Pain Tolerance Research Articles

Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial.

Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients havingPMPS, opening new avenues for pain management strategies.

Effects of Hydrotherapy on the Management of Childbirth and Its Outcomes-A Retrospective Cohort Study.

The main objective of this study was to generate further evidence on maternal and birth outcomes associated with the use of hydrotherapy during labor, specifically aiming to describe the effects of water immersion during all stages of labor (first, second, and third) on women. A retrospective cohort study was carried out on a random sample of women who gave birth at the Costa del Sol Hospital between January 2010 and December 2020. The calculated sample size was 377 women and the data were extracted from their partograms. After data extraction, two groups were formed: one group used hydrotherapy during childbirth (n = 124), while the other group included women who did not use hydrotherapy during the childbirth process (n = 253). The results highlight significant differences in pain perception, analgesia use, types of labor, and delivery times between the two groups. Women who did not use hydrotherapy reported higher pain perception, with a median (IQR) of 8 (7-9) on a numerical scale, compared to a median (IQR) of 6 (5-7) for the hydrotherapy group. Furthermore, the group without hydrotherapy required epidural analgesia in 40% of cases, while in the hydrotherapy group, it was only necessary in 20%. In terms of the type of delivery, the hydrotherapy group had more spontaneous vaginal deliveries compared to the non-hydrotherapy group, which had more operative vaginal deliveries. The overall duration of labor was longer in the hydrotherapy group, especially in women who arrived at the hospital late in labor. Hydrotherapy is associated with a longer time to delivery. Women with a higher pain tolerance tend to opt for hydrotherapy instead of epidural analgesia.

Intraoperative pain prediction of percutaneous kyphoplasty under local anesthesia by preoperative experimental pain assessment.

Percutaneous kyphoplasty (PKP) is the preferred treatment for osteoporotic vertebral compression fractures (OVCF) Currently, the preoperative anesthesia methods for PKP are mainly local anesthesia and tracheal intubation general anesthesia. To assess whether patient sensitivity to pain measured preoperatively could predict the patients' pain response during PKP treatment under local anesthesia, to facilitate the development of an optimal preoperative anesthesia plan for patients. Fifty-five female patients diagnosed with osteoporotic single vertebral fracture who were treated with PKP under local anesthesia were selected. The patients' pain sensitivities, including pain threshold and pain tolerance threshold, were evaluated with a pain test device on the day before the operation in the ward. Heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) were recorded before anesthesia, post-anesthesia, after needle puncture, and after balloon dilatation. At the same time, blood was drawn at the above time points to determine the level of norepinephrine (NA) as an indicator of intraoperative pain stress response. The numerical rating scale (NRS) during surgery was recorded at the end of the surgery. The preoperative pain tolerance threshold of 55surgical patients was correlated with the intraoperative NRS score (r=-0.768, P< 0.001), as well as with the preoperative and intraoperative changes in HR (r=-0.791, P< 0.001), MAP (r=-0.819, P< 0.001), and NA (r=-0.553, P< 0.001). Thus, the lower the preoperative pain tolerance threshold, the more severe the patient's response to pain during PKP treatment under local anesthesia, and the greater the hemodynamic changes. Consequently, the intraoperative experience becomes worse. However, there was no correlation between preoperative pain threshold and NRS scores (r=-0.069, P= 0.616) nor between the preoperative and intraoperative changes in HR (r= 0.103, P= 0.453), MAP (r= 0.086, P= 0.535), and NA (r=-0.058, P= 0.674). The results indicated that preoperative pain assessment could predict the level of pain response in OVCF patients during PKP surgery under local anesthesia.

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.

Analysis of clinical features and prognostic factors in Takayasu arteritis involving pulmonary hypertension: A retrospective study.

Multiple takayasu arteritis (TA) is a chronic nonspecific large to medium vasculitis disease that mainly accumulates the aorta and its branches. Pulmonary vascular disease is often seen as stenosis and occlusion, and patients may show no moderate to severe pulmonary hypertension (PH). This study aims to summarize the clinical characteristics and analysis of prognostic factors in patients with PH caused by TA. Patients diagnosed with aortitis involving the pulmonary artery by pulmonary arteriography or pulmonary artery and total aortic computed tomography arteriography (CTA). All patients underwent detailed clinical assessment, laboratory data collection, and analysis of imaging data. Patients were followed up and factors affecting the prognosis of the pulmonary arteries were analyzed. Most of the patients' complaints were chest tightness, shortness of breath, decreased activity tolerance, hemoptysis and chest pain. 56.90% of the patients were in at the time of admission. Echocardiographic estimation of pulmonary artery systolic pressure was 90.39 ± 22.87 mm Hg. In terms of laboratory tests, 39.66%% of the patients had elevated C-reactive protein and erythrocyte sedimentation rate, and amino-terminal natriuretic peptide precursor on admission. In terms of imaging, all patients had pulmonary artery involvement, which was combined with aortic involvement in 31.03%. Nuclide lung perfusion/ventilation imaging of the patients revealed multiple perfusion defects/absences in the segmental and subsegmental distribution of the lungs. Univariate Cox regression model analysis suggested that patients' WHO functional class at admission, age ≧ 51 years at the time of consultation, and amino-terminal natriuretic peptide precursor ≧ 3500 pg/mL were factors affecting the prognosis. Further multifactorial Cox regression model analysis suggested amino-terminal natriuretic peptide precursor ≧ 3500 pg/mL was an independent predictor of poor prognosis with a hazard ratio (HR) value of 5.248. Electrocardiogram and echocardiogram may suggest an increased right heart load; some patients have elevated serum inflammatory indexes. Characteristic imaging manifestations include widening of the main pulmonary artery, multiple pulmonary segmental and subsegmental stenoses.

Bystander Acknowledgment Mitigates the Psychological and Physiological Pain of Racial Discrimination for Black Young Adults: A Randomized Controlled Trial

Racism increases pain sensitization and contributes to racialized pain inequities; however, research has not tested interventions targeting racism to reduce pain. In this study, we examined whether White bystanders can act to mitigate racism’s pain-sensitizing effects. To simulate racial exclusion in the laboratory, Black young adults (age 18–30; N = 92) were randomly assigned to be included or excluded by White players in a ball-tossing game (Cyberball). For half of the excluded participants, White bystanders acknowledged and apologized for the racial exclusion. Participants completed a cold pressor task to assess pain threshold, tolerance, and unpleasantness, and completed a survey assessing psychological needs (ie, belongingness, self-esteem, meaningful existence, and self-control). Participants who experienced racial exclusion reported significantly more threatened psychological needs and increased laboratory pain sensitization (ie, lower pain threshold and tolerance) than those who were included. However, when a White bystander acknowledged the racism, excluded participants reported higher levels of self-control, self-esteem, and decreased pain sensitization (pain threshold and tolerance) relative to excluded participants whose experience was not acknowledged. Our findings support that racism increased Black people’s pain sensitivity and provide initial evidence for White bystander acknowledgment as a health intervention. PerspectiveContinual exposure to racism likely contributes to inequities in pain sensitization. We demonstrate that acute exposure to mild racism increases acute pain sensitization. Results suggest that a bystander acknowledging witnessed racism can buffer the acute sensitizing effects of racism on pain, pointing to the potential of interpersonal interventions targeting racism. Trial RegistrationClinicaltrials.gov NCT06113926.

Protective effects of hops (Humulus lupulus L.) extract on analgesic activity and oxidative stress markers in the brain of rats with carrageenan-induced paw edema

Hops (Humulus lupulus L.) are widely utilized worldwide as a raw material for various medical applications due to their numerous beneficial health effects. This study aimed to assess the potential neuroprotective effects of hop extract on cerebral oxidative markers and pain using rat models. In the experimental study, rats were divided into five groups and administered varying doses of Humulus lupulus L. extract (HLE) for a period of 15 days prior to the administration of carrageenan. To induce acute inflammation in rats, carrageenan (1 %) was injected into the sub-plantar region of the left paw. Subsequently, analgesic responses, the antioxidant activity and lipid peroxidation in the cerebral cortex were assessed. In the investigation of pain tolerance caused by inflammation in the hot plate test, the HLE treatment groups as exhibited a significant increase (P < 0.001) in delay time for removing the paw from the hot plate compared to the carrageenan group. The results demonstrate that HLE treatment significantly increased the activity of CAT (P < 0.001) and SOD (P < 0.01) enzymes, while decreasing the level of MDA (P < 0.01). It can be concluded that the consumption of hops may alleviate pain caused by inflammation and mitigate cerebral oxidative stress in rats.

대학생의 정신화가 대인관계문제에 미치는 영향

This study attempted to examine the effect of mentalization on interpersonal problem among college students and to verify the mediating effect of pain tolerance and experience avoidance in this process. For this purpose, the results of an online survey conducted with 300 college students from the metropolitan area were analyzed. Following the study, first, mentalization showed a positive correlation with pain tolerance and negative correlated with experience avoidance and interpersonal problems. Also, pain tolerance was negatively correlated with experience avoidance and interpersonal problems, and experience avoidance was positively correlated with interpersonal problems. Second, pain tolerance mediated the influence of mentalization on interpersonal problems. Third, experience avoidance mediated the influence of mentalization on interpersonal problems. Fourth, pain tolerance and experience avoidance sequentially mediated the effect of mentalization on interpersonal problems. Based on the findings, the study's significance, limitations, and future research directions were discussed.

1. Medical Management of Pancreatitis Pain

Chronic pain is the most distressing feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). Pain can arise from injury, inflammation, obstruction of ducts, neuritis, and/or inherent problems with pain processing and tolerance in the brain and nervous system. Professor Singh provides expert guidance on how he approaches patients with chronic pancreatic pain.

P014 Treatment response in psoriatic arthritis: a comparison between the disease activity scores psoriatic arthritis response criteria and disease activity score-28

Abstract Background/Aims Despite NICE guidelines recommending the use of the PsA response criteria (PsARC), to assess response to biologic therapies in patients with psoriatic arthritis (PsA), some clinicians use the Disease Activity Score (DAS-28) criteria, developed for rheumatoid arthritis. However, whether the two scores are interchangeable and/or capture similar information has not yet been explored. Here, we investigate the differences and overlap between these two disease activity scores, in identifying good/poor responders, in PsA. Methods Utilising treatment response data from the OUTPASS cohort; a UK based multi-centre observational study, PsA patients assessed with PsARC and DAS-28 scores were calculated at baseline (pre-treatment), 3-months and 6-months (3M),(6M), following treatment, where available. EULAR good/moderate response was combined and compared with PsARC responder status. Subgroup analysis of patients with both PsARC and DAS-28 scores at either 3M or 6M, were tested for agreement using the Cohen’s Kappa test. Statistical tests were also used, as appropriate, to investigate differences between the baseline subcomponents, in the observed concordant and discordant data. Results Response data from 418 patients was available. An average of 76% were classified as responders according to PsARC, and 80% according to the EULAR response criteria, for both 3M and 6M, with 12% discordance. A subgroup analysis of 218 patients assessed with both scores, (up to 6M), revealed 17.9% responder discordance between PSARC and DAS-28, and 82.1% concordance. The Cohen’s Kappa test defined the assessment of responder/non-responder outcome, as an ‘almost perfect agreement’ (0.82) between the two criteria. Further statistical analyses, of baseline subcomponents, of both response criteria, between these discordant/concordant subsets, showed no significant difference, except for PsARC Physician’s and Patient’s Global Assessments (PhGA), (PGA), (P = 0.01, P = 0.02, Table 1). Conclusion PsARC and EULAR response criteria show ‘almost perfect agreement’, strongly supporting clinical use for either score. PhGA, (not a subcomponent of DAS-28) and PsARC PGA were the only significantly different (P &amp;lt; 0.05) components between the discordant and concordant groups, highlighting the importance of considering psychosocial factors which may affect pain tolerance and treatment response. Comparative analyses with other widely used scores, such as DAPSA, would also be informative for future work. Disclosure K. Patel: Grants/research support; This project has received support from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 101007757 (HIPPOCRATES), the JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA, the results reflect only the author's view and the JU are not responsible for any use that may be made of the information it contains.. N. Nair: None. M. Jani: None. H. Chinoy: Consultancies; H.C. has received Consulting for PTC Therapeutics. Member of speakers’ bureau; H.C. has received fees as a speaker for GSK, UCB. Other; H.C. for Advisory Board member for Astra Zeneca, Pfizer, Argenx, Galapagos; Data and Science Monitoring Board chair for Horizon Therapeutics. J. Bluett: Grants/research support; J.B. has received a research grant award from Pfizer and travel/conference fees from UCB, Fresenius Kabi, Pfizer and Eli Lilly. (Pfizer: WI239449). A. Barton: Grants/research support; A.B. has received research grants from Bristol Myers Squibb and Pfizer and speaker fees from Galapagos.. P. Curry: None.

Pain tolerance as a ‘barrier’ to nonsuicidal self-injury: A longitudinal study

Theoretical perspectives underscore that low pain tolerance may be a relevant ‘barrier’ to non-suicidal self-injury (NSSI). However, there is limited longitudinal work on the link between pain tolerance and NSSI, which is needed to assess if pain tolerance precedes NSSI engagement, and/or if NSSI precedes altered pain tolerance. Further, assessing both NSSI frequency and versatility (or number of NSSI methods), in addition to engagement, can provide a more nuanced understanding of the influence of pain on NSSI severity. In the present study, 1125 undergraduate students at a large university (72 % female, Mage = 17.96) reported on their NSSI frequency, NSSI versatility, and perceived pain tolerance. Four individual regressions were run to examine the potential bidirectional nature of the association between NSSI frequency and pain tolerance, and NSSI versatility and pain tolerance. Pain tolerance predicted both NSSI frequency and versatility over time. Neither NSSI frequency nor versatility predicted pain tolerance. Results suggest that high pain tolerance may be a risk factor for severe NSSI engagement.

Suicidality in Veterinarians: Trends at Different Career Stages and a Test of the Interpersonal Theory of Suicide

Objective The aim of this study was to investigate sex differences in suicide ideation and attempt at different career stages and test hypotheses derived from the Interpersonal Theory of Suicide (IPTS) in a sample of veterinarians. Method The sample of currently practicing veterinarians used for this study (N = 10,319) was derived from a larger sample. Participants completed an online self-report questionnaire. Results As predicted, women generally had a higher prevalence of suicide ideation and attempt across career stages, except men and women showed similar rates of suicide attempt after veterinary school. Contrary to hypotheses, no interaction effects between IPTS variables were observed. However, perceived burdensomeness, thwarted belongingness, and hopelessness exhibited the main effects of suicide ideation, and there were main effects of perceived burdensomeness and hopelessness on suicide attempt. Compared with perceived burdensomeness and thwarted belongingness, hopelessness had a relatively more robust relationship with suicide ideation. We also found a significant relationship between fearlessness about death and suicide attempt, but no relationship between self-reported pain tolerance and suicide attempt. Conclusions Some of our findings were consistent with the IPTS while others were not. Future research would benefit from a longitudinal examination of suicidality in veterinarians.

How is range of motion of the fingers measured in hand therapy practice? A survey study.

A variety of techniques for measuring finger range of motion (ROM) are available for hand therapist use, however, there is no clear description of which finger ROM methods are preferred in practice. This study explored the preferred measurement techniques, the factors influencing clinical decision-making, and the clinical reasoning processes employed when faced with practice-based measurement scenarios. This was a cross-sectional online survey study of hand therapists and American or Canadian Society of Hand Therapists members. Quantitative methods were employed for participant demographics and categorical clinical questions about practice patterns. Qualitative descriptive questions and vignettes were analysed using inductive and deductive content analysis, respectively. Four hundred and eighty-one responses were included, representing hand therapists with a median age of 51years and median experience of 19years. Participants preferred measuring individual joints with a goniometer (N = 210, 44%) for perceived utility in informing treatment decisions, reliability, and confidence in measurement skills. Participants also preferred active functional ROM (N = 117, 24%) for being quick, easy, and useful in informing treatment decisions. Participants reported using different methods with time constraints in a busy clinic, taking precautions with pins/wounds, bulky dressings/casts, pain tolerance levels of patients, or with specific pathologies. Participants' responses to the multi-stage vignette identified distinct patterns of clinical reasoning approaches within individual vignettes. Hand therapists use multiple methods to measure finger ROM while preferring to use goniometers to measure individual finger joints. They engage procedural and pragmatic reasoning modified by contextual factors when measuring finger ROM.

Ayurvedic Insights on Improving Poor Sleep Quality

Sleep – this natural urge is so essential phenomenon of life that engages our one third of life-span, still indulging in being slept is mystery to everyone. At one side adequate sleep quality imparts fair concentration, emotional, cognitive motivational harmony inside body’s mind, soul and consciousness. Contrary to which inadequate sleep or poor sleep quality leads to tiredness, lack of focus, exhaustion, a low pain tolerance, anxiety, irritational thoughts, hallucinations, loss of appetite, constipation and many more. Sleep has a positive impact over digestion, metabolism, nourishment and health. It is irresistible, irreplaceable and unique boon for us, which is pillar of our life. The natural cycle of sleep and awakening is depending on Awastha of Sharir Dosha, Kaal Dosha, and few more factors as depicted in Ayurveda texts. So, the quality of sleep depends on these factors. If there is Kshaya of Kapha, or Vriddhi of Vata and Pitta, then the quality of sleep disturbs. In the realm of holistic well-being, Ayurveda, the ancient Indian system of medicine, offers profound insights into optimizing sleep quality. Through personalized approaches, Ayurvedic remedies like herbal formulations, lifestyle modifications, and relaxation techniques aim to rebalance Doshas and promote restful sleep. Integrating practices such as meditation, gentle yoga, and consistent sleep routines can pacify Vata and Pitta Dosha, calm the mind, and induce relaxation, fostering deeper and more rejuvenating sleep. Ayurveda's holistic perspective provides a natural and sustainable pathway to address poor sleep quality and promote overall well-being. The present paper is here to discuss in detail about Sukh Nidra.

Investigating mortality salience as a potential causal influence and moderator of responses to laboratory pain.

Because pain can have profound ramifications for quality of life and daily functioning, understanding nuances in the interplay of psychosocial experiences with pain perception is vital for effective pain management. In separate lines of research, pain resilience and mortality salience have emerged as potentially important psychological correlates of reduced pain severity and increased tolerance of pain. However, to date, there has been a paucity of research examining potentially interactive effects of these factors on pain perception. To address this gap, the present experiment investigated mortality salience as a causal influence on tolerance of laboratory pain and a moderator of associations between pain resilience and pain tolerance within a Chinese sample. Participants were healthy young Chinese adults (86 women, 84 men) who first completed a brief initial cold pressor test (CPT) followed by measures of demographics and pain resilience. Subsequently, participants randomly assigned to a mortality salience (MS) condition completed two open-ended essay questions in which they wrote about their death as well as a death anxiety scale while those randomly assigned to a control condition completed analogous tasks about watching television. Finally, all participants engaged in a delay task and a second CPT designed to measure post-manipulation pain tolerance and subjective pain intensity levels. MS condition cohorts showed greater pain tolerance than controls on the post-manipulation CPT, though pain intensity levels did not differ between groups. Moderator analyses indicated that the relationship between the behavior perseverance facet of pain resilience and pain tolerance was significantly stronger among MS condition participants than controls. This experiment is the first to document potential causal effects of MS on pain tolerance and Ms as a moderator of the association between self-reported behavior perseverance and behavioral pain tolerance. Findings provide foundations for extensions within clinical pain samples.

Pain Catastrophizing Moderates the Relationship Between Pain Sensitivity and Clinical Pain in Adolescents With Functional Abdominal Pain

Pain catastrophizing has been linked to amplified pain sensitivity assessed using quantitative sensory testing (QST) in adults; pediatric data are limited, particularly in youth with functional abdominal pain (FAP). With increasing use of QST to evaluate somatosensory function and predict pain outcomes, we examined the associations between QST and clinical pain in adolescents with FAP and tested the moderating effects of pain catastrophizing. Seventy-seven adolescents (mean age 16.6 years, 85.7% female, 72.7% White, 90.8% non-Hispanic) who fulfilled diagnostic criteria for FAP completed QST assessment (pressure pain threshold and tolerance, heat pain threshold, conditioned pain modulation) and measures of abdominal pain intensity, pain interference, and pain catastrophizing. Adjusting for age and sex, only higher heat pain threshold was associated with higher abdominal pain intensity (Beta per 1-standard deviation = .54, P = .026). Contrary to hypothesis, for youth with higher pain catastrophizing, higher pressure pain tolerance was associated with greater abdominal pain intensity, but associations were not significant for youth with lower catastrophizing (P = .049). Similarly, for those with higher pain catastrophizing (in contrast to lower pain catastrophizing), higher pressure pain thresholds and tolerance were associated with higher pain interference (P = .039, .004, respectively). Results highlight the need to investigate the influence of pain catastrophizing on QST. PerspectiveThis study demonstrated unexpected findings of pain catastrophizing moderating the relationships between pressure pain threshold and tolerance, and clinical pain in adolescents with FAP. This raised questions regarding our understanding of psychological contributions to QST findings in pediatric populations with chronic pain.

Large renal stone with ureteral stone caused by 15 years of forgotten stent

Introduction: Ureteral stents are commonly placed in urologic surgeries, and are especially indispensable in endourologic surgeries. But if it remains for more than 6 months, the probability of migration and calculus formation of the stent increases substantially. Case description: A 57-year-old female came to the urology outpatient clinic due to left flank pain. She had a history of open left nephrolithotomy 15 years ago and had ureteral stent placed. She also had a history of open vesicolithotomy surgery 4 years ago and was told to have a follow-up surgery for the remaining kidney stone but she didn’t come because of the limited level of local medical services and her pain tolerance. NCCT study showed moderate left hydronephrosis with a high volume renal stone measuring 60x35x20 mm (HU 1.021), two proximal ureteral stones measuring 40x10x10 mm (HU 1.021) and 60x5x5 mm (HU 1.021) with ureteral stent shadow in the center. She had elevated urea nitrogen and creatinine levels, microscopic hematuria, leukocyturia, and positive urine bacteria. The patient underwent percutaneous nephrolithotomy (PCNL) with endoscopic combined intra-renal surgery (ECIRS) for stone removal. Postoperative recovery was successful with no residual stones and significant pain relief. Conclusion: The case underscores the need for patient compliance, adequate practitioner counseling, and timely medical attention. The prevention of complications is the best treatment, and multimodal endourologic approaches can safely remove forgotten, encrusted double J stents.

Exploring the Severity of Kinesiophobia at Hospital Discharge in Patients Undergone Abdominal Surgery

Abstract Objective: The objective of the study was to explore the severity of kinesiophobia at hospital discharge in individuals undergone abdominal surgery by using the Tampa Scale of Kinesiophobia-11 (TSK-11). Materials and Methods: A cross-sectional observational study was carried out in a tertiary care hospital. Purposive sampling was used to select the individuals. A total of 80 participants (n = 80) were included in the study. The subjects were given the Marathi version of TSK-11. All responses were collected and statistically analyzed. Results: There were 80 participants in this study, from which 70% displayed combined “Low” and “Moderate” kinesiophobia levels. This data were collected on the day of discharge, which varied because each of the patients had different lengths of stay. The severity of kinesiophobia in these individuals displayed low-to-moderate levels of kinesiophobia due to the tolerance of pain as it differs from individual to individual. Conclusions: The study reveals that low-to-moderate kinesiophobia is common after abdominal surgery. Treatment of kinesiophobia can increase patient well-being and recovery through individualized therapy, early intervention, and psychological support. This study adds insight into postabdominal surgery kinesiophobia, highlighting varying severity levels within this population. Detecting and treating kinesiophobia in abdominal surgery patients can result in customized rehab, fewer complications, and improved health outcomes, promoting overall recovery.

The Effectiveness of Hypnoanalgesia Using Conventional and Placebo Hypnosis Induction

The effectiveness of hypnosis-based pain management is well-established. However, mechanisms of action and specific effective components are not well understood. The sociocognitive theory of hypnosis proposes that the effectiveness of hypnosis for pain management is determined by the nonspecific features of response expectancy and context. We tested this claim by contrasting the effectiveness of 2 hypnoanalgesia procedures in a within subjects design using the cold pressor task. The 2 procedures were identical, including analgesic suggestions, except for the hypnosis induction used. One condition involved a well-established hypnosis induction, including suggestions for focused attention, relaxation, and deepening. The other condition included a sham induction procedure using only white noise. In our confirmatory analysis (N = 46), we found that pain tolerance increased compared to baseline equivalently in the conventional and sham induction conditions (mean increase 13.7 and 12.4 seconds respectively, average within subject difference −1.27 seconds, 90% confidence interval [CI] = −8.46, 5.90). This finding supports the claim of the sociocognitive theory considering that response expectancy for pain reduction was also equivalent between the conditions (average difference 2.30, 90% CI = −2.23, 6.84). However, self-reported hypnosis depth was greater in the conventional induction condition (average difference −.78, 90% CI: −1.36, −.07), which contradicts sociocognitive predictions. Our findings indicate that conventional procedural elements of hypnosis inductions, such as suggestions for focused attention, relaxation, and deepening, may not be necessary to achieve acute pain reduction in an experimental setting when the hypnosis intervention includes analgesic suggestions. PerspectiveThis study assessed the necessary effective components of hypnosis-based analgesia interventions. Our findings suggest that procedural features such as suggestions for focused attention, relaxation, and deepening may not be necessary for hypnoanalgesia as long as pain relief suggestions are present, and the hypnosis context and response expectancy are established. Trial registrationThis trial was registered on Open Science Framework with the registry number e96xk, available at https://osf.io/e96xk.

Examining the Neural Basis of Pain Tolerance and Fearlessness About Death in Suicide Risk: A Research Protocol

Examining the Neural Basis of Pain Tolerance and Fearlessness About Death in Suicide Risk: A Research Protocol