Pain Group Research Articles

Clinical Impact of Preoperative Symptoms of Aortic Stenosis on Prognosis After Transcatheter Aortic Valve Replacement.

Background: The prognostic significance of different presentations of aortic stenosis (AS) remains unclear. Our aim was to analyze outcomes after transcatheter aortic valve replacement (TAVR) according to preoperative AS symptoms. Methods and Results: We retrospectively enrolled 369 consecutive patients (age 84.3±5.0 years, and 64% females) who underwent TAVR from 2014 to 2021. We divided them into 4 groups by the main preoperative symptom: asymptomatic (n=50), chest pain (n=46), heart failure (HF; n=240), and syncope (n=33). Post-TAVR rates of HF readmission, all-cause death and cardiac death were compared among the 4 groups. The 4 groups showed no significant trends in age, sex, stroke volume index, or echocardiography indices of AS severity. During a follow-up, the overall survival rate at 1 and 5 years after TAVR was 97% and 90% in the asymptomatic group, 96% and 69% in the chest pain group, 93% and 69% in the HF group, and 90% and 72% in the syncope group, respectively. HF and syncope symptom had significantly lower HF readmission or cardiac death-free survival at 5 years after TAVR (log-rank test P=0.038). In the Cox hazard multivariate analysis, preoperative syncope was an independent predictor of future HF readmission or cardiac death after TAVR (HR=9.87; 95% CI 1.67-97.2; P=0.035). Conclusions: AS patients with preoperative syncope or HF had worse outcomes after TAVR than those with angina or no symptoms.

Analysis of lower limb muscle strength characteristics of amateur runners with patellofemoral pain: A cross-sectional study.

To analyze the lower limb muscle strength characteristics of amateur runners with patellofemoral pain (PFP). Sixty amateur runners (30 in the knee pain group, 30 in the control group) underwent measurements of hip abduction strength, knee extension strength, and knee flexion strength. Additionally, the hamstring/quadriceps ratio and limb strength symmetry index were calculated for all participants. Statistical analyses were conducted using linear mixed models. The hip abduction and knee extensors strength of amateur runners with PFP was significantly lower than that of the control group. The hamstring/quadriceps ratio was significantly higher in the male knee pain group compared to the control group, while no significant difference was found between the female knee pain group and the control group. Furthermore, both the hip abduction strength symmetry index and knee extensors symmetry index were significantly lower in the knee pain group compared to the control group. Amateur runners with PFP exhibit distinct lower limb strength characteristics compared to non-knee pain runners. Additionally, differences in lower limb strength characteristics between male and female amateur runners with PFP were observed. These findings emphasize the importance of considering functional and gender differences in PFP rehabilitation training.

Interference with activities of daily living according to pain level after breast surgery

BackgroundThe degree to which postoperative pain interferes with activities of daily living (ADLs) after breast surgery is unclear. We assessed the effect of pain on interference and analgesic use following lumpectomy and sentinel lymph node biopsy (lump-SLNB), and mastectomy. MethodsWe retrospectively identified consecutive patients who completed ≥1 post-discharge survey(s) on postoperative days (POD) 1–5 (lump-SLNB) and 1–10 (mastectomy) from 1/2019–12/2020. The highest pain score was used to categorize none/mild and moderate/severe pain groups. Interference was reported as “none/a little”, “somewhat”, and “quite a bit/very much”. Two-sample non-parametric tests compared baseline characteristics. Results1067 patients underwent lump-SLNB; 1219 underwent mastectomy—436 (41%) and 857 (70%) patients reported moderate/severe pain, of whom 190 (44%) and 121 (14%) rated interference as “none/a little”, 178 (41%) and 341 (40%) as “somewhat”, and 68 (16%) and 395 (46%) as “quite a bit/very much”, respectively. Patients with moderate/severe pain more frequently reported “quite a bit/very much” interference versus those with none/mild pain (lump-SLNB: 16% versus 1.1%, p<0.001; mastectomy: 46% versus 3.8%, p<0.001). Compared to POD1, the proportion of patients with the highest degree of interference declined on each subsequent POD in both surgical cohorts. Following mastectomy, median opioid use was 2 pills overall, and 6 pills for the highest interference group. ConclusionsInterference was more common in patients with moderate/severe pain; however, postmastectomy opioid use was low regardless of interference level. Our findings can inform expectations regarding postoperative pain, interference, and the feasibility of opioid-sparing recovery pathways. SynopsisPatients with moderate/severe pain after breast surgery experience more interference compared to those with none/mild pain. Postmastectomy opioid use is low, including patients reporting higher interference; most patients experience an early return to baseline function regardless of pain level.

Characteristics of painful temporomandibular disorders and their influence on jaw functional limitation and oral health-related quality of life.

There is limited knowledge about the impact of painful temporomandibular disorders (TMDs) and pain characteristics on jaw functional limitation and oral health-related quality of life (OHRQoL) in TMD patients. The influence of painful TMDs and pain characteristics on jaw functional limitation and OHRQoL was investigated. Inter-relationships between limitation in jaw function and various OHRQoL domains, along with facial pain attributes predicting impaired jaw function and diminished OHRQoL were also examined. TMD patients were recruited from a university-based hospital. A comprehensive questionnaire comprising demographic variables, the DC/TMD Symptom Questionnaire, Graded Chronic Pain Scale, Jaw Functional Limitation Scale-8 (JFLS-8) and Oral Health Impact Profile-TMD (OHIP-TMD) was administered. Participants underwent a protocolized physical examination, and TMD diagnoses were determined utilising the DC/TMD algorithms. Participants were subsequently stratified into intra-articular/pain-related/combined TMD groups, as well as no TMD pain, acute/chronic pain and low/high-intensity pain groups. Data were assessed using non-parametric and hierarchical linear regression analyses (α = .05). The final sample consisted of 280 participants (mean age 31.2 (SD 11.8) years; 79.3% women). Significant differences in pain characteristics, JFLS-8, and global OHIP scores were observed across the various TMD subtypes, pain chronicity and pain intensity categories. Pain intensity and pain-related interference exhibited moderate correlations with JFLS-8 and global OHIP scores (rs = 0.53-0.60). Moderate associations were also noted between JFLS-8 and global OHIP, as well as most OHIP domains (rs = 0.42-0.64). Both jaw functional limitation and OHRQoL were predicted by sex, pain intensity and pain-related interference. Sex, pain intensity and pain-related interference are key determinants for both impaired jaw function and diminished OHRQoL, with pain-related interference exerting a more pronounced effect.

Sensorimotor tests in patients with neck pain and its associated disorders: a systematic review and meta-analysis

This systematic review aimed to synthesize the current evidence regarding neck sensorimotor testing in individuals with neck pain, assess the differences between neck pain groups and healthy controls, and recognize factors that might affect test results. We performed the data search using PubMed, Embase, PsycINFO, CINAHL, and Scopus databases. We used a two-step screening process to identify studies. Furthermore, we screened the reference lists for additional studies. Hedges g was used to present the difference between neck pain groups and asymptomatic individuals. We assessed the quality of the studies using the QUADAS tool. The final review included 34 studies, of which 25 were related to the joint position error test, four to the smooth pursuit neck torsion test and six to the balance test. Our meta-analysis showed poorer joint-position sense, oculomotor function, and wider postural sway in individuals with neck pain than healthy controls. The size of the difference between the groups seemed to be influenced by the intensity of the pain and the presence of dizziness. Therefore, it might be helpful in future studies to differentiate patients with neck pain into subgroups based on their symptom and demographic profiles to assess other factors that significantly affect cervical sensorimotor control.

Motivational impact, self-reported fear, avoidance, and harm perception of shoulder movements pictures in people with chronic shoulder pain

Objectives (1) to represent in pictures a group of items from the International Classification of Functioning (ICF) that represent daily situations; (2) to compare valence and arousal evoked by these pictures between chronic shoulder pain and pain-free control groups and assess self-reports of fear, avoidance, and harm perception. Methods This is a cross-sectional observational study and approved by Research Ethics Committee. Selected pictures representing items from the ICF were judged by members of the general public using an online form. We used the set of International Affective Picture System and the Self-Assessment Manikin to compare valence and arousal between groups. The chronic shoulder pain group answered questions regarding self-reports of fear, avoidance, and harm perception. Results The protocol consisted of 58 pictures. A repeated measures ANOVA for valence revealed a main effect of group, F(1, 9)=24.81;p < 0.005, and no effect on the arousal, F(1,9)=2.00;p < 0.190. The shoulder pain group judged shoulder pictures more aversive. The picture that represents the movement of carrying on shoulder presented the highest medians of self-reports of fear, avoidance, and harm perception 10(8-10). Conclusion The pictures represent daily activities that correspond to the items from the ICF. The valence of the shoulder pictures was different between the groups, shoulder pictures were considered more aversive for the group with chronic shoulder pain. The responses of avoidance, fear, and harm perception showed higher median in the carrying on shoulders, hip, and back picture.

Effectiveness of telerehabilitation on pain and function in musculoskeletal disorders: A systematic review of randomized controlled trials

AbstractIntroductionMusculoskeletal disorders are common, causing high hospital and healthcare utilisation. Telerehabilitation (TR) is a new strategy to deliver treatment remotely to patients in their own homes, with lower costs and easier accessibility. This study investigated the effectiveness of TR on pain and function in musculoskeletal disorders.MethodsA literature search of randomised controlled trials (RCTs) in the Medline/PubMed, Cochrane Library, and PEDro databases was conducted by two reviewers on 10 Jan 2023. We included studies that investigated pain and function with TR compared with a control group in any musculoskeletal disorders. The data synthesis included the TR platforms and measured outcomes. Effectiveness was measured based on the pain and function results. The study methodological quality was assessed by the PEDro scale for RCTs.ResultsAfter removing duplicated and irrelevant studies, 200 were initially identified. This review includes seven RCTs of a total of 183 participants with musculoskeletal conditions such as low back pain, fibromyalgia, total knee arthroplasty, shoulder subacromial decompression, knee osteoarthritis, and rotator cuff syndrome. The TR platforms used were smartphone and web apps, video, phone calls, and teleconference sessions. The findings showed no significant differences between the TR and control groups in pain and function. TR showed better improvement with a significant short‐term difference in some variables, but this was not sustained in the long term.ConclusionTR was comparably effective to clinic‐based rehabilitation for treating musculoskeletal disorders. However, it was not superior to conventional rehabilitation. TR showed lower costs and a high level of adherence. We recommend implementing new TR tools to remotely treat patients.Systematic Review RegistrationPROSPERO Registration Number CRD42022375048.

Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study.

The identification of pain originating from distinct biological processes may lead to individualised pain treatment. In this study, we aimed to explore the pain experiences of patients with rheumatoid arthritis (RA), differentiating between those predominantly exhibiting features of peripheral inflammatory versus centrally mediated pain. Through a multimethods approach we (i) quantitatively analysed the differences in pain descriptors between patients diagnosed with RA experiencing peripheral inflammatory and centrally mediated pain, utilising the Short Form-McGill Pain Questionnaire which includes the pain visual analogue scale (VAS) and (ii) qualitatively explored their subjective pain experiences grounded in the biopsychosocial model, commonly applied in chronic pain. Participants with centrally mediated pain reported higher pain scores on the VAS, used a wider range of pain descriptors, and a higher proportion selected each descriptor compared to those with inflammatory pain (p < .001). The qualitative analysis revealed the centrally mediated pain group's experiences were overwhelming and relentless, struggling to precisely articulate the nature of their pain. In contrast, individuals with inflammatory pain expressed their pain in more tangible terms and shared their adaptive and coping strategies. Importantly, both groups revealed the substantial psychological, functional and social impacts of their pain, highlighting the often 'invisible' and misunderstood nature of their symptoms. This study has gained a deeper insight into the pain experiences of patients living with RA, particularly in differentiating between centrally mediated and inflammatory types of pain, potentially facilitating a more individualised approach to pain treatment. Patients actively participated in the study conception and design. This engagement includes collaboration with key stakeholders, such as members of the National Rheumatoid Arthritis Society and Patient Research Partners (PRPs), who provided continuous feedback and guidance throughout the research process. Specifically, the qualitative element was coproduced with two PRPs, who were involved in co-leading the focus groups and data analysis.

Neck Pain among Dental Practitioners

Dentistry is a demanding profession regarding concentration and precision. Performance of dental treatment results in a very inflexible work posture and under stressful body position for prolonged period, bad pattern and faulty neck posture disturbs the normal spine curve of neck leading to muscular imbalance and consequently lead to neck pain and disability. The aim of the study is to measure the prevalence of neck pain among the Dental surgeons in Dhaka city of Bangladesh. This is a cross-sectional survey type study. Dentists who reported neck pain last for 12 months were selected as a study population. After screening Neck pain intensity was measured by using 101 NPRS. Then the dentists were given NPAD questionnaire to measure disability level due to neck pain. About 36.60% dental surgeons had neck pain whereas 63.40% did not have. Among 71 dental surgeons 55.20% had moderate neck pain according to neck pain and disability scale (NPAD scale) followed by 23.90% had mild pain and 20.90% had severe pain respectively. Statistically no significant association was found between neck pain and age group. Statistically significant association was found between neck pain and duration of job of the respondents. Moreover, study found that negative correlation between age of the dental surgeons and pain score and it was not statistically significant. It is concluded from the study that prevalence of neck pain among dental surgeons working in Dhaka city is still high i.e. one in every three dental surgeons suffered from neck pain. Preventive musculoskeletal awareness campaign and posture training can be conducted among dental surgeons.

Phenotyping of chronic pain in breast cancer survivors: an original study using the cancer pain phenotyping (CANPPHE) Network multidisciplinary international guidelines

PurposeThe primary aim of this cross-sectional study is to examine the prevalence of pain phenotypes in breast cancer survivors (BCS). A secondary aim entails examining whether health related quality of life differs between the main pain phenotypes in BCS.MethodsBCS who experienced chronic pain were asked to complete the numeric pain rating scale for pain, Margolis pain diagram, and short form 36 (SF-36). Following administration of questionnaires and quantitative sensory examinations were applied. To determine the prevalence of the predominant type of pain, a recently proposed classification system by the Cancer Pain Phenotyping (CANPPHE) Network was used.ResultsOf the 86 female participants, 19 (22.09%) had dominant neuropathic pain, 18 (20.93%) had dominant nociceptive pain and 14 (16.28%) had dominant nociplastic pain. 35 participants (40.70%) were classified as having mixed pain. One-way ANOVA revealed a significant difference between the four pain groups for the SF-36 general health (F = 3.205, p = 0.027), social functioning (F = 4.093, p = 0.009), and pain (F = 3.603, p = 0.017) subscale scores.ConclusionThis study found that pain in BCS was mostly of mixed phenotype, followed by predominantly neuropathic and nociplastic pain. Furthermore, it was found that, compared to BCS with predominant neuropathic and nociceptive pain, BCS with predominant nociplastic pain have lower health related quality of life in the areas of bodily pain and social functioning.

Association between multisite musculoskeletal pain and disability trajectories among community-dwelling older adults

BackgroundPain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.ObjectiveTo examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort.DesignWe used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL).ParticipantsA total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study.MethodsGroup-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics.ResultsPersons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites.ConclusionsPersons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.

Cervical Multifidus Stiffness Assessment in Individuals with and without Unilateral Chronic Neck Pain: An Inter-Examiner Reliability Study.

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE.

The usefulness of ultrasound in identifying the underlying findings linked to pain in podagra patients.

To explore whether ultrasound (US) can be employed to identify the underlying characteristics associated with painin patients with podagra by evaluating the relationship between ultrasound findings and clinical pain. Patients with podagra were recruited and grouped into a pain group (G1, 82 patients) and a non pain group (G2, 123 patients).US features were collected and compared. US data were analyzed by binary logistic regression analysis and ROC analysis.Interobserver reliability was assessed, too. A total of 205 patients (196 male and 9 female) were enrolled in thisstudy. In multivariate analysis, the thickness of the synovium (OR=1.928, CI=1.074-3.463), CD (color Doppler) signal of thesynovium (OR=1.458, CI=1.011-2.103), and CD signal of the tophi (OR=1.576, CI=1.142-2.177) were identified as risk factorsfor clinical pain. Areas under the ROC curves (AUC) were 0.713, 0.686 and 0.641 for the three indicators, respectively.The best cutoff points were 1 mm for the thickness of the synovium, grade 1 for the CD signal of the synovium and grade 2for the CD signal of the tophi. Ultrasound can provide valuable information for determining underlying featuresassociated with pain in patients with podagra.

Outcome Scores and Survivorship of Patients Undergoing Primary Hip Arthroscopy With Borderline Hip Dysplasia: A Propensity-Matched Study With Minimum 10-Year Follow-up

Background: Patients with borderline hip dysplasia (BHD) and concomitant femoroacetabular impingement syndrome (FAIS) have demonstrated similar outcomes at short- and midterm follow-up compared with equivalent patients without dysplasia. However, comparisons between these groups at long-term follow-up have yet to be investigated. Purpose: To compare long-term clinical outcomes between patients with BHD undergoing primary hip arthroscopy for FAIS versus matched control patients without BHD. Study Design: Cohort study; Level of evidence, 2. Methods: A retrospective cohort study was conducted on patients with BHD (lateral center-edge angle, 18°-25°) who underwent hip arthroscopy for FAIS between January 2012 and February 2013. Patients were propensity matched in a 1:3 ratio by age, sex, and body mass index to control patients without BHD who underwent primary hip arthroscopy. Groups were compared in terms of patient-reported outcomes (PROs) preoperatively and at 10 years postoperatively, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score, 12-item International Hip Outcome Tool, visual analog scale (VAS) for pain and satisfaction. Achievement rates for minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were compared between groups. Kaplan-Meier survivorship curves were assessed between groups. Results: At a mean follow-up of 10.3 ± 0.3 years, 28 patients with BHD (20 women; age, 30.8 ± 10.8 years) were matched to 84 controls who underwent primary hip arthroscopy. Both groups significantly improved from preoperative assessment in all PRO measures at 10 years (P < .001 for all). PRO scores were similar between groups, aside from HOS-SS (BHD, 62.9 ± 31.9 vs controls, 80.1 ± 26.0; P = .030). Rates of MCID achievement were similar between groups for all PROs (HOS-ADL: BHD, 76.2% vs controls, 67.9%, P = .580; HOS-SS: BHD, 63.2% vs controls, 69.4%, P = .773; modified Harris Hip Score: BHD, 76.5% vs controls, 67.9%, P = .561; VAS pain: BHD, 75.0% vs controls, 91.7%, P = .110). Rates of PASS achievement were significantly lower in the BHD group for HOS-ADL (BHD, 39.1% vs controls, 77.4%; P = .002), HOS-SS (BHD, 45.5% vs controls, 84.7%; P = .001), and VAS pain (BHD, 50.0% vs controls, 78.5%; P = .015). No significant difference was found in the rate of subsequent reoperation on the index hip between groups. Kaplan-Meier survival analysis demonstrated comparable survivorship at long-term follow-up (P = .645). Conclusion: After primary hip arthroscopy, patients with BHD in the setting of FAIS had significantly improved PRO scores at 10-year follow-up, comparable with propensity-matched controls without BHD. Rates of MCID achievement were similar between groups, although patients with BHD had lower rates of PASS achievement. Patients with BHD had similar long-term hip arthroscopy survivorship compared with controls, with no significant difference in rates of revision hip arthroscopy or conversion to total hip arthroplasty.

Efficacy and Safety of Ultrasound Guided Inter-semispinal Plane Block for Postoperative Analgesia in Posterior Cervical Laminectomy - A Prospective Randomised Controlled Study.

Prospective, randomized controlled study. To assess the safety and efficacy of an ultrasound-guided ISP block for postoperative analgesia in posterior cervical laminectomy. 88 patients requiring posterior cervical laminectomy were randomized into two groups, those who underwent ISP block with multimodal analgesia (ISPB group) and those with only multimodal analgesia (control group). Demographic details, intraoperative parameters (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used), and postoperative parameters (numeric rating scale, satisfaction score, mobilization time, and complications) were recorded. The total opioid consumption (128.41 + 39.65vs 284.09 + 140.92mcg; P < .001), muscle relaxant usage (46.14 + 6.18mg vs 59.32 + 3.97mg; P < .001), surgical duration (128.61 + 26.08/160.23 + 30.99mins; P < .01), and intra-operative blood loss (233.18 + 66.08mL vs 409.77 + 115.41mL; P < .01) were significantly less in the ISPB group compared to the control. In the postoperative period, the control group's pain score was significantly higher (P < .001) in the initial 48 hours. The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores were significantly better in the ISPB compared to the control (P < .001). The mean time required to ambulate was statistically less in ISPB (4.30 + 1.64hours) when compared to controls (9.48 + 3.07hours) (P < .001). In patients undergoing posterior cervical laminectomy, ISP block is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intra-operative opioid requirements and blood loss, better postoperative analgesia, and early mobilization.

Single-Center In-Hospital and Outpatient Opioid Use for Lower Extremity Arterial Disease.

The pain associated with lower extremity arterial disease is difficult to treat, even with lower extremity revascularization. We sought to evaluate in-hospital and post-operative opioid usage in patients with different disease severities and treatments for lower extremity vascular disease. A retrospective review was performed for all hospital encounters for patients with an International Classification of Diseases (ICD) code consistent with lower extremity arterial disease admitted to a single center between January 2018 and March 2023. Cases included patients admitted to the hospital with a primary diagnosis of lower extremity arterial disease. These patients were subdivided based on disease severity, treatment type, and comorbid diagnosis of diabetes mellitus. The analysis focused on in-hospital opioid use frequency and dosage among these patients. The control group (CON) included encounters for patients admitted with a secondary diagnosis of lower extremity atherosclerotic disease. A total of 438 patients represented by all the analyzed encounters were then reviewed for the number and type of vascular procedures performed as well as opioid use in the outpatient setting for one year. Critical limb ischemia (CLI) encounters were more likely to use opioids as compared to the CON and peripheral arterial disease (PAD) without rest pain, ulcer or gangrene groups (CLI 67.9% (95% CI: 63.6%-71.6%) versus CON 52.1% (95% CI: 48.5%-55.7%), p < 0.001 and CLI 67.9% (95% CI: 63.6%-71.6%) versus PAD 50.2% (95% CI: 42.6%-57.4%), p < 0.001). Opioid use was also more common in encounters for gangrene and groups treated with revascularization (REVASC) and amputation (AMP) as compared to CON (gangrene 74.5% (95% CI: 68.5%-82.1%) versus CON 52.1% (95% CI: 48.5%-55.7%), p < 0.01; REVASC 58.3% (95% CI: 57.3%-66.4%) versus CON 52.1% (95% CI: 48.5%-55.7%), p =0.01; and AMP 72.3% (95% CI: 62.1%-74.0%) versus CON 52.1% (95% CI: 48.5%-55.7%), p < 0.01). Significantly increased oral opioid doses per day (MME/day) were not noted for any of the investigated groups as compared to the CON. In the outpatient setting, 186 (42.5% (95% CI: 37.2%-46.4%)) patients were using opioids one month after the most recent vascular intervention. By one year, 31 (7.1% (95% CI: 1.30%-7.70%)) patients were still using opioids. No differences in opioid usage were noted for patients undergoing single versus multiple vascular interventions at one year. Patients undergoing certain vascular surgery procedures were more likely to be using opioids at one year. Patients with CLI and gangrene as well as those undergoing vascular treatment have a greater frequency of opioid use during hospital encounters as compared to those patients with less severe disease and undergoing conservative management, respectively. However, these findings do not equate to higher doses of opioids used during hospitalization. Patients undergoing multiple vascular procedures are not more likely to be using opioids long-term (at one year) as compared to those patients treated with single vascular procedures.

Cervical Health Parameters in Car Drivers: Assessing the Influence of Driving on Neck Pain, Mobility, Proprioception and Craniovertebral Angle - A Cross-Sectional Study.

Prolonged sitting during driving is linked to neck pain, uncomfortable body positions, and repetitive motions. Recognizing these challenges, this study aimed to investigate Cervical Health Parameters in Car Drivers. The sample consisted of 160 car drivers between 25 and 45 years. This subject was then divided into two groups based on neck pain. Participants met the required criteria, such as being between 25-45 years of age, maintaining a BMI of 18-24, and driving for at least 2 hours each day for at least 3-5 years. To evaluate the results, we employed a clinometer and compass app on a smartphone to measure the Cervical Range of Motion (CROM). We used Surgimap software to estimate the Craniovertebral Angle (CVA), and a (Cervical range of motion) CROM device was used for proprioception assessment. The result shows the participants in neck pain group displayed lower Cervical Range of Motion (CROM) values than without neck Pain Group. Similarly, the Craniovertebral Angle (CVA) was smaller in the neck Pain Group (mean difference of -6.3°), indicating a more forward head posture. Neck pain resulted in a mean difference of -4.5° in proprioception accuracy. This indicates that neck pain affects CROM, CVA, and proprioception in car drivers. Car driving significantly impacts cervical parameters in individuals with neck pain, reducing cervical range of motion, altered craniovertebral angle, and diminished proprioceptive accuracy. These findings emphasize the need for ergonomic interventions and proprioceptive training tailored for drivers. Future research should broaden demographic parameters and consider potential confounders to provide a holistic understanding of the relationship between car driving and neck health.

Qualitative findings from a randomized trial of mindfulness-based and cognitive-behavioral group therapy for opioid-treated chronic low back pain.

This article reports qualitative outcomes from a randomized controlled trial comparing eight weeks of cognitive-behavioral group therapy for chronic pain (CBT-CP) and mindfulness-based group therapy (MBT) in individuals with chronic low back pain (CLBP). Approximately 10 months post-treatment, 108 participants completed structured qualitative interviews to express how the study treatment affected their life or health. Responses were qualitatively analyzed to generate a set of themes and subthemes, with between-groups comparisons to evaluate differences (if any) in treatment-response between MBT and CBT-CP. A majority of participants (n = 88, 81.5%) across both groups reflected positively on the study intervention and outcomes, identifying benefits in pain management (31.5%), meditation and mindfulness skills (25.9%), and relaxation skills (22.2%). Perceived benefits varied widely, suggesting no one intervention may be ideal for CLBP. Future research should examine tailoring interventions to target diverse clinical presentations to achieve optimal outcomes.

Differential relationships between physical activity and pain phenotypes in individuals with spinal cord injury

Background Chronic pain affects 70% of individuals with spinal cord injury (SCI) and leads to declines in health and quality of life. Neuropathic and nociceptive pain are phenotypes derived from different mechanisms that contribute to pain perception. The objective of this research was to investigate differential pain responses to moderate-to-vigorous physical activity (MVPA) in two chronic pain phenotypes: neuropathic and nociceptive pain. Methods Community-based physical activity levels were collected for one week in 17 individuals with SCI using a wrist-worn accelerometer, and daily pain ratings were assessed and categorized by phenotype. Physical activity levels were summarized to calculate minutes of MVPA. Correlational analyses were conducted to compare relationships between pain intensity and MVPA across individual participants and between pain phenotype groups. Results The neuropathic pain group revealed significant negative correlation between MVPA and pain intensity. In the nociceptive pain group, there was no significant correlation between MVPA and pain intensity. Further analysis revealed two subgroups of positive (N = 4) and negative (N = 3) correlations between MVPA and pain intensity. Pain location differed between the subgroups of nociceptive pain. Individuals with negative correlation experienced neck and upper back pain, whereas individuals with positive correlation experienced unilateral upper extremity pain. Conclusion Differential relationships exist between pain phenotypes and MVPA in individuals with SCI. Pain location differed between the subgroups of nociceptive pain, which we presume may indicate the presence of nociplastic pain in some individuals. These results may contribute to the advancement of personalized pain management by targeting non-pharmacological interventions for specific pain phenotypes. Trial registration: ClinicalTrials.gov identifier: NCT05236933..

- Mechanism of LDH and IL-8 Involved in pancreatic cancer Pain and the Correlation of Pain Degree

Objective: To observe the mechanism of lactate dehydrogenase (LDH) and interleukin 8 (IL-8) in pancreatic cancer pain and their correlation with pain degree. Methods: 126 patients with pancreatic cancer who visited our hospital from January 2021 to February 2023 were selected. The patients were divided into 58 patients with low pain (1~3 points) and 68 patients with high pain (4~10 points) by visual analog scale (VAS). And 50 health examinees in the same period were selected as the healthy control group. The serum LDH and IL-8 concentrations are analyzed by enzyme-linked immunosorbent assay, as well as the subjective pain grading method scoreis analyzed. The differences in LDH and IL-8 concentrations among the three groups of patients were compared. Pearson correlation analysis was used to investigate the correlation between LDH, IL-8 concentrations and patient pain. Binary logistic regression was used to determine independent risk factors for high pain, and ROC curves were used to analyze the diagnostic efficacy of each indicator. Result: The serum LDH and IL-8 concentrations in the high pain group were exceed the low pain group’s (P&lt;0.05). The serum LDH and IL-8 concentrations in the low pain groupexceed the healthy control group’s(P&lt;0.05). Pearson correlation analysis revealed a positive correlation between serum LDH concentration and pain grading (r=0.736, P=0.000). The serum IL-8 has positive correlation with pain grading (r=0.680, P=0.000). Serum LDH and IL-8 concentrations have positive correlation(r=0.589, P=0.000). LDH and IL-8 concentrations are independent risk factors for high pain levels (OR=1.033, 1.142, P&lt;0.05). The logistic regression prediction model formula was used: Y=constant+B1X1+B2X2+...+BnXn to set the joint diagnostic prediction model as -12.063+0.033×LDH+0.133×IL-8. The areas under the ROC curves of LDH, IL-8, and predictive model (LDH+IL-8) in patients with high pain were 0.925, 0.945, and 0.974, respectively. The relevant standards for LDH are&gt;190U/L, IL-8 is&gt;36pg/mL, and the relevant standards for prediction models are&gt;5.75. Conclusion: LDH and IL-8 participate in the pain aggravation process of pancreatic cancer, and are closely related to the pain grading. The combination of LDH and IL-8 can be used as a biological indicator to evaluate the pain severity of pancreatic cancer, and provide reference for clinical diagnosis and treatment.