Pain In Patients Research Articles

The STarT Back Screening Tool: The Nepali Translation, Cross-Cultural Adaptation and Measurement Properties in Adults With Non-Specific Low Back Pain.

The STarT Back Screening Tool (SBST) stratifies low back pain (LBP) patients based on their risk of chronicity to guide treatment accordingly. The absence of its validated Nepali version limits stratified LBP care in Nepal. The study aimed to translate and cross-culturally adapt the SBST into Nepali and evaluate its measurement properties in adults with LBP. The measurement properties of the Nepali SBST were evaluated in 102 Nepali adults with non-specific LBP. We assessed content validity, internal consistency, test-retest reliability, construct and discriminant validity. Item redundancy was evaluated using Cronbach's alpha (α>0.90), test-retest reliability using Intraclass Correlation Coefficient (ICC2,1) and Cohen's kappa using established cutoffs score for categorising patients into risk groups, construct validity using hypothesis testing (if a minimum of 75% of the hypotheses were supported), and discriminant validity using Area Under the Curve (AUC) with the reference scales administered at baseline. Cronbach's alphascores were 0.72 for the overall scale and 0.66 for the psychosocial subscale. Test-retest reliability values were good to excellent with ICC2,1 of 0.94 (95% CI: 0.87-0.97) for the overall scale and 0.87 (95% CI: 0.73-0.94) for the psychosocial subscale and Kappa values of 0.68 (95% CI: 0.43-0.93) for the overall scale and 0.79 (95% CI: 0.52-1.00) for psychosocial subscale. Construct validity was confirmed as 100% of a priori hypotheses were met. Acceptable discriminative validity was observed with reference scales with AUCs (0.75-0.80). Nepali SBST demonstrates the reliability and validity of screening for chronicity risk in Nepali adults with LBP. Future studies should evaluate its responsiveness, predictive abilities, and effectiveness in stratifying LBP patients in the Nepalese context.

Virtual Reality Therapy for Chronic Pain: A Scoping Review on Indications, Mechanisms of Action, and Effectiveness

Background: The application of virtual reality (VR) technology as a nonpharmacologic treatment option for chronic pain has been increasingly studied. However, the mechanisms underlying this treatment modality's potential positive effects and appropriate indications are not well understood or summarized in the literature. Objectives: This scoping review aims to better understand the chronic pain populations best indicated for head-mounted display-based VR interventions, explore their efficacy on pain score reduction, and characterize the mechanisms of action underlying their efficacy. Methods: PubMed database systematic searches were conducted including articles from January 2010 to August 2023 with primary qualifying criteria including but not limited to use of head-mounted display VR and adequate VR treatment dosage. Mechanisms of action(s) were deduced via an exploratory approach whereby characteristics of VR treatment interventions were analyzed and categorized. Results: Fourteen studies met qualifying criteria, representing a total treatment group of 327. Study data extracted were solely relative to VR treatment group participants. VR intervention mechanisms of action were best characterized via 2 broad but distinct categories: addressing kinesiophobia and psychobehavioral modulation. Three studies investigating chronic neck pain used addressing kinesiophobia as a mechanism of action and demonstrated a significant improvement [weighted average numerical rating scale (NRS): 4.6 at baseline, 2.5 post-intervention, and 2.5 3 months post-intervention]. Six studies investigated chronic low back pain, for which 5 studies, representing 99% of the subgroup, used psychobehavioral modulation. Each demonstrated significant reduction in pain (weighted average NRS: 5.1 baseline and 3.2 post-intervention). Conclusion: This large-scale within-group analysis review proposes 2 broad mechanisms of action underlying the efficacy of VR interventions for chronic pain indications. VR interventions addressing kinesiophobia seem to be significantly effective in nontraumatic chronic neck pain patients. Psychobehavioral VR interventions demonstrate significant efficacy in the chronic low back pain population. Studies with interventions targeting nonspecific chronic pain populations did not show significant results.

Fear of movement interacts with trunk mobility, and pain intensity to predict disability in patients with chronic low back pain: a classification and regression tree (CART) analysis.

Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies. This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain. This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors. Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17). The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

UK medical cannabis registry: A clinical outcome analysis of medical cannabis therapy in chronic pain patients with and without co-morbid sleep impairment.

Chronic pain (CP) affects 35.0%-51.3% of the UK population, with 67%-88% reporting sleep disturbances. Cannabis-based medicinal products (CBMPs) have shown therapeutic potential in managing CP. Evidence suggests poor sleep worsens pain perception; therefore, this study aimed to assess patient-reported outcome measures (PROMs) following CBMP treatment in CP patients with and without co-morbid sleep impairment. A prospective cohort study of CP patients from the UK Medical Cannabis Registry was conducted. Participants were separated by baseline single-item sleep quality scale (SQS) score into sleep impaired (SQS ≤3) and unimpaired (SQS ≥4) cohorts. The primary outcome assessed changes in PROMs from baseline to 1-, 3-, 6-, and 12-months. Participants completed the following: SQS, General Anxiety Disorder-7, EQ-5D-5L, Brief Pain Inventory (BPI), and Short-Form McGill Pain Questionnaire-2. Significance was defined as p < 0.050. 1139 participants met the inclusion criteria (sleep impaired: n = 517, 45.4%; sleep unimpaired: n = 622, 54.61%). The sleep impaired cohort showed improvements in all PROMs at each follow-up (p < 0.010). The sleep unimpaired cohort showed similar results (p < 0.050), except in SQS and ED-5Q-5L: self-care and anxiety/depression scores (p > 0.050). However, the sleep impaired cohort observed greater improvements in BPI pain severity (p < 0.050) and SQS (p < 0.001) than the sleep unimpaired cohort at all follow-ups. 2817 adverse events were self-reported between both cohorts (p = 0.197). These findings align with literature that shows associated improvements in pain outcomes following CBMP administration. Sleep impaired individuals were more likely to experience greater pain severity improvements. However, this was not confirmed on multivariate logistic regression analysis and instead may be confounded by baseline pain severity. Whilst these results show promise for the effects of CBMPs on CP, they must be examined within the limitations of the study design. These findings provide further evidence to support the design of subsequent randomized controlled trials to verify causality between CBMPs and pain outcomes.

Association between joint position sense, range of motion, pain-related anxiety, disability and deep neck muscles thickness in non-specific chronic neck pain patients with high and low levels of fear of pain: a cross-sectional study

Association between joint position sense, range of motion, pain-related anxiety, disability and deep neck muscles thickness in non-specific chronic neck pain patients with high and low levels of fear of pain: a cross-sectional study

Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life.

To identify the factors associated with the pain-related functional interference level in people with chronic low back pain. Cross-sectional. Chronic low back pain patients. Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level. 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037). Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Musculoskeletal pain is associated with poor sleep quality and increased daytime sleepiness in dental students: a cross-sectional pilot study.

While a bidirectional relationship between sleep health and musculoskeletal (MSK)-pain have been established among chronic pain patients, few studies explored it among dental students. This cross-sectional study assessed the relationship of self-report MSK-pain with sleep health and psychological outcomes among dental students, and whether differences existed as a function of number and location of painful body-sites. Validated questionnaires were sent through REDCap to dental students at a predoctoral dental school, assessing presence, location (head, shoulder/neck, jaw, back, body), and intensity of MSK-pain, sleep health (risk of sleep apnea, insomnia severity symptoms, sleep quality, daytime sleepiness, and chronotype), and psychological outcomes (anxiety/depression). Differences between those with and without MSK-pain, and across participants with different number and location of painful sites were tested with t-tests and ANOVA, adjusting for age/gender. Out of 80 participants (82.5% females), 76.3% reported MSK-pain (68.9% in neck/shoulders). Those with MSK-pain scored significantly worse in sleep quality (7.7±3.7 vs. 4.8±2.1, p<.001), daytime sleepiness (6.1±4.2 vs. 3.3±2.7, p<.001). Those with >3 painful body-sites reported worse sleep quality (p=.006) and daytime sleepiness (p=.003) than pain-free controls. There were no differences on sleep and psychological outcomes as a function of number of painful body-sites. Those reporting back pain scored worse in insomnia (p=.037), daytime sleepiness (p=.002), and sleep quality (p=.006) than those without back pain. MSK-pain is prevalent among dental students and associated with worse sleep health. While number of painful sites may not influence sleep/psychological health, specific locations (e.g., back pain) were associated with worse sleep functioning.

HPB SO14 - Surprise Inside: Gallbladder Herniation in a Parastomal Hernia - A Rare Case Report and Management Insight

Abstract Background Parastomal hernias are a common complication of stoma formation, affecting approximately 40% of patients within two years. Gallbladder herniation within a parastomal hernia is a rare phenomenon, with only 18 cases previously reported. Patients are typically elderly females, with the condition attributed to ageing factors such as loss of visceral fat and elastic tissue, liver shrinkage, and the increased length and loss of elasticity of the gallbladder mesentery. These factors contribute to visceroptosis of the gallbladder, increasing its mobility and the risk of herniation. Method We present the case of a 68-year-old female with a four-day history of severe parastomal hernia pain and swelling. She had an emergency left hemicolectomy and transverse colostomy in the right upper quadrant 10 years prior for ischaemic colitis and perforation. Her stoma was functioning well. Vital signs and biochemistry results were normal. On examination her hernia was severely tender but partially reducible. CT revealed a right upper abdominal parastomal hernia containing loops of colon and surprisingly the gallbladder with a long stretched cystic duct. There was no evidence of cholecystitis, bowel obstruction, or compromise within the hernial sac. Results With analgesia, the patient's pain improved, though her hernia remained irreducible. She was discharged after two days of conservative management and referred back to the hospital where she had the initial operation. On enquiry with that hospital it was reported that an elective parastomal hernia repair with completion right colectomy and end ileostomy was performed. The gallbladder was mobilised and reduced back into the peritoneal cavity, and the hernial defect was closed. The patient made an excellent recovery and was discharged home three days after surgery. Conclusion Cholecystic parastomal herniation is a very rare phenomenon and should be considered as a differential in similar cases. Management should be based on clinical presentation, radiological diagnosis, and a multidisciplinary team approach. No standardised classification or approach exists. We propose classifying gallbladder herniations as either being simple (without inflammatory sequelae) or complicated (with cholecystitis, gallbladder torsion, incarceration or perforation). Simple herniations, such as the case presented, can be managed electively with intra-operative reduction of the gallbladder sufficing. Complicated herniations during acute admissions indicate the need for emergency surgical intervention with combined cholecystectomy and parastomal hernia repair.

The Efficacy of Botulinum Toxin A Injection in Pelvic Floor Muscles in Chronic Pelvic Pain Patients: A Double-Blinded Randomised Controlled Trial.

To evaluate and compare the efficacy and safety of Botulinum Toxin A (BTA) injections versus placebo injections, combined with pelvic floor muscle therapy (PFMT), in women with chronic pelvic pain (CPP). Randomised, double-blinded clinical trial (January 2020-April 2023). This multicentre study was conducted at four hospitals in the Netherlands. Ninety-four women with CPP and increased pelvic floor muscle tone despite previous PFMT, were enrolled. Participants received either BTA injections (100 units) or placebo injections into the pelvic floor muscle, followed by four PFMT sessions. Primary outcomes included the number of women with at least a 33% reduction in pain and those reporting (very) much improvement of their pain. Secondary outcomes covered quality of life and pelvic floor function. Follow-up visits were scheduled at 4, 8, 12, and 26 weeks post-treatment. Mixed models for repeated measurements were used for analysis. A 33% reduction or more in average pain score was reported by 15 participants (33%) after BTA treatment and 9 participants (20%) after placebo treatment (odd ratio placebo/BTA 1.88; 95% CI 0.72-4.90, p = 0.19). In both groups, 8 women (17%) reported their improvement as (very) much better (odd ratio placebo/BTA 0.947; 95% CI 0.32-2.80, p = 0.92). Pelvic floor resting activity decreased significantly after BTA treatment compared to placebo (p = 0.001). The results from this study do not support the use of BTA injections in the management of CPP in women.

About Distress in Chronic Pain Conditions: A Pre–Post Study on the Effectiveness of a Mindfulness-Based Intervention for Fibromyalgia and Low Back Pain Patients

Chronic pain (CP) affects about 30% of the global population and poses significant challenges to individuals and healthcare systems worldwide. The interactions between physiological, psychological, and social factors are crucial in the onset and development of CP conditions. This study aimed to evaluate the effectiveness of mindfulness-based intervention, examining its impact on perceived stress (PSS), depression and anxiety (BDI-II, PGWBI/DEP, SAS, STAI Y), sleep quality (PSQI), and mindfulness abilities (MAAS) in individuals with CP. Participants (N = 89, 84.3% female) underwent one of two diagnoses [fibromyalgia (FM) or low back pain (LBP)] and took part in an MBSR intervention. The mindfulness program proved effective in reducing PSQI scores (F = 11.97; p &lt; 0.01) over time, independently of the type of diagnosis. There was also a marginal increase in trait mindfulness as measured by MAAS (F = 3.25; p = 0.07) in both groups. A significant difference between the two groups was found for the effect on PSS: F (1,87) = 6.46; p &lt; 0.05. Mindfulness practice also reduced anxiety in FM and depressive symptoms in LBP, indicating a reduction in psychological distress among participants. Our findings suggest that mindfulness-based interventions may offer promising avenues for personalized pain management in clinical settings.

Current Concepts of the Management of Painful Traumatic Peripheral Nerve Neuromas

Painful neuromas are a complex clinical condition that results in notable disability and functional impairment after injury to a peripheral nerve. When regenerating axons lack a distal target, they form a stump neuroma. Up to 60% of neuromas are painful because of mechanical sensitivity and crosstalk between nerve fibers. Clinical evaluation includes a thorough history and physical examination followed by directed diagnostic imaging and procedures to assess pain generators and their effect on quality of life. Nonsurgical management options may include pharmacological interventions, desensitization strategies, injections, and therapies to reduce pain perception and improve function. Surgical interventions, such as nerve reconstruction by direct repair or grafting, redirection to alternative targets, and containment of regenerating axons by relocation into innervated tissues or in grafts, are considered when conservative measures fail. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas. The plan should consider the underlying pathology, pain generators, and psychosocial factors contributing to the patient's pain.

Performance of Computerised Self-Reported Medical History-Taking and HEAR Score for Safe Early Rule-Out of Cardiac Events in Acute Chest Pain Patients: The CLEOS-CPDS Prospective Cohort Study

Abstract Objective A simplified version of the History, ECG, Age, Risk factors, Troponin (HEART) score, excluding troponin, has been proposed to rule out major adverse cardiac events (MACE). Computerised history taking (CHT) provides a systematic and automated method to obtain information necessary to calculate the HEAR score. We aimed to evaluate the efficacy and diagnostic accuracy of CHT in calculating the HEAR score for predicting MACE. Methods Prospective study including clinically stable adults presenting with chest pain at the emergency department of Danderyd University Hospital (Stockholm, Sweden), in 2017-2019. Participants entered their medical histories on touchscreen tablets using CHT software. HEAR and HEART scores were calculated from CHT data. 30-day MACE and ACS outcomes were retrieved, and the diagnostic accuracy was assessed. Logistic regression was used to determine the most predictive components of the HEAR score. Results Among 1,000 patients, HEART and HEAR scores could be calculated from CHT data in 648 and 666 cases, respectively, with negative predictive values (95% CI) of 0.98 (0.97–0.99) and 0.99 (0.96–1.00). Two patients with HEAR score &amp;lt;2 experienced a 30-day MACE. The Age (OR 2.75, 95% CI 1.62–4.66) and History (OR 2.38, 95% CI 1.52–3.71) components of the HEAR score were most predictive of MACE. ACS outcomes provided similar results. Conclusions HEAR score acquired by CHT identifies very-low risk patients with chest pain in the ED, safely ruling out ACS and MACE. This highlights the value of computerised history-taking by patients, which may reduce unnecessary tests and hospital admissions. Trial Registration ClinicalTrials.gov NCT03439449.

Abstract 4122284: HEART Score Classification of Major Adverse Cardiovascular Events in Patients with Diabetes Mellitus

Introduction: Risk stratifying diabetes mellitus (DM) patients with chest pain in the emergency department (ED) can pose significant challenges because of atypical symptoms, non-specific ECG changes, and elevated baseline troponin levels. This study aims to evaluate HEART Score performance in DM versus non-DM patients. Methods: A prospective observational cohort study included chest pain patients transported by Emergency Medical Services to University of Pittsburgh Medical Center-affiliated hospitals. Data collection involved extracting data from electronic health records, including both DM and non-DM patients with chest pain. The HEART Score was retrospectively calculated by impartial assessors.The primary endpoint was major adverse cardiac events (MACE) within 30 days. This analysis included the classification performance of bivariate comparisons between the HEART Score and ACS outcomes using the area under the receiver-operator characteristic curve (AUC). Results: 4,058 patients were included. 52.7% were male, 42% were white, there was a mean age of 59.24 years (16.13 SD), 28.63% had DM, and 22.1% had MACE. MACE prevalence was 19.7% in non-DM patients and 28% in patients with DM. The AUC demonstrated more robust discriminatory ability of the HEART Score in non-DM (AUC = 0.81) (95% CI 0.79-0.83) versus DM patients (AUC = 0.74) (95% CI 0.71-0.78) (p 0.001). The performance of HEART Score components, including history, age, and risk factors, exhibited better significant predictive capability for MACE in non-DM patients compared to DM patients. Conversely, the HEART-ECG and troponin components were not different between the DM and non-DM groups. The HEART Score demonstrates better performance in White individuals and females when contrasted with males and Black individuals. Nevertheless, these disparities do not reach statistical significance. Conclusion: The HEART Score performs differently in DM versus non-DM patients, with stronger discrimination observed in non-DM individuals. The troponin and ECG components exhibit poorer performance in diabetes mellitus (DM) patients within the context of the HEART Score. This underscores the complexity of risk assessment in DM patients with chest pain and suggests the necessity for further exploration and refinement of risk stratification strategies in this population.

Validation analysis of Polish version of Neuropathic Pain Questionnaire - Short Form (NPQ-SF-PL) and assessment of quality of life in patients with chronic neuropathic pain.

The aims of this study were to translate and culturally adapt the Polish version (PL) of the Neuropathic Pain Questionnaire-Short Form (NPQ-SF), as well as to compare this questionnaire to other diagnostic tools in terms of reliability and psychometric validity. Neuropathic pain (NP) affects up to 10% of the general population. Despite a large number of studies, almost 50% of patients have a poor therapeutic outcome. Diagnostic tools are intended to distinguish between NP and non-NP (NoP) and to guide the examiner to perform further diagnostics in accordance with the guidelines. A total of 140 patients with chronic pain (ChP), 90 with NP and 50 with NoP, were enrolled into this study. NPQ-SF-PL has been developed following the guidelines for translation and cultural adaptation. Reliability of the translated version was examined using internal consistency, predictive validity, and intraclass correlation coefficient (ICC). In the study, women predominated over men, and the average age was 53.22. Cronbach's α value for the entire scale was 0.76 and ICC for test-retest reliability was 0.631. Receiver-operating characteristic curve analysis gave a sensitivity of 90.0% and a specificity of 88.0%. Area under the curve was 0.94. NPQ-SF-PL was moderately associated with self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and weakly associated with the Numerical Rating Scale (NRS). The NP group obtained statistically significantly lower scores than the NoP group in all domains of the 36-Item Short Form Health Survey (SF-36), thus indicating worse health status. Patients aged over 41 years presented a worse quality of life compared to younger ones. Also, more than half of the patients with NP of both genders experienced symptoms of mild or more severe depression. NPQ-SF-PL is a valid screening tool for assessing NP in Polish chronic pain patients. The obtained results showed very good psychometric properties and adequate internal consistency. The repeatability of the questionnaire indicated moderate reliability. Clinical implications/future directions. We believe this study will provide physicians with a new instrument for the evaluation of NP for clinical and research purposes.

Hemostatic effect of 3D-printed hip fixators in children with retinoblastoma after intra-arterial chemotherapy: a non-randomized controlled trial.

This study aimed to investigate the benefits of using three-dimensional (3D)-printed hip joint fixators after intra-arterial chemotherapy (IAC) by inguinal femoral artery puncture in children with retinoblastoma. Overall, 79 cases of retinoblastoma who had undergone IAC through the femoral artery were selected and divided into an observation group of 50 cases and an intervention group of 29 cases according to the hemostasis method employed. The patients in the observation group were treated with sandbags for hemostasis, while those in the intervention group were given 3D-printed hip joint fixators to help immobilize the hips and sandbags. We used the Face, Legs, Activity, Cry and Consolability scale (FLACC), the Wong-Baker Facial Expression Pain Scale, and self-made questionnaires to evaluate demographics, clinical characteristics, pain, complications, satisfaction, and other indicators of the two groups. There were no significant differences in general data, such as age, gender, height, weight, manual compression time, diseased eye, tumor stage, platelet count, puncture times, pain distribution, and total score, between the groups. There was a positive correlation between FLACC pain and the total Wong-Baker pain score (r = 0.599, p < 0.001). During the 2h of sandbag compression, sandbags were dislodged in the observation group as many as ten times, which was significantly higher than that in the intervention group (up to four times; p < 0.001). This was correlated with a very high score of satisfaction (92.34 ± 19.96 out of 100). The 3D-printed hip fixator is easy to operate, has a low incidence of complications, and saves time and effort. It effectively reduces the incidence of sandbags falling off after IAC in children with retinoblastoma and does not increase the patient's pain. It is a method that could improve hemostasis in young children undergoing IAC by inguinal femoral artery.

Comparison of different techniques used for inferior alveolar nerve block anaesthesia regarding the pain caused in cooperative children.

The aim of this study is to compare the application of inferior alveolar nerve block (IANB) anaesthesia in children with traditional plastic syringe (TPS) and computer-controlled injection device Dentapen® using two different modes [continuous mode (DC) and ramp-up mode (DR)] in terms of pain. This study included 96 children aged 7-12 who were determined to be positive (3) or definitely positive (4) according to the Frankl Behaviour Evaluation Scale and in need of treatment who had IANB anaesthesia indication in the right and left regions. Patients were divided into three groups and compared in terms of pain felt during IANB anaesthesia according to heart rate, oxygen saturation, Wong Baker Pain Rating Scale, Face Legs Activity Cry Consolability Pain Scale and patient preference distributions. Heart rate values increased significantly during the injection of IANB anaesthesia with all methods [TPS, DC and DR methods (p < 0.05)]. No significant differences were found in terms of pain between the TPS, DC and DR methods in the intragroup and intergroup assessments. However, among the patient preferences of TPS and DC methods, the number of patients who preferred the DC method was found to be statistically significantly higher those who preferred the TPS method (p = 0.026). Although the TPS group scored higher than the Dentapen® groups in terms of pain, the difference between the investigated IANB anaesthesia techniques was not statistically significant. However, the majority of the patients preferred the Dentapen® device compared to the TPS. It appears that more research is needed on the Dentapen® device in local anaesthesia applications in children.

Improving Pain Assessment After Inpatient Orthopedic Surgery: A Comparison of Two Scales.

In pain assessment, the commonly used Numeric Rating Scale (NRS) offers an incremental 0-to-10 range of response options. But this broad range often leads to discordant evaluations between nurses and their patients. This study aimed to compare the NRS to the three-category Interventional Pain Assessment (IPA) scale, validate the IPA scale in an inpatient setting, and determine RN and patient scale preferences. This prospective study enrolled 122 postoperative orthopedic patients and their designated 104 RNs at a level 1 trauma center in the midwestern United States. Patients were asked to verbally rate their pain from 0 to 10 using the NRS and from 0 to 2 on the IPA scale. Patients were also asked which scale best conveyed their pain. The RNs were asked which scale best informed them of their patient's pain situation and which scale they preferred. To establish a correlation between the two scales, we considered NRS values of 0 to 7 (signifying no pain to moderate pain) to correspond to IPA scale values of 0 to 1 (signifying no pain to tolerable pain). NRS values of 8 to 10 (signifying severe pain) were considered to correspond to IPA scale values of 2 (signifying intolerable pain). Responses in which patients reported IPA scores indicating no pain to tolerable pain but NRS scores above 7 or IPA scale scores indicating intolerable pain but NRS scores of 7 or below were defined as discordant answers. Data analysis revealed a strong significant correlation between the NRS and IPA scale (τ = 0.597), with an 82.7% concordance rate. Once an NRS score rose above 7, more discordance between the two scales became increasingly prevalent, as evidenced by the 45% of patients who also reported tolerable pain on the IPA scale. Significantly more patients (89.3%) preferred the IPA scale to communicate their pain level than the NRS (10.7%). Significantly more RNs (76%) felt the IPA scale best informed them of their patient's pain and was a better guide for treatment than felt the NRS did so (24%). The IPA scale asks about pain tolerability and thus has a direct role in the management of pain medications. Both patients and nurses felt they were better able to convey and understand pain when using the IPA scale than when using the NRS. There was consensus regarding pain scale preference among patients and their RNs, with both groups preferring the IPA scale due to its simplicity and, among the RNs, its usefulness in guiding treatment. The IPA scale may be a much better tool for accurately assessing a patient's pain experience and needs, with the potential to change practice and improve pain management.

Back to the Future: Historic Insights and Recent Innovations in Pediatric Regional Anesthesia

Pediatric regional anesthesia is evolving with new peripheral nerve blocks and techniques aimed at improving perioperative pain management. While caudal blocks have long been standard due to their simplicity and low complication rates, newer fascial plane blocks offer comparable efficacy with enhanced nerve coverage tailored to specific surgeries. Moreover, adjuncts like dexmedetomidine and dexamethasone have shown promise in prolonging block duration and enhancing post-operative pain relief and patient satisfaction. The integration of these advancements into clinical practice has yielded significant benefits, including reduced intraoperative fluid requirements, decreased reliance on opioids postoperatively, earlier initiation of enteral nutrition, lower readmission rates, shorter hospital stays, and decreased overall hospital costs. Our review underscores the technical progress and expanding literature supporting the rapid adoption of these impactful regional anesthesia techniques in pediatric care.

Surgical Recovery Among Patients With Chronic Pain Undergoing Pelvic Reconstructive Surgery.

Limited data exist on postoperative recovery among patients with chronic pain undergoing pelvic reconstructive surgical procedures. The objective of this study was to evaluate if patients with versus without self-reported chronic pain experience different recovery after pelvic reconstructive surgery. From September 2022 to May 2023, this prospective cohort study enrolled patients with and without chronic pain, who were undergoing vaginal or laparoscopic procedures for pelvic organ prolapse. Preoperative pain was assessed using the Brief Pain Inventory (BPI) and Pepper Assessment Tool for Disability (PAT-D). Postoperative recovery was evaluated at 2, 4, and 12 weeks using the Postdischarge Surgical Recovery (PSR) scale, Global Surgical Recovery (GSR) index, and PAT-D questionnaire. The primary outcome was PSR scores at 4 weeks postoperatively. Ninety patients were recruited, with 43 reporting chronic pain and 47 without. Demographics were similar. Patients with chronic pain had higher preoperative BPI and PAT-D scores. Perioperative outcomes and hospital stay were similar. Patients with chronic pain used more postoperative opioids in the hospital (27.0 ± 27.8 vs 24.3 ± 60.3 morphine milligram equivalents [MME]; P = 0.03) and at home (40.1 ± 54.7 vs 19.9 ± 39.0 MME; P = 0.03). The PSR scores at 4 weeks were not significantly different. No differences were observed in PSR or GSR scores at all time points. Patients with chronic pain had a higher PAT-D score at 12 weeks. Fewer chronic pain patients returned to work by 12 weeks and desired more time off work. Patients with and without chronic pain had similar surgical outcomes and recovery. However, chronic pain patients required more postoperative opioid pain medication and preferred more time off work.

Assessing cognitive impairment in chronic pain: a cross-sectional study with healthy controls

Purpose The aim of this study is to clarify inconsistencies in the literature regarding the neuropsychological impact of chronic pain and determine how pain catastrophizing and pain intensity may explain cognitive impairment. Methods This cross-sectional study involved 30 participants with chronic primary musculoskeletal pain and 30 healthy controls without pain. The instruments used were the Pain Catastrophizing Scale, the Visual Analogue Scale, the Beck Anxiety Inventory, the Beck Depression Inventory–II, the Wisconsin Card Sorting Test, the Stroop Test, and the Working Memory Index of the Wechsler Adult Intelligence Scale. Results Chronic pain patients showed slight cognitive impairments in selective attention, sustained attention, working memory, problem solving, planning, abstract reasoning, inhibition, and resistance to interference. The data also indicate that higher levels of pain catastrophizing and pain intensity were independently associated with greater cognitive impairment in patients with pain, specifically in attention and executive functioning. Additionally, the interaction between these pain-related variables predicted further cognitive impairment. Conclusions This research has contributed to establishing the neuropsychological profile of patients with chronic primary musculoskeletal pain and reinforces evidence of the impact of chronic pain on cognition. These findings may help guide the design of programs aimed at improving cognitive performance.