Pain Perception Research Articles

Neuropsychological mechanisms of observational learning in human placebo effects.

Scientific evidence indicates that placebo effects are psychoneurobiological events involving the contribution of distinct central nervous systems and peripheral physiological mechanisms that influence pain perception and other symptoms. Placebo effects can occur without formal conditioning and direct prior experience because crucial information can be acquired through observational learning. Observation of benefits in another person results in placebo effects of a magnitude like those induced by directly experiencing an analgesic benefit. Understanding the psychological mechanisms of observationally induced placebo effects is a complex and multifaceted endeavor. While previous reviews have highlighted various frameworks and models to understand these phenomena, the underlying biological mechanisms have been overlooked. We summarize critically current understanding of its behavioral and neural mechanisms. Understanding the neural mechanisms of hypoalgesia driven by observation can serve as a foundation for future development of novel theoretical and methodological approaches and ultimately, applications.

Protocol for physiotherapeutic management of home care for elderly patients with hip and knee osteoarthritis

Background: Lower body musculoskeletal disorders are problems that affect muscles, bones, joints, tendons, ligaments, and nerves of the lower limbs. Osteoarthritis of the hip and knee is a degenerative disease that affects the cartilage of the hip and knee joints. It causes pain, stiffness, and limited movement. Objective: to implement a physiotherapy management protocol for home care for the elderly with osteoarthritis of the hip and knee, to improve functional capacity. Methods: a study was carried out with a 12-week intervention guideline on 20 participants with a mean age of 72 years. Weight was measured with a scale (omron) and height with a stadiometer (seca) in order to obtain the value of the Body Mass Index (BMI). The exercise guide consists of three phases: the first includes isometric exercises; the second involves isotonic and resistance exercises; and, the third includes balance exercises, gait re-education, reintegration into activities of daily living, a study with initial and final assessment, and instruments to measure functional capacity. The Short Physical Performance Battery (SPPB) was used. It consists of three tests (balance, walking, sitting and standing). The manual dynamometer measures muscle strength in lower limbs and the visual scale measures the perception of pain in the hip and knee. Results: the physical exercise guideline in elderlies with hip and knee osteoarthritis improved functional capacity increased muscle-strength, and pain perception. Conclusions: the exercise protocol increases the functional capacity of the elderly with osteoarthritis of the hip and knee, presenting adequate control in the lower body.

Effectiveness of Preoperative Alpha Wave Entrainment in Pediatric Dental Patients: A Randomized Controlled Trial.

Background Pediatric dental anxiety is a significant barrier to effective dental care, necessitating non-pharmacological interventions. Alpha wave entrainment has shown promise in adult studies for reducing procedural anxiety and pain perception, but its effectiveness in pediatric dental settings remains underexplored. Objective This study aims to evaluate the effectiveness of preoperative alpha wave entrainment in alleviating anxiety in gender-specific participants to the interventions. Methods We conducted a randomized controlled trial involving 252 pediatric patients (aged 7-12) with cooperative dispositions. Participants were randomly assigned to either an experimental group receiving alpha wave entrainment or a control group receiving conventional behavior management techniques. The experimental interventioninvolved 10-minute sessions of binaural beats with visualstimulation designed to induce alpha-wave synchronization. Anxiety levels were assessed using physiological measures (heart rate and blood pressure), both pre- and post-interventions. Results The intervention group demonstrated a significant reduction in heart rate and systolic blood pressure post-intervention compared to the control group. These changes indicate a decrease in anxiety levels, with no significant gender differences in the response to the intervention. Conclusion Alpha wave entrainment effectively reduces dental anxiety in pediatric patients, with similar efficacy observed across genders. This study supports the incorporation of alpha wave entrainment into pediatric dental practices as a viable alternative to traditional anxiety management techniques.

A Suspended, Three-dimensional Morphing Sensory System for Robots to Feel and Protect.

Artificial sensory systems with synergistic touch and pain perception hold substantial promise for environment interaction and human-robot communication. However, the realization of biological skin-like functional integration of sensors with sensitive touch and pain perception still remains a challenge. Here, we propose a concept of suspended electronic skins enabling three-dimensional deformation-mechanical contact interactions for achieving synergetic ultra-sensitive touch and adjustable pain perception. The suspended sensory system can sensitively capture tiny touch stimuli as low as 0.02Pa and actively perceive pain response with reliable 5200 cycles via 3D deformation and mechanical contact mechanism, respectively. Based on the touch-pain effect, a visualized feedback demo with miniaturized sensor arrays on artificial fingers is rationally designed to give a pain perception mapping on sharp surfaces. Furthermore, we show the capability of the suspended electronic skin serving as a safe human-robot communication interface from active and passive view through a feedback control system, demonstrating potential in bionic electronics and intelligent robotics. This article is protected by copyright. All rights reserved.

The psychophysiology of music-based interventions and the experience of pain

In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels – the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music’s impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.

Association between immigration status and total knee arthroplasty outcomes in Ontario, Canada: a population-based matched cohort study.

Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients. We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups. We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients. Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty.

Outcome in paraplegic dogs with or without pain perception due to thoracolumbar fibrocartilaginous embolic myelopathy or acute non-compressive nucleus pulposus extrusion

BackgroundFibrocartilaginous embolic myelopathy (FCEM) and acute non-compressive nucleus pulposus extrusion (ANNPE) are common causes of acute spinal cord injury in dogs. Outcome among paraplegic deep pain positive (DPP) and deep pain negative (DPN) dogs with either condition and factors influencing recovery have not been clearly established.MethodsDogs with thoracolumbar FCEM or ANNPE resulting in paraplegia presenting to university hospitals between 2012 and 2022 were retrospectively included. Diagnosis of FCEM or ANNPE was based on clinical and magnetic resonance imaging findings. Outcome was defined as successful (recovery of independent ambulation) or unsuccessful (non-ambulatory ≥3 months following diagnosis or at the time of death/euthanasia). Logistic regression analysis was performed to investigate associations between clinical or imaging variables and outcome.ResultsThirty-one dogs were included. In total, 14 dogs were initially paraplegic DPP (8 FCEM, 6 ANNPE) and 17 dogs were paraplegic DPN (11 FCEM, 6 ANNPE). Outcome was available for 26 dogs (14 DPP, 12 DPN) with a median follow-up time of 182 days (range 0–2,311) including 2 dogs euthanized at the time of diagnosis; 1 of 12 DPN dogs (8.3%) regained independent ambulation, whereas 9 of 14 DPP dogs (64.3%) regained independent ambulation. DPN dogs had a significantly higher risk of not regaining independent ambulation compared with DPP dogs (OR: 47.40, 95% CI: 2.09–1073.99). No other variables were associated with outcome.ConclusionWhile recovery of ambulation was possible, these results confirm that the absence of pain perception is a useful negative prognostic indicator in dogs with severe thoracolumbar FCEM or ANNPE.

Effectiveness of Virtual Reality in Reducing Perceived Pain and Anxiety Among Patients Within a Hospital System: Protocol for a Mixed Methods Study.

Within hospital systems, diverse subsets of patients are subject to minimally invasive procedures that provide therapeutic relief and necessary health data that are often perceived as anxiogenic or painful. These feelings are particularly relevant to patients experiencing procedures where they are conscious and not sedated or placed under general anesthesia that renders them incapacitated. Pharmacologic pain management and topical anesthetic creams are used to manage these feelings; however, distraction-based methods can provide nonpharmacologic means to modify the painful experience and discomfort often associated with these procedures. Recent studies support distraction as a useful method for reducing anxiety and pain and as a result, improving patient experience. Virtual reality (VR) is an emerging technology that provides an immersive user experience and can operate through a distraction-based method to reduce the negative or painful experience often related to procedures where the patient is conscious. Given the possible short-term and long-term outcomes of poorly managed pain and enduring among patients, health care professionals are challenged to improve patient well-being during medically essential procedures. The purpose of this pilot project is to assess the efficacy of using VR as a distraction-based intervention for anxiety or pain management compared to other nonpharmacologic interventions in a variety of hospital settings, specifically in patients undergoing lumbar puncture procedures and bone marrow biopsies at the oncology ward, patients receiving nerve block for a broken bone at an anesthesia or surgical center, patients undergoing a cleaning at a dental clinic, patients conscious during an ablation procedure at a cardiology clinic, and patients awake during a kidney biopsy at a nephrology clinic. This will provide the framework for additional studies in other health care settings. In a single visit, patients eligible for the study will complete brief preprocedural and postprocedural questionnaires about their perceived fear, anxiety, and pain levels. During the procedure, research assistants will place a VR headset on the patient and the patient will undergo a VR experience to distract from any pain felt from the procedure. Participants' vitals, including blood pressure, heart rate, and rate of respiration, will also be recorded before, during, and after the procedure. The study is already underway, and results support a decrease in perceived pain by 1.00 and a decrease in perceived anxiety by 0.3 compared to the control group (on a 10-point Likert scale). Among the VR intervention group, the average rating for comfort was 4.35 out of 5. This study will provide greater insight into how patients' perception of anxiety and pain could potentially be altered. Furthermore, metrics related to the operational efficiency of providing a VR intervention compared to a control will provide insight into the feasibility and integration of such technologies in routine practice. DERR1-10.2196/52649.

Nursing-sensitive outcomes for the provision of pain management in pediatric populations with intellectual disabilities: a scoping review protocol.

This aim of this review is to identify and map nursing-sensitive outcomes for the provision of pain management in pediatric populations with intellectual disabilities that are currently reported in the literature. The experience of pain is highly individualized and subjective, with physiological, biochemical, and psychological differences contributing to pain perception. Pediatric populations with intellectual disabilities are at increased risk of ubiquitous pain exposure. Pain management effectiveness can be determined through the measurement of nursing-sensitive outcomes, which have not been mapped in the context of pediatric populations with intellectual disabilities. Quantitative, qualitative, mixed methods, and gray literature discussing nursing pain management in pediatric populations with intellectual disabilities will be included. No date limits will be applied. Only studies published in English will be considered. This review will be guided by the JBI methodology for scoping reviews. The search strategy will aim to locate published and unpublished literature using the databases CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), Scopus, PsycINFO (ProQuest), LILACS, SciELO, and ProQuest Dissertations and Theses Global. Titles and abstracts, and then full-text studies, will be selected and reviewed by 2 independent researchers against the inclusion criteria. Content analysis using the NNQR-C, C-HOBIC, NDNQI, and Donabedian model frameworks will be used for data extraction and organization, accompanied by charted results and narrative summaries, as appropriate.

The relationship between traumatic exposure and pain perception in children: the moderating role of posttraumatic symptoms.

Adverse childhood experiences (ACEs) affect approximately half of all children worldwide. These experiences have been linked to increased pain sensitivity in adulthood and a higher likelihood of developing severe chronic pain. However, most studies have assessed the effects of ACEs retrospectively, long after they occurred, leaving room for other factors to influence the observed outcomes. We investigated, for the first time, the association between ACEs and concurrent pain perception among young children who live in a conflict zone and are consistently exposed to potentially traumatic experiences. Participants were 60 elementary school children (ages 8-11 years) living in conflict regions (n = 39) or nonconflict regions (n = 21). Posttraumatic stress symptom (PTSS) severity, traumatic exposure, pressure pain threshold (PPT), and mechanical detection threshold (MDT) were measured. Trauma-exposed children had significantly lower PPT than did controls, but MDT was similar across groups. Pressure pain threshold correlated positively with proximity to the conflict zone and inversely with traumatic exposure magnitude and PTSS severity. In addition, PTSSs moderated the relationship between repeated traumatic exposure and PPT. Children with higher PTSS severity displayed pain hypersensitivity regardless of their traumatic exposure level, whereas in children with lower PTSS severity, greater traumatic exposure correlated with pain hypersensitivity. The results suggest that ACEs among children lead to concurrent pain hypersensitivity and distress and may put them at elevated risk of chronic pain early in life. In addition, our findings emphasize the need for identifying children with various PTSS levels to provide tailored interventions and mitigate the long-term negative effects of ACEs.

Oral and topical analgesia in pediatric electrodiagnostic studies.

Electrodiagnostic examinations, such as nerve conduction studies (NCS) and needle electromyography (EMG), are perceived as painful by children and their parents/guardians. Methods to reduce peri-procedural pain improve compliance and have neurocognitive and neuropsychiatric benefits. This study aimed to assess the efficacy of combined oral and topical analgesics (COTA), oral analgesics (OA), and placebo in reducing pain during NCS/EMG in children. We performed a double-blind, randomized, placebo-controlled trial on children presenting to our neurophysiology lab. Patients were stratified into two age groups (6M-6Y and 7Y-18Y) and randomized into three arms: COTA, OA, and placebo. Pain scores post-NCS/EMG were assessed using the Modified Behavioral Pain Scale (MBPS) and Faces Pain Scale-Revised (FPS-R). One hundred thirteen participants were enrolled. A comparison of participants from both age groups combined revealed no significant differences in guardian FPS-R scores across all arms for NCS and EMG. A significant difference in the distribution of post-NCS FPS-R score severities in children aged 7Y-18Y was noted between OA and placebo (p = .007). EMG was more painful than NCS across all arms (p < .05). In children aged 6M-6Y undergoing at least 10 muscle samplings during EMG, those receiving COTA had significantly lower pain scores (p = .014). This study reveals the complexity of pediatric pain perception during NCS/EMG and highlights that other methods to reduce experienced pain are required. Our findings suggest that procedural characteristics, such as number of muscles sampled, may influence the effectiveness of analgesia and serve as a foundation for future research aimed at optimizing pain management strategies.

Pain reflects the informational value of nociceptive inputs.

Pain perception and its modulation are fundamental to human learning and adaptive behavior. This study investigated the hypothesis that pain perception is tied to pain's learning function. Thirty-one participants performed a threat conditioning task where certain cues were associated with a possibility of receiving a painful electric shock. The cues that signaled potential pain or safety were regularly changed, requiring participants to continually establish new associations. Using computational models, we quantified participants' pain expectations and prediction errors throughout the task and assessed their relationship with pain perception and electrophysiological responses. Our findings suggest that subjective pain perception increases with prediction error, that is, when pain was unexpected. Prediction errors were also related to physiological nociceptive responses, including the amplitude of nociceptive flexion reflex and electroencephalography markers of cortical nociceptive processing (N1-P2-evoked potential and gamma-band power). In addition, higher pain expectations were related to increased late event-related potential responses and alpha/beta decreases in amplitude during cue presentation. These results further strengthen the idea of a crucial link between pain and learning and suggest that understanding the influence of learning mechanisms in pain modulation could help us understand when and why pain perception is modulated in health and disease.

Combination administration of alprazolam and N-Ethylmaleimide synergistically enhances sleep behaviors in mice with no potential CNS side effects.

N-Ethylmaleimide (NEM), an agonist of the potassium chloride cotransporters 2 (KCC2) receptor, has been correlated with neurosuppressive outcomes, including decreased pain perception and the prevention of epileptic seizures. Nevertheless, its relationship with sleep-inducing effects remains unreported. The present study aimed to investigate the potential enhancement of NEM on the sleep-inducing properties of alprazolam (Alp). The test of the righting reflex was used to identify the appropriate concentrations of Alp and NEM for inducing sleep-promoting effects in mice. Total sleep duration and sleep quality were evaluated through EEG/EMG analysis. The neural mechanism underlying the sleep-promoting effect was examined through c-fos immunoreactivity in the brain using immunofluorescence. Furthermore, potential CNS-side effects of the combination Alp and NEM were assessed using LABORAS automated home-cage behavioral phenotyping. Combination administration of Alp (1.84 mg/kg) and NEM (1.0 mg/kg) significantly decreased sleep latency and increased sleep duration in comparison to administering 1.84 mg/kg Alp alone. This effect was characterized by a notable increase in REM duration. The findings from c-fos immunoreactivity indicated that NEM significantly suppressed neuron activation in brain regions associated with wakefulness. Additionally, combination administration of Alp and NEM showed no effects on mouse neural behaviors during automated home cage monitoring. This study is the first to propose and demonstrate a combination therapy involving Alp and NEM that not only enhances the hypnotic effect but also mitigates potential CNS side effects, suggesting its potential application in treating insomnia.

Postoperative Negative Pain Thoughts and Their Correlation With Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair: An Observational Cohort Study.

Pain and pain perception are influenced by patients' thoughts. The short form Negative Pain Thoughts Questionnaire (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between NPTQ-SF scores and orthopaedic surgery outcomes is not known. The purpose was to assess the relationship between negative pain thoughts, as measured by the NPTQ-SF, and patient-reported outcomes in patients undergoing arthroscopic rotator cuff repair, as well as to compare NPTQ-SF scores and outcomes between patients with and without a history of chronic pain and psychiatric history. It was hypothesized that patients with worse negative pain thoughts would have worse patient-reported outcomes. Cohort study; Level of evidence, 2. In total, 109 patients undergoing arthroscopic rotator cuff repair were administered the 4-item NPTQ-SF, 12-item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES) Shoulder Evaluation Form, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed ≥6 months postoperatively by 74 patients confirmed to have undergone arthroscopic rotator cuff repair. Preoperative NPTQ-SF scores did not show any correlation with the postoperative patient-reported outcomes measured in this study. Postoperative NPTQ-SF scores were statistically significantly negatively correlated with postoperative SF-12 Physical Health Score, SF-12 Mental Health Score, ASES, and satisfaction scores (P < .05). Postoperative NPTQ-SF scores were statistically significantly positively correlated with postoperative visual analog scale scores (P < .001). Moreover, postoperative NPTQ-SF scores were statistically significantly negatively correlated with achieving a Patient Acceptable Symptom State and the minimal clinically important difference on the postoperative ASES form (P < .001 and P = .009, respectively). Postoperative patient thought patterns and their perception of pain are correlated with postoperative outcomes after rotator cuff repair. This correlation suggests a role for counseling and expectation management in the postoperative setting. Conversely, preoperative thought patterns regarding pain, as measured by the NPTQ-SF, do not correlate with postoperative patient-reported outcome measures. Therefore, the NPTQ-SF should not be used as a preoperative tool to aid the prediction of outcomes after rotator cuff repair.

Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review

Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review

Pain of Threatened Self: Explicit and Implicit Self-Esteem, Cortisol Responses to a Social Threat and Pain Perception.

Background: Rejection, injustice, and exclusion from meaningful interpersonal relationships are often extremely painful and stress-generating experiences. This study aimed to define the role of explicit and implicit self-esteem in pain perception as a component of the physiological-psychological system that regulates the body's response to stress associated with the threat of social rejection. Methods: In total, 360 individuals participated in this study. The measurement of cortisol in saliva, the assessment of pain thresholds using thermal stimuli, the IAT to assess implicit self-esteem, and a questionnaire on global self-esteem and social pain were used. The study included three measurements: baseline and 15 and 45 min after the application of a laboratory socially threatening stimulus (the Trier Social Stress Test). Results: People experiencing chronic social pain (CSP) are more likely to have fragile self-esteem, higher pain thresholds, and tend to experience reduced pain tolerance in situations of acute social threat than people without CSP experience. In people with CSP and fragile self-esteem, after the introduction of a social threat, an increase in pain tolerance was observed along with a longer-lasting increase in cortisol levels. Conclusions: Fragile self-esteem, along with feelings of chronic exclusion, injustice, and rejection, may prolong stress reactions and produce a hypoalgesic effect.

Does a broad‐spectrum cannabidiol supplement improve performance in a 10‐min cycle ergometer performance‐test?

AbstractCannabidiol (CBD) is a non‐intoxicating phytocannabinoid which has been proposed to possess anti‐inflammatory and analgesic properties. Given the potential for perceptions of pain to limit exercise performance, the aim of the present study was to investigate if 3 weeks of daily CBD supplementation (150 mg day−1) improved performance in a 10‐min performance‐trial on a cycle ergometer. In a randomized, double‐blind and placebo‐controlled study, 22 healthy participants (n = 11 male and n = 11 female) completed two 10‐min performance trials on a WattBike cycle ergometer interspersed with a 3‐week supplementation period. Supplementation involved either 150 mg day−1 oral CBD or 150 mg day−1 of a visually identical placebo (PLA). During trials, ratings of perceived exertion (RPE [6–20]), heart rate (HR) and blood lactate (BLa) were collected every 2 min. Mean power (W) was also taken throughout the exercise at each time point. All data were analyzed using two‐way ANOVAs. There were no significant differences (P &gt; 0.05) between CBD or PLA groups for mean power (W) during the 10‐min performance trial. There were also no significant differences (P &gt; 0.05) in any of the physiological or perceptual parameters (HR, BLa and RPE) between conditions. Three weeks supplementation of a broad‐spectrum CBD supplement did not improve performance via any change in RPE during a 10‐min time trial on a cycle ergometer, and as such, this evidence does not support the claim that broad‐spectrum CBD supplements could be performance‐enhancing in this exercise modality.

Virtual reality-based interventions, a neoteric approach for management and rehabilitation in patients with breast cancer.

Breast cancer (BC) patients and survivors can experience immense emotional and psychosocial trauma. Treatment modalities for BC, including surgery, chemotherapy and radiotherapy are associated with certain displeasing and undesirable effects, including physical restrictions as well as mental stress. However, it has been ascertained that appropriate supportive and rehabilitative strategies can significantly help to alleviate the distress. Along with several conventional physical therapy options, the novel Virtual Reality (VR) tool has opened a new gateway in rehabilitative approaches in patients with BC. We reviewed the role of VR based management for BC-related incapacitations and found that its efficacy is comparable to that of contemporary therapy options. It has the additional benefits of modulating pain perceptions, improving mobility, and overall enhancing the quality of life of BC survivors.

Effect of early weight bearing program with conventional physiotherapy on functional outcomes in surgically treated proximal tibia fracture: a pilot randomized controlled trial.

Patients are often instructed to avoid weight bearing on the proximal tibia for 6 - 12 weeks post-surgery to avoid fracture fixation failure. However, delayed weight bearing leads to delayed mobility, causing difficulties in daily activities; problems such as pain, limited knee ROM, reduced quadriceps muscle strength, and impaired functional outcomes are reported in long-term follow-up. This study primarily aimed to evaluate the feasibility and explore the effect size. The secondary aim was to determine the effectiveness of early weight bearing along with conventional physiotherapy on functional outcomes. A single-blinded pilot randomized controlled trial with 30 participants with proximal tibia type I, II, and III fractures were included; they were randomized using computer-based software. Seven patients were lost to follow-up. Group I received early weight bearing along with conventional physiotherapy whereas Group II received restricted weight bearing along with conventional physiotherapy. Assessments were made on post-operative day 3 (POD-03), at discharge, at 6 weeks, and at 12 weeks. Radiographs were recorded immediately after the operation, at discharge, and at 12 weeks. A full-scale RCT is feasible with an effect size between 0.3 - 0.7. A statistically significant difference (p < 0.05) was found within both groups 12 weeks post-surgery in all outcome measures; the difference was more prominent in the intervention group. A statistically significant difference (p < 0.05) was found between both the groups post-12 weeks in all outcome measures except quadriceps isometric muscle strength. A full-scale RCT for early weight bearing along with conventional physiotherapy for patients operated for Type I, II, and III proximal tibia fracture is feasible. Early weight bearing along with conventional physiotherapy could have a positive effect on reducing patient's pain perception and increasing knee joint mobility, quadriceps isometric muscle strength, knee function, and quality of life without any adverse effects. ClinicalTrialsRegistry.gov (CTRI/2022/10/046797).

Abstract PO2-10-01: Discrimination, Trust, and Pain Outcomes Among Black Women with Early-Stage Breast Cancer After Mastectomy

Abstract BACKGROUND Differences in perception, assessment, communication, and management of pain contribute to racial/ethnic pain disparities in breast cancer (BC). We previously found that Black women (BW) reported higher pain severity and interference with life after breast surgery compared to White women after adjusting for type of surgery and other potential confounders. Racial/ethnic inequities persist despite prior trials to improve disparate pain outcomes. This is likely because multiple factors contribute to pain expression, and structural factors affect the ability to control pain adequately. Perceived discrimination is associated with mistrust of medical providers. These factors are known to affect clinical outcomes, but their impact on pain has been understudied. In this preliminary analysis, we examine medical discrimination, trust in physician, and pain outcomes among BW with early-stage breast cancer after mastectomy. METHODS We surveyed BW with stage 0-III breast cancer who had mastectomy &amp;lt; 2 years of study enrollment at Baylor St. Luke’s Medical Center or Harris Health Smith Clinic in Houston, TX. Participants completed a demographic survey as well as the Brief Pain Inventory (BPI), Discrimination in Medical Settings Scale (DMS), and Trust in Physician Scale (TPS). In the BPI, participants reported their pain severity (PS) on a 0-10 scale at its worst, least, and on average. They reported pain interference with life (PI) from 0-10, types of pain treatments, and % relief from pain treatments. DMS and TPS questions were assessed on 5-point Likert scale. We performed chart review to obtain baseline clinical data related to BC diagnosis and treatment and comorbidities. We summarized patients’ baseline demographic and clinical information using descriptive statistics. PI and DMS were scored as a mean of the total items of each survey. We created mean Trust and Mistrust scores using means of the TPS questions related to each category. RESULTS Of the 37 BW surveyed, 36 (97.3%) were non-Hispanic. 23 (62.2%) had HR+ BC, and 2 (6.7%) had HER2+ disease. 26 (70.3%) women received chemotherapy, 10 (27%) received radiation therapy, and 17 (45.9%) received endocrine therapy. 26 (70.3%) women had &amp;gt; 1 comorbidity; the mean (SD) number reported was 1.3 (1.1). Mean BMI was 30.9 (6.6). 10 (29.4%) women completed high school, and 8 (23.5%) completed some college. 19 (55.9%) had a household income &amp;lt; $25,000, and 11 (32.4%) had private health insurance. Mean worst PS was 4.2 (3.1), and mean average PS was 3.6 (2.9). Mean composite PI score was 2.7 (2.7). 11 (29.7%) women were taking opioids for pain, 17 (45.9%) were taking non-opioid analgesics, and 3 (8.1%) were receiving non-medication treatments. Mean % pain relief with treatment was 52.3% (38.3). Mean DMS score was 1.2 (0.6). Mean composite TPS Trust and Mistrust scores were 4.4 (0.7) and 1.8 (1.0), respectively. CONCLUSION BW may continue to experience pain requiring opioid and/or non-opioid analgesics up to 2 years following mastectomy. Study participants reported relatively low levels of discrimination and high levels of trust on average. We are currently enrolling additional participants in the Emory Healthcare System and Grady Memorial Hospital in Atlanta, GA. After enrolling at least 80 total patients, we will determine the association between DMS and pain outcomes among participants adjusting for demographic, socioeconomic, and clinical factors as well as assess TPS as a potential mediator in the causal pathway between DMS and PS. Citation Format: Demetria Smith-Graziani, Yichun Cao, Jeffrey Switchenko, Mothaffar Rimawi, Abenaa Brewster. Discrimination, Trust, and Pain Outcomes Among Black Women with Early-Stage Breast Cancer After Mastectomy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-01.