Previous Pain Experience Research Articles

Analysis of painful situations during unsedated esophagogastroduodenoscopy

Background and study aim: 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). Conclusions: 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.

Acute Pain and Analgesia in children

Acute pain is a complex process involving activation of nociceptors, chemical mediators and inflammation. All the major children’s hospitals now have dedicated pain services to provide evaluation and immediate treatment of pain in any child. Children experience pain in a similar way to adults. Pain intensity in children depends on the surgical procedure itself but also on numerous other factors such as age, emotional state or the level of anxiety associated with the hospital stay. The perception and communication of the child’s pain depends on his or her intellectual and social development. Expression of pain therefore relies on the child’s ability to understand, quantitate and communicate it. Previous pain experiences or chronic diseases that required many medical procedures may significantly change the pain threshold in paediatric patients. Moreover, genetic predispositions and environmental effects are significant. The American Academy of Pediatrics and the American Pain Society have reiterated the importance of a multidisciplinary approach in order to eliminate pain in children. In all pediatric settings, an adequate assessment is the initial stage in a proper clinical approach to pain, especially in the emergency departments; therefore, an increasing number of age-related tools have been validated. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The total number of behaviors that are present in the child are used to estimate his/her pain at the time of assessment. Pain assessment is important to facilitate effective postoperative pain management in these vulnerable children. The purpose of this study is to investigate acute pain as well as analgesia and availability of the used analgesic drugs in children. A multimodal approach to preventing and treating pain is usually used.

How do the activity patterns of people with chronic pain influence the empathic response of future health professionals: an experimental study*

Empathy in healthcare professionals is associated with better treatment outcomes and higher satisfaction among patients with chronic pain. Activity patterns play an essential role in the adjustment of these patients and, as a pain behaviour, may have a communicative function and elicit distinct empathic responses. This study investigated whether the activity pattern profiles characteristic of these patients had differential effects on the empathic response (empathic distress and compassion/sympathy) of future healthcare professionals. Healthcare professionals should improve their knowledge about the role of different activity patterns in the well-being of people with chronic pain and receive specific training in empathic skills. We controlled for several variables that could affect the empathic response (sex, age, academic degree, previous experience of chronic pain, and dispositional empathy).A total of 228 undergraduates performed an experimental task using vignettes depicting four activity pattern profiles displayed by people with chronic pain and completed questionnaires measuring dispositional and situational empathy. We conducted a MANCOVA analysis.Undergraduates showed more compassion/sympathy toward the medium cycler profile than toward the doer profile. Participants’ age was associated with empathic distress. Sex, academic degree, and previous experiences with chronic pain were not associated with their empathic response to the vignettes. Dispositional perspective-taking and empathic concern were significantly associated with compassion/sympathy responses, and personal distress was significantly associated with empathic distress.Activity pattern profiles may have a communicative function and elicit different empathic responses toward people with chronic pain. Individual differences in dispositional empathy play an important role on situational empathic responses.

What’s new for the clinician – summaries of recently published papers

Pain is an important physiological and emotional experience, whose intensity may vary with age, gender, emotional state, cultural background and previous pain experience.1 Almost 95% of patients undergoing orthodontic treatment have reported varying degrees of pain. After an orthodontic force is applied, an immediate and a delayed painful response occurs. While the cause of the immediate response was to be the compression of the periodontal ligament (PDL), the delayed response was attributed to the hyperalgesia of the PDL. This hyperalgesia is associated with prostaglandins which make the PDL sensitive to algogens released in the environment, such as histamine, bradykinin, serotonin and substance.

“I am accustomed to something in my body causing pain”: a qualitative study of knee replacement non-improvers’ stories of previous painful and stressful experiences

BackgroundApproximately 20% of total knee arthroplasty patients experience persistent postsurgical pain one year after surgery. No qualitative studies have explored previous stories of painful or stressful life experiences in patients experiencing persistent postsurgical pain after total knee replacement. This study aimed to explore stories of previous painful or stressful experiences in life in a cohort of patients that reported no improvement in pain one year after total knee arthroplasty.MethodsThe study employed an explorative-descriptive qualitative design. Data was collected through semi-structured interviews five to seven years after surgery, with patients who reported no improvement in pain-related interference with walking 12 months after total knee replacement. The data was analyzed using qualitative content analysis.ResultsThe sample consisted of 13 women and 10 men with a median age of 67 years at the time of surgery. Prior to surgery, six reported having at least one chronic illness and 16 reported having two or more painful sites. Two main themes were identified in the data analysis: Painful years - the burden of living with long lasting pain, and the burden of living with psychological distress.ConclusionsThe participants had severe long lasting knee pain as well as long lasting pain in other locations, in addition to experiences of psychologically stressful life events before surgery. Health personnel needs to address the experience and perception of pain and psychological struggles, and how it influences patients’ everyday life including sleeping routines, work- and family life as well as to identify possible vulnerability for persistent postsurgical pain. Identifying and assessing the challenges enables personalized care and support, such as advice on pain management, cognitive support, guided rehabilitation, and coping strategies both pre-and post-surgery.

Parents' Awareness and Knowledge of Testicular Torsion in the Western Region of Saudi Arabia.

Introduction Testicular torsion (TT) is the most common urological emergency in children that requires immediate intervention. The prognosis of testicular torsion depends on the patient's time of presentation to the emergency department (ED), as well as on the time at which the diagnosis is established and treatment is initiated. Raising public awareness of testicular torsion, particularly among parents, plays a crucial role in preventing delay in presentation and reducing the frequency of orchiectomy. To this end, the study is designed to assess the level of awareness and knowledge of testicular torsion, as well as the response of parents to the scrotal pain of their children. Methods A descriptive cross-sectional study was conducted among parents in the western region of Saudi Arabia. Data was collected between the 23rd of November and the 22nd of December 2022. A simple random sampling technique was implemented. The data was collected and analyzed using SPSS software (IBM Corp., Armonk, NY). Results A total of 394 parents participated in this study. It showed that 13.5% of parents reported having a child with a previous experience of pain in the scrotum. Of them, only 25.4% previously heard about torsion of the testicles. Only 68.8% and 76.6% correctly reported that if the child complains of pain in the scrotum during working hours or over the weekend, they will drive him to the hospital immediately. Good knowledge about TT was significantly higher among children's fathers compared to mothers (66.7% vs. 33.3%) (p≤0.05). Conclusion Testicular torsion (TT) represents significant morbidity among male patients and early identification is crucial to avoid the need for orchiectomy and all its prominent physical and psychological consequences. To improve children's well-being, we need to raise parents' awareness of TT and the potential future implications of this critical condition as it is not widely known in our community. Further studies evaluating the knowledge regarding testicular torsion among preadolescent and adolescent boys are warranted.

Lumbopelvic pain and sick leave during pregnancy: A comparison of Italy and Norway.

Pregnancy-related lumbopelvic pain is a frequently reported musculoskeletal disorder, but few studies have compared data between countries. Examine prevalence, severity, and sick leave and explore potential risk factors associated with pregnancy-related lumbopelvic pain in Italian women and compare the results to a similar study in Norway, utilizing the same questionnaire. Cross-sectional. Italian (n = 481) and Norwegian women (n = 435) were allocated from two public hospitals in Rome (Fatebenefratelli San Giovanni Calibita-Isola Tiberina) and Oslo (Oslo University Hospital), as well as four antenatal clinics in Modena (Italy). The questionnaire was completed between gestation weeks 32 and 36, addressing women's experiences of pregnancy-related lumbopelvic pain and sick leave in current week, and retrospectively for prepregnancy, first and second trimesters. In Italy and Norway, 39% and 57% of pregnant women reported pregnancy-related lumbopelvic pain, respectively, with 11% and 25% experiencing severe pregnancy-related lumbopelvic pain. Pregnancy-related lumbopelvic pain was associated with sick leave in Norway (p < 0.01), but not in Italy (p = 0.66) at late gestation. In both countries, women with pregnancy-related lumbopelvic pain versus those with no pregnancy-related lumbopelvic pain were more likely to be multiparous (Italy: 40% versus 31%, p = 0.06 and Norway: 53% versus 38%, p < 0.01), and have gestational weight gain above guidelines (Italy: 21% versus 13%, p = 0.02% and Norway: 27% versus 14%, p < 0.01) and previous experience of pregnancy-related lumbopelvic pain (Italy: 15% versus 2%, p < 0.01 and Norway: 31% versus 4%, p < 0.01). Maternal exercise (⩾2 times weekly) was associated with less pregnancy-related lumbopelvic pain (Italy: odds ratio = 0.33, 95% confidence interval = 0.11-1.0, p = 0.05 and Norway: odds ratio = 0.55, 95% confidence interval = 0.29-1.0, p = 0.06). We observed high rates of pregnancy-related lumbopelvic pain in Italy and Norway, with Norwegian women reporting the highest prevalence and severity level. While both countries had similar rates of sick leave in late gestation, an association between pregnancy-related lumbopelvic pain and sick leave was observed among Norwegian women only. Health care providers should be proactive in addressing pregnancy-related lumbopelvic pain through open communication and seeking input from pregnant individuals. However, it is essential to acknowledge that the current evidence on effective treatments remains limited and inconclusive, highlighting the need for further research in this field.

The application of 3D printing technology for developing a lumbar support garment for obese women

The purpose of this study was to develop a lumbar support garment, using three-dimensional (3D) printing technology, that has a good fit and great aesthetics for obese women in their 30s and 40s. To this end, a survey was conducted to investigate consumers’ satisfaction with commercially available lumbar supports. One participant with class 2 obesity, aged between 30 and 49 years, with previous experience of back pain and wearing a lumbar support, was selected for the 3D body scanning procedure. A lumbar support was designed based on the 3D shape data obtained by the 3D body scan of the participant and was then printed using a 3D printer. The lumbar support garment was designed as a sleeveless wrap-style innerwear piece combined with lumbar support. Cross-sectional comparisons, a wear test, and an appearance evaluation were also conducted. The cross-sectional comparisons confirmed that wearing the lumbar support garment straightened the back and waist posture and tightened the abdomen. Three obese women in their 30s and 40s were recruited for the wear test and, based on the test results, the lumbar support garment scored very high on air permeability, material, washing, and long wearability. Furthermore, because the lumber support garment can be worn under another garment, the participants felt more comfortable psychologically. The support also received good scores on appearance evaluations. However, spine experts suggested reducing the support’s thickness to improve its functionality and appearance.

Craniofacial Pain: Frequent Combined Diagnosis in Complex Unique Patients

Pain is a frequent symptom that is present in several areas of the medical field. Innumerous conditions show this unpleasant complaint, which pathophysiological particularities need to be understood in order to achieve an accurate diagnosis. Besides, although there are diagnostic criteria and classifications essential to the clinical practice, there is a role of individual parameters, such as previous pain experiences, personality, pain history, comorbidities, predisposing factors, and associated diseases [1,2]. This unique combination of factors makes pain a singular experience, a reason why patients’ assessment by doctors depends on training, study, and dedication.

Patients’ reactions to digital rectal examination of the prostate

Background: Digital rectal examination (DRE) of the prostate is a simple, fast, cost effective and safe procedure, however, because of previous painful experience, some men may refuse it. Other negative factors include cultural barriers, fear of discovering cancer and embarrassments. However, some men accept DRE because of their symptoms and wishes to contribute to science. The aim of this study was to examine how previous experience of DRE could influence a repeat and to further evaluate their impression before and after DRE including pain score.Patients and Methods: We evaluated one hundred patients who met the inclusion criteria using a structured questionnaire that detailed information on patients biodata, their previous DRE experiences, expectations before and reactions after a repeat. Pain score was also examined using visual analog scale of 0 to 10. Data were collated and analysed using statistical package for social sciences (SPSS) version 20.0. P-value was set at &lt;0.05.Results: Mean age of patients was 64.88±7.53 years ranging from 46 to 82 years. Forty five percent of them complained of pain from previous DRE while 55% reported no pain. Forty one percent of the men anticipated pain before this present procedure but only 8% of them reported that it was painful and humiliating after the procedure. Fifty nine percent had good impression before DRE and after the procedure 92% reported good impression. All patients expressed their willingness to repeat DRE in future if need be and to encourage friends who may need DRE evaluation of their condition. Mean pain score was 0.59 ± 1.349 (0 – 9).Conclusion: Patients previous experience of DRE could negatively influence a repeat procedure because of pain, improper counseling apart from some cultural barriers. DRE in the hands of Urologists has been better tolerated than other clinicians. This calls for proper exposure of medical students to this procedure and need for continuous medical education for other clinicians for skills improvement.

Prevalence, distribution and correlates of pain in patients with mucormycosis-A cross-sectional study

Context:COVID-19 has led to a spate of rhino-orbital-cerebral mucormycosis cases in India, the epidemiology of which was least understood before. Only a few case series and case reports discuss the symptomatology of mucormycosis.Aims:The primary objective of our study was to estimate the prevalence of pain in patients with mucormycosis. The secondary objectives include the type, regional distribution, characteristics and determinants of pain in patients with mucormycosis.Settings and Design:A cross-sectional study was conducted on consecutive adult patients with mucormycosis in our hospital.Materials and Methods:Following recruitment, a preplanned written questionnaire that was tested for validity with peers, with closed-ended queries was filled on a sole visit by an anesthesia postgraduate based on the response by the patient.Statistical analysis used:Categorical variables were summarized as proportion and percentage. To compare quantitative variables, Chi-square test was used.Results:A total of 69 out of the 80 patients recruited complained of pain (P value = 0.468). A total of 76.8% of patients had pain in the supraorbital region with 84% of the patients complaining of throbbing pain and 98.6% needing analgesics. Gender, pre-existing diabetes mellitus, organs affected due to mucormycosis, prior steroid usage, prior COVID illness, surgical intervention, and previous experience of pain in the same region had no influence on the presence or severity of pain.Conclusions:Pain is one of the presenting symptoms in patients with mucormycosis which is usually in the supraorbital and maxillary region, nociceptive type and throbbing in nature, and moderate to severe in intensity usually managed with simple analgesics.

Psychometric evaluation of the Lebanese Arabic version of the Dental Fear Survey: a cross-sectional study

BackgroundDental fear is a prevalent problem that can lead to poor dental health. The Kleinknecht’s Dental Fear Survey (DFS) is one of the used scales to assess dental fear. The present study aims to evaluate the psychometric properties of the Lebanese Arabic version of the DFS (DFS-A) and to determine the optimal cut-off to identify dental fear as well as the correlates of dental fear in a group of Lebanese adults dental patients.MethodsA cross-sectional study was conducted among a group of 442 dental patients (18–65 years) recruited at 29 dental clinics from March to June 2019. Patients completed a questionnaire including questions about demographic characteristics, previous bad dental experience, trauma’s experience period, the sensation of nausea during dental treatment, the DFS-A scale, the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A), and a general question about dental fear.ResultsDFS-A revealed evidence of adequate psychometric properties. DFS-A scale demonstrated high internal consistency (cronbach’s alpha = 0.93). Test–retest reliability assessment demonstrated strong reproducibility of the DFS-A scale score (ICC = 0.92 with 95% CI (0.83–0.96), p value < 0.0001 (N = 30). Confirmatory factor analysis revealed a three-factor structure of the DFS-A reflecting fear associated with specific dental stimuli and procedures, patterns of dental avoidance and anticipatory anxiety, and physiologic arousal during dental treatment. A significant correlation was found between DFS-A and the MDAS-A indicating a good convergent validity. The optimal cut-off point to identify patients with and without dental fear is 41. Considering this cut-off score, the prevalence of dental fear in our sample was reported at 33.8%. Multivariable analysis showed that having previous scary and painful dental experiences, a sensation of nausea during treatment, and having dental anxiety were identified as predictors of dental fear.ConclusionThe adapted Arabic version of the DFS (DFS-A) is a valid tool to evaluate dental fear among Lebanese adult patients.

Exploring pain characteristics in nulliparous women; A precursor to developing support for women in the latent phase of labour

BackgroundAdmission to hospital in the latent phase of labour is associated with a cascade of unnecessary intervention. Women who seek early hospital admission may have heightened fear and anxiety in relation to pain routed in their pre-pregnancy experiences. ObjectiveTo determine the prevalence of pain catastrophising in a healthy non-pregnant population and explore previous pain experiences and fear of childbirth as characteristics that might predict pain catastrophising. DesignProspective observational study across two higher education institutions in Scotland and England using a semi-structured survey administered through Bristol Online Surveys. Four validated questionnaires were used to identify the prevalence of pain catastrophising and fear of childbirth in nulliparous women of reproductive age. ResultsThe survey was completed by 122 women undertaking an undergraduate degree and aged between 18 and 23 years. A high prevalence of pain catastrophising was found: a cut-off score of 20 and above = 47.5% (58/122 participants), a cut-off score of 30 and above = 21.3% (26/122). Fear of pain (β = 0.14, t = 4.21, p <0 .001) and pain-related anxiety (β = 0.40, t = 11.39, p <0 .001) were significant predictors of pain catastrophisation. However, there was no correlation between fear of childbirth and pain catastrophisation. Conclusions and implications for practiceIt is reasonable to hypothesise that the pain catastrophising scale may be a good tool to predict those women likely to require additional support in the latent phase of labour; however further work is needed to explore this with a group of pregnant women.

Attention to Pain Modulates the Vasoconstriction Response to Thermal Pain in Sickle Cell Disease Subjects but Not in Controls

Sickle Cell Disease (SCD) is a genetic disorder in which sudden onset of painful vaso-occlusive crises (VOC) can occur due to the obstruction of the microvasculature by the rigid sickled red blood cells. We have previously shown that pain itself could be a trigger for VOC by causing significant neural mediated vasoconstriction in the microvasculature and thereby promoting obstruction and eventual progression to VOC. Many scientific models and experimental studies have shown that increased attention to painful stimuli influences subjective pain measures such as pain sensitivity and tolerance and can alter acute pain outcomes. In this study, we explored the role of pain attention in modulating the objective vasoconstriction response to thermal pain in SCD and controls.Methods: 76 subjects were exposed to heat pain via a TSA II Neurosensory analyzer thermode that was placed on the arm and microvascular blood flow (MBF) was measured in the contralateral thumb using photo-plethysmography (PPG). In the first cohort consisting of 23 SCD and 25 controls, subjects were alerted of upcoming heat pain and they were required to focus on the stimuli and respond when they reached their threshold for heat pain. In the second cohort consisting of 17 SCD and 11 controls, subjects were exposed to their predetermined specific heat pain threshold temperature without alerting them or calling any attention to the pain stimuli.We derived the mean MBF during heat pain from the PPG amplitude and calculated the percent change in MBF from the baseline period immediately prior to the pain. Higher percent change signifies stronger vasoconstriction.Results: There was a significant drop in MBF during heat pain in both cohorts but the percent change in MBF was higher in the cohort with pain attention (p<0.0001). Among SCD subjects, those with pain attention had a significantly higher percent change in MBF than those without pain attention (p<0.0001). This effect was only seen to a lesser degree among controls (Figure 1). The average heat pain threshold was lower (43.5 °C) in the cohort with pain attention compared to the cohort without pain attention (47.4 °C) (p<0.0001). This suggests that along with higher subjective pain sensitivity, there is greater drop in MBF due to pain attention.Conclusions: Attention to painful stimuli significantly modulates the neural mediated vasoconstriction response to thermal pain in SCD but not so in controls. These data suggest that SCD subjects have significant pain anxiety likely from previous pain experiences and this might contribute to progressive vaso-occlusion by enhancing their vasoconstriction response to pain. Attenuation of this pain anxiety response in the peripheral perfusion might be a potential modality by which cognitive behavior therapies could improve pain outcomes in SCD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Youngsters' perceptions of the experience of pain and utilisation of over-the-counter pain medication as needed in community: A qualitative study.

Pain is common in youngsters. No matter its nature, youngsters' consideration of pain is complex since its communications vary as a function of several components. The aim of this study is to explore the youngsters' perception linked to their experience of physiological pain at the home/family setting, as well as their experience with the utilisation of over-the-counter pain medication as needed. A qualitative exploratory study was undertaken with 22 youngsters aged 5-17 years old. Semidirected interviews led to the understanding of these components by means of the pain experiences. Thematic analysis allowed the detection of the themes and subthemes emerging from the verbatim collected with the participants. The way pain is described is influenced by the child's development, previous experiences, and the projection of having pain. The pain communication is influenced by the severity perceived, the beliefs of the youngster experiencing pain, the comparison of the pain communication with his brothers and sisters, as well as the anticipated consequences of expressing his pain. The choice of behaviour towards pain is influenced by self-management through nonpharmacological management, with medicines if needed, and by family modelization. This study confirms that previous pain experiences, beliefs related to pain tolerance and intended reactions of parents exert influence not only on the communication of pain, but also on youngsters' behaviour towards pain. It is important to consider these elements whenever youngsters' pain is evaluated.

The Effect of Topical Anesthetic Gel versus Relaxation Exercise in Controlling the Pain of Anterior Maxillary Injection

Background and Aim:Adequate intraoral anesthesia is a major prerequisite for many dental procedures. Bubble breath exercise, distraction, and play therapy technique may be used as relaxation exercises to decrease pain. This study aimed to compare the efficacy of bubble breath exercise versus topical anesthetic gel in controlling the pain of anterior maxillary infiltration.Methods:This crossover clinical trial was performed on 50 children aged 10-12 years. Subjects received a total of 100 maxillary injections (two per person) in the buccal mucosal area of canine teeth of both sides at intervals of 2 to 3 days. On one side, the injection was performed after applying 20% benzocaine gel. On the other side, a similar injection was performed after the bubble breath exercise. The injection solution was 1/4 of 1.8 mL cartridge of 2% lidocaine containing 1:200,000 epinephrine using a 30-gauge needle. The pain was measured immediately after anesthesia injection using a Visual Analogue Scale (VAS). Data analysis was carried out using SPSS Version 18.0 (IBM Inc., Chicago, IL, USA). Wilcoxon signed-rank tests were used to compare with the 10-mm visual analog scale (VAS) scores obtained from all participants. The level of significance was considered at 5% (p &lt;0.05). The correlation between gender and pain score (VAS) for the two methods was analyzed using the Mann-Whitney U test.Results:The results showed no statistically significant difference between injection pain after topical anesthetic gel application and injection pain after bubble breath exercise (p value=0.30). Also, no statistically significant difference was found between injection pain after gel application and injection pain after bubble breath exercise in boys (p value=0.59) or girls (p value=0.32). There were statistically significant differences between boys and girls in terms of injection pain after gel application (p value=0.001) and also injection pain after e bubble breath exercise (pvalue=0.004).Conclusion:There is no significant difference between perceived injection pain after bubble breath exercise and after applying the topical anesthetic gel. Furthermore, future studies should explore the role of age, dental fear, and anxiety, previous painful experiences, the pain thresholds.

Anxiety in a dental and maxillofacial surgery consulting room: does previous experience matter?

Objectives To explore the associations between previous dental visits and dental anxiety among patients presenting at the dental and maxillofacial surgery clinic of Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria. Materials and methods This study was a cross-sectional study conducted among 172 patients. Study instrument was a 9-item structured questionnaire, which obtained information about the participants regarding their: demographic profile; previous dental experience; and dental anxiety status in a dental and maxillofacial surgery consulting room. Data collected were analyzed using the SPSS Version 20 Software. Associations between variables were evaluated using Chi-square statistics using a p < 0.05 to determine the level of statistical significance. Results Roughly, six-tenth (57.6%) of the participants were males. The observed prevalence of dental anxiety among the participants was 47.7%. A history of pain experience during past dental treatment as well as a history of past dental visit were found to have statistically significant relationships with participants’ dental anxiety status (p-values < 0.05). However, the frequency of previous dental visits, a history of past dental treatment, and a history of use of intraoral injections in the course of past dental treatment were found to have no statistically significant relationship with participants’ status of dental anxiety (p-values > 0.05). Finally, the prevalence of dental anxiety among the groups of female folks with “a history of previous visit to a dentist” and “a history of pain experience in the past dental treatment” were found to be significantly higher than that observed among similar groups among the male folks (p-values < 0.05). Conclusion Previous experience of pain plays a major role of influence over dental anxiety experience among patients. Hence, dental practitioners need to pay more attention towards dental anxiety management among patients, especially women.

Prevalence of Headache Attributed to Airplane Travel Among Medical Students in Brazil.

Headache attributed to airplane travel is a rare form of headache that develops exclusively during airplane travel. It is characterized by occurring during takeoff, landing, or both, and improves spontaneously within 30minutes after the ascent or descent of the airplane is completed. Our objectives were to determine the prevalence of headache attributed to airplane travel among medical students who traveled by plane, the time of flight when it occurred, and the emotional state of passengers on new trips. The study was prospective, cross-sectional, using a non-random sample of medical students who traveled by plane. In total, 155 passengers who traveled by plane on at least 3 flights, regardless of duration were interviewed. Headache during flight occurred 3 or more times in 7.5% (80/1070) of the trips and 14.2% (22/155) of the passengers, especially during takeoff or landing (17/22; 77.3%), having a stabbing character and lasting less than 30 minutes. The headache improved spontaneously at the end of the landing phase (17/22; 77.3%). When traveling again, 68.2% (15/22) of passengers traveled normally, despite previous painful experience. This study demonstrated that headache attributed to airplane travel is not as rare as previously thought, being predominant during takeoff or landing. In addition, despite the bothersome feeling, most passengers who experienced this headache traveled normally, despite previous painful experience.

Perception of pain in Class II malocclusion children treated with cervical headgear: a randomized controlled trial.

The aims of this study were: 1. to evaluate the experience of pain perceived by children during separator placement and headgear wear; 2. to find possible associations between the perceived intensity of pain and the levels of Substance P (SP) and interleukin-1 beta (IL-1β) in the gingival crevicular fluid (GCF) during these procedures; 3. to identify other factors, such as previous pain experience, which could be associated to the patients' perceived discomfort or pain during treatment. Nine-month parallel-group randomized controlled trial. Forty Class II malocclusion children (8-12 years) were included, half of which received a cervical headgear while the other half did not receive any treatment during the study period. Baseline pain data were recorded including previous experience to general and dental pain, Corah's Dental Anxiety Scale, and baseline pain using a visual analogue scale (VAS). Elastic separators were placed in children for 1 week, followed by molar band and cervical headgear placement. Children were seen at various time points throughout the 9-month period where at each appointment, a VAS assessment of pain as well as GCF sampling was carried out to quantify the levels of SP and IL-1β. Multiple regression analysis was performed to ascertain the influence of factors including sex, age, time, headgear wear, and baseline pain data on pain severity. Pain severity and SP and IL-1β levels in the GCF follow a similar pattern, with peaks being observed 1 day after orthodontic elastic separator placement. Pain was more severe after the placement of orthodontic separators than following cervical headgear wear. With regard to pain predictors, pain is more severe in older children, those with a worse previous general pain experience, and those with higher levels of IL-1β, particularly after elastic separator placement. Orthodontic pain and discomfort following orthodontic separator placement and cervical headgear wear depends on factors including age, previous pain experience, and the level of IL-1β in the GCF.

Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors.

Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered. We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. Premature birth (b=-0.721), caffeine (b=-0.302), and the behavioural states quiet and awake (b=-0.283), active and asleep (b=-0.158), and quiet and asleep (b=-0.498) were associated with changes in behavioural pain scores. Premature birth (b=-0.232), mechanical ventilation (b=-0.196), and duration of the heel stick procedure (b=0.0004) were associated with changes in physiological pain scores. Premature birth (b=-0.907), Caffeine (b=-0.402), the behavioural states quiet and awake (b=-0.274), and quiet and asleep (b=-0.459), and duration of the heel stick procedure (b=0.001) were associated with changes in the modified BPSN total scores. Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.