Pain Questionnaire Research Articles

Exploring Vietnamese Pain Terms and Pain Descriptors: To What Extent are the McGill Pain Questionnaire (MPQ) Words Employed in the Vietnamese Context?

Exploring Vietnamese Pain Terms and Pain Descriptors: To What Extent are the McGill Pain Questionnaire (MPQ) Words Employed in the Vietnamese Context?

On possibility of using pain questionnaires and scales in clinical practice (a literature review)

Pain is one of the main, and sometimes the only, reason for visiting a doctor, therefore, in order to establish a diagnosis and provide effective treatment, it is important to correctly and objectively assess this condition of the patient, but the perception of pain is a very subjective phenomenon, so it is necessary to develop ways of qualitative and quantitative assessment of pain sensations. The World Health Organization has defined pain as «an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage». Pain sensations have both physical and psychological aspects that need to be considered when assessing and treating pain. Objectification of pain is a challenging yet important task for the clinician. Pain perception is a versatile field of study at present, as each person evaluates pain sensations completely differently. Currently, various methods of assessing pain sensation have been described, among which a separate place is allocated to scales and questionnaires. The disadvantages of all scales and questionnaires are their limitations; only one scale cannot be used to obtain a detailed picture of the patient's condition, and the use of only one type of questionnaire does not cover all aspects of the pain syndrome and does not take into account the individual characteristics of the patient. There are modern technical methods of pain intensity assessment, but their high cost and insufficient distribution in clinical practice limit their use. After a detailed study of the problem of pain syndrome assessment, we can conclude that this topic is in demand in modern medicine and still remains open for innovations.

Pain Characteristics of Parkinson's Disease Using Validated Arabic Versions of the King's Parkinson's Disease Pain Scale and Questionnaire: A Multicenter Egyptian Study.

Pain is one of the most common nonmotor symptoms in Parkinson's disease (PD), with variable characteristics among populations. This multicenter Egyptian study aimed to translate and validate the King's Parkinson's Disease Pain Scale (KPPS) and Questionnaire (KPPQ) into Arabic versions and to investigate the pain characteristics in Egyptian people with PD (PWP). A total of 192 PWP and 100 sex- and age-matched controls were evaluated by the KPPS-Arabic and KPPQ-Arabic. Both tools were assessed for test-retest reliability, floor or ceiling effects, construct validity and convert validity. PWP were also assessed by the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr scale (H&Y), Non-Motor Symptom Scale (NMSS), PD Questionnaire-39, and Non-Motor Fluctuation Assessment (NoMoFA). The KPPS-Arabic and KPPQ-Arabic showed inter- and intrarater consistency and high validity, with an acceptable ceiling effect. A total of 188 PWP (97.9%) reported at least 1 type of pain (p < 0.001). The severity and prevalence of all pain domains in the KPPS-Arabic were significantly higher among PWP than among controls (p < 0.001). Fluctuation-related and musculoskeletal pains were the most common (81.3% and 80.7%, respectively). In the PD group, the total and domains of KPPS-Arabic were significantly correlated to the MDS-UPDRS total score and the scores of Parts I, II, III, postural instability gait disorder, axial, and H&Y but not with age or age of onset. The predictors of KPPS-Arabic scores included the total MDS-UPDRS, the part III-OFF, disease duration, the total NMSS, and the NoMoFA scores. The current multicenter study provided validated Arabic versions of the KPPS and KPPQ, which exhibited high reliability and validity, and demonstrated a high prevalence and severity of pain within Egyptian PWP and characterized its determinants.

Perineural Invasion Is Associated With Function-evoked Pain and Altered Extracellular Matrix in Patients With Head and Neck Squamous Cell Carcinoma

Head and neck squamous cell carcinoma (HNSCC) is painful, and perineural invasion (PNI) has been associated with the worst pain. Pain due to HNSCC is diverse and may vary based on clinicopathological factors. This study aims to characterize different pain patterns linked with PNI, its influence on daily functioning, and gain insights into molecular changes and pathways associated with PNI-related pain in HNSCC patients. We conducted a cross-sectional study across 3 medical centers (n = 114), assessing pain phenotypes and their impact on daily functioning using 2 self-reported pain questionnaires, given to patients prior to their cancer surgery. Furthermore, we conducted RNA-seq analysis utilizing the The Cancer Genome Atlas dataset of HNSCC tumor from patients (n = 192) to identify genes relevant to both PNI and pain. Upon adjusting for demographic and clinicopathological variables using linear regression models, we found that PNI independently predicted function-evoked pain according to the University of Calfornia San Francisco Oral Cancer Pain Questionnaire, as well as the worst pain intensity reported in the Brief Pain Inventory. Distinct pain patterns were observed to be associated with daily activities in varying manners. Our molecular analyses revealed significant disruptions in pathways associated with the extracellular matrix structure and organization. The top differentially expressed genes linked to the extracellular matrix are implicated in cancer development, pain, and neurodegenerative diseases. Our data underscore the importance of properly categorizing pain phenotypes in future studies aiming to uncover mechanistic underpinnings of pain. Additionally, we have compiled a list of genes of interest that could serve as targets for both cancer and cancer pain management. PerspectivePNI independently predicts function-evoked pain. Different pain phenotypes affect daily activities differently. We identified a list of candidate genes involved in the extracellular matrix structure and function that can be targeted for both cancer and cancer pain control.

Is there a relationship between somatosensory impairment and the perception of pain in stroke survivors? An exploratory study.

Pain and somatosensory impairments are commonly reported following stroke. This study investigated the relationship between somatosensory impairments (touch detection, touch discrimination and proprioceptive discrimination) and the reported presence and perception of any bodily pain in stroke survivors. Stroke survivors with somatosensory impairment ( N = 45) completed the Weinstein Enhanced Sensory Test (WEST), Tactile Discrimination Test, and Wrist Position Sense Test for quantification of somatosensation in both hands and the McGill Pain Questionnaire, visual analog scale and the Neuropathic Pain Symptom Inventory (NPSI) for reporting presence and perception of pain. No relationship was observed between somatosensory impairment (affected contralesional hand) of touch detection, discriminative touch or proprioceptive discrimination with the presence or perception of pain. However, a weak to moderate negative relationship between touch detection in the affected hand (WEST) and perception of pain intensity (NPSI) was found, suggesting that stroke survivors with milder somatosensory impairment of touch detection, rather than severe loss, are likely to experience higher pain intensity [rho = -0.35; 95% confidence interval (CI), -0.60 to -0.03; P = 0.03]. Further, a moderate, negative relationship was found specifically with evoked pain (NPSI) and touch detection in the affected hand (rho = -0.43; 95% CI, -0.72 to -0.02; P = 0.03). In summary, our findings indicate a weak to moderate, albeit still uncertain, association, which prevents making a definitive conclusion. Nevertheless, our findings contribute to our understanding of the complexities surrounding the experience of pain in survivors of stroke and provide direction for future studies.

Clinical Characteristics of Cutaneous Pain in Psoriasis.

Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the study (34% female; mean age 42.1 ± 13.0 years). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Itch severity was evaluated using the numeric rating scale (NRS) and 4-Item Itch Score (4IIS). The intensity of skin pain was measured through the NRS, short-form McGill pain questionnaire (SF-MPQ), visual analog scale (VAS), and Douleur Neuropathique-4 questionnaire (DN4). Results: In the past week, 84.9% of psoriasis patients reported itch, while 50% of them reported skin pain. The average NRS for itch was 4.52 ± 2.88 points, and the 4IIS yielded a mean score of 6.79 ± 4.37 points. In terms of the intensity of cutaneous pain, the mean NRS was 2.42 ± 2.96 points; the SF-MPQ score averaged 4.84 ± 7.51 points; and the VAS score was 1.92 ± 2.65 points. Furthermore, 17% of adult psoriasis patients reported neuropathic pain. In 84.9% of the participants, skin pain was concurrent with areas affected by itch, while 18.9% of patients exhibited cutaneous pain encompassing all itchy areas. The pain NRS demonstrated significant correlations with the SF-MPQ (r = 0.531, p < 0.001), VAS (r = 0.779, p < 0.001), itch NRS (r = 0.551, p < 0.001), and 4IIS (r = 0.569, p < 0.001). No association was found between the pain NRS and PASI or disease duration. Conclusions: Skin pain of mild intensity and itch of moderate intensity are prevalent symptoms in psoriasis patients. Strong correlations between skin pain and itch can be explained by the process of neurogenic inflammation.

A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled 14-Week Study of Mirogabalin in Chinese Patients with Diabetic Peripheral Neuropathic Pain.

There is no approved effective drug for diabetic peripheral neuropathic pain (DPNP) in China. Gabapentinoids including mirogabalin have shown promise, although data in Chinese patients are scarce. This phase 3, multicenter, randomized, double-blind, placebo-controlled trial investigated the efficacy and safety of mirogabalin for treating DPNP in China. Mirogabalin was administered at 5mg twice daily for the first week and uptitrated to 15mg twice daily for a total duration of 14weeks. The primary efficacy endpoint was the change from baseline in weekly average daily pain score (ADPS) at week 14; secondary endpoints included the ADPS responder rate, Short-Form McGill Pain Questionnaire visual analogue scale score, patient global impression of change (PGIC), average daily sleep interference score (ADSIS), EuroQol 5-dimensions 5-levels (EQ-5D-5L), and incidence of treatment-emergent adverse events (TEAEs). Of 393 patients (mirogabalin, n = 196; placebo n = 197), the mean age was 58.2years (mirogabalin, 58.7years; placebo, 57.7years) and 54.2% were male (mirogabalin, 56.1%; placebo, 52.3%). Mirogabalin elicited a greater change from baseline in the weekly ADPS vs. placebo at week 14: least-squares mean difference (95% confidence interval) vs. placebo - 0.39 (- 0.74, - 0.04), p = 0.0301. PGIC, ADSIS, and EQ-5D-5L data reflected significantly better improvements for patients receiving mirogabalin vs. placebo. The incidence of TEAEs was 75.0% and 75.1% in the mirogabalin and placebo groups, respectively. Most TEAEs were mild or moderate, and the incidence of TEAEs leading to treatment discontinuation was 2.6% in the mirogabalin group and 1.5% in the placebo group. Although the effect size of mirogabalin was reduced due to the placebo effect, mirogabalin is a safe and effective treatment option for Chinese patients with DPNP. ClinicalTrials.gov identifier, NCT04094662.

Alterations in metabolites in the anterior cingulate cortex and thalamus and their associations with pain and empathy in patients with chronic mild pain: a preliminary study.

Proton magnetic resonance spectroscopy (1H-MRS) has shown inconsistent alterations in the brain metabolites of individuals with chronic pain. We used 3T 1H-MRS to investigate the brain metabolites in the anterior cingulate cortex and thalamus of 22 patients with chronic mild pain and no gait disturbance and 22 healthy controls. The chronic-pain group included patients with chronic low back pain and/or osteoarthritis but none suffering from hypersensitivity. There were no significant between group-differences in glutamate, glutamate plus glutamine (Glx), N-acetylaspartate, glycerophosphorylcholine (GPC), glutamine, creatine plus phosphocreatine, or myo-inositol in the anterior cingulate cortex, but the patients showed a significant decrease in GPC, but not other metabolites, in the thalamus compared to the controls. The GPC values in the patients' thalamus were significantly correlated with pain components on the Short-Form McGill Pain Questionnaire (SF-MPQ-2) and affective empathy components on the Questionnaire of Cognitive and Affective Empathy (QCAE). The GPC in the patients' anterior cingulate cortex showed significant correlations with cognitive empathy components on the QCAE. Myo-inositol in the controls' anterior cingulate cortex and Glx in the patients' thalamus each showed significant relationships with peripheral responsivity on the QCAE. These significances were not significant after Bonferroni corrections. These preliminary findings indicate important roles of GPC, myo-inositol, and Glx in the brain of patients with chronic mild pain.

Photoplethysmography-based assessment of varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics.

Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to evaluate varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics by photoplethysmography. The study sample consisted of 100 healthcare professionals without a diagnosis of peripheral venous insufficiency. Data were collected using a descriptive characteristics form, the Health Belief Model Scale for Exercise, the Short-Form McGill Pain Questionnaire, and photoplethysmography. This study found that OR nurses had shorter venous refill times and experienced more pain due to prolonged standing, despite their high health beliefs about exercise. Healthcare professionals working in operating rooms should be screened for venous insufficiency and trained regarding the practices to prevent venous insufficiency, such as lying down, elevating legs, and using elastic stockings.

Validation of a questionnaire for Central nervous system Aspects of joint Pain: the CAP questionnaire.

Neuropathic-like pain, fatigue, cognitive difficulty, catastrophising, anxiety, sleep disturbance, depression, and widespread pain associate with a single factor in people with knee pain. We report the Central Aspects of Pain questionnaire (CAP) to characterise this across painful musculoskeletal conditions. CAP was derived from the 8 item CAP-Knee questionnaire, and completed by participants with joint pain in the Investigating Musculoskeletal Health and Wellbeing survey. Subgroups had osteoarthritis, back pain or fibromyalgia. Acceptability was evaluated by feedback and data missingness. Correlation coefficients informed widespread pain scoring threshold in relation to the other items, and evaluated associations with pain. Factor analysis assessed CAP structure. Intraclass Correlation Coefficient (ICC) between paper and electronic administration assessed reliability. Friedman test assessed score stability over 4 years in people reporting knee osteoarthritis. Data were from 3579 participants (58% female, median age; 71 years), including subgroups with osteoarthritis (n = 1158), back pain (n = 1292) or fibromyalgia (n = 177). Across the 3 subgroups, ≥10/26 painful sites on the manikin scored widespread pain. Reliability was high (ICC= 0.89 (95% CI: 0.84-0.92)) and CAP scores fit to 1 and 2 factor model, with a total CAP score that was associated with pain severity and quality (r = 0.50-0.72). In people with knee pain, CAP scores were stable over 4 years at the group level, but displayed significant temporal heterogeneity within individual participants. Central Aspects of Pain is reliably measured by the CAP questionnaire across a range of painful musculoskeletal conditions, and is a changeable state.

(039) DIVERSITY OF CAUSES OF DYSPAREUNIA IN REAL CLINICAL PRACTICE IN THE OUTPATIENT GYNECOLOGY DEPARTMENT

Abstract Introduction Dyspareunia is a women's sexual health problem that still often goes undiagnosed, despite its high prevalence and negative impact on sexual, marital and psychological well-being. Genito-pelvic pain/penetration disorder (GPPPD) refers to significant pain and difficulty with penetrative sex that lasts for at least six months and might be caused by various diseases alone and their combinations. Objective Thus, the purpose of this study is to determine the contribution of different conditions to the total number of patients who applied for a primary appointment for GPPPD. Methods Women who agreed to participate in the study were presenting complaints on painful intercourse or inability to have intercourse for more than 6 months. Patients underwent a gynecological examination consisted of inspection, Q-tip testing, pelvic floor muscle testing and bimanual palpation in the lithotomy position (if it was possible). Diagnoses were documented according to the International Classification of Diseases Tenth Revision World Health Organization guidelines. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale. Assessment of pelvic floor muscle dysfunction was based on an International Continence Society report on the terminology for pelvic floor muscle assessment. Vulvar pain conditions were classified based on the consensus vulvar pain terminology committee of the International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women's Sexual Health, and International Pelvic Pain Society. Statistical analyses were performed by SPSS Statistics. Results The average age of the examined women was 30,63±0,69 years. As a cause of GPPPD vaginismus and dyspareunia were diagnosed in 19.31 and 80.69 % respectively. Predominant cause of dyspareunia was pelvic floor muscles dysfunction (66,19%) which was combined with other pathologies (scar deformity of the perineum, endometriosis and chronic pelvic pain, candidiasis, etc.) in 20 cases. The percentage of women diagnosed with endometriosis without the formation of central pain mechanisms was 11.36%. The overlapping chronic pain conditions such as migraine, interstitial cystitis/bladder pain syndrome, irritable bowel syndrome, endometriosis and vulvodynia were diagnosed in 21.13% patients with dyspareunia. Dyspareunia due to vaginal atrophy associated with lactation, combined oral contraception use and menopause was diagnosed in 4 patients (2.82%, 1.41% and 1.41%, respectively). Scar changes of the perineum due to traumatic delivery or episiotomy amounted to 4.23%. Lichen planus was diagnosed in one patient (1.41%). Vulvodynia was diagnosed in 8 patients with dyspareunia (11.26%) and was associated with pelvic floor tension myalgia and pelvic floor myofascial pain syndrome in 75% of cases. Conclusions GPPPD can be caused by various conditions with significant involvement of the pelvic floor muscles in the process of pain formation. Taking into account the risk of overlapping chronic pain conditions, a multidisciplinary approach is required in the treatment of this group of patients. Disclosure No.

(030) PATIENT-REPORTED OUTCOMES OF CORE EXCISION FOR SURGICAL MANAGEMENT OF NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Among patients with neuroproliferative vestibulodynia (NPV) experiencing pain on cotton-tip swab testing at the 1:00-11:00 vestibule prior to complete vestibulectomy surgery, a subset also had pain at the 12:00 vestibule. Excision of the 12:00 core region may be performed concomitantly or after healing from the vestibulectomy. Given that a vaginal flap cannot be advanced to this area, only a core excision is removed and closed using surrounding 12:00 tissue. Differences between the post-operative improvement in the 1:00-11:00 and the 12:00 regions have not been examined to date. To better understand the success of core excision of the 12:00 region, we assessed post-operative patient-reported outcomes specifically of this vestibular region. Objective To characterize patients who underwent 12:00 excision as well as assess Patient Global Impression of Improvement (PGI-I) specifically regarding 12:00 core excision in individuals with NPV. Methods We performed a retrospective chart review of patients from one clinic who had undergone a 12:00 core excision. Preoperative baseline assessments included Vulvar Pain Functional Questionnaire (V-Q), Female Sexual Function Index (FSFI), Short Form McGill Pain Questionnaire (SF-MPQ), cotton-tip swab test results. Dimensions of the excised tissue as determined by pathology report, responses to the PGI-I scale at &amp;gt; 6 months post-op, and any adverse events were collected. Descriptive statistics were conducted to analyze the PGI-I scores and other outcomes. Results The majority of patients (67%, n=21), with an average age of 26, rated their 12:00 pain as “much improved” or “very much improved” on the PGI-I scale. Mean duration of follow up since surgery was one year and five months, with a minimum follow up of 9 months. Most patients (90%) did not have regrets about having the 12:00 region removed. Most patients (83%) would recommend this surgery to other patients who have 12:00 pain. There were no significant post-operative adverse events with 12:00 excision. Mean dimensions of the excised specimen were 1.01 cm x 0.60 cm x 0.21 cm, 3% of the size of the 1:00-11:00 vestibule excised. Preoperatively, patient reported mean FSFI pain domain was 0.67, SF-MPQ 16.80, affective 5.15 and PPI 3.42. Mean V-Q prior to surgery was 11.68, mean cotton-tip swab test result for the 12:00 region was 6.15. Conclusions Performing core excision of a very small volume of tissue during surgery in patients with 12:00 pain is associated with an improved PGI-I score in 67% of patients. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings and optimize the management of vestibulodynia. In patients who fail 12:00 core excision surgery, buccal mucosal grafting of the entire 12:00 vestibule may be a future option. Disclosure No.

(089) CORRELATIONS BETWEEN IMMUNOHISTOCHEMICAL STAINING AND PAIN-RELATED ASSESSMENTS IN PATIENTS WITH NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Mast cell accumulation and nerve proliferation has been hypothesized to lead to pain symptoms for patients with neuroproliferative vestibulodynia (NPV). A clinically suspected diagnosis of NPV can be confirmed by examining immunohistochemical (IHC) staining of excised vestibular specimens. Compared to controls, specimens from NPV patients have been found to contain &amp;gt;8 mast cells per high-power field (HPF) and increased density of nerves. Objective To assess for correlations between patient reported pain-related measures and computer-assisted histometry of excised vestibulectomy specimen IHC staining with CD117 (marker for mast cells) and PGP9.5 (marker for nerves) in a cohort of histopathologically confirmed NPV patients. Methods Patients (n=65) with lifelong or acquired NPV undergoing vestibulectomy had IHC-staining of excised vestibular tissue. Tissue sections from the 1:00-11:00 and/or 12:00 regions of the vestibule were examined and high-resolution images were captured using a microscope at 100x and 200x magnification. A minimum of 2 photomicrographs per magnification were taken for each tissue section that included epithelial basement membrane and adjacent subepithelium representative of the majority of immunostained tissue. Fractional area of positive immunostaining of all photomicrographs was determined using computer-assisted histometry by ImageJ. Mean fractional area was determined from 3 separate measurements of each photomicrograph. Correlations were made between density of IHC staining and the following assessments: pain domain of the Female Sexual Function Index (FSFI), the Short Form McGill Pain Questionnaire (SF-MPQ), and cotton-tipped swab testing. We also examined correlations with the Patient Global Impression of Improvement (PGI-I), a treatment response index and indirect assessment of pain. Data were analyzed using Spearman correlations and the Mann-Whitney test. Results The study cohort had a median age of 26 (IQR = 23-31) years and experienced symptoms for a median duration of 11 (IQR = 6-15) years. While all patients reported high levels of pain (median FSFI pain domain score = 0.0), there were no correlations between CD117- or PGP9.5-immunopositive mean fractional area and FSFI pain domain or SF-MPQ scores. There was no difference in immunopositive mean fractional area between lifelong and acquired NPV. A positive correlation between fractional area of CD117 immunostaining in the 1:00-11:00 region of the vestibule and cotton-tipped swab test pain score approached but did not reach statistical significance (r = 0.24, p = 0.063). No correlations were observed between immunostaining and PGI-I or cotton-tipped swab testing scores. Likewise, SF-MPQ domain scores had no correlation to PGI-I or cotton-tipped swab testing. Median cotton-tipped swab testing pain scores were significantly higher (p &amp;lt; 0.001) in patients with lifelong NPV (7.6) compared to those with acquired NPV (5.7). Conclusions Our findings suggest that the high levels of pain experienced by NPV patients over a prolonged period of time may be dissociated from the density of mast cells and nerves in vestibular tissue. We postulate that any potential threshold of mast cell accumulation and increased nerve density that results in symptoms of vestibulodynia has been exceeded in our patient cohort. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience; Pfizer; Prometheus Laboratories; Sprout Pharmaceuticals.

Acupuncture combined with tuina therapy for stiff neck with levator scapula injury type: a randomized controlled trial

To observe the clinical efficacy of acupuncture combined with tuina therapy for stiff neck with levator scapula injury type. A total of 162 patients with stiff neck of levator scapula injury type were randomly divided into an acupuncture combined with tuina group (combined group, 52 patients), a tuina group (55 patients), and an acupuncture group (55 patients). The patients in the acupuncture group received acupuncture on the affected side's Houxi (SI 3), inserting the needle 10 to 20 mm towards Laogong (PC 8) with strong or moderate stimulation, and patients were instructed to move their neck, shoulders, and upper limbs during the process, with the needle retained for 2 to 3 min. The patients in the tuina group received strong stimulation pressing on tender points to release the starting and ending points of the trapezius muscle with modified techniques. The combined group first received tuina therapy, followed immediately by acupuncture treatment at the Houxi (SI 3). Treatments were administered every other day for a total of three sessions. Before treatment and on 1, 3, and 7 days after treatment, the simple McGill pain questionnaire (SF-MPQ) scores [including the pain rating index (PRI), visual analogue scale (VAS), and present pain intensity (PPI) scores] of the head, neck and shoulder, cervical spine mobility scores were observed, and the clinical efficacy and safety of each group were evaluated. On the 1, 3, and 7 days after treatment, the SF-MPQ, PRI, VAS, and PPI scores of the head, neck, and shoulder in all groups were significantly reduced (P<0.01). On the 1 and 3 days after treatment, the above scores in the combined group were lower than those in the tuina group and the acupuncture group (P<0.05, P<0.01). On the 7 days after treatment, the above scores in the combined group were lower than those in the acupuncture group (P<0.01). On the 3 days after treatment, the SF-MPQ, PRI, and VAS scores in the tuina group were lower than those in the acupuncture group (P<0.01). On the 7 days after treatment, the SF-MPQ, PRI, VAS, and PPI scores in the tuina group were lower than those in the acupuncture group (P<0.01, P<0.05). On the 1, 3, and 7 days after treatment, the cervical spine mobility scores in each group were decreased compared to those before treatment (P<0.01). On the 3 days after treatment, the cervical spine mobility score in the combined group was lower than that in the acupuncture group and the tuina group (P<0.01). On the 1, 3, and 7 days after treatment, the cured rate in the combined group was higher than that in the tuina group and the acupuncture group (P<0.01). During the treatment period, no serious adverse reactions occurred in any group. Acupuncture combined with tuina therapy could effectively improve stiff neck with levator scapula injury type, alleviate patient pain, restore cervical spine mobility, and clinically outperform both tuina and acupuncture therapy alone.

Abnormal brain spontaneous neural activity in neuromyelitis optica spectrum disorder with neuropathic pain

BackgroundNeuropathic pain is one of the most common symptoms in neuromyelitis optica spectrum disorder (NMOSD). Notwithstanding, its underlying mechanism remains obscure.MethodsThe amplitude of low-frequency fluctuations (ALFF) metric was employed to investigate spontaneous neural activity alterations via resting-state functional magnetic resonance imaging (rs-MRI) data from a 3.0 T MRI scanner, in a sample of 26 patients diagnosed with NMOSD with neuropathic pain (NMOSD-WNP), 20 patients with NMOSD but without neuropathic pain (NMOSD-WoNP), and 38 healthy control (HC) subjects matched for age and sex without the comorbidity of depressive or anxious symptoms.ResultsIt was observed that patients with NMOSD-WNP displayed a significant ALFF decrease in the left amygdala and right anterior insula, relative to both patients with NMOSD-WoNP and HC subjects. Furthermore, ALFF values in the left amygdala were negatively correlated with the scores of the Douleur Neuropathique en 4 Questions and McGill Pain Questionnaire (both sensory and affective descriptors) in patients with NMOSD-WNP. Additionally, there were negative correlations between the ALFF values in the right anterior insula and the duration of pain and the number of relapses in patients with NMOSD-WNP.ConclusionThe present study characterizes spontaneous neural activity changes in brain regions associated with sensory and affective processing of pain and its modulation, which underscore the central aspects in patients with NMOSD-WNP. These findings might contribute to a better understanding of the pathophysiologic basis of neuropathic pain in NMOSD.

Exercise Capacity, Muscle Function, Functional Balance, and Cognitive Status in Patients with Post COVID-19 Syndrome Compared to Healthy Controls

Objective: There is limited data on the effect of post-COVID-19 syndrome on functional outcomes compared with healthy uninfected individuals. This study aimed to compare the muscle function, exercise capacity, and quality of life of patients with post-COVID-19 syndrome with that of healthy controls. Methods: Twenty patients with post-COVID-19 syndrome and twenty healthy controls participated in the study. The Incremental Shuttle Walk Test (ISWT) was used to measure exercise capacity, and the Timed Up and Go Test (TUG) was used to assess functional balance. Quadriceps muscle strength (QMS) and handgrip strength (HGS) were measured. Assessment tools included the McGill Pain Questionnaire (SF-MPQ) for pain, the Tampa Scale for Kinesiophobia (TSK) for movement fear, the Modified Medical Research Council Dyspnea Scale (mMRC) for dyspnea, the Fatigue Severity Scale (FSS) for fatigue perception, and the Cognitive Failures Questionnaire (CFQ) for cognitive status. Results: The mMRC dyspnea, TSK, FSS, SF-MPQ total scores, and pain severity of patients with post-COVID-19 syndrome were higher than those of healthy controls (p

An Ayurveda Approach Towards Acute Sciatica with Paraesthesia

Sciatica is pain or paraesthesia which is radiates path of the sciatic nerve and its branches from the lower back through the hips and buttocks and down to the leg. A 41-year-old female patient with an acute low back ache to radiate to left lower limb with paraesthesia for three months came to Kayachikitsa IPD of Vaidyaratnam Ayurveda College on 18/3/24. The pain was graded eight out of ten in the VAS pain scale and her overall Oswestry low back pain score is 32 which means severe functional disability. She underwent for Vatakapha hara chikitsa protocol. It includes Rookshana, Snigda sweda, Vata hara, and Brihmana chikitsa. Ayurvedic preparations like Aadarisahacharadi kasayam, Suntibaladi choornam Vyoshadi guggulu were given Swedam, Patrapoliswedam, and Pizhichil, Shastika pinda swedam, Yoga vasti along with passive exercise were given. After 30 days of treatment outcome of these treatments found to be very positive. There was a substantial recovery in walking duration, heaviness, touch temperature perception and pain relief was observed. Subjective parameters like, SLR test, Oswestry low back pain disability questionnaire, Sciatica bothersome index, Sciatica frequency index, Roland morris low back pain and disability questionnaire was taken for assessment parameters. The patient got relief in all parameters after treatment. It was proved significant improvement of patient’s primary symptoms. These therapies reduce pain, stiffness and improve circulation.

Gender differences in the quantitative and qualitative assessment of chronic pain among older people.

Pain, regardless of its causes, is a subjective and multidimensional experience that consists of sensory, emotional and cognitive factors that cannot be adequately captured by a single number on a pain scale. The aim of the study was to understand gender differences in the assessment of quantitative and qualitative chronic pain among older people. The study used a questionnaire that included questions about demographic and social characteristics as well as the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Depression Scale (GDS-15), McGill Pain Questionnaire (MPQ). The pain rating index based on rank values of adjectives was higher among women than men (18.36 ± 7.81 vs. 17.17 ± 9.69, p = 0.04). The analysis of the frequency of selection of individual adjectives describing the sensory aspects of pain showed that men described the pain as "stabbing" more often than women (26.1% vs. 14.3%, p < 0.05). Women chose adjectives from the emotional category more often than men (59.8% vs. 75.4%, p < 0.05), describing the pain as "disgusting" (8.9% vs. 1.4%, p < 0.05), "unbearable" (19.6 vs. 4.3, p < 0.05). In the subjective category, there was a difference between women and men in terms of describing pain as "terrible" (23.2% vs. 7.2%, p < 0.05) and as "unpleasant" (11.6% vs. 23.3%, p < 0 0.05). When referring to pain, women tend to employ more detailed and factual language, indicative of heightened emotional sensitivity. Men tend to use fewer words and focus on the sensory aspects of pain. Subjective aspects of pain were demonstrated by both women and men.

The exploration of the upper body kinematics and kinematic asymmetries during forwards and backwards wheelchair propulsion

The current literature available on the kinematic asymmetries in the upper body during wheelchair propulsion remains limited (Slowick, Requejo, Mulro. &amp; Neptune, 2015, Front Bioeng Biotech, 3, 86-86). This research provides an opportunity to add to this limited area and help provide an understanding of the how the upper body movements change when faced with a change in speed and direction. The present cross-sectional laboratory study aimed to explore the kinematics and kinematic asymmetries during forwards and backwards wheelchair propulsion in able bodied individuals. This study investigated the effect of changes in speed and quantified the upper body kinematics of forwards and backwards wheelchair propulsion. Upon ethical approval, five able bodied participants, 3 male and 2 female (age = 21 ± 1 years, stature = 173 ± 8 cm, mass = 73 ± 7 kg) provided written informed consent and participated in this study. Participants took part in exercise regularly but had no prior wheelchair experience. Individual measurements (Height, weight, weekly exercise levels, injury history, dominant hand and upper body pain via the musculoskeletal pain questionnaire) were taken then participants took part in a series of trials in a wheelchair. Four Inertial Measurement Units (IMeasureU, Blue Trident, VICON, Oxford, UK) were placed on the participant's 7th cervical vertebrae, underneath the wheelchair seat and on the lateral side of each humerus above the elbow joint. Before testing began, participants were given a five-minute familiarisation period on the wheelchair. The testing consisted of ten forwards and ten backwards self-paced wheelchair propulsions on an Invictus Active Trainer (Invictus Active, Wolverhampton, UK), a 20 metre sprint overground on a track (with verbal encouragement throughout the sprint) and a single arm 3 kg medicine ball throw. All tests were performed from a stationary start and shoulder angles were measured to 180° before each test began. This research expects to see a difference in angular velocity between each participant's arms, with a greater level of asymmetry as speed increases. Participants are required to work harder in order to gain speed and as a result their propulsion technique will change to meet the new demands. The other expectation is to see the same side as the participants dominant hand have a higher level of force production during propulsion compared to their arm with the non-dominant hand.

An exploratory randomized controlled trial of virtual reality as a non-pharmacological adjunctive intervention for adults with chronic cancer-related pain

BackgroundThe growing popularity and affordability of immersive virtual reality (VR), as adjunctive non-pharmacological interventions (NPIs) for chronic pain, has resulted in increasing research, with mixed results of its effectiveness reported. This randomized controlled superiority trial explored the effects of a home-based adjunctive 3D VR NPI for chronic pain in cancer patients, compared to the same NPI experienced through a two-dimensional (2D) medium.MethodsThe NPI used four different applications experienced for 30 min for six days a week at home for four weeks using established cognitive distraction and mindfulness meditation techniques. Participants were randomly assigned (N = 110) into two arms: a VR group (n = 57) where the NPI was delivered through a VR system, and a control group (n = 53) which used a computer screen for delivery. Participants were blinded to which arm of the study they were in, and sequence of the NPI applications experienced was randomized. Primary outcomes of daily pre/post/during exposure, and weekly average pain scores were assessed via the Visual Analog Scale (VAS) and the Short Form McGill Pain Questionnaire (SF-MPQ), and secondary outcomes of weekly Quality of Life (SF-12), and sleep quality (Pittsburgh Sleep Quality Index) were measured.ResultsFindings indicate VR applications were not significantly superior to the 2D group, but both VR and control NPIs provided clinically important pain reduction for participants when experiencing significant daily pain of a VAS ≥ 4. No significant adverse effects were encountered, although many of the participants in the VR group reported some cybersickness in certain applications (VR group n = 46 vs 2D group n = 28).ConclusionsOverall, VR did not provide superiority as an NPI for pain relief compared to 2D computer-based applications. For those experiencing significant pain, cognitive distractive applications appeared superior for VR-based pain reduction during exposure, whilst meditative applications supplied better pain relief post-exposure. Findings from this trial support some clinical efficacy of home-based VR immersive experiences as NPIs for chronic cancer-related pain but in this context the 2D computer-based applications demonstrated similar value.Trial registrationClinicaltrials.gov, identifier NCT02995434, registered 2017–07-31.