared to the ongoing pain group, both in the short-term (7weeks; treatment success 79.2% vs. 53.2%, p < 0.001) and long-term (58months; treatment success 61.1% vs. 42.0%, p = 0.001). Sixteen (minor) complications (6.2%) were reported, resulting in three surgical re-interventions (1.2%). A posterior neurectomy is long-term beneficial in approximately half of patients although treatment success is better for recurrent pain than ongoing pain. These findings aid in optimizing preoperative patient counseling.

Hip and waist circumference correlations with demographic factors and pain intensity in patients with chronic pain.

Aim: This study aimed to investigate how demographic factors such as race, age, sex and ethnicity can impact hip circumference (HC) and waist circumference (WC) in patients with chronic pain.Materials & methods: We queried the NIH-sponsored All of Us database for patients with documented HC, WC and waist/hip ratio (WHR) data. This cross-sectional study categorized participants into four groups: total cohort, no chronic pain, mild/moderate chronic pain (numeric rating scale < 7) and severe chronic pain (numeric rating scale > 7). Further subgroup analyses were performed based on race, age, sex and ethnicity. We examined the correlation between chronic pain and WC, HC and WHR. ANCOVA analysis was used to determine to investigate demographics.Results: This study included 204,013 participants, with 25.22% having a chronic pain diagnoses. In most subgroups, females had significantly greater HC, while males had greater WC and WHR. WC (p<0.001 in females, p<0.01 in males), HC (p<0.001 in females) and WHR (p<0.001 in females, p<0.05 in males) were significantly greater in the severe pain group compared with the mild/moderate pain group.Conclusion: These findings suggest that when assessing HC and WC, demographic variables need to be considered to develop more personalized and comprehensive treatment plans for chronic pain patients.

Communication and empathy within the patient-physician relationship among patients with and without chronic pain.

Chronic pain may affect the relationship between patients and their treating physicians. This study was designed to compare four aspects of physician communication and physician empathy reported by patients with chronic pain and in chronic pain-free controls. A cross-sectional study was conducted within a national pain research registry from July 2020 through January 2024. Patients with chronic low back pain of greater than 3months duration were matched to chronic pain-free controls utilizing propensity scores derived froma logistic regression model based on 11 variables thatincluded sociodemographic characteristics, cigarette smoking status, history of comorbid medical conditions, and duration of the current patient-physician relationship. Patients reported on the primary outcomes of physician communication utilizing the Communication Behavior Questionnaire (CBQ) and physician empathy utilizing the Consultation and Relational Empathy (CARE) measure. Group means were compared for each aspect of physician communication (patient participation and patient orientation, effective and open communication, emotionally supportive communication, and communication about personal circumstances) and physician empathy, and Cohen's d statistic was utilized to assess the clinical relevance of between-group differences. Secondary exploratory analyses were also performed to compare patients treated by osteopathic physicians vs. allopathic physicians and to determine whether study group X physician type interaction effects were present. The 387 patients in each study group were matched within a caliper width of 0.001 on the propensity score. Overall, patients ranged from 21 to 79 years of age (mean, 50.7 years; standard deviation [SD], 15.1 years), and 617 (79.7 %) of them were female. Patients in the chronic pain group reported poorer scores for all aspects of physician communication and physician empathy than the chronic pain-free controls. All between-group differences were clinically relevant. There were no differences in physician communication or physician empathy according to physician type in the exploratory analyses, and study group X physician type interaction effects were not observed. In this cross-sectional study, patients with chronic pain reported having physicians with poorer communication and less empathy than chronic pain-free controls. Longitudinal research is needed to more clearly determine the temporal relationship between patients' chronic pain and physician communication and physician empathy during medical encounters.

Thriving Through Pain: A Whole-Person and Resilience Comparative Study Using Mobile Health Application Technology for Individuals With Self-Reported Pain Challenges

BackgroundPain is a complex condition and affects one's life beyond physical symptoms. National pain management recommendations include a whole-person approach that includes strengths (or resilience). PurposeThe purpose of this study was to examine de-identified data from the MyStrengths+MyHealth application to examine, Strengths, Challenges, and Needs for the population and a subset of the data for those with and without self-reported Challenges in the Pain concept. DesignThis cross-sectional comparative study used de-identified consumer-generated whole-person strengths data from the MyStrengths+MyHealth (MSMH) application. MethodsData was collected from various community settings between 2019 and 2023 and approved by the University's Institutional Review Board. From the sample population (N=1737), we identified those with self-reported Pain (n=1280) and without self-reported Pain (n=457) and compared Strengths, Challenges, and Needs. ResultsThe sample population (N=1737) was largely in the age range of 45-64 years (51.2%), Male (56.4%), White (90.5%), non-Hispanic/Latino (86.6%), and Married (74.2%). The Pain group (n=1280) reported significantly fewer Strengths (p<0.001) and more average Challenges and Needs (p<0.001) than the Without Pain Group (n=457) across all concepts. For the Pain Group, the most frequent Strength reported was Role Change (70.5%), the most frequent Challenge Nutrition (96.1%), and the greatest Need was Income (89.9%). ConclusionsDespite reporting Challenges and Needs, the Pain Group identified many Strengths. The Pain Group identified Role Change (70.5%) as a top Strength was surprising and may suggest adaptability to chronic pain. MSMH has potential to empower individuals to provide a comprehensive whole-person assessment and resilience which may be particularly useful for those living with chronic pain. Clinical ImplicationsThis study has clinical implications for supporting the use of digital health tools such as mobile applications for capturing contextual data directly from patients to enable nurses to provide more accessible and personalized care to patients.

Predicting the Presence of Pain in Youth Baseball Pitchers Using the Concept of Biomechanical Efficiency.

Increases in peak shoulder distraction force and peak elbow valgus torque may influence throwing-arm pain and injury risk in youth pitchers. The purpose of this study was to determine whether shoulder distraction force and elbow valgus torque while accounting for anthropometrics and pitch velocity can predict the presence of pain in youth baseball pitchers. It was hypothesized that throwing-arm pain could be predicted using the concept of biomechanical efficiency, where a pitcher who is less efficient (having higher force or torque with the same pitch velocity) is more likely to experience pain. Descriptive laboratory study. A total of 38 youth baseball pitchers (mean age, 13.3 ± 1.7 years) were divided into a pain group and pain-free group based on presence of throwing-arm pain as reported on a health history questionnaire. Each pitcher threw 3 maximal-effort fastballs to a catcher at regulation distance, and kinematics were measured using an electromagnetic motion-capture system (minimum 100 Hz). Height and weight as well as mean peak shoulder distraction force, peak elbow valgus torque, and pitch velocity across the 3 trials were evaluated. Logistic regression analyses determined whether shoulder distraction force or elbow valgus torque could predict the presence of throwing-arm pain when holding anthropometrics (body weight for shoulder distraction force; body weight and height for elbow valgus torque) and pitch velocity constant. Shoulder distraction force significantly predicted the presence of throwing-arm pain after accounting for body weight and pitch velocity (χ2 = 9.49; P = .023). Specifically, for every 1-N increase in peak shoulder distraction force while holding body weight and pitch velocity constant, there was a 0.6% increased likelihood of experiencing throwing-arm pain. Elbow valgus torque could not predict the presence of pain when holding body weight, height, and pitch velocity constant. The models demonstrated that increases in peak shoulder distraction forces when holding pitch velocity and body weight constant increased a youth baseball pitcher's likelihood of experiencing throwing-arm pain. The study results support the concept of the biomechanical efficiency framework by offering evidence that maintaining pitch velocity with a lower joint load led to a lower likelihood of pain. Results suggest that practicing efficient movement strategies can decrease the likelihood of experiencing throwing-arm pain while maintaining performance.

Effectiveness of Platelet-rich Plasma Injection as an Adjunct Treatment to Arthroscopy for TFCC Injury: A Retrospective Cohort Study.

Triangular fibrocartilage complex (TFCC) injuries can cause significant patient dysfunction. Platelet-rich plasma (PRP) has emerged as a potential adjunctive treatment for arthroscopic TFCC repair, with some studies suggesting improved outcomes. This study aims to evaluate and compare PRP as an adjunctive treatment in arthroscopic TFCC tear repair. This retrospective cohort study examined patients undergoing arthroscopic TFCC repair at Institut de la Main, Paris, France (December 2021-2022). Patients were split into two groups: arthroscopic repair alone (1) and repair with PRP injections (2). Physical examinations were conducted pre- and posttreatment, recording flexion, extension, and radial/ulnar deviation of the affected and contralateral wrists. A total of 33 patients (20 men and 13 women) with a mean age of 30.55 ± 9.17 years were included. PRP injections were given to 16 patients with arthroscopic TFCC repair; 17 had repair only. No significant differences existed preoperatively between groups in wrist function or pain (P > 0.05). The Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score differed significantly (P = 0.004). The non-PRP group demonstrated better postoperative upper extremity function, with a mean Quick DASH score of 7.75 ± 5.91 compared with 12.64 ± 6.79 in the PRP group. No significant difference between groups was observed in the pain visual analog scale (P > 0.05). PRP injections with TFCC repair did not improve function over repair alone. The non-PRP group showed better function (lower Quick DASH scores). Pain reduction was similar between groups. Larger trials and cost-effectiveness studies are needed to fully assess PRP's benefits in TFCC repair.

Mid-term patient-reported outcomes are inferior in opening-wedge high tibial osteotomy patients with untreated medial meniscus posterior root tear.

The impact of untreated medial meniscus posterior root (MMPR) tear (MMPRT) during opening-wedge high tibial osteotomy (OWHTO) on patient-reported outcomes (PROs) remains poorly understood. This retrospective cohort study aimed to investigate the association between the presence of MMPRT and post-operative PROs in patients who underwent OWHTO. A total of 83 knees that underwent OWHTO that were followed up for 6.6 years were included. Post-operative PROs were assessed using the knee injury and osteoarthritis outcome score (KOOS) subscales. Medial meniscus extrusion (MME) was measured by magnetic resonance imaging (MRI). MMPRT was diagnosed based on preoperative MRI and intraoperative arthroscopy findings. The participants were categorized into the MMPRT and MMPR intact (MMPRI) groups, and their KOOS subscales were compared. Additionally, logistic regression analysis was conducted to explore the correlation between KOOS and MMPRT presence. In total, 29 out of 80 (36.3%) knees were classified into the MMPRT group, while three knees underwent total knee arthroplasty. Preoperative MME was 3.5 ± 1.9 (range 0-8.9) mm, showing correlation with the presence of MMPRT (p = 0.004) by regression analysis. The post-operative KOOS subscales of the MMPRT group were lower than the MMPRI group for pain (p = 0.017), activities of daily living (ADLs) (p = 0.001), sports (p < 0.001) and quality of life (QOL) (p < 0.001). Additionally, regression analysis showed the presence of MMPRT was correlated with lower KOOS subscale scores for pain (p = 0.041), ADLs (p = 0.011), sports (p < 0.001) and QOL (p = 0.002). Preoperative MMPRT correlated with a reduction in mid-term post-operative PROs, as assessed using the KOOS, among patients who underwent OWHTO. Surgeons should consider addressing an MMPRT at the time of OWHTO. Level IV.

Botulinum Toxin A for the management of temporomandibular myofascial pain - a cohort study

Myofascial pain represents the largest subgroup of TMD (Temporomandibular Disorders), which accounts for a common cause of non-dental orofacial pain. The management of TMD is complex, due to the chronic nature of the condition, alongside acute episodes presenting to the clinician. A fundamental part of TMD management is consideration of the bio-psycho-social element in the aetiology of TMD. First-line treatment of myofascial TMD includes; early diagnosis, explanation and education and conservative self-care measures. More recently, Botulinum Toxin A (BTX-A) is being used increasingly as an adjunct to conservative management of muskulo-skeletal pain disorders, due to its muscle-relaxant and analgesic properties. However, the scientific evidence regarding this is conflicting and it has been suggested that there is insufficient evidence to support the efficacy of BTX-A. A mixed method analysis of a TMD-myofascial pain cohort who underwent BTX-A injections to assess the effectiveness of masseteric BTX-A was carried out. 149 patients completed one round of masseteric BTX-A treatment, of whom 61 completed an additional round of BTX-A. In total, 398 masseter muscles were injected. The average VAS pain score pre-operatively was 8/10, compared with a postoperative mean score of 3/10 at 6 weeks after treatment. The mean percentage reduction in pain was 50%. Pain scores were classified as mild (≤4) , moderate (≤7) or severe (≥8). Pain scores and quality of life scores were found to improve considerably more in the severe pain group in comparison to the mild group. Complete resolution of symptoms was reported in 21% of patients (n=31). The treatment significantly improved patients’ reported pain and quality of life scores, highlighting key beneficial effects for the myofascial pain subgroup of TMD.

Magnetic resonance imaging verification of anterior capsular impingement in the hip joint: A three-dimensional analysis

BackgroundThis study aimed to clarify whether the anterior hip capsular ligament is impinged between the acetabulum and femur during hip flexion or adduction and to determine the difference in the distance between the femur and capsular ligament in healthy adults and those with hip pain. MethodsMagnetic resonance imaging of the hip joint was conducted at the following hip positions: 0° of flexion, 60° of flexion, maximal flexion, and maximal flexion with adduction. A three-dimensional model of the capsular ligament and femur was constructed. The minimal distance between the femur and capsular ligament, termed the capsule-femur distance, was computed. Because a capsule-femur distance of 0 mm indicates contact between the femur and the capsular ligament, that is, capsular impingement, the distance in each position was compared for each group using a one-sample t-test. The capsule-femur distance in the various groups and for different positions was compared using a split-plot analysis of variance. FindingsFifteen healthy individuals and sixteen individuals experiencing hip pain were enrolled. The capsule-femur distance was significantly greater than 0 mm in all positions in both groups, and none of the groups had a capsule-femur distance of 0 mm. The capsule-femur distance was significantly longer in the other positions than in the 0° flexion position, and significantly longer in the hip pain group than in the healthy group. InterpretationCapsular impingement did not occur in either group, even during hip flexion or adduction. Furthermore, the capsule-femur distance was longer in the hip flexion and hip pain groups.