Recall Of Pain Research Articles

An Analysis of the Structures People With Shoulder Pain Recall After Receiving Their Diagnostic Imaging Results.

Rotator cuff related shoulder pain (RCRSP) is a prevalent cause of musculoskeletal pain. Patients presenting with this condition often undergo diagnostic imaging. However, many patients appear to have difficulty recalling the nature of their diagnosis. This may impact their rehabilitation outcomes. The aim of this study was to explore peoples' recall of their structural features relating to RCRSP by comparing their recalled description of their condition with the contents of their imaging reports as reported in an online questionnaire. In doing so, we aim to explore the potential emphasis they place on structural features related to their condition. This study was a content analysis embedded within a larger survey study published previously. Data containing patients' recall of their diagnosis was used from the study, and analysed using content analysis to quantify content in terms of codes and categories. The aims of frequency, completeness and accuracy of recall were then explored. The analysis identified eight categories of terminology either recalled by patients or reported in imaging reports. The most frequent categories in reports were tendinopathy (71%) and joint (67%), but only 17% and 36% of participant responses contained these codes, respectively. Participants' completeness of recall compared with their imaging report was 30% on average. In terms of accuracy, only 8 out of 95 participants recalled their diagnoses 100% correctly. This study indicates that patients have poor overall recall of their RCRSP-related structural features. We contend that participants may have been able to recall what they viewed to be the most prominent structural feature in their imaging findings. It may be important for clinicians to consider the impact of diagnostic labelling, and whether a patient's ability to recall such labelling may have an influence on their outcomes.

Thinking Beyond the Default User: The Impact of Gender, Stereotypes, and Modality on Interpretation of User Needs

Abstract Throughout the mechanical design process, designers, the majority of whom are men, often fail to consider the needs of women, resulting in consequences ranging from inconvenience to increased risk of serious injury or death. Although these biases are well studied in other fields of research, the mechanical design field lacks formal investigation into this phenomenon. In this study, engineering students (n = 301) took a survey in which they read a Persona describing a student makerspace user and a Walkthrough describing the user’s interaction with the makerspace while completing a project. During the Walkthrough, the user encountered various obstacles or Pain Points. Participants were asked to recall and evaluate the Pain Points that the user encountered and then evaluated their perceptions of the makerspace and user. The independent variables under investigation were the gender of the user Persona (woman, gender-neutral, or man), the Walkthrough room case (crafting or woodworking makerspace), and the modality of the Persona and Walkthrough (text- or audio-based). Results showed that participants from the Text-based modality were better able to recall Pain Points compared to participants from the Audio-based modality. Pain Points were assessed as more severe when they impacted women users, potentially stemming from protective paternalism. In addition to finding that the gender of a user impacted the way a task environment was perceived, results confirmed the presence of androcentrism, or “default man” assumptions, in the way designers view end users of unknown gender. Promisingly, providing user Persona information in an audio modality significantly reduced this bias compared to text-based modalities, indicating that providing richer detail in user personas has the capability to reduce gender bias in designers.

Where is Your Pain? Achilles Tendinopathy Pain Location on Loading Is Different to Palpation, Imaging and Recall Location.

OBJECTIVE: To describe and compare pain maps reported during Achilles tendon loading exercises with recall pain location, in people with pain on palpation in their Achilles tendon and tendon pathology on imaging. DESIGN: Cross-sectional analysis of baseline RCT. METHOD: Participants were recruited from a larger Achilles tendinopathy clinical trial. Inclusion criteria were at least 2-month self-reported history of Achilles tendinopathy, midtendon palpation pain, and pathology on ultrasound tissue characterization. Participants were asked to identify their Achilles tendon pain location on a pain map with 8 prespecified locations while at rest prior to loading (recall pain), and subsequently during tendon loading exercises (loading pain). Participants could select multiple locations or select "other" if the locations did not represent their pain. RESULTS: Ninety-three participants were included (93% of participants from a clinical trial). The locations of pain on loading were diverse; all 8 pain locations (and an "other" option) were represented within this sample. Twenty-five percent of participants did not report pain with loading (n = 23 of 93). Of the 70 participants with loading pain, recall pain location differed to loading pain location in 40% (n = 28 of 70) of the participants. CONCLUSION: Palpation pain location, recall pain location, or location of pathology on imaging were not valid proxies for load-related pain in the Achilles tendon. How different pain locations respond to treatment is unknown. Some pathologies (eg, plantaris) have clear pain locations (eg, medial tendon), and assessing pain location may assist differential diagnosis. J Orthop Sports Phys Ther 2024;54(1):1-9. Epub 7 December 2023. doi:10.2519/jospt.2023.12131.

Recall of OTC pain and fever reliever products for children due to acetaminophen instability

Recall of OTC pain and fever reliever products for children due to acetaminophen instability

Could Vulnerability to Motion Sickness and Chronic Pain Coexist within a Sensorimotor Phenotype? Insights from over 500 Pre-Pain Motion Sickness Reports.

The sensorimotor incongruence theory proposes that certain instances of pain result from conflicts in the brain's sensorimotor networks. Indeed, injuries may cause abnormalities in afferent and cortical signaling resulting in such conflicts. Motion sickness also occurs in instances of incongruent sensorimotor data. It is possible that a sensory processing phenotype exists that predisposes people to both conditions. The aim of this study was to investigate whether participants with chronic pain recall greater susceptibility to motion sickness before chronic pain onset. Data were collected via an online LimeSurvey. A self-report tendency toward motion sickness was measured using the Motion Sickness Susceptibility Questionnaire. Group differences were analysed using analysis of covariance methods. 530 patients (low back pain, n = 198; neck pain, n = 59; whiplash-associated disorder, n = 72; fibromyalgia syndrome, n = 114; Migraine, n = 41) and 165 pain-free controls were surveyed. ANCOVA analysis, using sex and anxiety as covariates, suggested that childhood motion sickness susceptibility scores differed by group (F = 2.55 (6, 615), p = 0.019, (ηp2) = 0.024). Planned comparisons, with corrected p-values, suggested that childhood motion sickness was not statistically greater for low back pain, rheumatoid arthritis, migraine, neck pain or whiplash-associated disorder (ps > 0.05), although scores were on average 27%, 42%, 47%, 48% and 58% higher, respectively. Childhood susceptibility was statistically higher in people with FMS (p = 0.018), with scores on average 83% higher than controls. ANCOVA analysis, using sex and anxiety as covariates, suggested that adult motion sickness susceptibility scores did not differ by group (F = 1.86 (6, 613), p = 0.086), although average scores were, on average, at least 33% higher in persistent pain groups. According to retrospective reporting, greater susceptibility to motion sickness appears to pre-date persistent pain in some conditions. This supports the possibility that motion sickness and chronic pain may, in some cases, have overlapping mechanisms related to the handling of incongruent sensorimotor data.

Daily Pain Prediction Using Smartphone Speech Recordings of Patients With Spine Disease.

Pain evaluation remains largely subjective in neurosurgical practice, but machine learning provides the potential for objective pain assessment tools. To predict daily pain levels using speech recordings from personal smartphones of a cohort of patients with diagnosed neurological spine disease. Patients with spine disease were enrolled through a general neurosurgical clinic with approval from the institutional ethics committee. At-home pain surveys and speech recordings were administered at regular intervals through the Beiwe smartphone application. Praat audio features were extracted from the speech recordings to be used as input to a K-nearest neighbors (KNN) machine learning model. The pain scores were transformed from a 0 to 10 scale to low and high pain for better discriminative capacity. A total of 60 patients were enrolled, and 384 observations were used to train and test the prediction model. Using the KNN prediction model, an accuracy of 71% with a positive predictive value of 0.71 was achieved in classifying pain intensity into high and low. The model showed 0.71 precision for high pain and 0.70 precision for low pain. Recall of high pain was 0.74, and recall of low pain was 0.67. The overall F1 score was 0.73. Our study uses a KNN to model the relationship between speech features and pain levels collected from personal smartphones of patients with spine disease. The proposed model is a stepping stone for the development of objective pain assessment in neurosurgery clinical practice.

Differing Effects of Nociception and Pain Memory on Isometric Muscle Strength in Participants With and Without a History of Injury: A Quasi-Experimental Study.

The goals of this study are to establish whether mechanical pressure pain, short-term memory recall of a painful stimulus, or long-term memory of a previous painful lower limb injury alters isometric muscle strength and whether there was a difference in responses between participants with and without a previous history of injury. Fifty-nine pain-free participants (29 with previous injury and 30 without) participated in this study. Tibialis anterior isometric muscle strength was compared pre- and post-noxious mechanical stimulus with instructions to recall pain (short- and long-term). Short- and long-term pain recall produced a significant reduction in muscle strength (short-term: F (1,57) = 160.472, P < 0.001; long-term: F (1,57) = 128.899, P < 0.001). A greater decrease was experienced with short- and long-term pain memory than exposure to mechanical pain (mechanical pain: -14.8% or -32.98 kg, 95% confidence interval [CI], -41.57 to -24.19; short-term: -24.1% or -52.70 kg, 95% CI = -60.98 to -44.34; long-term: -20.3% or -44.63 kg, 95% CI = -52.77 to -36.95). There was no significant difference in responses associated with an injury history. Findings suggest that recalled pain memory can impact motor responses and calls attention to the role of past injury history in the rehabilitation process.

Gabapentin as an adjunct for pain management during dilation and evacuation: A double-blind randomized controlled trial

ObjectivesTo assess the analgesic efficacy of preoperative gabapentin among patients undergoing dilation and evacuation (D&E) with moderate sedation. Study designWe conducted a randomized, controlled, double-blind trial among patients undergoing same-day D&E at 14 to 19 weeks gestation under moderate sedation. We randomized participants 1:1 to gabapentin 600 mg or placebo after cervical preparation at least 1 hour prior to D&E. We assessed pain using a 100-mm visual analog scale before, during, and after the procedure. The primary outcome was postoperative recall of maximum procedural pain with a 13-mm a priori threshold for clinical significance. We standardized initial fentanyl and midazolam dosing. We assessed satisfaction with pain control, nausea, and vomiting via Likert scales and anxiety using a validated instrument. ResultsWe enrolled 126 participants and randomized 61 to gabapentin and 65 to placebo, with study medication administered a mean of 211 (SD 64) minutes preoperatively. Recall of maximum pain was 41 mm for gabapentin and 49 mm for placebo (p = 0.24). Gabapentin resulted in reduced pain during uterine aspiration (56 vs 71 mm, p= 0.003) compared to placebo, but not for any other time points. The gabapentin group had higher satisfaction (78% vs 65% very or somewhat satisfied, p= 0.01). Median fentanyl dose was lower in the gabapentin group (75 vs 100 mcg, p = 0.005). Midazolam dose, nausea, vomiting, and anxiety did not differ between groups. No serious adverse events occurred in the gabapentin group. Sedation reversal was not required. ConclusionsThe addition of gabapentin to moderate sedation during D&E did not result in lower maximum recalled procedural pain. Gabapentin resulted in reduced intra-operative pain during uterine aspiration and increased satisfaction with pain control. ImplicationsGabapentin reduces intraoperative pain and improves satisfaction with pain management when administered prior to second-trimester surgical abortion and may be considered as an adjunct to intravenous sedation. Moderate sedation may impair assessment and recall of pain. Additional research is needed to identify the most effective pain management regimens for D&E.

P09 Does a virtual pain education workshop increase young person understanding of chronic pain, and confidence to self-manage?

P09 Does a virtual pain education workshop increase young person understanding of chronic pain, and confidence to self-manage?

Severe Recalled Labor Pain and Elective Cesarean Section in a Subsequent Delivery: A Cohort Study of Norwegian Parous Women

(Acta Obstet Gynecol Scand. 2021;100:1678–1687) Although the pain experienced in labor is quickly forgotten by most women, some with negative childbirth experiences may recall intense labor pain years later. These women may experience postpartum anxiety which can have a negative impact on the women and their ability to tend to their newborns. This can also affect other childbearing decisions including increased spacing between pregnancies, a reduced number of children, and an increased request for elective cesarean delivery (CD) in subsequent pregnancies. The rate of CD in Norway has risen by 13.3% from 1972 despite the WHO CD recommendation of a 10% to 15% CD rate together with evidence that there is no reduction in maternal or child mortality if the CD rate is &gt;10%. With patient-requested CD increasing, the authors from Norway investigated whether a patient’s recall of labor pain from a previous vaginal delivery (VD) influenced their preference for their future mode of delivery. In addition, potential confounders such as maternal demographic, somatic and mental health factors were also evaluated in case these may have influenced such an association.

Comparative Study of Pain on Injection of Propofol MCT-LCT with Propofol Nanoemulsion for General Anaesthesia

Introduction: Pain during injection of propofol continues to be a major discomfort for patients. Different propofol formulations have been introduced to reduce the incidence of pain.&#x0D; Aims: To know the incidence, severity of pain at induction and post operative amnesic effect of two different formulations of propofol.&#x0D; Methods: This double-blinded comparative study involved randomly selected 100 patients undergoing elective surgery under general anesthesia with physical status score I or II (American Society of Anesthesiologists). Out of 100 patients, 50 received medium and long chain triglyceride Propofol (Group A) while another 50 received nanoemulsion Propofol (Group B) intravenously. Parameters measured and compared were the gender, age, weight, physical status score, pain on injection and postoperative recall of pain during injection of propofol.&#x0D; Results: Both groups were comparable with regards to age, gender, physical status score, mean duration of surgery. The presence of pain during injection with propofol in group A was 76% (38 patients) while 36% (18 patients) in group B which was statistically significant (p =0.0001). Severity of pain was more in group A which was statistically significant in comparison to group B (p=0.0001). The arm withdrawal during the injection of propofol was found more in Group A than Group B, 24% vs 0% (p=0.0002). Recall of pain after 4 hours postoperatively was found in 5 patients of Group A (10%) and 3 patients of Group B (6%) which came out to be statistically insignificant (p=0.715). There was no significant difference between groups regarding heart rate, mean arterial pressure, respiratory rate and arterial hemoglobin oxygenation at all assessed times (p &gt; 0.05) intraoperatively.&#x0D; Conclusion: This study clearly shows the incidence and severity of pain on intravenous administration in nanoemulsion Propofol is significantly less. However, amnestic effect was equally present in both the groups.

Assessment of Pain and External Load in Amputee Football Using Digital Pain Drawing and GNSS Tracking—A Pilot Study

Amputee Football (AF) players move using lofstrand crutches (LC) and a single leg during training and matches, which may expose them to excessive loads. Due to a lack of scientific articles describing these issues, this pilot study aims to gain insight into the assessment of pain experiences, as well as external loads during training and matches in AF. An observational study design was followed. Twelve male AF players (2 goalkeepers—GK and 10 field players—FP), 29.9 ± 8.7 years, stature 178.3 ± 6.5 cm, body mass 77.2 ± 8.9 kg were involved in the study. After stature and body mass measures, participants filled out the questionnaire for pain. The players were familiarized with digital pain drawing (DPD). Afterwards, they reported pain typically felt in relation to regular AF training and playing matches—recall pain (RP). During a two-day training camp (TC) with two training sessions each day and during a two-day international tournament (IT) with two matches each day, the players were monitored using DPD, rate of perceived exertion (RPE) and overall pain level (OPL) scales. In addition, during an international tournament (IT), match players were monitored using a GNSS tracking system for external load assessment. All of the participants reported multiple locations of pain after AF training or a match. The area of recall pain (RP) was the highest: +0.5% when compared to the end of TC and +43% when compared to end of IT. The pain area registered at the end of IT was significantly lower (p = 0.028) compared to RP and lower without statistical significance when compared to the end of TC. Average RPE was 3.31 ± 1.38 and average OPL was 2.86 ± 1.81 in 0–10 scale. Typical RPE was higher than that registered at the end of IT. Also typical OPL was higher compared to that registered after the end of TC, which was higher than after the end of IT. The average distance covered by a FP during a match ranged from 2483.14 ± 583.64 m to 2911.08 ± 828.90 m. AF field players suffered pain as a consequence of training and matches. The loads coming from playing and training, combined with pain, may lead to injuries. Further research directions should include assessments of the relationship of pain characteristics, injuries and GNSS tracking parameters.

Autobiographical memory predicts postsurgical pain up to 12 months after major surgery.

Recent cross-sectional studies have identified differences in autobiographical memory (AM) among individuals with chronic pain, but the temporal relationship between the 2 is unknown. Moreover, AM has yet to be studied in patients undergoing major surgery. This study addressed these gaps by conducting a prospective, longitudinal study of memory performance, postsurgical pain, and psychosocial factors in 97 adult participants scheduled for major surgery. Memories were evaluated using the Autobiographical Memory Test before and one month after surgery when participants were asked to recall personal events related to positive and pain-related word cues. Responses were coded for level of specificity, emotional valence, and surgery-related content. Questionnaires assessing presence/absence of pain and psychological functioning were administered before and at 1-, 3-, 6-, and 12-month follow-ups. Generalized estimating equations modelled pain at each postsurgical time point with memory variables as predictors. As hypothesized, higher numbers of specific pain memories recalled before surgery predicted lower odds of pain across all time points (OR = 0.58, 95% CI [0.37-0.91]). Participants who took longer to recall pain memories before surgery (OR = 2.65, 95% CI [1.31-5.37]) and those who produced more surgery-related content at the one-month assessment (OR = 1.31, 95% CI [1.02-1.68]) had greater odds of reporting postsurgical pain up to 12 months later. These findings indicate that presurgical AM biases are risk factors for development and maintenance of postsurgical pain. To the extent that these biases are causal, presurgical interventions that modify the quality and content of patients' memories may prove to be promising strategies in the prevention of chronic postsurgical pain.

Responsiveness of different pain measures and recall periods in people undergoing surgery after a period of splinting for basal thumb joint osteoarthritis

BackgroundBasal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Many instruments are available to measure pain for this condition including single item and multidimensional measures. To inform our choice of instrument for the purpose of evaluating the value of surgery for people with thumb OA, the aim of this study was to compare the longitudinal validity and signal to noise ratio of a single item numeric rating scale (NRS) for pain and the Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale, and to assess if recall period affects longitudinal validity of the NRS pain and reported pain levels.MethodsWe invited 52 patients referred for surgical treatment of basal thumb joint OA to participate in this study. All wore a splint for six weeks followed by surgery. Pain during the past day, week, and month and the PRWHE were collected at baseline, operation day, and 3, 6, 9 and 12 months after surgery. Responsiveness was assessed with two methods: 1) using participant-reported global improvement and PRWHE function subscale as external anchors (longitudinal validity) and 2) comparing Standardized Response Means (SRM).ResultsThe Spearman’s ρ between PRWHE pain and participant-reported global improvement was better (0.71) compared with NRS past day (0.55), past week (0.62), or past month (0.59). Similar findings were found with PRWHE function as anchor (Pearson’s r for PRWHE pain 0.78; NRS past day 0.68; past week 0.73; past month 0.69). The SRM of PRWHE pain subscale (2.8) and NRS past week (2.9) outperformed pain past day (2.3) and month (2.4). Mean pain was 0.3 points (on a 0 to 10 scale) worse during past week when compared with past day and 0.3 worse during past month than during past week.ConclusionsAll studied pain measures captured the change in pain over time. For clinical trials, we recommend PRWHE pain subscale or NRS past week due to their better signal noise ratio.Trial registrationRetrospectively registered.

Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis.

BackgroundJuvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management.ObjectiveThis systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA.MethodsWe systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model.ResultsOf the 301 studies identified in the search strategy, 15 (5%) fair-to-good–quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children’s and young people’s HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I2=79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD −0.14, 95% CI −0.43 to 0.15; I2=53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I2=74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence.ConclusionsEvidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist–children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.

The demographics of pain after spinal cord injury: a survey of our model system.

Survey OBJECTIVES: Better understand the demographics of pain after spinal cord injury (SCI). Academic Level 1 trauma center and SCI Model System. A survey including general demographic questions, questions of specific interest to the authors, the standardized SCI Pain Instrument (SCIPI), International SCI Pain Data Set, Basic form (ISCIPDS:B), Patient Reported Outcomes Measurement Information System (PROMIS) neuropathic 5a (PROMIS-Neur), and PROMIS nociceptive 5a (PROMIS-No). 81% of individuals with SCI experience chronic pain and 86% of individuals with pain have neuropathic pain. 55% of individuals had shoulder pain. Females and those who recall >5/10 pain during initial hospital stay had significantly higher PROMIS-Neur scores. Completeness of injury correlates inversely with the degree of neuropathic pain. Those who recall >5 pain during the initial hospital stay and those who reported the worst or second worst pain as being shoulder pain had significantly higher PROMIS-No scores. Lumbosacral injuries trended towards higher PROMIS-No scores and had the highest PROMIS-Neur scores. Those with tetraplegia were more likely to develop shoulder pain and those with shoulder pain had higher PROMIS-No scores. Chronic pain is almost universal in patients with SCI. Pain is more commonly reported as neuropathic in nature and females reported more neuropathic pain than males. Physicians should monitor for nociceptive shoulder pain, particularly in those with tetraplegia. Patients with incomplete injuries or lumbosacral injuries are more likely to report higher levels of neuropathic pain and pain levels should be monitored closely. Those with more neuropathic and nociceptive pain recall worse pain at initial hospitalization. Better understanding pain demographics in this population help screen, prevent and manage chronic pain in these patients.

Moderate sedation for complex oral surgical procedures in the dental clinic

Context: Intravenous sedation has become vastly employed in dental offices to manage anxiety and pain during surgical procedures. Several guidelines have focused on patient evaluation, safety of agents used, credentialling of operators, acquisition of resuscitative skills.Objective: To assess the safety and application of the principles of moderate sedation in the management of complex maxillofacial surgical procedures in the dental office setting.Study design: Jaw resection was carried out in six patients who are ASA I and II with histologically intramuscular benign jaw lesions in the dental office under a combination of intravenous diazepam, intramuscular pentazocine and lidocaine containing epinephrine infiltration and nerve block. Serial measurements of blood pressure, pulse rate, respiratory rate and pulse oximetry was done at baseline and every 15 minutes until wound closure. Blood loss and patients pain recall after the procedure was measured.Results: Male and female were of equal proportion with a mean age of 29.3 ± 5.8 years. Four had mandibular surgery while two had maxillary procedures. The mean blood loss was 208.3 ± 115.8ml. Although there were variations in the SBP, DBP, PR, RR and SpO2 during the surgery, they all were within the physiologic range. There was no association between SBP, DBP, PR, RR and SpO2 and perioperative time (p&gt;0.05)Conclusion: Moderate sedation by the administration of diazepam and pentazocine is safe for invasive jaw procedures in the dental office in patients ASA I and II. We however suggest accreditation of dental anaesthesiology in the postgraduate medical colleges for proper credentialling of dentists.

Spatiotemporal patterns of pain distribution and recall accuracy: a dose-response study.

Clinical decisions rely on a patient's ability to recall and report their pain experience. Monitoring pain in real-time (momentary pain) may reduce recall errors and optimize the clinical decision-making process. Tracking momentary pain can provide insights into detailed changes in pain intensity and distribution (area and location) over time. The primary aims of this study were (i)to measure the temporal changes of pain intensity, area, and location in a dose-response fashion and (ii) to assess recall accuracy of the peak pain intensity and distribution seven days later, using a digital pain mapping application. The secondary aims were to (i)evaluate the influence of repeated momentary pain drawings on pain recall accuracy and (ii) explore the associations among momentary and recall pain with psychological variables (pain catastrophizing and perceived stress). Healthy participants (N=57) received a low (0.5ml) or a high (1.0ml) dose of hypertonic saline (5.8%) injection into the right gluteus medius muscle and, subsequently, were randomized into a non-drawing or a drawing group. The non-drawing groups reported momentary pain intensity every 30-s. Whereas the drawing groups reported momentary pain intensity and distribution on a digital body chart every 30-s. The pain intensity, area (pixels), and distribution metrics (compound area, location, radiating extent) were compared at peak pain and over time to explore dose-response differences and spatiotemporal patterns. All participants recalled the peak pain intensity and the peak (most extensive) distribution seven days later. The peak pain intensity and area recall error was calculated. Pain distribution similarity was determined using a Jaccard index which compares pain drawings representing peak distribution at baseline and recall. The relationships were explored among peak intensity and area at baseline and recall, catastrophizing, and perceived stress. The pain intensity, area, distribution metrics, and the duration of pain were lower for the 0.5mL than the 1.0mL dose over time (p<0.05). However, the pain intensity and area were similar between doses at peak pain (p>0.05). The pain area and distribution between momentary and recall pain drawings were similar (p>0.05), as reflected in the Jaccard index. Additionally, peak pain intensity did not correlate with the peak pain area. Further, peak pain intensity, but not area, was correlated with catastrophizing (p<0.01). This study showed differences in spatiotemporal patterns of pain intensity and distribution in a dose-response fashion to experimental acute low back pain. Unlike pain intensity, pain distribution and area may be less susceptible in an experimental setting. Higher intensities of momentary pain do not appear to influence the ability to recall the pain intensity or distribution in healthy participants. The recall of pain distribution in experimental settings does not appear to be influenced by the intensity despite differences in the pain experience. Pain distribution may add additional value to mechanism-based studies as the distribution reports do not vary with pain catastrophizing. REC# N-20150052.

Severe recalled labor pain and elective cesarean section in a subsequent delivery: a cohort study of Norwegian parous women.

Some women keep on recalling intense labor pain experienced at childbirth to a degree that may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference for and delivery by an elective CS in the subsequent delivery. Furthermore, we investigated whether co-occurring maternal demographic, somatic and mental health factors related to the previous and subsequent delivery, explain parts of a potential association. The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed on a numeric rating scale at pregnancy week 17, and at pregnancy week 32, the preference for an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was retrieved from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS. Severe recalled labor pain at the previous birth was associated with a preference for an elective CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.25-5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32-9.59). This association remained statistically significant for the preference for an elective CS (adjusted OR [aOR] 2.12, 95% CI 1.24-3.62) but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99-5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as number of years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience and fear of childbirth were also linked to preference for and delivery by an elective CS. Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared with women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and, irrespective of severe recalled labor pain, preference for an elective CS was statistically significantly associated with actual delivery by elective CS.

A Comparative Study of Lignocaine, Pethidine, Ketamine and Placebo for Prevention of Pain on Propofol Injection

Background: Pain caused by propofol injection is a common occurrence.&#x0D; Aims and Objectives: The aim of this study was to compare and evaluate the efficacy of three drugs, lignocaine, pethidine and ketamine for prevention of pain during propofol injection.&#x0D; Materials and Methods: This double blind, placebo-controlled, parallel multi-arm study was done after written informed consent and ethics clearance. Hundred patients of ASA I and II, 18-65 years of age, and with body mass index 18-30 kg/m2 were included. Exclusion criteria were significant cardiovascular or hepatic diseases, renal insufficiency, and a history of allergy to the study drugs. Group A (Normal Saline), Group B (Ketamine 25 mg), Group C (Lignocaine 20 mg) and Group D (Pethidine 25 mg) were pre-treated with 2 ml of the study agents before propofol injection. The primary outcome was the incidence of pain with propofol injection and the secondary outcomes were the induction time, pain scores at various time intervals, the incidence of recall of pain after surgery, haemodynamic changes and adverse effects.&#x0D; Results: There were highly significant differences (p&lt;0.001) in the incidences of pain during propofol injection in group A and the other three groups. The difference in incidence of pain was also significant between Group C and other groups. The differences in the pain scores (p&lt;0.001) and recall of pain (p&lt;0.05) between group A and the other three groups were significant.&#x0D; Conclusion: Lidocaine may be considered as a good choice for the purpose of reduction of pain during propofol injection.