Subjective Pain Research Articles

The Potential of a Robot Presence in Close Relationship to Influence Human Responses to Experimental Pain

Pain management is a critical challenge in healthcare, often exacerbated by loneliness and emotional distress. This study investigated the potential of a communication robot, Moffuly, to reduce pain perception and influence hormonal responses in a controlled experimental setting. Nineteen healthy participants underwent heat pain stimulation under two conditions: with and without robotic interaction. Pain levels were assessed using the Short-form McGill Pain Questionnaire and the Visual Analogue Scale, while mood and mental states were evaluated through established questionnaires including the Profile of Mood States, Hospital Anxiety and Depression Scale, and Self-Rating Depression Scale. Hormonal changes, including cortisol, growth hormone, oxytocin, estradiol, and dehydroepiandrosterone-sulfate, were measured from blood samples collected at key time points. The results demonstrated significant reductions in subjective pain and improvements in mood following robotic interaction. These effects were accompanied by favorable hormonal changes, including increased oxytocin and decreased cortisol and growth hormone levels. The findings suggest that robotic interaction may serve as an innovative approach to pain management by addressing both physiological and psychological factors. This study highlights the potential of robotics to complement traditional therapies in alleviating pain and enhancing emotional well-being. By mitigating emotional distress and loneliness, robotic interventions may enhance existing pain therapies and offer innovative solutions for resource-limited healthcare systems.

A randomized controlled clinical study to evaluate the efficacy of Karanja Patra Arka in the management of Dusta Vrana vis-à-vis Chronic Non-Healing Ulcer

Background: Dusta Vrana is a prevalent surgical issue that delays healing due to infection, slough, poor hygiene, and foreign bodies. A holistic approach is essential for chronic leg ulcer care, addressing underlying causes, accurate diagnosis, and peculiar treatment. Karanja patra is indicated for wound management in Arka Prakasha. Therefore, this study seeks to assess this aspect. Objectives: To evaluate the efficacy of Karanja Patra Arka in the management of Dushta Vrana and to compare the efficacy of Karanjapatra Arka and Gomutra Arka. Methodology: A single-blind study with a total number of 40 patients with selection criteria of Dushta Vrana were included in this study. In Group A Karanja Patra Arka wound dressing. In Control: Gomutra Arka dressing. Daily wound care for 30 days or granulation tissue formation. Weekly follow-ups and statistical analyses were done. Result: A significant improvement was noted in both subjective (Pain, Itching, and smell) and objective (Bates Jenson criteria) outcomes. Conclusion: Both Arkas shows improvement in subjective symptoms (smell, itching, pain), but differ in their objective outcomes. Karanjapatra Arka excelled in wound healing (Vrana Ropana), while Gomutra Arka showed stronger wound cleansing (Vrana Shodhana).

Comparison of the Effectiveness of Two Different Methods of Alleviating Pain and Anxiety during Local Anaesthesia Administration in Children: A Split-mouth Study

Abstract Introduction: This study aimed to compare the effectiveness of two different methods, a custom-designed mucosal vibrator and topical benzocaine gel, in alleviating pain and anxiety during local anaesthesia (LA) administration in paediatric patients. Materials and Methods: A randomised, split-mouth controlled trial was conducted with 30 paediatric patients aged 5–10 years. Each child received LA with a custom-designed mucosal vibrator in one session and with topical benzocaine gel in another. Pain perception and anxiety were assessed using the Wong-Baker FACES Pain Rating Scale, Sound–Eye–Motor Scale and pulse rate measurements. The sequence of interventions was randomised using the sequentially numbered, opaque, sealed envelope technique. Results: The study found that the custom-designed mucosal vibrator significantly reduced pain perception compared to the benzocaine gel, as evidenced by both subjective and objective pain scores (P < 0.05). However, the two methods showed no significant difference in anxiety levels, as indicated by similar pulse rate changes (P > 0.05). Conclusion: The custom-designed mucosal vibrator offers a cost-effective and efficient alternative to topical benzocaine for reducing pain during LA in children, though it does not significantly alter anxiety levels. This device could be a valuable tool for paediatric dental practitioners to improve the comfort of their patients during dental procedures.

Myofascial trigger points therapy increases neck mobility and reduces headache pain in migraine patients – pilot study

BackgroundThis study aimed to evaluate the effects of Ischemic Compression Myofascial Trigger Points (IC-MTrPs) therapy, applied mainly to the upper trapezius muscle (UTM), on: [1] cervical spine range of motion (CS-ROM), and [2] headache characteristics in migraine patients. Reduced CS-ROM can further contribute to musculoskeletal strain and neurological discomfort in migraine sufferers. The application of IC-MTrPs therapy is of particular interest because it targets these trigger points, potentially normalizing muscle tone and improving local blood flow, which may alleviate pain and restore mobility.DesignA case series employing a repeated-measures design; pilot study.MethodsFifty-three adult female migraine patients were classified into three groups: episodic migraine without aura (MO, n = 31), episodic migraine with aura (MA, n = 15), and chronic migraine (CM, n = 7). Patients underwent seven sessions of IC-MTrPs therapy targeting the shoulder and neck muscles. Assessments were conducted across five sessions: pre-therapy (baseline), post-1st therapy, post-4th therapy, post-7th therapy, and at a 1-month follow-up. Outcome measures included: CS-ROM (assessed using an accelerometer system), subjective headache pain intensity (evaluated via the Visual Analog Scale (VAS)), and calcitonin gene-related peptide (CGRP) concentrations.ResultsCS-ROM for horizontal rotation and forward flexion improved significantly at the 1-month follow-up compared to pre-therapy (baseline) (P < 0.05). Headache intensity during a migraine attacks, as well as headache frequency and duration, significantly decreased at post-7th therapy compared to baseline across all patients (P < 0.05). The highest CGRP concentrations were recorded in CM patients (240.73 ± 79.51 ng/ml). While no significant changes in CGRP levels were observed in patients with MO, CGRP concentration in patients with MA increased significantly at the 1-month follow-up compared to baseline, rising from 151.70 ± 50.85 ng/ml to 176.17 ± 77.21 ng/ml. In patients with CM, the therapy did not result in statistically significant changes in CGRP levels, although reductions in headache frequency and intensity were noted.ConclusionsIC-MTrPs therapy proved effective in increasing CS-ROM and alleviating headache characteristics in all migraine subtypes. However, no significant changes in CGRP levels were observed. Distinct characteristics and responses among different migraine subtypes highlight the need for tailored therapeutic approaches.Trial registrationThe study protocol was retrospectively registered on December 2, 2022, as a clinical trial in the international clinical trial database ClinicalTrials.gov (identifier: NCT05646160). Clinical trial number: not applicable.

Feasibility of a novel back support device to improve spine stability and muscular activity during trunk flexion: A prospective cross-sectional study with healthy controls and low back pain subjects - preliminary.

Low back pain is a prevalent global condition often challenging to address due to the absence of a definitive diagnosis in over 80% of cases. Manual lifting, common in many work environments, contributes to low back pain due to lumbar spine stresses, and existing assistive technologies like abdominal belts and exoskeletons have limitations in managing low back pain effectively. This paper presents a novel back support device designed to generate abdominal compression during flexion activities, potentially enhancing lumbar stability through increased intra-abdominal pressure. The study involved 14 participants with chronic non-specific low back pain and 18 gender-matched healthy controls doing controlled movement tests with and without the support device. Results suggest that the back support device increased intra-abdominal pressure in both groups during various functional tasks, more notably in active flexion and lifting tasks (up to +43%). The device also contributed to decreasing lumbar range of motion during guided flexion (-18 to -37%, except at the lumbosacral junction in the low back pain group), emphasizing its potential impact in limiting excessive spinal movement. Muscle activity assessments revealed decreased activation during active flexion and lifting movements while wearing the device, suggesting the possibility to assist trunk stabilization without the corresponding antagonistic muscle activation and associated compressive load on the spine. These effects could help workers to maintain their activities in the workplace and help workers suffering from low back pain to gradually reintegrate work or physical activities, contributing to better overall management of back health.

Multimodal Pain Recognition in Postoperative Patients: Machine Learning Approach.

Acute pain management is critical in postoperative care, especially in vulnerable patient populations that may be unable to self-report pain levels effectively. Current methods of pain assessment often rely on subjective patient reports or behavioral pain observation tools, which can lead to inconsistencies in pain management. Multimodal pain assessment, integrating physiological and behavioral data, presents an opportunity to create more objective and accurate pain measurement systems. However, most previous work has focused on healthy subjects in controlled environments, with limited attention to real-world postoperative pain scenarios. This gap necessitates the development of robust, multimodal approaches capable of addressing the unique challenges associated with assessing pain in clinical settings, where factors like motion artifacts, imbalanced label distribution, and sparse data further complicate pain monitoring. This study aimed to develop and evaluate a multimodal machine learning-based framework for the objective assessment of pain in postoperative patients in real clinical settings using biosignals such as electrocardiogram, electromyogram, electrodermal activity, and respiration rate (RR) signals. The iHurt study was conducted on 25 postoperative patients at the University of California, Irvine Medical Center. The study captured multimodal biosignals during light physical activities, with concurrent self-reported pain levels using the Numerical Rating Scale. Data preprocessing involved noise filtering, feature extraction, and combining handcrafted and automatic features through convolutional and long-short-term memory autoencoders. Machine learning classifiers, including support vector machine, random forest, adaptive boosting, and k-nearest neighbors, were trained using weak supervision and minority oversampling to handle sparse and imbalanced pain labels. Pain levels were categorized into baseline and 3 levels of pain intensity (1-3). The multimodal pain recognition models achieved an average balanced accuracy of over 80% across the different pain levels. RR models consistently outperformed other single modalities, particularly for lower pain intensities, while facial muscle activity (electromyogram) was most effective for distinguishing higher pain intensities. Although single-modality models, especially RR, generally provided higher performance compared to multimodal approaches, our multimodal framework still delivered results that surpassed most previous works in terms of overall accuracy. This study presents a novel, multimodal machine learning framework for objective pain recognition in postoperative patients. The results highlight the potential of integrating multiple biosignal modalities for more accurate pain assessment, with particular value in real-world clinical settings.

The influence of high doses of vitamin C on functional recovery and postoperative pain in patients with trochanteric fracture after intramedullary nailing during a three-month follow-up: a pilot study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To determine the effects of high peri- and postoperative doses of vitamin C administration on severity of pain in postoperative period and functional outcome of the patients with trochanteric fracture treated with intramedullary nailing during a three-month follow-up.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; A prospective, randomized, pilot study included 56 patients who were randomly divided into vitamin C (intervention) and control groups. In the intervention group, patients received vitamin C perioperatively by an intravenous route for 2 days, and oral vitamin C for 38 days postoperatively. Baseline characteristics, postoperative metamizole consumption, Visual Analogue Scale (VAS) score, Harris Hip Score (HHS) value, and the prevalence of complications were evaluated in both groups.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; No significant differences were noted between the groups regarding age, gender, length of hospitalization, and distribution in fracture type. Postoperative metamizole consumption was notably higher in the control group compared to the vitamin C group (p=0.006). Postoperative VAS score was higher in the control group (p&amp;amp;lt;0.05). No significant differences in HHS values were detected between the groups at 6 and 12 weeks postoperatively (p=0.655 and p=0.755, respectively). The group variable significantly contributed to VAS score, and age and gender variables significantly contributed to HHS value.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; A significant reduction of subjective pain levels and lower analgesic consumption was found in patients who received vitamin C, suggesting that it should be considered as an adjuvant agent for analgesia in patients with hip fracture.&amp;lt;/p&amp;gt;

Momentary physical activity, subjective age, and the moderating role of pain

Subjective age, that is felt age compared to chronological age, is an important predictor of health and well-being in later life. It can fluctuate from day to day and from one moment to another. Previous cross-sectional and macro-longitudinal studies have shown that feeling younger is related to physical fitness and exercise. Yet, there is limited knowledge on the effects of physical activity on subjective age in daily life and moderators of this association. We thus aim to investigate the association of momentary physical activity with momentary subjective age, expecting that more activity is related to feeling younger. We further expect that concurrent pain experience attenuates this relationship. N = 54 participants aged 50–62 years (Mage = 56.1 years, 75% female) wore chest-sensors measuring their physical activity (step count, movement acceleration) for one week and reported on their subjective age five times per day. Multilevel regression analyses revealed between and within-person variation in momentary subjective age (ICC = 0.74), pain (ICC = 0.63) and physical activity (ICC Moac30 = 0.078, steps30 = 0.053). Pain emerged as a consistent predictor of momentary subjective age (b = 4.64, p = 0.000), whereas results were mixed for the physical activity measures. No significant moderating effect of pain was observed on the relationship between physical activity and subjective age. Our study shows the importance of pain experiences for momentary subjective age, whereas the role of momentary physical activity needs further exploration.

Optimizing Recovery Strategies in Elite Speedskating: A Comparative Analysis of Different Modalities.

Background/Objectives: As short-track speed skaters have to race multiple races to achieve success during competition, optimizing the recovery between efforts is a noteworthy performance determinant. Therefore, we compared three different recovery modalities (active cycling recovery, pneumatic compression boots, and isocapnic breathing protocol) in the context of perceived subjective pain and recovery variables, multiple biochemical and biomechanical indices, CMJ height and power, as well as repeated efforts on the ice track. Methods: Fifteen elite short-track speed skaters (eight males and seven females; age 18.3 ± 1.0 years, height 175.6 ± 7.5 cm, weight 73.7 ± 7.7 kg, 23.8 kg/m2, VO2max 55.5 mL·kg-1·min-1: ♂ 58 20 ± 3.6 mL·kg-1·min-1; and ♀ 53 ± 4.5 mL·kg-1·min-1) completed the study experiment and were included in the analyses. Repeated measures ANOVA with optional post hoc Bonferroni correction was used to assess the association magnitude of changes in variables across the recovery methods. Results: All the investigated protocols were associated with significant changes in multiple recovery indices observed within all the investigated protocols (p ≤ 0.05). However, for this sample, they resulted in analogous effects on subjective variables, hormonal response, creatine kinase, CMJ parameters, and on-ice performance (between-protocol effect: p ≥ 0.002). Changes in creatine kinase were generally higher in males than females (p = 0.05), which might suggest that optimal recovery protocols in short-track are gender-dependent. Conclusions: Since compression and active cycling remain gold standard recovery protocols, a similar response from isocapnic breathing suggests it may be a modality particularly useful in real-world settings.

EFFECT OF AGNIKARMA IN AMSAMARMA ABHIGHATA - TRAUMATIC PERI-ARTHRITIS OF THE SHOULDER JOINT- A CASE REPORT

Periarthritis of the shoulder joint is a condition characterised by disabling pain, inflammation, stiffness, and restriction of both active and passive movements of the shoulder joint. Among the factors suggested for the cause of the disease, trauma is found to be one of them. Traumatic periarthritis of the shoulder joint may be correlated with Amsamarma Abhighata due to similarity in clinical features such as Bahukriyaharam and Stabdabahutha. Acharya Susrutha mentioned that Agnikarma is effective in Ruja pertaining to Sira, Snayu, Sandhi and Asthigata Vikara. Amsamarma is a Snayu Marma and Acharya Susrutha has mentioned Dahanopakarana like Kshoudra, Guda, Sneha for Agnikarma in Sira, Snayu, Sandhi, Asthi gata Vikara. In this study, a female patient 60 years was treated with Agnikarma to assess the effect of Agnikarma with Tila Taila in Amsamarma Abhighata - Traumatic periarthritis of shoulder joint. Agnikarma has properties like Vatakaphahara, Ushna, Sookshma, and Ashukari Guna, which help relieve pain and stiffness instantly. Snigdha dravyas have deep heat penetration capacity with a greater latent heat period. It is helpful in musculoskeletal disorders and can be done on an OPD basis. The assessment was done on subjective parameter, pain and objective parameter like range of movements(Abduction). The patient was assessed before and after treatment. Follow-up was done on the 7th, 15th and 30th day for 1 month.

Vibration Energy Color Doppler Imaging (VECDI) in Evaluating the Effect of Screw Fixation on Sacroiliac Joint Stiffness: A Prospective Pilot Study

BackgroundThe sacroiliac joints (SIJ) are specialized articulations in the pelvis that allow load transfer between the upper and lower body. Traumatic pelvic disruption often requires surgical fixation of at least one of these joints. Subsequent SIJ pain is associated with asymmetries in joint laxity or stiffness. This pilot study examines SIJ stiffness in patients with intact sacroiliac screw fixation after posterior pelvic ring injuries. This information will prove valuable to informing surgeons about technique efficacy in SIJ injury stabilization.Questions/purposesThis pilot study examined SIJ stiffness in patients with intact sacroiliac screw fixation to: (1) establish vibration energy color Doppler imaging (VECDI) SIJ intra-rater reliability; (2) measure SIJ stiffness in subjects following surgical fixation using VECDI; (3) compare stiffness data between post-surgical and healthy control subjects; (4) evaluate the relationship between stiffness data and pain and disability scores.Methods13 reliability and 19 experimental subjects were tested using VECDI. Subjects were placed into a side-lying position on top of a shaker apparatus that transmitted vibration energy to the pelvic ring while color Doppler images were taken from the bilateral posterior SIJ. One investigator performed SIJ measurements on healthy subjects to establish reliability and then evaluated post SIJ fixation stiffness in experimental subjects at four-weeks (T1) and eight-weeks (T2). Visual analog scales were used to collect subjective pain scores at each time point.ResultsHealthy subject VECDI values suggested good intra-rater reliability (ICC = 0.819; CI 95% = 0.405–0.945). No significant differences in SIJ stiffness (ΔTU) were observed between healthy and experimental subjects at both time points (p > .05). Pearson correlation coefficients highlighted relationships between current pain at T1 and T2 (p = .004, r = .879), and Oswestry Disability Index (ODI) values at T1 and T2 (p = .003, r = .890).ConclusionsAsymmetric laxity through the SIJ can be associated with pain resulting from either trauma or inherent physiologic variations. Prior to this study, the mainstay of evaluation was subjective indexes, such as the ODI. Here we propose VECDI as a potentially objective tool in SIJ assessment. Following surgical fixation necessitated by trauma, fixation using SI screws demonstrated similar stiffness values through the SIJ at four- and eight-weeks post-operatively when compared to healthy controls. Direct inferences regarding VECDI’s exact sensitivity to SIJ dysfunction cannot be concluded from our investigation due to small sample sizes. Future investigations should include a larger sample size to enhance our understanding of stiffness measurements obtained using VECDI, validate the technique, and determine the time-course of healing from SIJ surgical stabilization.

Differences in Plasma BDNF Levels Between Chronic Primary Musculoskeletal Pain, Fibromyalgia Syndrome, and Asymptomatic Subjects: A Cross-Sectional Study.

This cross-sectional study compared plasma brain-derived neurotrophic factor (BDNF) levels among chronic primary musculoskeletal pain patients, chronic widespread pain patients, and asymptomatic controls. The study included 126 participants aged 18-65, divided into three groups of 42 each. Pain intensity was assessed using a Numeric Rating Scale (NRS), and plasma BDNF levels were measured via ELISA. Differences between groups were evaluated using ANOVA with 2000 bootstrap resamples and a bias-corrected and accelerated method. Results showed significantly higher plasma BDNF levels in chronic widespread pain patients (mean difference [MD] = 0.44; 95% CI = 0.28, 0.62; p < .001) compared to controls, and higher than in chronic primary musculoskeletal pain patients (MD = 0.83; 95% CI = 0.64, 1.02; p < .001). Chronic primary musculoskeletal pain patients had lower plasma BDNF levels compared to controls (MD = -0.39; 95% CI = -0.54, -0.24; p < .001). No significant correlations were observed between plasma BDNF levels and clinical variables. These findings suggest the potential of BDNF as a biomarker to differentiate chronic primary pain conditions.

The Effect of Denosumab on Pain and Radiological Improvement in Giant Cell Tumours of the Spine in the Acute Setting.

Retrospective Cohort Study. The current recommended treatment for Giant Cell Tumour (GCT) of the spine is en bloc excision. Denosumab is a monoclonal antibody reducing osteoclast activity that shows promising results when used as a neo - adjuvant treatment. However, the current literature remains limited. The purpose of this study was to assess the effect of denosumab on tumour characteristics and symptom relief in the acute phase of treatment of spinal GCT. We performed a retrospective review of 16 patients treated with denosumab as neo-adjuvant and stand - alone treatment. MRI and PET tumour characteristics were taken before and after treatment and patients were interviewed for subjective pain responses. Following treatment, all patients showed improvement of pain, of which 68.7% of patients were pain free with 43.75% noting improvement within 48hours. Mean relative volumetric reduction in tumour volume was 37.3% (P < .001). Eight patients showed high grade of Bilsky classification (Epidural spinal cord compression scale - ESCC) with seven of them showing significant improvement to low grade of ESCC (P = .016). Median baseline PET Standardised Uptake Value (SUV)max was 14.57 and post treatment was 4.8 (P < .001). This study provides necessary insight to the limited literature on the use of denosumab for spinal GCT in the acute phase. The clinical and radiographic responses observed demonstrate the critical role that neo-adjuvant denosumab has by reducing the tumour burden around critical adjacent neurovascular structures before eventual resection, significant pain improvement even with presence of fractured vertebra.

Knee injury and osteoarthritis outcome score and knee society score for the minimal clinically important differences after cruciate-retaining total knee arthroplasty: Two-year follow up.

This study investigated changes in the Knee Injury and Osteoarthritis Outcome Score (KOOS), 2011 Knee Society Score (KSS), and minimal clinically important differences (MCIDs) of these scores preoperatively to 2years after total knee arthroplasty (TKA). This single-center retrospective study included 168 patients who underwent primary cruciate-retaining (CR) TKA using the subvastus approach. The KOOS and KSS were assessed preoperatively and during the 3-month, 6-month, 1-year, and 2-year follow ups. The MCIDs of the KOOS and KSS were calculated using distribution-based methods with standard deviation. All patient-reported outcome measures improved considerably from preoperatively to 3months postoperatively. KOOS pain and symptom scores considerably improved at approximately 2years postoperatively, with KOOS activities of daily living (ADL) and sports/recreation subscale scores showing rapid improvement within 3months, followed by smaller gains. MCID thresholds for KOOS subscales were as follows: pain, 14.3-15.3; symptoms, 14.1-15.6; ADL, 15.2-16.0; sport/recreation, 11.7-11.8; and quality of life, 13.6-14.4. KSS objective knee indicators and satisfaction improved considerably approximately 2years postoperatively; however, scores on the expectation and functional activity subscales did not improve after 1year. MCID thresholds for KSS subscales were as follows: objective knee indicators, 4.6-4.7; satisfaction, 4.9-5.0; expectation, 2.4; and functional activities, 12.0-12.3. Improvements in the KSS objective knee indicators and KOOS subjective pain and symptom scores were similar over the 2-year follow up. These findings may help better understand the expected outcomes of CR-type TKA, especially in severe osteoarthritis cases, thereby informing patient counseling.

Altered lumbo-pelvic-hip complex muscle morphometry and contraction change in postpartum pelvic girdle pain and asymptomatic subjects: a cross-sectional study.

Lumbo-pelvic-hip complex muscle training is considered a crucial component of exercise rehabilitation for postpartum women with pelvic girdle pain (PGP). However, there is a paucity of research evidence regarding the morphological changes and contraction function of these muscles in postpartum women with PGP. Understanding the alterations in lumbo-pelvic-hip complex muscles function associated with PGP, is crucial for tailoring effective rehabilitation strategies and promoting optimal postpartum recovery. Therefore, this study aims to compare the differences in muscle thickness and contraction function of lumbo-pelvic-hip complex muscle between postpartum women with PGP and asymptomatic controls using ultrasound imaging. One hundred and fifty postpartum women with PGP and fifty age-matched asymptomatic postpartum women were recruited in this study. Real-time musculoskeletal ultrasound was utilized to measure the resting muscle thickness of nine lumbo-pelvic-hip complex muscles, including the erector spinalis (ES), latissimus dorsi (LD), quadratus lumbalis (QL), gluteus maximus (GMax), gluteus medius (GMed), piriformis (PF), iliacus muscle (IM), rectus femoris (RF), and biceps femoris (BF). The thickness of the GMax, GMed, RF, and BF muscles were measured at maximum contraction to calculate a contraction: rest ratio. Compared to the asymptomatic women, those with PGP exhibited reduced resting thickness of the ES and GMax muscles bilaterally, as well as increased resting thickness of the right LD and IM muscles. Furthermore, the PGP group demonstrated decreased thickness of the left GMed and right RF muscles at maximum contraction. The contraction ratio was also diminished for the GMax muscles bilaterally, left GMed, and right RF in women with postpartum PGP. Conclusion: Postpartum women with PGP demonstrated reduced thickness, asymmetry, and diminished contractility of the lumbo-pelvic-hip complex muscles. Exercise prescriptions for postpartum women with PGP should incorporate targeted strengthening of the ES, GMax, GMed, and RF muscles. Postpartum women with PGP demonstrated reduced thickness, asymmetry, and diminished contractility of the lumbo-pelvic-hip complex muscle. Exercise prescriptions for postpartum women with PGP should incorporate targeted strengthening of the ES, GMax, GMed, and RF muscles.

Anxiety and depression prior to total knee arthroplasty are associated with worse pain and subjective function: A prospective comparative study.

The aim of this study was to investigate the influence of preoperative anxiety and depression on subjective function, pain and revision rates following total knee arthroplasty (TKA). A prospective comparative study was conducted, including 349 patients undergoing TKA surgery between January 2019 and April 2021. Patients completed the Hospital Anxiety and Depression Scale (HADS) questionnaire preoperatively, and a set of Patient-Reported Outcome Measures (PROMs) preoperatively and at 6, 12 and 24 months postoperatively. Patients were categorized into anxiety and depression groups based on HADS scores. PROMs included the Knee injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), Oxford Knee Score (OKS) and NRS-Pain. Differences in PROM scores between the anxiety/depression group and, respectively, nonanxiety/nondepression group were assessed, as well as differences in minimal clinical important difference (MCID) and attainment of Patient Acceptable Symptom State (PASS). Lastly, revision rates were compared. Anxiety and depression groups exhibited inferior subjective function preoperatively and postoperatively compared to nonanxiety and nondepression groups (all p < 0.05), experienced more pain preoperatively (p < 0.001) and also postoperatively for depression patients (all p < 0.05). Significantly fewer patients with anxiety and depression reached the PASS for KOOS-PS, OKS and NRS-Pain (all p < 0.05). There were no differences in the proportion of patients reaching the MCID for all PROMs (all p > 0.060), and revision rates did not differ between groups (both p > 0.96). Preoperative anxiety and depression negatively influence subjective function and pain preoperatively and up to 2-year follow-up in patients undergoing TKA. Revision rates did not differ between groups, and there were no relevant differences in clinical improvement of subjective function and pain. Level II, prospective comparative study.

Efficacy and safety of SHR8554 on postoperative pain in subjects with moderate to severe acute pain following orthopedic surgery: A multicenter, randomized, double-blind, dose-explored, active-controlled, phase II/III clinical trial.

Biased µ-opioid receptor (MOR) agonists enhance pain relief by selectively activating G protein-coupled receptor signaling and minimizing β-arrestin-2 activation, resulting in fewer side effects. This multicenter Phase II/III trial evaluated the optimal dosage, efficacy, and safety of SHR8554, a biased MOR agonist, for postoperative pain management following orthopedic surgery. In Phase II, 121 patients were divided into four groups to receive varying patient-controlled analgesia (PCA) doses of SHR8554 or morphine. Phase III involved 320 patients with similar groupings, including a placebo group. The primary outcome was the resting summed pain intensity difference over 24 hours (rSPID24). Secondary outcomes included rSPID and active-SPID (aSPID) at other time points, rescue analgesia received, cumulative dose of analgesics, and satisfaction scores. Safety endpoints included treatment-emergent adverse events (TEAEs) and AE of special interest (AESIs). In both phases, SHR8554 demonstrated significant analgesic efficacy. In Phase II, the least squares (LS) mean differences in rSPID24 compared to morphine for the 0.05 mg,0.1 mg, and 0.2 mg SHR8554 groups were 16.8 (p = 0.01), 7.4 (p = 0.27), and 0.2 (p = 0.98), respectively. Phase III confirmed the efficacy of the 0.05 mg and 0.1 mg SHR8554 doses compared to placebo, with LS mean differences of 15.4 (p = 0.0001) and -19.8 (p < 0.0001), respectively. Trends in other secondary outcomes mirrored these findings. Safety analysis revealed that the 0.2 mg SHR8554 group had higher incidences of TEAEs (83.3 %) and AESIs (33.3 %) compared to other groups in Phase II. Similarly, in Phase III, the incidences of TEAEs were 81.0 %, 73.4 %, and 74.1 % in the 0.05 and 0.1 mg SHR8554 and morphine groups, respectively, compared with 61.3 % in the placebo group, while the AESIs were 29.1 %, 20.3 %, and 24.7 % compared with 12.5 % in the placebo group. In conclusion, SHR8554 exhibited efficacy compared to placebo and safety comparable to morphine for patients experiencing moderate-to-severe acute pain following unilateral total knee replacement or knee ligament reconstruction surgery. TRIAL REGISTRATION: Trial Name: Study on the Efficacy and Safety of SHR8554 Injection for Postoperative Analgesia in Orthopedics: Multicenter, Randomized, Double Blind, Dose Exploration, Placebo/Positive Control, Phase II/III Clinical Trial Registered on: chinadrugtrials.org.cn Identifier: CTR20220639.

The Investigation of the Relationship Between Individual Pain Perception, Brain Electrical Activity, and Facial Expression Based on Combined EEG and Facial EMG Analysis.

Pain is a multidimensional, unpleasant emotional and sensory experience, and accurately assessing its intensity is crucial for effective management. However, individuals with cognitive impairments or language deficits may struggle to accurately report their pain. EEG provides insight into the neurological aspects of pain, while facial EMG captures the sensory and peripheral muscle responses. Our objective is to explore the relationship between individual pain perception, brain activity, and facial expressions through a combined analysis of EEG and facial EMG, aiming to provide an objective and multidimensional approach to pain assessment. We investigated pain perception in response to electrical stimulation of the middle finger in 26healthy subjects. The 32-channel EEG and 3-channel facial EMG signals were simultaneously recorded during a pain rating task. Group difference and correlation analysis were employed to investigate the relationship between individual pain perception, EEG, and facial EMG. The general linear model (GLM) was used for multidimensional pain assessment. The EEG analysis revealed that painful stimuli induced N2-P2 complex waveforms and gamma oscillations, with substantial variability in response to different stimuli. The facial EMG signals also demonstrated significant differences and variability correlated with subjective pain ratings. A combined analysis of EEG and facial EMG data using a general linear model indicated that both N2-P2 complex waveforms and the zygomatic muscle responses significantly contributed to pain assessment. Facial EMG signals provide pain descriptions which are not sufficiently captured by EEG signals, and integrating both signals offers a more comprehensive understanding of pain perception. Our study underscores the potential of multimodal neurophysiological measurements in pain perception, offering a more comprehensive framework for evaluating pain.

Pharmacological and non-pharmacological interventions for pain control in outpatient hysteroscopy: A systematic review.

Outpatient hysteroscopy (OPH) is an important diagnostic and therapeutic intervention in gynaecology. However, the most common reason for failure is pain. Currently, there is no consensus regarding analgesia for OPH amongst the literature. The aim of this systematic review was to assess the efficacy of pharmacological and non-pharmacological interventions for pain control during OPH. Randomised controlled trials (RCT) from January 2017 to February 2024 assessing efficacy of pharmacological and non-pharmacological methods for analgesia in OPH were included. MEDLINE, Embase and CENTRAL databases were used to search papers for inclusion. Two independent reviewers selected eligible studies for systematic review. The primary outcome was pain assessed via a subjective pain screening tool. Secondary outcomes included adverse events. 16 RCTs were included with the majority being 'low risk' of bias. Tramadol, vaginal misoprostol and cervical lidocaine flushing significantly reduced pain. Hyoscine-N-butyl Bromide (HBB) with diclofenac and lidocaine in distension media produced conflicting results. Oral misoprostol and diclofenac alone failed to show significant differences in pain scores. Regarding non-pharmacological interventions, vocal distraction, transcutaneous electrical nerve stimulation and video-based multimedia information all significantly reduced pain. The effect of warmed distension media and virtual reality for pain control is unclear. Only one study found the treatment group (HBB and diclofenac) was associated with significantly higher adverse events. This study highlights potential use of both pharmacological and non-pharmacological methods as safe and effective forms of analgesia for OPH. We hope the results of this systematic review will help improve clinical practice and assist with developing future pain management protocols for OPH while also highlighting areas of interest for future research.

Kinetics of recovery and normalization of running biomechanics following aerobic-based exercise-induced muscle damage in recreational male runners.

The study aimed to examine the effects of exercise-induced muscle damage on running kinetics. Twenty-six adult recreational male runners performed 60 min of downhill running (-10 %) at 65 % of maximal heart rate. Running gait changes, systemic and localized muscle damage markers were assessed pre - and post-exercise induced muscle damage protocol. Running gait was analyzed using a 3D treadmill at baseline, immediately post, 24 h, and 48 h to determine changes in running pressure sway and vertical ground reaction forces. Blood markers, subjective pain perception, and magnetic resonance imaging utilizing T2 relaxation time of the thigh muscles assessed systemic and localized damage. Linear mixed-effects models examined changes over time. Significant decreases were found in the left leg's first (-454.0 to -396.1, P < 0.05) and second (-532.8 to -498.2, P < 0.05) VGRF peaks across all time points compared to baseline. The right leg showed reductions in the first vertical ground reaction forced peak at immediately post (-348.4, P = 0.036) and the second peak at immediately post and 24 h (-467.4 and -396.8, P < 0.05). Creatine kinase increased significantly (P < 0.001) at 24 h and 48 h compared to baseline. The anterior thigh muscle compartment showed significant (P < 0.05) increases in mean T2 values 1 h following exercise protocol remained elevated up to 48 h. Negative correlations were identified between running biomechanics to local and systemic muscle damage markers. Running biomechanics remained impaired for up to 48 h following exercise induced muscle damage and correlated with markers of muscle damage using magnetic resonance imaging.