Profile Of Pain Research Articles

An Observational Study of Various Risk Factors and Etiological Profile in Patients with Lower Back Pain at Tertiary Care Center.

The study aimed to analyze the risk factors and etiological profile of lower back pain (LBP) among patients attending a neurology outpatient department at a tertiary care center. A cross-sectional observational study was conducted, involving 170 patients, aged over 18, presenting with LBP between March and August 2023. Sociodemographic and lifestyle data were collected, and diagnostic investigations, including X-ray and magnetic resonance imaging (MRI), were performed. Patients were categorized into acute and chronic LBP groups for analysis. Age-acute LBP was more prevalent in younger patients (<35 years), while chronic LBP was predominant in older age-groups (≥55 years). Gender-females showed a higher prevalence of LBP compared to males, with chronic LBP more common among females. Triggering events-heavy weightlifting was a significant trigger for chronic LBP, while coughing/sneezing was common in acute LBP. Occupation-patients with physically exerting jobs were more prone to acute LBP, while chronic LBP was prevalent among homemakers and those with no work. Body mass index (BMI)-obesity and overweight were associated with chronic LBP. Medication-chronic LBP patients were more likely to be on medication compared to acute LBP patients. MRI findings-prolapsed intervertebral disk (PIVD) was the most prevalent etiology, more common in chronic LBP patients. Other etiologies included vertebral fracture, tumor, tuberculosis, and various spinal conditions. Lower back pain is a multifaceted condition influenced by age, gender, BMI, and lifestyle factors. Effective management and prevention strategies should consider these risk factors to improve patients' quality of life. A comprehensive approach is essential to address the complex etiology of LBP.

E64 Clinical, radiological, and etiological profile of hip pain in children

Abstract Background Hip pain is a frequent complaint in the pediatric population, in orthopedics, and in rheumatology. In children, the clinical features of hip pain vary widely according to age. This clinical variability represents a diagnosis challenge for clinicians. This study aimed to identify the clinical, paraclinical, and etiological spectrum of hip pain in children. Methods A retrospective, descriptive study was conducted between January 2017 and December 2020. We included children aged under 16 years who were hospitalized in the rheumatology and/or pediatric orthopedics department at Mohamed Kassab orthopedics institute for non-traumatic hip pathology. Clinical, biological, and radiological data were collected from recorded medical files. Missed anamnestic data were collected from parents by telephone call. Results We included 81 children. Male predominance was noted (48 boys and 33 girls). The mean age was 9.9 ± 4.4 years with extremes from 1.3–16 years. Limping was the presenting feature in 84.4% of children, followed by pain (76.5%) and refusal to bear weight (12.3%). The mean time of onset to presentation was 8.8 ± 21.3 months. The mean diagnosis delay was 3.5 ± 15.3 months with extremes from 0 to 10 years. Fifty-four (66.7%) children visited their physician at least once before diagnosis. In clinical examination, fever was found in 12 children, and local inflammatory signs in 2 children. Leg length discrepancy was noted in 13 children, hip joint pain in 47 children, and restricted hip movement in 58 children. Elevation of erythrocyte sedimentation rate was noted in (23/28) of children and elevation of C reactive protein in (14/33) of children. An elevated leucocyte count was present in (10/79) patients. Radiographs showed anomalies in 76.5% of cases and Ultrasonography in 90.9% of cases. The final diagnoses of our sample were: slipped capital femoral epiphysis (37%), juvenile idiopathic arthritis (18.5%), hip dysplasia (14.8%), septic arthritis (12.3%), transient synovitis (8.6%) and tumors (4.9%). The chirurgical approach was conducted in 71.6% of patients. Most children (72.5%) had benign outcomes. Conclusion The diagnosis of pediatric hip pain should always follow a standard algorithm. This starts with taking a detailed history from the patient, if possible, and parents and conducting a thorough clinical examination; imaging and/or blood tests may follow if necessary. Ethics The authors declare that they have no conflict of interest.

"Prevalence and Profile of Pain and Catastrophic Thinking in Workers of a Health Care Provider"

"Prevalence and Profile of Pain and Catastrophic Thinking in Workers of a Health Care Provider"

Clinical profile of pain in post-COVID-19 patients: systematic review

Clinical profile of pain in post-COVID-19 patients: systematic review

Symptom descriptors and patterns in lumbar radicular pain caused by disc herniation: a 1-year longitudinal cohort study

ObjectiveThe objective of the present study was to explore the diversity, quality, severity and distribution of symptoms in patients with radicular pain and a lumbar disc herniation.DesignLongitudinal cohort study.SettingHospital-based back...

Clinical Study of Pain in Right Iliac Fossa

Background: To study the clinical profile of pain in right iliac fossa.&#x0D; Methods: 100 patients with signs and symptoms of right iliac fossa mass admitted in Hospital were identified and were studied by taking detailed clinical history, physical examination and were subjected to various investigations like x ray erect abdomen, chest x-ray, contrast x-ray .&#x0D; Result: In this study of out of 100 cases, 71.00% of cases were related to appendicular pathology either in the form of appendicular mass or appendicular abscess. There were 9.00% cases of Ileocaecal tuberculosis.&#x0D; Conclusion: Appendicular lump remains the most common cause for right iliac fossa pain. Ileocaecal tuberculosis is one of the most important differential diagnoses for pain abdomen.&#x0D; Keywords: Appendicitis, , Right Iliac Fossa Mass, Pain

Pain assessment and clinical profile of burn patients

Background: Burn injuries are a major global public health concern with up to 52% of burn patients suffering from chronic pain. The aim of the study was to asses clinical profile and management of pain in burn patients.Methods: The study was a prospective hospital-based study on a total of 300 patients admitted in burn unit of the department of surgery over a period of two years. BSA burns was determined by Wallace's rule of nine in adults and in children by Lund and Browder chart. Pain was assessed using Wong-Baker FACES pain rating scale. Statistical analysis was done using SPSS program.Results: In the present study, most of the burns i.e., 46.7% were seen in &lt;20 years age group, and more in male (58.7%) subjects. Accidental burns and superficial burns were the most common. There were 113 (53.3%) patients with pain score of 2 followed by 160 (53.3%) with pain score 3, 22 (7.3%) pain score 4 and 5 (1.7%) with pain score of 1. For pain management, 171 (57%) patients were given NSAIDS, 78 (26%) needed opioid and NSAIDs and 51 (17%) needed opioid only. Complications in our studied patients on follow up revealed 29 (9.7%) had PTSD, 22 (7.3%) had post burn contracture, 16 (5.3%) had post burn pain, 15 (5.0%) were having anxiety.Conclusions: Pain in burn victims is present throughout the rehabilitation and so should be dealt with multimodal specialties.

Influence of Pregnancy on the Occurrence of Lumbar Spine Pain in Polish Women: A Retrospective Study.

(1) Background: Low Back Pain is a major health concern. Pregnancy-related lower back pain is a common complaint among women. The aim of this study was to determine the influence of pregnancy history on the occurrence and profile of pain in the lower spine. (2) Methods: The diagnosis of Lower Back Pain during pregnancy was based on the authors’ questionnaire, Visual Analogue Scale (VAS), Oswestry Disability Index and Roland Morris Disability Questionnaire. The research group consisted of 1112 women who were students or came for various reasons to the Gynecology and Obstetrics Clinical Hospital of Poznan University of Medical Sciences and completed the questionnaires. Patients were divided into two groups. The first group consisted of women who had never been pregnant (never-pregnant, n = 872 (78.4%), and the second group consisted of women who had been pregnant at least once in their lives (ever-pregnant, n = 240 (21.6%)). (3) Results: In the never-pregnant and the ever-pregnant women, respectively, the intensity of pain was 4.6 ± 1.6 and 5.0 ± 2.0 on the VAS scale, the degree of disability on the Oswestry Disability Index Questionnaire was 5.0 ± 3.9 and 5.5 ± 4.4, while the impact of pain on functioning on the Roland Morris Disability Questionnaire was 3.9 ± 3.1 and 3.9 ± 3.3. There were no significant differences (Mann-Whitney U test) between the studied groups in the parameters tested. (4) Conclusions: Pregnancy is a risk factor for back pain during pregnancy, but one year or more after pregnancy the occurrence of back pain is similar to that in women who have never been pregnant.

Further decoding the mystery of American pain: The importance of work.

A recent paper showed that, whereas we expect pain to rise with age due to accumulated injury, physical wear and tear, and disease, the elderly in America report less pain than those in midlife. Further exploration revealed this pattern was confined to the less educated. The authors called this the ‘mystery of American pain’ since pain appears to rise with age in other countries irrespective of education. Revisiting this issue with the same cross-sectional data we show that what matters in explaining pain through to age 65 is whether one is working or not. The incidence of pain across the life-course is nearly identical for workers in America and elsewhere, but it is greater for non-working Americans than it is for non-workers elsewhere. As in other countries, pain is hump-shaped in age among those Americans out of work but rises a little over the life-course for those in work. Furthermore, these patterns are apparent within educational groups. We show that, if one ascribes age-specific employment rates from other OECD countries to Americans, the age profile of pain in the United States is more similar to that found elsewhere in the OECD. This is because employment rates are lower in the United States than elsewhere between ages 30 and 60: the simulation reduces the pain contribution of these non-workers to overall pain in America, so it looks somewhat similar to pain elsewhere. We conclude that what matters in explaining pain over the life-course is whether one is working or not and once that is accounted for, the patterns are consistent across the United States and the rest of the OECD.

The profile of musculoskeletal pain and its associations with sleep quality and depression during the COVID-19 in Turkey.

BackgroundThe current pandemic has affected people’s health multidimensionally. This study aims to investigate musculoskeletal pain, sleep quality, depression levels, and their relationships in individuals belonging to different age groups during COVID-19 in Turkey.MethodsA web-based self-administered survey that consisted of demographic questions, The Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and scores of musculoskeletal pain was sent to participants. Pearson correlation analysis was used for determining the statistical relationship between variables.ResultsThe study includes 1,778 participants. The highest percentage for mild, moderate, and severe pain was in the head (49.8%), back (15.5%), and head (11.5%), respectively. The PSQI-total had shown a weak correlation with pain levels in all body parts. The highest correlation for sleep quality and pain levels was between the PSQI-5 and lower back pain. There was a weak correlation between PSQI-2 and the BDI score, and a moderate correlation between the PSQI-1, PSQI-5, PSQI-7, PSQI-total, and BDI score. Pain in all body parts showed a weak correlation with depression level.ConclusionsThis study showed that musculoskeletal pain was varied in body parts with different intensities according to age groups in Turkey during the pandemic. The most common pain was in the head, back, and lower back. Headache was found correlated with the parameters of sleep quality. Pain of the head, neck, back, lower back, and shoulder were correlated with sleep latency. Sleep quality was associated with depression and musculoskeletal pain, while musculoskeletal pain was correlated with depression.

Perfil da dor lombar em trabalhadores dos restaurantes de uma universidade pública do sul do Brasil

The tasks that workers in university restaurants (URs) perform involves repetitive movements of the back, lifting excessive weight, remaining in a standing posture for prolonged periods of time, and, thus, an evaluation of the lumbar region of these workers is indicated. Therefore, the objective of this study was to outline the profile of lower back pain in workers from the URs of a Public University in the South of Brazil. This is a cross-sectional, observational, quantitative study, in which participants aged 18 to 59 years, of both sexes, who performed some function within the restaurants of a university in southern Brazil and who reported the presence of lower back pain were selected. Participants were evaluated by a sociodemographic questionnaire, a visual analogue scale (VAS) for pain, a range of motion (ROM) of the lumbar spine evaluation, and the Brazilian Start Back Screening Tool (SBST) questionnaire. Results are presented as absolute and relative frequencies, with a Spearman correlation, and numerical variables as mean and standard deviation or median, minimum, and maximum. Twenty-eight participants were included in the study, 71.4% of whom were women, with a mean age of 36.3 (±10.8) years old. The report of pain above 4 in the VAS was 71.4% of the participants and all had a decrease in ROM in all movements evaluated in the lumbar spine. Most (71.4%) had low risk for psychosocial factors by SBST. The profile of restaurant workers at the evaluated university is characterized by being primarily performed by women, and these workers presented severe pain and limited joint movements in their lumbar region.

Postoperative Analgesia in Laparoscopic Cholecystectomy following Intraperitoneal Magnesium Sulphate: A Prospective Cohort Study

Introdution: Postoperative pain and discomfort after laparoscopic cholecystectomy is partly because of distension, tearing, separation of parietal peritoneum and surgical manipulation. Intraperitoneal administration of Magnesium Sulphate (MgSO4 ) is thought to desensitise the after effects of pneumoperitoneum in addition to providing analgesia. Aim: To analyse the effect of intraperitoneal magnesium sulphate on postoperative analgesia and occurrence of shoulder pain after laparoscopic cholecystectomy. Materials and Methods: The present study was a prospective cohort study which was conducted at the Government Medical College, Kozhikode, Kerala, India, from February 2019 to December 2020, included 60 adult patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were selected and they were divided into two groups, group M and group N. Patients in group M received 30 mg/kg MgSO4 which was instilled into the gallbladder bed intraperitoneally by the surgeon after resection of gallbladder and patients who did not receive MgSO4 were included in group N. Postoperative pain was assessed using Visual Analog Scale (VAS) and VAS score&gt; 3 was managed with Intravenous (IV) paracetamol 15 mg/kg. If pain was not relieved by this, IV tramadol 50 mg was supplemented. Time to first rescue analgesic, the total analgesic requirement and the incidence of shoulder pain in 24 hours were noted. Haemodynamics, recovery profile, incidence of Postoperative Nausea and Vomiting (PONV), any adverse events were also noted and analysed. Results: Mean pain scores (VAS) were significantly lower in group M and time to first analgesic requirement was longer in group M (4.23±2.31 hours) compared with group N (1.07±0.67 hours), PONV was significantly higher in group N. Sedation scores were significantly high in group M and there were no significant differences in haemodynamic and recovery profile and incidence of shoulder pain in both the groups. Conclusion: Intraperitoneal instillation of MgSO4 provides effective postoperative analgesia and reduces nausea and vomiting in patients undergoing laparoscopic cholecystectomy without any significant side-effects.

Lower back pain profile in restaurant workers at a public university in southern Brazil

The tasks that workers in university restaurants (URs) perform involves repetitive movements of the back, lifting excessive weight, remaining in a standing posture for prolonged periods of time, and, thus, an evaluation of the lumbar region of these workers is indicated. Therefore, the objective of this study was to outline the profile of lower back pain in workers from the URs of a Public University in the South of Brazil. This is a cross-sectional, observational, quantitative study, in which participants aged 18 to 59 years, of both sexes, who performed some function within the restaurants of a university in southern Brazil and who reported the presence of lower back pain were selected. Participants were evaluated by a sociodemographic questionnaire, a visual analogue scale (VAS) for pain, a range of motion (ROM) of the lumbar spine evaluation, and the Brazilian Start Back Screening Tool (SBST) questionnaire. Results are presented as absolute and relative frequencies, with a Spearman correlation, and numerical variables as mean and standard deviation or median, minimum, and maximum. Twenty-eight participants were included in the study, 71.4% of whom were women, with a mean age of 36.3 (±10.8) years old. The report of pain above 4 in the VAS was 71.4% of the participants and all had a decrease in ROM in all movements evaluated in the lumbar spine. Most (71.4%) had low risk for psychosocial factors by SBST. The profile of restaurant workers at the evaluated university is characterized by being primarily performed by women, and these workers presented severe pain and limited joint movements in their lumbar region.

Multidisciplinary approach to screening and management of children with Fabry disease: practice at a Tertiary Children\u2019s Hospital in China

BackgroundFabry disease (FD) remains poorly recognized, especially in children in China. Considering the diversity and nonspecific clinical manifestations accompanying with life-threatening aspect of this disease, methods to improve effective screening and management of the suspects are needed. This study aims to explore how it can be done effectively from a multidisciplinary perspective for children with FD at a tertiary children’s hospital in China.MethodsA multidisciplinary team (MDT) of pediatric FD experts was launched at Children’s Hospital of Fudan University. Children with high-risk characteristics were referred by the MDT screening team using the dried blood spot (DBS) triple-test (α-galactosidase A, globotriaosylsphingosine, GLA gene). For newborns who were undergoing genetic testing in the hospital, the GLA gene was listed as a routine analysis gene. Evaluation, family screening, and genetic counselling were implemented after screening by the MDT management team.ResultsBefore the establishment of the MDT, no case was diagnosed with FD in the hospital. However, twelve months following the MDT program's implementation, thirty-five children with high-risk profiles were referred for screening by DBS triple-test, with a yield of diagnosis of 14.3% (5/35). These 5 diagnosed children were referred due to a high-risk profile of pain accompanied by dermatological angiokeratoma and hypohidrosis (n = 2), pain accompanied by abnormal liver function (n = 1), pain only (n = 1), and unexplained renal tubular dysfunction (n = 1). Two neonates were detected early with GLA mutations in the hospital, with a yield of detection of 0.14% (2/1420). Furthermore, another 3 children diagnosed with FD were referred from other hospitals. Family screening of these 10 diagnosed children indicated that 9 boys inherited it from their mothers and 1 girl inherited it from her father. Four of them started to receive enzyme replacement therapy.ConclusionScreening and management of children with FD is effective based on a defined screening protocol and a multidisciplinary approach. We should pay more attention to the high-risk profiles of pain, angiokeratoma, decreased sweating, and unexplained chronic kidney disease in children.

Clinico-Radiological Profile of Abdominal Pain in Children Admitted in a Tertiary Care Centre-A Retrospective Cohort Study

Background and Aim: Mesenteric lymphadenitis in pediatric population usually presents with abdominal pain mimicking appendicitis mounting a challenging task for physicians to diagnose. It is a self-limiting inflammatory process and resolves spontaneously. In addition to clinical features, ultrasonography is the primary diagnostic modality. We aimed to evaluate the clinico-radiological characteristics of mesenteric adenitis in patients presenting with abdominal pain. Materials and Methods: A total of 108 patients attending paediatric out-patient and paediatric surgery clinic in Saveetha Medical College and Hospital, Chennai, between January 2018 and December 2020 with abdominal pain for several aetiologies were included in this study. The clinical presentation, laboratory parameters and the ultrasonographic findings were noted. Data summarized as numbers, percentages and Mean ± Standard Deviation (SD).&#x0D; Results: Peak prevalence was found to be at around 8 [range 6-10] years. Clinically, 58.3% had fever, 40.7% had dysuria and 36.1% had diarrhoea. Laboratory parameters were non-specific for this condition. Majority of the enlarged lymph nodes were found in the right lower quadrant (81.5%) followed by (10.2%) in the para-umbilical region and (8.3%) in left lower quadrant.&#x0D; Conclusions: Mesenteric lymphadenitis as an individual clinical entity is a very challenging task for the paediatricians to evaluate and diagnose due to several possible variations in the clinical presentation. Although mesenteric lymphadenitis is usually a self limiting entity, a cohort of children warrant medical interventions.

Impact of Bifrontal Home-Based Transcranial Direct Current Stimulation in Pain Catastrophizing and Disability due to Pain in Fibromyalgia: A Randomized, Double-Blind Sham-Controlled Study

This randomized, double-blind trial tested the hypothesis that 20 sessions of home-based anodal(a)-transcranial direct current stimulation (tDCS) (2mA for 20 minutes) bifrontal, with anodal on the left dorsolateral prefrontal cortex (l-DLPFC) would be better than sham-(s)-tDCS to reduce scores on Pain Catastrophizing Scale and disability-related to pain assessed by the Profile of Chronic Pain: Screen (primary outcomes). Secondary outcomes were depressive symptoms, sleep quality, heat pain threshold , heat pain tolerance , and serum brain-derived-neurotrophic-factor (BDNF). Forty-eight women with fibromyalgia, 30 to 65 years-old were randomized into 2:1 groups [a-tDCS (n = 32) or s-tDCS (n = 16)]. Post hoc analysis revealed that a-tDCS reduced the Pain Catastrophizing Scale total scores by 51.38% compared to 26.96% in s-tDCS, and a-tDCS reduced Profile of Chronic Pain: Screen total scores by 31.43% compared to 19.15% in s-tDCS. The a-tDCS improved depressive symptoms, sleep quality and increased the heat pain tolerance. The delta-value in the serum BDNF (mean post treatment end minus pretreatment) was conversely correlated with the a-tDCS effect in pain catastrophizing. In contrast, the a-tDCS impact on reducing the disability-related to pain at the treatment end was positively associated with a reduction in the serum BDNF and improvement of depressive symptoms, sleep quality and pain catastrophizing symptoms. PerspectiveHome-based bifrontal tDCS with a-tDCS on the l-DLPFC are associated with a moderate effect size (ES) in the following outcomes: 1) Decreased rumination and magnification of pain catastrophizing. 2) Improved the disability for daily activities due to fibromyalgia symptoms. Overall, these findings support the feasibility of self-applied home-based tDCS on DLPFC to improve fibromyalgia symptoms.

Neuromodulatory effects of Transcranial Pulsed Current Stimulation (tPCS) in Fibromyalgia: protocol for a double-blinded, sham-controlled, randomized clinical trial

Fibromyalgia (FM) is a functional syndrome characterized by musculoskeletal, diffuse and persistent (&gt; 3 months) chronic pain, that is also characterized by sleep disturbances, fatigue, humor changes and cognitive and psychological changes. Transcranial Pulsed Current Stimulation (tPCS) is a new Transcranial Electrical Stimulation (tES) that has been studied as a treatment option for chronic pain and neurological conditions . Studies have shown that tPCS is capable of pain and cognitive modulation; however, there are not enough studies with evidence of its efficacy.Therefore, the primary aim of this study is to evaluate the effects of tPCS in pain, evaluated through Visual Analogue Scale (VAS) in FM patients; besides that, it is aimed to evaluate the effects of tPCS on quality of life, cognitive impairments, pain pressure threshold, descending inhibitory system of pain, and serum levels of Brain Derived Neurotrophic Factor (BDNF) and S100 Calcium-Binding Protein B (S100B). A randomized, double-blinded, controlled with sham clinical trial will be conducted with 70 (Critical f: 2.003; ES: 0.76; alpha: 0.05; power: 0.80) women with Fibromyalgia, from 30 to 65 years with pain on the Visual Analogue Scale (VAS) higher than 6 in the last 3 months. All patients will read and sign an Informed Consent Form (ICF). Each patient will be randomized to either 1+4 sessions of tPCS (2mA, 6-10Hz, 1-20ms, 20-25 minutes) or Sham. Patients will complete the following questionnaires/tests: Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Fibromyalgia Impact Questionnaire (FIQ), Pain Catastrophizing Scale (PCS), Profile of Chronic Pain (PCP), Conditioned Pain Modulation Task (CPM-T), Pain Pressure Threshold Task (PPT-T), Rey Auditory-Verbal Learning Test (RAVLT), Controlled Oral Word Association Test (COWAT) and blood collection for serum levels of BDNF and S100B. For the main outcome, comparison between variables during time will be made through linear regression, with an adjustment for baseline levels and possible confounders.

Clinico-etiological profile and ultrasonographic evaluation of recurrent abdominal pain in children aged 5 years and above

Background: Recurrent abdominal pain (RAP) is very common and the most troublesome health related issue in school aged children affecting up to 10-20%, but very rare below 5 years and above 15 years. Objective of this study was to assess clinico-etiological profile and ultrasonographic finding in children with recurrent abdominal pain at tertiary care hospital in southern Rajasthan.Methods: This prospective observational study was carried out at tertiary care hospital Udaipur, from January 2019 to June 2020. Total 57 children aged 5 years and above who fulfilled the Apley’s criteria for recurrent abdominal pain were enrolled. Patient’s detailed history and physical examination including detailed per abdominal examination were recorded on pre-structured Performa. All patient underwent for routine investigation which consists of complete blood count, urine routine and microscopy with culture, stool examination and USG of abdomen and pelvis.Results: Mean age of children with recurrent abdominal pain in this study was 9.9 years with SD±2.86 with male to female ratio was 1.28:1. Out of 57 children, organic cause was found in 21 (36.84%) children and in 36 (63.16%) children no organic cause was found for recurrent abdominal pain. Most common organic cause was urinary tract infection in 8 (38.09%) children. Total 19 (33.33%) children had mesenteric lymphadenopathy on ultrasonography, out of which organic cause was present in 10 (52.64%) children and no cause was found in 9 (47.36%) children (p value&gt;0.05).Conclusions: Recurrent abdominal pain might occur either due to organic or non-organic causes. Urinary tract infection is one of the most common organic cause in this study. Mesenteric lymphadenopathy was the most common ultrasonography finding in children presented with recurrent abdominal pain.

Oxycodone/Acetaminophen: The Tailoring Combination Treatment for Specific Clinical Profile of Opioid Well-Responsive Cancer Pain.

BackgroundInternational guidelines recommend moderate-to-severe cancer pain to be treated with strong opioids. However, pain management remains an unsolved matter, at least in the demanding oncology and palliative care setting. Although cancer pain consists of multiple components, which interact in complex ways where combination therapy can better intercept multiple pain characteristics, few studies have used a non-opioid/opioid association to exploit possible synergistic actions. Even the efforts of a recent approach emphasizing appropriate pain assessment and accurate classification to obtain personalized pain management have not produced a satisfactory analgesic strategy.ObjectiveThis analysis was intended to evaluate the effectiveness of the immediate release fixed combination of oxycodone/acetaminophen (OxyIR/Par) for the treatment of moderate-to-severe intensity background pain used alone or in combination with other strong opioids in cancer patients with breakthrough cancer pain (BTcP). This is a secondary analysis of a wider observational, prospective, multicenter study [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] performed on 179 patients treated with opioids for cancer pain who received the fixed combination of oxycodone/acetaminophen (OxyIR/Par) for the treatment of background pain (BGP).ResultsCancer patients with breakthrough cancer pain and controlled BGP (Background Pain) were classified according to the presence of analgesic therapy with tablets of fixed combination OxyIR/Par alone (group A, n=120) or tablets of fixed combination OxyIR/Par combined with other strong opioids (group B, n=59). Clinical features of group A were different to group B: higher mean Karnofsky Performance Status Index 70.3% (95% CI=67.2–73.5; median=70, CI=60–80) vs 58.3 (95% CI=53.4–63.2; median=50, CI=45–70) (P<0.001), and mainly group A patients were treated in an ambulatory setting (55.0% group A vs 33.9% group B) (p<0.001). Both groups had managed BGP with similar mean dosages (group A: 12.0, CI=10.5–13.4; group B: 13.1, CI=11.0–15.1) and frequencies of OxyIR/Par alone for group A and in association to other opioids for group B, but Breakthrough cancer Pain (BTcP) exhibited different characteristics in the two groups, showing a lower mean intensity numerical rating scale (NRS) of 7.5 (95% CI=7.2–7.7; median=7, CI=7–8 group A) vs 7.9 (95% CI=7.6, 8.2; median= 8, CI=7–9 group B) (P=0.04) and a higher percentage of patients had a faster onset, defined as the maximum intensity reached in less than 10 minutes, 81.7% (N=98) in group A vs 59.3% (n=35) in group B (P=0.002).ConclusionThis is the first analysis about the efficacy of an immediate-release fixed combination of OxyIR/Par in the real world for moderate-to-severe background cancer pain and breakthrough cancer pain. The oral fixed combination OxyIR/Par provided an adequate level of analgesia for moderate–severe background cancer pain, in a different cohort of cancer patients with different performance status, both in ambulatory and palliative settings. The low dosage of fixed combination OxyIR/Par was effective alone or in association with other opioids.

Pain catastrophizing in daughters of women with fibromyalgia: a case-control study

Fibromyalgia is a syndrome characterized by chronic pain related to the musculoskeletal system. Patients feel incapable and show catastrophic thoughts (exaggeration of the sensations) related to painful events. This study aimed to compare catastrophic thoughts of pain between daughters of women with fibromyalgia and daughters of women without fibromyalgia, no daughter having the syndrome. It was a case-control study in which 76 women were included: 38 daughters of women diagnosed with fibromyalgia (case group), and 38 daughters of women without fibromyalgia (control group). The Brazilian versions of the Profile of Chronic Pain: Screen, the Pittsburgh Sleep Quality Index, the Pain Catastrophizing Scale, Resilience Scale, Beck Depression Inventory-II, and the State-Trait Anxiety Inventory were used. Data were tabulated and analyzed using SPSS 20.0. Continuous variables were compared between the groups using the Mann-Whitney U test or Student’s t-test for independent samples. A significant difference was considered at p < 0.05. Regarding catastrophism, the case group had higher total catastrophism compared to the control group (p = 0.025). Daughters of patients with fibromyalgia showed higher rumination and magnification levels related to pain (p = 0.028 and p = 0.007, respectively) but did not show hopelessness. This study concludes that daughters of women with fibromyalgia are more likely to have symptoms of fibromyalgia due to their visualization of the syndrome. This indicates that emotional aspects may induce changes, and additional research on an individual basis is necessary.