Pain In People Research Articles

Effects of transcutaneous electrical nerve stimulation on pain, function, and descending inhibition in people with non-specific chronic low-back pain: a study protocol for a randomized crossover trial

BackgroundLow back pain (LBP) is a significant public health problem, is very prevalent, and is often characterized by the persistence of symptoms. Transcutaneous electrical nerve stimulation (TENS) may benefit people with chronic LBP because it can activate descending inhibitory pathways and inhibit central excitability. However, previous studies that have investigated the effects of TENS on pain in people with LBP have failed to use proper intensities of current, and the timing of the assessment of pain was not performed during the peak of the analgesic response or functional activities. Therefore, the present study aims to assess the effects of TENS on measures of pain, function, and descending inhibition using the maximal tolerable intensity of TENS in participants with LBP.Methods/designThis study will be a randomized crossover trial. The participants for this study will be recruited from various places, including the University of Hartford, physical therapy clinics, and local businesses in the Hartford area, as well as online websites geared towards clinical trial recruitment. A total of 34 participants will receive all three treatments: active TENS, placebo TENS, and no treatment control. The treatment order will be randomized using a website-based randomization tool. For active TENS, a modulating frequency of 2–125 Hz will be applied with a variable pulse duration and maximal tolerable intensity for 30 min. The TENS will be left on for post-treatment testing to assess the effects during its maximally effective period for a total of 50 to 60 min. Furthermore, the intensity may be turned down if muscle twitching is present to ensure blinding of the evaluator. For placebo TENS, the unit will deliver current for 45 s, ramping to 0 in the last 15 s. The primary outcome will be pain intensity at rest and with movement, determined using the numerical pain rating scale. The secondary outcomes will be pressure pain threshold, heat pain threshold, temporal summation of pain, conditioned pain modulation, sit-to-stand test, and repeated trunk flexion. The assessments will be performed immediately before and after treatment. Statistical analysis of the data obtained will consider a significance level of p < 0.05.DiscussionThis study will provide evidence concerning the effects and mechanisms of TENS treatment in participants with chronic non-specific low back pain. The outcomes, including pain, function, and descending inhibition, will help us gain a greater understanding of how TENS can be used for these participants.Trial registrationClinicalTrials.gov NCT05812885. Registered on 24th May 2023.

The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review.

Opioid use disorder often co-occurs with chronic pain but assessment and treatment of these co-occurring disorders is complex. This review aims to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. Scoping review. The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA-ScR checklist was used to guide reporting. Forty-seven publications addressing the issue of co-occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness-Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. The scoping review reveals gaps in evidence-based knowledge to effectively care for co-occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders as well as collaborative interdisciplinary work. Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.

The efficacy of multimodal physiotherapy and usual care in chronic whiplash-associated disorders with facet-mediated pain undergoing platelet rich plasma (PRP) treatment: a series of single case experimental designs (SCEDs)

Purpose Chronic whiplash-associated disorders (WAD) is a heterogeneous condition with limited effective treatment options available. This study evaluated the efficacy of multimodal physiotherapy and usual care in chronic WAD with facet-mediated pain receiving platelet-rich plasma (PRP) injections to determine if pain interference and confidence completing activities in the presence of neck pain could be improved. Materials and methods A multiple-baseline, single-case experimental design was used to evaluate the 6-week effect of physiotherapy or usual care in two groups of three participants each. Results All six participants demonstrated a significant reduction in pain interference, and three participants showed improved confidence to perform daily activities when in pain. Weighted Tau-U demonstrated a significant reduction of pain interference with large to very large effect sizes (> 0.75) for both interventions in all participants irrespective of treatment allocation with no significant group difference demonstrated. Similar effects were demonstrated for the confidence to perform daily activities with neck pain (ES > 0.46), although this was only evident in three participants (two PT and one UC). Generalisation measures also showed improvements in pain and disability, psychological and quality of life outcomes. No adverse events were reported. Conclusions Both physiotherapy and usual care demonstrated improvements in pain interference and confidence to perform activities of daily living with neck pain in people with chronic WAD following cervical facet joint PRP. Trial Registration The trial was registered with ClinicalTrials.gov (Protocol Number: NCT03949959).

COMPARISON OF ROPIVACAINE ALONE VS ROPIVACAINE WITH METHYLPREDNISOLONE INJECTION AS A TREATMENT OF TRIGGER POINTS FOR MYOFASCIAL PAIN: A SUPERIORITY RANDOMIZED CLINICAL TRIAL

Soft tissue rheumatism, known as myofascial pain syndrome (MPS), is typified by taut bands, transferred pain that is distinct, sensory alterations that occur, and a local twitch response. It is also connected with trigger points in one or more muscles. The purpose of the research is to evaluate the effects of injections of Ropivacaine alone vs. Ropivacaine with methylprednisolone in decreasing pain in people in our community who have myofascial pain caused by trigger points. The design of this study was a randomized controlled trial. This study was carried out from July 2022 to August 2023. The research comprised 50 individuals (27 females and 23 males) diagnosed with MPS who came to our clinic. Using online randomization software, the patients were randomly divided into two groups. Group B got a mixture of 0.25% Ropivacaine &amp; 10mg methylprednisolone in 3ml normal saline at each trigger point, whereas Group A received 3ml of 0.25% Ropivacaine. Dry needling of trigger sites was done in both groups. Patients were assessed at two, four, and eight weeks of intervention. The patients' pre-treatment assessment measures showed no statistically significant differences. After 4 and 8 weeks of assessment, Group B NRS pain and BDI scores showed statistically significant improvements compared to pre-treatment results (p&lt;0.05). NRS and BDI scores were reduced in group A compared to their pretreatment values, but that was not clinically significant. Results of our study showed that there was a statistically significant difference between both groups in terms of pain, stress, and anxiety after the intervention. Ropivacaine with methylprednisolone gave better results than Ropivacaine alone in reducing pain and anxiety among the study population.

Factors related to nurses' beliefs regarding pain assessment in people living with dementia.

To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. A descriptive cross-sectional survey was conducted between July 2022 and April 2023. An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.

PASHTO TRANSLATION, VALIDITY AND RELIABILITY OF LEEDS ASSESSMENT OF NEUROPATHIC SYMPTOMS AND SIGNS (LANSS) IN SPINAL CORD INJURY PATIENTS

Objective: The aim pf this study was to translate to translate English version of Leeds assessment of Neuropathic symptoms and signs (LANSS) pain scale into Pashto language and to determine the validity and reliability of Pashto version of LANSS pain scale in spinal cord injury patients. Material &amp; Methods: LANSS was translated from original language into Pashto and then back translated to English. It was reviewed by ten physical therapy experts for face and content validity. The scores of the Pashto version of the LANSS were studied in a sample of 113 spinal cord injury patients having pain from Pashto speaking region, Khyber Pakhtunkhwa, Pakistan. Comparison between Pashto LANSS and DN4 Questionnaire score was done to check for concurrent validity. Intra-class correlation coefficient, Cohen’s kappa agreement and internal consistency were estimated to check the reliability of Pashto version of LANSS. Results: For a p-value of &lt;0.01, the overall mean score of Pashto-LANSS was higher in patients suffering from neuropathic pain. The ICC score for Pashto-LANSS was 0.76, kappa value 0.76 and Cronbach’s alpha 0.83 indicating significant scores. The results of Pearson’s correlation showed significant correlation between Pashto-LANSS and DN4. Conclusion: Pashto LANSS is a reliable and valid tool to identify neuropathic pain in SCI patients. Pashto version of LANSS can be used in differentiating neuropathic pain from nociceptive pain in people with spinal cord injury (SCI). Key terms: LANSS, Neuropathic pain, DN4 Questionnaire, Spinal cord injury, Pashto version of LANSS (Pashto-LANSS).

Sirtuin 3 Mediated by Spinal cMyc-Enhancer of Zeste Homology 2 Pathway Plays an Important Role in Human Immunodeficiency Virus-Related Neuropathic Pain Model.

Clinical data demonstrate that chronic use of opioid analgesics increases neuropathic pain in people living with human immunodeficiency virus (HIV). Therefore, it is important to elucidate the molecular mechanisms of HIV-related chronic pain. In this study, we investigated the role of the transcription factor cMyc, epigenetic writer enhancer of zeste homology 2 (EZH2), and sirtuin 3 (Sirt3) pathway in HIV glycoprotein gp120 with morphine (gp120M)-induced neuropathic pain in rats. Neuropathic pain was induced by intrathecal administration of recombinant gp120 with morphine. Mechanical withdrawal threshold was measured using von Frey filaments, and thermal latency using the hotplate test. Spinal expression of cMyc, EZH2, and Sirt3 were measured using Western blots. Antinociceptive effects of intrathecal administration of antisense oligodeoxynucleotide against cMyc, a selective inhibitor of EZH2, or recombinant Sirt3 were tested. In the spinal dorsal horn, gp120M upregulated expression of cMyc (ratio of gp120M versus control, 1.68 ± 0.08 vs 1.00 ± 0.14, P = .0132) and EZH2 (ratio of gp120M versus control, 1.76 ± 0.05 vs 1.00 ± 0.16, P = .006), and downregulated Sirt3 (ratio of control versus gp120M, 1.00 ± 0.13 vs 0.43 ± 0.10, P = .0069) compared to control. Treatment with intrathecal antisense oligodeoxynucleotide against cMyc, GSK126 (EZH2 selective inhibitor), or recombinant Sirt3 reduced mechanical allodynia and thermal hyperalgesia in this gp120M pain model. Knockdown of cMyc reduced spinal EZH2 expression in gp120M treated rats. Chromatin immunoprecipitation (ChIP) assay showed that enrichment of cMyc binding to the ezh2 gene promoter region was increased in the gp120M-treated rat spinal dorsal horn, and that intrathecal administration of antisense ODN against cMyc (AS-cMyc) reversed the increased enrichment of cMyc. Enrichment of trimethylation of histone 3 on lysine residue 27 (H3K27me3; an epigenetic mark associated with the downregulation of gene expression) binding to the sirt3 gene promoter region was upregulated in the gp120M-treated rat spinal dorsal horn; that intrathecal GSK126 reversed the increased enrichment of H3K27me3 in the sirt3 gene promoter. Luciferase reporter assay demonstrated that cMyc mediated ezh2 gene transcription at the ezh2 gene promoter region, and that H3K27me3 silenced sirt3 gene transcription at the gene promoter region. These results demonstrated that spinal Sirt3 decrease in gp120M-induced neuropathic pain was mediated by cMyc-EZH2/H3K27me3 activity in an epigenetic manner. This study provided new insight into the mechanisms of neuropathic pain in HIV patients with chronic opioids.

Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease.

Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.

Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort.

Reports suggest pain is common in head and neck cancer (HNC). However, past studies are limited by small sample sizes and design and measurement heterogeneity. Using data from the Head and Neck 5000 longitudinal cohort, we investigated pain over a year post-diagnosis. We assessed: temporal trends; compared pain across HNC treatments, stages, sites and by HPV status; and identified subgroups of patients at increased risk of pain. Sociodemographic and clinical data and patient-reported pain (measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline (pre-treatment), 4- and 12- months. Using mixed effects multivariable regression, we investigated time trends and identified associations between (i) clinically-important general pain and (ii) HN-specific pain and clinical, socio-economic, and demographic variables. 2,870 patients were included. At baseline, 40.9% had clinically-important general pain, rising to 47.6% at 4-months and declining to 35.5% at 12-months. HN-specific pain followed a similar pattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55); 12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels were increased in: younger patients, smokers, and those with depression and comorbidities at baseline, and more advanced, oral cavity and HPV negative cancers. There is high prevalence of general pain in people living with HNC. We identified subgroups more often reporting general and HN-specific pain towards whom interventions could be targeted. Greater emphasis should be placed on identifying and treating pain in HNC. Systematic pain screening could help identify those who could benefit from an early pain management plan.

The Difficulties of Managing Pain in People Living with Frailty: The Potential for Digital Phenotyping.

Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug-drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences ("phenotyping") may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of "digital phenotyping" in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely tobenefit from specific and targeted treatments.

Pain and functional neurological disorder: a systematic review and meta-analysis

BackgroundFunctional neurological disorder (FND) is characterised by neurological symptoms, such as seizures and abnormal movements. Despite its significance to patients, the clinical features of chronic pain in people with FND,...

Physical activity and pain in people with and without cancer.

Performing physical activity may provide analgesic benefit, although this effect is more established for noncancer pain rather than cancer pain. The relationship between physical activity and pain outcomes in adults with and without a history of cancer was examined. Totals of 51,439 adults without a cancer history and 10,651 adults with a cancer history from the Cancer Prevention Study II Nutrition Cohort were included. Exposures included self-reported moderate to vigorous physical activity (MVPA) as well as 2-year change in MVPA. Pain outcomes included pain intensity (primary outcome) and analgesic use (secondary outcome). MVPA was inversely associated with pain intensity for adults with (odds ratio [OR], 0.84 [≥15 metabolic equivalent of task (MET) h/week vs.<7.5 MET h/week]; 95% confidence interval [CI], 0.76-0.93) and without (OR, 0.79; 95% CI, 0.75-0.82) a history of cancer. Compared to remaining inactive, participants who became sufficiently active (cancer: OR, 0.76; 95% CI, 0.68-0.86; no cancer: OR, 0.73; 95% CI, 0.69-0.77), became inactive (cancer: OR, 0.79; 95% CI, 0.71-0.88; no cancer: OR, 0.84; 95% CI, 0.80-0.89), or remained sufficiently active (cancer: OR, 0.66; 95% CI, 0.60-0.72; no cancer: OR, 0.62; 95% CI, 0.60-0.65) also reported less pain. Physical activity was not related to analgesic use. The relationship between physical activity and pain intensity was not substantially different between people with and without a history of cancer. Cancer survivors who perform more activity, or who increase their activity, may experience less pain than cancer survivors who consistently perform less. People who have had cancer often experience ongoing pain. Being physically active may help reduce the intensity of the pain they experience.

Associations between facial expressions and observational pain in residents with dementia and chronic pain.

To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real-time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision-making in clinical practice. Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence-based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. The study adheres to the CONSORT reporting guidelines. One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).

Reliability and validity of portable dynamometers in testing shoulder and shoulder girdle strength: A systematic review

Introduction&#x0D; The prevalence of shoulder pain is high in overhead athletes and in wheelchair users with a spinal cord injury (SCI). Especially in the latter, shoulder pain can have detrimental consequences for an individual's mobility, participation, and quality of life. Shoulder problems have been associated with high and/or repetitive loads induced by for example overhead activities, as well as manual wheelchair activities (Leong et al., 2019; Morrow et al., 2011). Modifiable risk factors for shoulder pain are related to the capacity of the shoulder musculature and include the relative strength or lack of force in certain shoulder muscles (Mulroy et al., 2015). Although isokinetic dynamometers are considered the gold standard in assessing muscle strength, they are typically not available in a therapy or training setting. Strength measurements with portable dynamometers offer a more feasible and financially affordable alternative. To assess changes in muscle strength over time, reliable and valid shoulder and shoulder girdle muscle strength tests are required. Therefore, the aim of this study was to identify validated and reliable portable dynamometer protocols to assess changes in shoulder strength in the general population and wheelchair users with SCI over time.&#x0D; Methods&#x0D; A literature search was performed with defined terms from the three main concepts “shoulder joint”, “strength testing” and “reproducibility of results”. The electronic search strategy was developed with the help of a librarian and adapted for the following databases: PubMed (Medline), Cochrane Library (Central register of controlled trials), Web of Science (Core Collection), CINAHL. The population of interest was the general population (≥ 18 years) with and without shoulder pain with a special focus on wheelchair users with SCI. Title and abstract screening, full-text screening, quality assessment and data extraction was performed using Covidence.org. For quality assessment selected boxes from the “COSMIN Risk of Bias tool” were used. Data extraction was performed by two independent authors. The main outcome measures extracted where test-retest reliability (intraclass correlation coefficient, standard error of measurement and minimum detectable difference) and concurrent validity (intraclass correlation coefficient).&#x0D; Results&#x0D; Trough systematic search 8,020 studies were identified for screening. Initially 2,267 were excluded as duplicates and 5,647 were excluded for not meeting the inclusion criteria. 106 full-texts have been screened. As data extraction is ongoing the results of reliability and validity of portable dynamometer in testing shoulder strength will be presented at the conference.&#x0D; Discussion/Conclusion&#x0D; As data extraction is ongoing the discussion and conclusion will be presented at the conference.&#x0D; References&#x0D; Leong, H. T., Fu, S. C., He, X., Oh, J. H., Yamamoto, N., &amp; Yung, S. H. P. (2019). Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 51(9), 627-637. https://doi.org/10.2340/16501977-2598&#x0D; Morrow, M. M. B., Kaufman, K. R., An, K.-N. (2011). Scapula kinematics and associated impingement risk in manual wheelchair users during propulsion and a weight relief lift. Clinical Biomechanics, 26(4), 352-357. https://doi.org/10.1016/j.clinbiomech.2010.12.001&#x0D; Mulroy, S. J., Hatchett, P., Eberly, V. J., Lighthall Haubert, L., Conners, S., &amp; Requejo, P. S. (2015). Shoulder strength and physical activity predictors of shoulder pain in people with paraplegia from spinal injury: Prospective cohort study. Physical Therapy, 95(7), 1027-1038. https://doi.org/10.2522/ptj.20130606

Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study

BackgroundPhantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. ObjectivesThe aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). MethodsSixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. ResultsWe found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. ConclusionThese results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.

P176 TYK2 inhibition attenuates the stimulation of sensory neurons with hyper-IL-6

Abstract Background Abdominal pain and diarrhoea are a cause of significant morbidity for people with colitis. Recent single cell RNA sequencing of sensory neurons innervating the gut highlights a likely role for sensory nerves in the pathophysiology of these symptoms based on the marked expression of cytokine receptors from the IL-6 receptor family in gut projecting sensory neurons. In keeping with the reported downstream signalling pathway for these receptors marked co-expression of TYK2 transcripts were also found along with IL-6 signal transducer (GP130) in colonic nociceptors characterised by expression of the capsaicin receptor TRPV1. These observations suggest that TYK2 inhibitors may ameliorate symptoms of pain and diarrhoea in people with colitis by preventing neurogenically mediated gut contractility and nociceptor activation. Methods TYK2 mediated sensory neuron activation: changes in the intracellular [Ca2+]i within thoracolumbar (T12-L5 spinal segments) dorsal root ganglia sensory neurons were examined in cells cultured overnight and loaded with Fluo-4-AM (30min) prior to imaging. Responses were measured to the hyper-IL-6 fusion protein of the soluble IL-6 receptor and IL-6, which transactivates the GP130 receptor subunit to mimic IL-6 family receptor signalling following pre-treatment with vehicle, the TYK2 inhibitor Deucravacitinib (100nM) or the pan-JAK inhibitor Pyridone-6 (2 μM). Afterwards cells were exposed to capsaicin (1 µM) followed by 50 mM KCl, to confirm the presence of nociceptors and neurons respectively by positive response. All experiments were performed using tissue from male C57/B6 mice euthanised by rising concentration of CO2followed by exsanguination in accordance with Schedule 1 of the UK Animals Scientific Procedures act (1986). Results Application of hyper-IL-6 produced a robust increase in [Ca2+]i levels in DRG sensory neurons which was significantly attenuated by pre-treatment with the TYK2 specific inhibitor Deucravacitinib (p&amp;lt;0.01) or the pan JAK inhibitor Pyridone-6 (p = &amp;lt;0.05). Conclusion Findings demonstrate that inhibition of TYK2 inhibitor prevents sensory neuron activation in response to IL-6 trans-signalling. This data suggests that TYK2 inhibitors may have utility for the treatment of abdominal pain in people with colitis.

P009 IL-17 mediates visceral hypersensitivity by sensitising colonic nociceptors

Abstract Background Comparison of cytokine expression in colitic tissue with respective cytokine receptor expression in pain sensing neurons highlights a likely contribution of IL-17 to the production of abdominal pain during flare. To explore this pro-nociceptive potential of IL-17 in colitis we examined the ability of IL-17 to stimulate sensory neurons and the colonic afferent response to noxious distension. Methods IL-17 mediated sensory neuron activation: changes in the intracellular [Ca2+]i within thoracolumbar (T12-L5 spinal segments) dorsal root ganglia sensory neurons were examined in cells cultured overnight and loaded with Fluo-4-AM (30min) prior to imaging. Responses were measured to IL-17 (10-300 ng/mL) alone and following pre-treatment with either TRPV1 or TRPA1 inhibitors. Afterwards cells were exposed to capsaicin (1 µM) followed by 50 mM KCl, to confirm the presence of nociceptors and neurons respectively by positive response. In a separate set of experiments the effect of IL-17 was also examine on a neuron pure cell culture in which non-neuronal cells were removes by magnet assisted cell sorting. IL-17 mediated colonic nociceptor activation: electrophysiological recordings were made of lumbar splanchnic nerve activity and the response to noxious luminal distension of the isolated colorectum (ex-vivo), perfused with carbogenated Krebs solution, examined following pre-treatment with IL-17 (50 ng/mL) alone or in the presence of respective inhibitors. All experiments were performed using tissue from male C57BL/6J mice euthanaised by rising concentration of CO2followed by exsanguination in accordance with Schedule 1 of the UK Animals Scientific Procedures act (1986). Results Consistent with the ability of IL-17 to stimulate sensory neurons including those classified as nociceptors by their co-sensitivity to capsaicin, pre-treatment with IL-17 also produced a significant sensitisation of the colonic afferent response to luminal distension at noxious distending pressures. The increase in [Ca2+]i produced by IL-17 in sensory neurons was blocked by pre-treament with a TRPV1 antagonist but not a TRPA1 antagonist. Furthermore, the proportion of neurons stimulated by IL-17 was comparable between standard DRG cell cultures and neuron pure cell cultures demonstrating a direct effect of IL-17 on sensory neurons. Finally, IL-17 mediated mechanosensitisation of colonic nociceptors was unaffected by TRPV1 inhibition. Conclusion Our findings demonstrate that IL-17 stimulates capsaicin-sensitive nociceptors and mediates visceral hypersensitivity in colonic nociceptors consistent with a causative role for IL-17 is the generation of abdominal pain in people with colitis.

Gray Matter Adaptations to Chronic Pain in People with Whiplash-Associated Disorders are Partially Reversed After Treatment: A Voxel-based Morphometry Study

Gray matter (GM) changes are often observed in people with chronic spinal pain, including those with chronic whiplash-associated disorders (CWAD). These GM adaptations may be reversed with treatment, at least partially. Pain neuroscience education combined with exercise (PNE+Exercise) is an effective treatment, but its neural underlying mechanisms still remain unexplored in CWAD. Here, we performed both cross-sectional and longitudinal voxel-based morphometry to 1) identify potential GM alterations in people with CWAD (n = 63) compared to age- and sex-matched pain-free controls (n = 32), and 2) determine whether these GM alterations might be reversed following PNE+Exercise (compared to conventional physiotherapy). The cross-sectional whole-brain analysis revealed that individuals with CWAD had less GM volume in the right and left dorsolateral prefrontal cortex and left inferior temporal gyrus which was, in turn, associated with higher pain vigilance. Fifty individuals with CWAD and 29 pain-free controls were retained in the longitudinal analysis. GM in the right dorsolateral prefrontal cortex increased after treatment in people with CWAD. Moreover, the longitudinal whole-brain analysis revealed that individuals with CWAD had decreases in GM volumes of the left and right central operculum and supramarginal after treatment. These changes were not specific to treatment modality and some were not observed in pain-free controls over time. Herewith, we provide the first evidence on how GM adaptations to CWAD respond to treatment. PerspectiveThis article presents which gray matter adaptations are present in people with chronic pain after whiplash injuries. Then, we examine the treatment effect on these alterations as well as whether other neuroplastic effects on GM following treatment occur.

Pain Management in the Community: The Empowerment of District on Collaboration of Complementary Nursing at Bukittinggi, West Sumatera

Pain is a global health issue. It is estimated that every year 20% of the world's population experiences pain and half of this is chronic pain. In Indonesia there has been no large-scale research discussing the prevalence and quality of all types of pain. Indonesia also does not yet have practical parameters for assessing pain, patient comfort levels, and the effect of pain on the quality of life of the Indonesian people. This Community Service (PKM) seeks to provide training and raise information about pain treatment in one of the districts of Bukittinggi, West Sumatera, through socializing and outreach to the community. The strategy employed in this PKM includes counseling about pain management in the community and how to handle it. This PKM obtained an increase in the knowledge and skill of community members in controlling their pain. According to the findings of monitoring and analyzing PKM activities, the community health service was ready to improve people's pain management strategies. It is believed that this activity will be beneficial in enhancing the knowledge and experience of pain management that may be used in the community health service by individuals and their families, particularly in non-pharmacological approaches as complementary pain management nursing.

Warm Ginger Compress and Static Stretching for The Change of Pain in Gout Arthritis

Gout Arthritis is a joint inflammation resulted from excessive levels of the uric acid in the blood. The characteristic of the symptoms was monoarticular, swollen, reddish, and pain that interferes activity These conditions need therapy because it could affect the quality of life. The non-pharmacological therapy that can be given was the combination of warm ginger compress and static stretching. The purpose of this research was analyzing the effectiveness of the combination of warm ginger compress and static stretching for change pain in gout arthritis. This research used Randomized Controlled Trial (RCT) method to 30 people with gout arthritis in Tambaksari Surabaya. This research used simple random sampling technique. The respondents were divided into two groups, control and treatment group were also determined randomly. The intervention was given for 15-20 minutes, 6 times in 2 weeks. The data analysis used t-test 2 sample. The result of t-test in the intervention group revealed that there was change pain before and after given intervention while the independent sample showed that there was difference in pain in both groups. The warm ginger compress therapy caused vasodilation blood vessel so as to prevent spasm of the muscles, while static stretching through relaxation muscles so increased physical relaxation. The both intervention were useful as non pharmacology therapy to reduce pain in people with gout arthritis.