Painful Situations Research Articles

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

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

Neural empathy mechanisms are shared for physical and social pain, and increase from adolescence to older adulthood.

Empathy is a critical component of social interaction that enables individuals to understand and share the emotions of others. We report a pre-registered experiment in which 240 participants, including adolescents, young adults and older adults, viewed images depicting hands and feet in physically or socially painful situations (vs. non-painful). Empathy was measured using imagined pain ratings and EEG mu suppression. Imagined pain was greater for physical vs. social pain, with young adults showing particular sensitivity to social pain events compared to adolescents and older adults. Mu desynchronisation was greater to pain vs. no-pain situations, but the physical/social context did not modulate pain responses. Brain responses to painful situations increased linearly from adolescence to young and older adulthood. These findings highlight shared activity across the core empathy network for both physical and social pain contexts, and an empathic response that develops over the lifespan with accumulating social experience.

Analysis of painful situations during unsedated esophagogastroduodenoscopy.

Background and study aims Although esophagogastroduodenoscopy (EGD) is a widely used technique, the procedure is often associated with discomfort. This study aimed to analyze painful situations, their frequency, and factors associated with patient discomfort during EGD. Patients and methods This prospective observational study included patients scheduled to undergo EGD. Seven endoscopists recruited patients scheduled for EGD screening or surveillance. Each endoscopist enrolled 20 patients, performing 10 EGD procedures using ultraslim endoscopes and 10 with standard-sized endoscopes. Data regarding painful situations and frequency were collected using specialized buttons pressed by the patients during EGD. A survey about overall discomfort was conducted after the procedure. Results We analyzed data from 140 patients. Esophageal insertion and duodenal observation were associated with the highest incidence of pressing the pain button, accounting for 59.3% and 40.7% of the cases, respectively. The factor associated with pressing the pain button during esophageal insertion was endoscopist experience (< 10 years). In contrast, younger age and female sex were the factors associated with pressing the pain button during duodenal observation. In the post-procedure survey, 63.6% of patients reported discomfort. Factors associated with patient discomfort included pressing the pain button during esophageal insertion (odds ratio [OR]: 2.84, P = 0.01) and previous painful EGD experience (OR: 2.41, P = 0.03). Concusions This study provides objective data on painful situations, their frequency, and related factors during EGD. Further research and interventions focusing on pain reduction during endoscopic procedures are warranted. The results of this study will help endoscopists manage painful situations and potentially improve skills.

Prevalence and risk factors of low back pain in military personnel: a systematic review.

Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories. For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8. Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494-2.89), history of LBP (OR = 2.2-8.91), and sedentary position (OR = 0.55-3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively. Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.

The feasibility of a Swiss complex interprofessional intervention to improve the management of procedural pain in neonates in the Finnish context: A qualitative study.

To evaluate the feasibility of the Swiss complex interprofessional intervention, NEODOL© (NEOnato DOLore), for improving the management of procedural pain in neonates in the Finnish context. Interprofessional collaboration is important for all professionals involved in the care of neonates and for neonates' parents, to understand the appropriate use of non-pharmacological and/or pharmacological methods for each pain situation and how to assess pain in real-life situations. Appropriate methods of pain relief for neonates should be preferred as they protect the development of the neonate's brain. A descriptive qualitative design. Data were collected through semi-structured focus group discussions following the Medical Research Council's framework for evaluation of complex interventions, in this case NEODOL© which aims to improve the procedural pain management of neonates. A purposive sample (n = 13) included eleven professionals representing various professions within Finnish Neonatal Intensive Care Units and two parents of infants who have received care in a Neonatal Intensive Care Unit. Data were analysed using inductive content analysis, and the results were reported in accordance with the COREQ guidelines. Professionals' and parents' evaluations suggest that NEODOL© is feasible, because it is consistent and addresses a current need. They assessed its overall content to be relevant and accessible, and its components to be internally coherent. However, they emphasise the need for further evaluation and refinement of the intervention to achieve the desired outcomes and cost-effectiveness. While NEODOL© is considered feasible, it requires further evaluation and refinement in the local context of each hospital before implementation.

Biomolecular therapies for chronic discogenic low back pain: A narrative review.

Chronic low back pain caused by intervertebral disc (IVD) degeneration, also termed chronic discogenic low back pain (CD-LBP), is one of the most prevalent musculoskeletal diseases. Degenerative processes in the IVD, such as inflammation and extra-cellular matrix breakdown, result in neurotrophin release. Local elevated neurotrophin levels will stimulate sprouting and innervation of sensory neurons. Furthermore, sprouted sensory nerves that are directly connected to adjacent dorsal root ganglia have shown to increase microglia activation, contributing to the maintenance and chronification of pain. Current pain treatments have shown to be insufficient or inadequate for long-term usage. Furthermore, most therapeutic approaches aimed to target the underlying pathogenesis of disc degeneration focus on repair and regeneration and neglect chronic pain. How biomolecular therapies influence the degenerative IVD environment, pain signaling cascades, and innervation and excitability of the sensory neurons often remains unclear. This review addresses the relatively underexplored area of chronic pain treatment for CD-LBP and summarizes effects of therapies aimed for CD-LBP with special emphasis on chronic pain. Approaches based on blocking pro-inflammatory mediators or neurotrophin activity have been shown to hamper neuronal ingrowth into the disc. Furthermore, the tissue regenerative and neuro inhibitory properties of extracellular matrix components or transplanted mesenchymal stem cells are potentially interesting biomolecular approaches to not only block IVD degeneration but also impede pain sensitization. At present, most biomolecular therapies are based on acute IVD degeneration models and thus do not reflect the real clinical chronic pain situation in CD-LBP patients. Future studies should aim at investigating the effects of therapeutic interventions applied in chronic degenerated discs containing established sensory nerve ingrowth. The in-depth understanding of the ramifications from biomolecular therapies on pain (chronification) pathways and pain relief in CD-LBP could help narrow the gap between the pre-clinical bench and clinical bedside for novel CD-LBP therapeutics and optimize pain treatment.

Empathy in autistic children: Emotional overarousal in response to others' physical pain.

Different empathic responses are often reported in autism but remain controversial. To investigate which component of empathy is most affected by autism, we examined the affective, cognitive, and motivational components of empathy in 25 5- to 8-year-old autistic and 27 neurotypical children. Participants were presented with visual stimuli depicting people's limbs in painful or nonpainful situations while their eye movements, pupillary responses, and verbal ratings of pain intensity and empathic concern were recorded. The results indicate an emotional overarousal and reduced empathic concern to others' pain in autism. Compared with neurotypical children, autistic children displayed larger pupil dilation accompanied by attentional avoidance to others' pain. Moreover, even though autistic children rated others in painful situations as painful, they felt less sorry than neurotypical children. Interestingly, autistic children felt more sorry in nonpainful situations compared with neurotypical children. These findings demonstrated an emotional overarousal in response to others' pain in autistic children, and provide important implications for clinical practice aiming to promote socio-emotional understanding in autistic children.

AB069. Type of personality and cancer-related pain in central nervous system (CNS) tumor patients: a cross-sectional study.

Pain is the most common complaint experienced by central nervous system (CNS) tumor patients. Pain, especially cancer pain, involves the whole aspect of a person, such as personality, cognition, and behavior. Personality characteristics play an important role in how a person perceives pain rate and deals with painful situation. This study aimed to describe types of personality and investigate relationship between types of personality and cancer-related pain in CNS patients. This study was conducted at Cipto Mangunkusumo General Hospital from January to December 2023, that was determined by random sampling. The analysis included a total of 99 subjects from inpatient settings. In depth interview was used to assess type of personality and Numeric Rating Scale (NRS) was used to assess intensity of pain. Data analyses were carried out using the Chi-squared and Fisher's exact test to assess the relationship between types of personality and cancer-related pain in CNS patients. There were 99 subjects with mean age of 48.37±12.96 years, mostly women (60.6%). The results showed that in patients with CNS tumor, the most common neurological deficit was cancer pain (93.9%), consisting of no-mild pain (30.3%) and moderate-severe pain (69.7%). The prevalence of narcissistic personality was 73.7%, followed by histrionic personality 15.2%, and other personality (11.1%) such as borderline, obsessive-compulsive, and avoidant personality. Narcissistic personality traits were found in 48.5% of patients with moderate-severe pain. However, bivariate analysis showed that there was no significant relationship between types of personality and intensity of pain in CNS tumor patients (P=0.60). Although there was no significant relationship, cluster B personality (narcissistic, histrionic, and borderline) was found in a large percentage of CNS tumor patients. Research findings showed that intensity of pain was caused by biological components of pain and may be influenced by the patient's perception of pain itself, not solely due to personality. Therefore, it's important for health workers to pay attention and give optimal management to every patient's pain complaint, and not to ignore or minimize it. Psychiatrists can be involved by giving psychotherapy so that patients can deal with their pain in a more adaptive way.

Neuronal activation patterns during self-referential pain imagination

In clinical assessments and pain therapy, patients are asked to imagine themselves in pain. However, the underlying neuronal processes remain poorly understood. Prior research has focused on empathy for pain or reported small sample sizes. Thus, the present study aimed to promote the neurobiological understanding of self-referential pain imagination. We hypothesised to find activation contrasts (pain vs. no pain) across pain-related areas and expected two of the most prominent predictors of chronic pain, pain sensitivity (PS) and locus of control (LoC), to be moderators.In an fMRI study, N = 82 participants completed a pain imagination task, in which they were asked to imagine themselves in painful and non-painful situations presented in the form of pictures and texts. After each trial, they were instructed to give painfulness ratings. As a laboratory measure of PS, electrical pain thresholds were assessed. A questionnaire was completed to measure LoC.Across presentation modes we found activity contrasts in previously pain-related regions, such as the prefrontal, supplementary motor, primary motor, somatosensory and posterior parietal cortices, and the cerebellum. We found positive associations of PS and external LoC with painfulness ratings, and a negative correlation between PS and internal LoC. Despite our hypotheses, neither PS nor internal LoC were significant predictors of the BOLD-signal contrasts.Though future studies are needed to draw further conclusions, our results provide preliminary evidence of a potential neuronal imagination-perception overlap in pain.

Reduced Late Positive Potentials to distress in individuals with high psychopathic traits during pain judgment tasks

This study examined the empathic processing of individuals with psychopathic traits and healthy controls in response to pain, applying affective perspective-taking (Self vs. Other). Twenty subjects with high psychopathic traits and twenty control subjects performed pain judgment tasks in the study. During the tasks, late positive potentials (LPPs) of the participants were measured to assess emotional processing in reaction to visual stimuli depicting painful or non-painful situations. In early LPP time stage (500-700ms), the control group and the psychopathic trait group exhibited comparable levels of empathic processing regarding pain. However, in late LPP time window (700-1,100ms), the control group showed a greater LPP amplitude to Pain stimuli than No-pain stimuli, whereas the psychopathic trait group exhibited non-significant amplitude differences between Pain and No-pain stimuli. These findings imply that individuals with high psychopathic traits may swiftly terminate the processing and encounter difficulties in reappraising distress cues, especially in the late stage, providing psychophysiological support for distinctive empathic processing with temporal aspects.

LIMITATIONS IN THE USE OF SUBCUTANEOUS DEFIBRILLATOR IN PATIENTS WITH LOW BODY MASS INDEX

Abstract Introduction Subcutaneous defibrillator is an effective and widely used tool in clinical practice but the presence of large fluctuations in the body mass index and the reduction of subcutaneous tissue may limit its application to all patients. Case Report In 2014, a 51–year–old woman underwent implantation of a dual–chamber transvenous defibrillator with left subclavian vein approach in secondary prevention for long Qt syndrome (LQT3). About 6 years after implantation she presented a ventricular lead breakage due to subclavian crush syndrome and was subjected to multiple inappropriate shocks due to lead failure. For this reason, the transvenous defibrillator was replaced with a single–chamber pacemaker for atrial stimulation and a subcutaneous defibrillator was implanted (Fig.1). In the following years the patient lost 14 kg and in the first months of 2022 she complained of the onset of stabbing pain in the precordial region near the upper face of the left sixth rib on the midclavicular line (Fig.2). Over the months, this symptomatology has become increasingly limiting and poorly responsive to normal analgesics but only to opiates; furthermore the pain has also occurred after a few weeks at the left parasternal level along the course of the distal portion of the subcutaneous catheter. For this reason, after discussing the case with the patient, we proceeded to implant a new transvenous lead via left subclavian vein and upgrade to a dual–chamber defibrillator. Subsequently, in the same operating session, the subcutaneous defibrillator was removed, finding only a modest traction resistance of the catheter in the parasternal area, resolved with the use of a 10 French introducer used as a sheet to debride the course of the same from the fibrotic adhesions (Fig .3). In the days following the procedure, the patient reported a progressive total disappearance of the pain symptoms. Reassessed after one year, the patient reports subjective well–being with total absence of chest pain and good quality of life. Conclusions The subcutaneous defibrillator represents an important resource for the management of the main ventricular arrhythmias, especially in patients with a high risk of infection and with a long life expectancy. The presence of a stable amount of subcutaneous tissue is a necessary condition to guarantee the tolerance of the lead over time and to avoid chronic pain situations that can lead to its removal.

Hope in children with cancer: A narrative review and a concept synthesis

Background: Hospitalized children with cancer encounter pain, suffering, fear, and life-threatening situations which can cause them to feel hopeless. Purpose: The aims of this study are to acquire new insights about the concept of hope in children with cancer and to identify the attributes, antecedents, and consequences of hope in children with cancer. Methods: Nine English and Thai-language studies that discussed the hope in children or adolescents with cancer were located using the online database in nursing (1990–2023). Qualitative analysis and synthesis of these studies were completed using an adaptation of Walker and Avant’s concept synthesis method. Results: The antecedents of hope of children with cancer were hope of other persons surrounding them and the relationship between these children and others. The attributes of hope in children with cancer were hope for cure, intentional hope and inner strength. Also, the consequences of hope in children with cancer were well-being, quality of life, coping behavior, expressing new feelings of safety or comfort, and conveying trust to others. Conclusions: This study found that hope is important and has a positive effect on body-mind and the emotions of children with cancer. Thus, healthcare providers such as nurses should enhance hope in children with cancer by promoting their inner resources, positive experiences, and emotional support, while decreasing negative emotional factors. Therefore, children with cancer have hope in their treatment outcomes and inner strength, leading to their expressing new feelings of safety and a good quality of life.

Qualified Listening to Relatives of Users at a Psychosocial Care Center

Introduction. The Psychiatric Reform introduced a new people-centered care model to replace psychiatric hospitals: the Psychosocial Care Center. Qualified listening can be used to achieve the integrality and humanization of the health care provided. It allows for the appreciation of content, the respect of its uniqueness, empathy, and the promotion of a space in which freedom of expression is provided. Objective. To identify the understanding of qualified listening from the perspective of the relative of a person with a mental disorder at a Psychosocial Care Center. Method. Qualitative, descriptive, exploratory study. Ten relatives over the age of 18 participated, contributing to the production of information. Data was obtained through the triangulation method, through semi-structured individual and collective interviews, observation, and field diary records. Results. For relatives, qualified listening translates into clarifying the illness, understanding the family’s painful situation and providing help and support during the psychosocial rehabilitation process. Discussion and conclusion. Listening constitutes a means of consolidating care networks, through the strengthening of bonds and co-responsibility, in a centered and expanded family-user logic model.

Acute physiological responses and muscle recovery in females: a randomised controlled trial of muscle damaging exercise in hypoxia

BackgroundStudies have investigated the effects of training under hypoxia (HYP) after several weeks in a male population. However, there is still a lack of knowledge on the acute hypoxic effects on physiology and muscle recovery in a female population.MethodsThis randomized-controlled trial aimed to investigate the acute effects of muscle damaging exercise, performed in HYP and normoxia (CON), on physiological responses and recovery characteristics in healthy females. Key inclusion criteria were recreationally active female participants between the age of 18 to 35 years without any previous surgeries and injuries, whilst key exclusion criteria were acute pain situations, pregnancy, and medication intake. The females conducted a muscle-damaging protocol, comprising 5 × 20 drop-jumps, in either HYP (FiO2: 12%) or CON (FiO2: 21%). Physiological responses, including capillary oxygenation (SpO2), muscle oxygenation (SmO2), heart rate (HR), core- (Tcore) and skin- (Tskin) temperature were assessed at the end of each exercise set. Recovery characteristics were quantified by taking venous blood samples (serum creatine-kinase [CK], C-reactive protein [CRP] and blood sedimentation rate [BSR]), assessing muscle swelling of the quadriceps femoris muscle, maximum voluntary isometric contraction (MVIC) of the knee extensor muscles, countermovement jump (CMJ) performance and muscle soreness ratings (DOMS) at 24-, 48- and 72-hrs post-exercise.ResultsSpO2 (HYP: 76.7 ± 3.8%, CON: 95.5 ± 1.7%, p < 0.001) and SmO2 (HYP: 60.0 ± 9.3, CON: 73.4 ± 5.8%, p = 0.03) values were lower (p < 0.05) in HYP compared to CON at the end of the exercise-protocol. No physiological differences between HYP and CON were observed for HR, Tcore, and Tskin (all p > 0.05). There were also no differences detected for any recovery variable (CK, CRP, BSR, MVIC, CMJ, and DOMS) during the 72-hrs follow-up period between HYP and CON (all p > 0.05).ConclusionIn conclusion, our results showed that muscle damaging exercise under HYP leads to reduced capillary and muscle oxygenation levels compared to normoxia with no difference in inflammatory response and muscle recovery during 72 h post-exercise.Trial registrationNCT04902924, May 26th 2021.

Empathy bodyssence: temporal dynamics of sensorimotor and physiological responses and the subjective experience in synchrony with the other's suffering.

Empathy is foundational in our intersubjective interactions, connecting with others across bodily, emotional, and cognitive dimensions. Previous evidence suggests that observing individuals in painful situations elicits whole bodily responses, unveiling the interdependence of the body and empathy. Although the role of the body has been extensively described, the temporal structure of bodily responses and its association with the comprehension of subjective experiences remain unclear. Building upon the enactive approach, our study introduces and examines "bodyssence," a neologism formed from "body" and "essence." Our primary goal is to analyze the temporal dynamics, physiological, and phenomenological elements in synchrony with the experiences of sportspersons suffering physical accidents. Using the empirical 5E approach, a refinement of Varela's neurophenomenological program, we integrated both objective third-person measurements (postural sway, electrodermal response, and heart rate) and first-person descriptions (phenomenological data). Thirty-five participants watched videos of sportspersons experiencing physical accidents during extreme sports practice, as well as neutral videos, while standing on a force platform and wearing electrodermal and heart electrodes. Subsequently, micro-phenomenological interviews were conducted. Bodyssence is composed of three distinct temporal dynamics. Forefeel marks the commencement phase, encapsulating the body's pre-reflective consciousness as participants anticipate impending physical accidents involving extreme sportspersons, manifested through minimal postural movement and high heart rate. Fullfeel, capturing the zenith of empathetic engagement, is defined by profound negative emotions, and significant bodily and kinesthetic sensations, with this stage notably featuring an increase in postural movement alongside a reduction in heart rate. In the Reliefeel phase, participants report a decrease in emotional intensity, feeling a sense of relief, as their postural control starts to reach a state of equilibrium, and heart rate remaining low. Throughout these phases, the level of electrodermal activity consistently remains high. This study through an enactive approach elucidates the temporal attunement of bodily experience to the pain experienced by others. The integration of both first and third-person perspectives through an empirical 5E approach reveals the intricate nature of bodyssence, offering an innovative approach to understanding the dynamic nature of empathy.

Character Change in Less Frequent Therapies: Psychodynamic and Transference Implications.

An approach to a once-weekly, or bimonthly (every second week), ongoing psychodynamic psychotherapy is described. The detailed description of individual sessions is intended to show the process of the uncovering of unconscious phenomena using this approach, though the therapies described are not complete. Important changes that have already occurred are described. The approach is characterized by a direct method of discovery of early painful situations that underlie specific problematic experiences in the present. The therapeutic stance is designed to establish a collaborative relationship with the patient that becomes the substrate of the relationship and often leads to an identification with the therapist who becomes an ongoing presence in the patient's life.

On the Unidimensionality and Agreement of Four Self-Report Pain Intensity Scales: A Study with Arabic-Speaking Children and Adolescents

ABSTRACT Purpose The agreement of pain intensity reports is still a matter of controversy in pediatric pain studies. The aims of this study were to determine the unidimensionality of the electronic versions of four of the most widely used scales (i.e. eNRS-11, eVAS, eFPS-R and eCAS), and the level of agreement between their pain intensity scores, when used with Arabic-speaking children and adolescents. Methods A convenience sample of 292 participants, including 137 children (8–12 years old) and 155 adolescents (13–18 years old) were asked to imagine themselves in a painful situation and rate the expected pain intensity using the four scales. A confirmatory factor analysis (CFA) was conducted to determine their unidimensionality. Subsequently, the level of agreement was calculated using the Bland—Altman method in the samples of children and adolescents independently. The maximum limit of agreement was set at ±2 with a confidence interval of 80% (CI). Results The data showed the unidimensionality of the four scales and that, with a confidence interval of 80%, only the pain intensity reports of the eVAS and the eCAS in the sample of adolescents were concordant. The data showed no agreement among the pain intensity scores in the sample of children. Conclusions The findings suggest that the Arabic versions of the four scales measure a single factor; pain intensity. However, only the scores of the eVAS and the eCAS in adolescents could be used interchangeably.

Antitumor Necrosis Factor-α Drugs and Disease-Modifying Antirheumatic Drugs for Low Back Pain

The widespread and often debilitating ailment known as low back pain (LBP) is a significant worldwide energy concern. Despite its diversity, the pathophysiology of LBP is significant for attraction, incidence, and persistence. Currently, there is a growing interest in investigating the use of disease-modifying anti-rheumatic medicines (DMARDs) and anti-tumor necrosis factor-α (TNF-α) medications as prospective therapeutic alternatives for managing LBP, especially in cases where the angering component is evident. A proinflammatory cytokine called TNF-α is present in various chronic pain situations that entail LBP. TNF-α inhibitors, typically used secondary in conditions like rheumatoid arthritis, have been demonstrated to reduce pain and inflammation in people with low back pain. Similarly, DMARDs have been purposefully introduced due to their ability to alleviate LBP. They do this by harmonizing the invulnerable reaction and occupying antagonistic-instigative belongings. This abstract highlights the role of DMARDs and TNF-α inhibitors in the instigative component of the illness and describes how they work in the administration of LBP. This emphasizes how several learning approaches must be combined in order to administer LBP because these medications are guided by potential antagonistic possessions and embodied situation designs. It also discusses ongoing, objective issues and guidelines meant to provide evidence-based justifications for their application in LBP. Although DMARDs and TNF-α inhibitors show promise as LBP treatments, more study is needed to confirm their long-term safety and efficacy. As our comprehension of the intricate pathophysiology of LBP deepens, these pharmacological incursions allow us to improve useful approaches in comprehensive treatment of this contentious illness

Pengaruh Trauma Masa Lalu terhadap Kesehatan Mental Seseorang

Trauma on human mental health, refers to the inevitable conflict, stress and frustration in social life. This phenomenon, although common, can cause an imbalance in interpersonal relationships which can lead to mental health problems. Trauma, regardless of age, occupation or skin color, occurs as a result of painful situations, both physical and psychological. The definition of trauma by Evi Sukmaningrum, Psi., Msi, highlights the individual nature of reactions to traumatic events. In the context of mental health, especially in developing countries, this problem is still not given adequate priority. Therefore, this research aims to explore the impact of trauma, explore the role of interpersonal relationships, and respond to the urgent need to increase attention to mental health problems, especially in the context of developing countries. Mental health as an integral part of human well-being is in the global spotlight, but major challenges are visible, especially in developing countries. Traumatic situations in many cases create long-term scars in the memory and subconscious mind, according to the understanding by Evi Sukmaningrum, Psi., Msi. This research seeks to approach mental health problems as an integral part of overall health, with the hope of finding effective approaches to prevention and treatment.

Physical Activity, Bleedings and Quality of Life in Patients with Haemophilia a without Inhibitors - a Multicenter, Observational Italian Study with a Wearable Device

Introduction: Haemophilia A (HA) is characterized by spontaneous or traumatic recurrent bleedings, especially in joints and muscles, which can cause haemophilic arthropathy, impaired function, and in turn, reduce physical and social activities and negatively impact the quality of life (Franchini M at al., Semin Thromb Hemost, 2022 Nov; Mannucci PM et al., N Engl J Med, 2001 Jun). Despite regular physical activity (PA) being strongly recommended by guidelines as a key element to improve well-being and mental health, the perception of an associated increased risk of bleeding and bleed-related issues discourage people with hemophilia A (PWHA) (Makris M at al, Haemophilia, 2013 Jan; Matlary RED at al., Haemophilia, 2022 Nov; Srivastava A et al., Haemophilia, 2020 Aug 1) Methods: This cohort study (NCT04165135 - POWER) is a multicenter study conducted in 18 investigational Italian sites aimed at gathering data on activity status, bleeding, QoL, and health status, through the use of a wearable device and an ePRO app, in individuals with moderate or severe HA without inhibitors receiving standard of care (SoC) treatment. This population was observed for 12 months or up to 18 months if the therapy with a newly approved product was initiated during the study. The study started in January 2020 and has been completed in April 2022 with the last data collection. Results: A total of 103 male patients represented the Intention To Treat Population (ITT). Of them, 97 (94.2%) had severe (FVIII &amp;lt;1%) and 6 (5.8%) moderate (FVIII 1-2%) HA without inhibitors. They were aged 12-50 years (17, 16.5% aged 12-17 years [adolescents]; 46, 44.7% aged 18-30 years [young], and 40, 38.8% aged 31-50 years [adults]); 21 subjects switched to a newly approved agent for HA during the study and were followed for additional six months after the switch. Eighty-eight (85%) completed the study. The primary outcome measures included the duration and type of PA, distance covered, calories burned, body weight, heart rate, sleep data, active minutes, metabolic equivalents for tasks (METs), and step counts. The secondary measurements included the documentation of PA by type and intensity, the description of the population in terms of adherence to WHO Guidelines, disease severity, and treatment regimen for HA, health status, joint health status, and BMI. PA data were collected continuously through a fitness tracker worn by the patient. HRQoL questionnaires, joint health assessments, intensity of pain and bleeding episodes were recorded by the patient through an ePRO app (Petracca F. at al., JMIR Form Res 2021) Only 54/103 subjects (52.4%), which represented the Evaluable Population (EVL), were using the fitness tracker for at least 10 hours in 50% of their days for a period of at least 6 months in the study; adolescents were the least compliant age group. The fitness tracker's analysis of the type of activity collected showed low weekly rates for all activities (no differences in the different physical activities). High-intensity physical activities were poorly represented in all the subgroups. Approximately 51% of the subjects (including all adolescents) had sedentary behavior (Figure1). The mean METs per day were lower in adults. The EQ-5D utility score did not change during the observational period. The mean EQ-5D VAS progressively worsened, indicating a situation of discomfort and pain during the study. The results of HRQoL showed that a sedentary condition was associated with a worse quality of life, a higher risk of hospitalization, and a worse joint status compared to active patients. At least one bleeding (mean 2.9; median 2.0) was reported in 43.7% of the subjects (Figure 2), with a higher proportion in sedentary than active subjects. The physical activity in the 2 days preceding the bleeding was comparable to the one observed in the overall observational period. Adherence to the treatment regimen was quite poor overall (mean 55%) and only 26.2% of the subjects had an adherence ≥ 80%. Conclusion: The results from this study show that patients with HA without inhibitors have a lower-than-expected physical activity. Despite the poor PA, around half of the subjects reported bleeds, especially in the sedentary population. This suggests that other causes than PA, such as treatment adherence and type of treatment, might affect the number, frequency, and severity of bleedings. This study has been sponsored and financially supported by Roche Italy.