Pain Severity Scores Research Articles

Recall Bias in Client-Reported Outcomes in Canine Orthopaedic Patients Using Clinical Metrology Instruments.

The aim of this study was to determine the accuracy of client recollection of their dogs' preconsultation status using clinical metrology instruments such as the Liverpool Osteoarthritis in Dogs (LOAD) and Canine Brief Pain Inventory (CBPI) questionnaires in dogs presenting to a referral orthopaedic clinic. This is a longitudinal prospective cohort study of client-owned dogs presenting for investigations of lameness (n = 217). LOAD and CBPI questionnaires were completed by the owners at the first consultation (T0). Owners were contacted at 2 (T1), 6 (T2), and 12 (T3) months and asked to recall their dogs' T0 status by completing another LOAD and CBPI questionnaire. The agreement between the T0 and recalled LOAD and CBPI scores was determined using the two-way mixed effects intraclass correlation coefficient (ICC). The Wilcoxon signed-rank test was used to determine the difference between scores. For the LOAD scores, there was moderate agreement between T0 and T1 (ICC: 0.64) and T0 and T2 (ICC: 0.53) scores and poor agreement between T0 and T3 (ICC: 0.496). For the CBPI Pain Severity Scores, there was poor agreement between T0 and all three subsequent time points (ICC < 0.5). For the CBPI Pain Interference Scores, there was moderate agreement between T0 and T1 (ICC: 0.57) and T2 (ICC: 0.56) scores and poor agreement between T0 and T3 (ICC: 0.43). The LOAD and CBPI questionnaires are subject to recall bias. Studies reporting retrospectively acquired CMI data should be interpreted with caution.

Effects of Instrument-Assisted Compressive Versus Decompressive Myofascial Release in Patients with Non-Specific Low Back Pain

Non-specific low back pain, a common condition, affects vast majority of the population worldwide and can be treated with soft tissue mobilization either with compression or decompression. Objective: To compare the effects of instrument-assisted compressive versus decompressive myofascial release on pain intensity, lumbar range of motion, and disability in non-specific low back pain. Methods: This quasi-experimental study was conducted at Laeeque Rafiq Hospital from February 2023 to April 2023. Two groups were included: one received instrument-assisted compressive myofascial release (Ergon tool), and the other received decompressive myofascial release with dry cupping. The study followed the patients for three weeks, collecting measurements of pain intensity, lumbar flexion and extension range of motion (ROM), and disability scores of low back pain. Data analysis were performed using SPSS 21.0. Results: There were a total of 44 patients. 23 patients were assigned to the compressive myofascial release technique group and 21 patients to the decompressive myofascial release group. Pain severity and disability score in the decompressive myofascial release group reduced significantly compared to the compressive myofascial release group at the end of the third week and first week respectively (p-value=0.02 and p-value=0.05 respectively). Lumbar flexion and extension ROM improved significantly in the compressive release group as compared to the decompressive release group after 1st and 2nd week respectively (p-value=0.01 and p-value=0.04 respectively). Conclusions: Decompressive myofascial release reduces low back pain and disability, while compressive myofascial release improves lumbar range of motion.

Cannabinoid-based medicines in clinical care of chronic non-cancer pain: an analysis of pain mechanism and cannabinoid profile

Aim: Among treatments for chronic non-cancer pain (CNCP), cannabinoid-based medicines (CBMs) have become extremely popular. Evidence remains modest and limited primarily to delta-9-tetrahydrocannabinol (THC) for neuropathic pain; nevertheless, the use of various CBMs, including cannabidiol (CBD) to treat neuropathic, nociceptive, and mixed pain has increased globally. This observational case-series assessed the impact of CBMs as a complementary treatment by pain mechanism and cannabinoid profile over three months. Methods: An analysis of patients with CNCP and treated with CBMs who consented to an ongoing registry was performed. Outcomes were patient-reported such as the Edmonton symptom assessment system-revised, brief pain inventory-short form, and 36-item short form health survey. Data from patients with complete outcomes for baseline and 3-month follow-up was extracted. Characteristics of adverse drug reactions (ADRs), including a description of the suspected product were also assessed. Results: A total of 495 patients were part of this analysis (mean age = 56 years old; 67% women). At 3-month, the proportional use of THC:CBD balanced and THC-dominant products increased. Patients with neuropathic pain had higher pain-severity scores vs. nociceptive pain. In addition to patients with neuropathic pain, patients with nociceptive and mixed pain also reported improvements in pain severity and secondary symptoms such as anxiety, depression, drowsiness, fatigue, sleep disturbances, and overall, health-related quality of life. THC-dominant treatment is more likely to be recommended when pain is severe, whereas CBD-dominant is favored for less severe cases. ADRs were more frequent among cannabis-naive patients and included dizziness, headache, and somnolence among others. Conclusions: Findings suggest that CBMs can be effective for neuropathic as well as nociceptive and mixed pain. THC is more frequently recommended for neuropathic and severe pain. Future research on CBMs in pain management must include details of CBM composition, and pain mechanism and must consider potential ADRs.

Mild traumatic brain injury: Insomnia or sleepiness

IntroductionSleep disorders caused by TBI are considered serious post-injury consequences and barriers to recovery. These disorders can last for years and disrupt the quality of life. Therefore, the present study investigated insomnia, its severity, and sleepiness in patients with Mild Traumatic Brain Injury. MethodThe present descriptive-analytical study was conducted in 2022. A total of 329 patients with diagnosed mTBI, were examined at 2 weeks, 3, 6, and 12 months after the injury. The demographic information and medical history, pain, and Injury Severity Scores were questioned. Furthermore, the Insomnia Severity Index, Athens Insomnia Scale, and the Epworth Sleepiness Scale were used to diagnose insomnia, its severity, and sleepiness. ResultsIn all 4 periods, insomnia had a significant difference with sleepiness (P < 0.05) in a way that patients with mTBI had higher insomnia than sleepiness. The mean score of insomnia increased 12 months after mTBI compared to 2 weeks after, indicating the increase in patients' insomnia over time (P < 0.05). The mean sleepiness score decreased12 months after mTBI compared to 2 weeks after, indicating a decrease in sleepiness over time in the patients. There was a statistically significant difference between sleepiness in the 12th month with the 6th, 3rd, and 2nd weeks (P < 0.05). There were also significant and direct relationships between the mean scores of pain and AIS and between the mean scores of ISS and AIS (P < 0.05). DiscussionThe treatment of sleep disorders after mTBI should be considered a common problem and the necessary solutions should be provided during the patient's discharge.

478-P: Brain Volume Changes after Long-Term Opioid Treatment in Painful Diabetic Peripheral Neuropathy

Aim: Opioid medications are commonly used to treat Painful-Diabetic Peripheral Neuropathy (Painful-DPN). However, opioids are associated with significant adverse effects, including prescription opioid use disorder which has reached epidemic proportions in the United States. There is an urgent need to determine the effect of long-term opioid treatment (&amp;gt;6-months) on cerebral structure in Painful-DPN. Methods: A total of 56 participants with Painful-DPN were recruited (17 on long-term opioid treatment [O+] and 39 not on opioid treatment [O-]). Participants underwent detailed clinical and neurophysiological assessments and cerebral imaging (3T, Phillips Medical Systems, Holland). Brain morphometric analysis was performed using Freesurfer. Results: O+ participants were prescribed: codeine (n=3, 18%), tramadol (n=5, 29%), morphine modified release (n=1, 6%), buprenorphine (n=1, 6%), and combination treatment (n=5, 29%). O+ participants had a longer duration of diabetes, greater HbA1c, higher pain severity and higher scores on Hospital Anxiety and Depression scales compared to the O- group. Participants in the O+ group had a greater mean caudate volume (O+ 3.5mL ± 0.4; O- 3.2 ± 0.4mL, p=0.034); mean insula volume (O+ 6.3 ± 0.8; O- 5.9 ± 0.6, p=0.049) and mean insular vertices (O+ 3,286 ± 411; O- 3055 ± 282, p=0.018). Conclusion: This is the first study to examine the impact of long-term opioid use on cerebral structure in Painful-DPN. Our findings suggest that chronic opioid use may alter affective/attentional pain processing (insular cortex) and brain regions associated with binge/intoxication (caudate nucleus). These results may have important clinical implications for uncovering the effects of long-term prescription opioid use on brain structure in Painful-DPN. Clearer clinical utility will come from future longitudinal modelling of the prognostic characteristics of opioid use disorder from the neuroimaging features identified in this study. Disclosure G.P.Sloan: None. K.Teh: None. P.Shillo: None. S.Tesfaye: Advisory Panel; Bayer Inc., Wörwag Pharma GmbH &amp; Co. KG, Angelini, Speaker's Bureau; Viatris Inc., Nevro Corp., Procter &amp; Gamble, Novo Nordisk, Berlin-Chemie AG. D.Selvarajah: None. I.D.Wilkinson: None. Funding European Foundation for the Study of Diabetes; Novartis Knowledge Exchange Support Fund (X/162218); Efficacy and Mechanism Evaluation Programme (NIHR129921); Medical Research Council/National Institute for Health Research Partnership

A prospective, randomized, double-blind, placebo-controlled multisite, parallel-group field study in dogs with osteoarthritis conducted in the United States of America evaluating bedinvetmab, a canine anti-nerve growth factor monoclonal antibody

ObjectiveBedinvetmab, a fully canine anti-nerve growth factor monoclonal antibody, was evaluated in dogs for control of osteoarthritis-related pain in a study conducted to support registration in the USA. Study designRandomized, double-blind, placebo-controlled, multicenter, parallel-group study. AnimalsGeneral practice client-owned dogs with osteoarthritis (n = 272). MethodsDogs were block randomized 1:1 to placebo (saline, n = 137) or bedinvetmab (n = 135; 0.5–1.0 mg kg–1) administered subcutaneously, once monthly. The primary end point, day 28 Canine Brief Pain Inventory (CBPI) treatment success (TS), required pain severity score (PSS; 0–10) decrease ≥1 and pain interference score (PIS; 0–10) decrease ≥ 2. CBPI TS rates [and number needed to treat (NNT)], change in scores [and standardized effect size (ES)], change in quality of life (QoL) and bedinvetmab half-life were calculated. ResultsSignificant (p < 0.05) improvement with bedinvetmab over placebo occurred (days 28, 42, 56, 84) for CBPI TS. Of cases evaluable for day 28 CBPI TS (placebo, n = 131; bedinvetmab, n = 128), success rates were 36.6% and 47.4%, respectively (p = 0.0410) (NNT, 9.3; PSS and PIS ES, 0.3). CBPI TS increased after the second dose in both groups, plateaued for bedinvetmab at day 42 and decreased for placebo beginning day 84. Day 84 NNT (4.3), PSS (0.4) and PIS (0.5) showed continued improvement with monthly dosing. After the first dose, mean (± standard deviation) bedinvetmab half-life was 19.1 (8.3) days. Adverse events were similar between groups and not considered treatment-related. There was a significant effect of bedinvetmab versus placebo on all CBPI components (PIS, PSS, QoL). Conclusions and clinical relevanceThese results corroborated those previously reported and provide further support of safety and effectiveness of bedinvetmab (0.5–1.0 mg kg–1) administered subcutaneously at monthly intervals to dogs for control of osteoarthritis-related pain.

Economic analysis of patient-related effects of an interdisciplinary pain self-management program.

Active Day Patient Treatment (ADAPT) is a well-established 3 week intensive cognitive-behavioural, interdisciplinary pain management program for patients with disabling chronic pain. The aim of this analysis was to conduct an economic analysis of patient-related effects of ADAPT using hospital administrative data, specifically, to compare the costs and health outcomes for patients 1 month after participating in the program, with the preprogram period when they were receiving standard care. This retrospective cohort study included 230 patients who completed ADAPT (including follow-ups) between 2014 and 17 at the Pain Management and Research Centre at the Royal North Shore Hospital in Sydney, Australia. Data on pain-related healthcare utilization and costs before and after the program were assessed. Primary outcome measures were labour force participation for patients' average weekly earnings and cost per clinically meaningful change in Pain Self-efficacy Questionnaire, Brief Pain Inventory (BPI) Severity, and BPI interference scores (n = 224). We estimated patients, on average, earned $59 more each week at 1 month follow-up compared with baseline. The cost per clinically meaningful change in pain severity and interference score based on the BPI severity and BPI interference were AU$9452.32 (95% CI: $7031.76-$12,930.40) and AU$3446.62 (95% CI: $2851.67-$4126.46), respectively. The cost per point improvement and per clinically meaningful change in the Pain Self-efficacy Questionnaire were $483 (95% CI: $411.289-$568.606) and $3381.02, respectively. Our analysis showed a better health outcome, reduced healthcare services' cost, and reduced number of medications taken 1 month after participating in ADAPT.

#3369 THE EFFECT OF ACUPRESSURE APPLIED TO DIFFERENT FISTULA AREA ON FISTULE NEEDLE ENTRY PAIN

Abstract Background and Aims This study was conducted to determine the effectiveness of acupressure application on Hegu point on the severity of acute pain caused by fistula needle in patients with brescia-cimino, snuff-box and antecubital fistula. Method This study was randomized control study which was conducted with 66 intervention and 65 control participants, recruited from a dialysis centre of a foundation university in Turkey between October 2021 and February 2022. Simple randomization was used for sample selection in the study. The participants in the intervention group were divided into 3 groups according to the fistula area. The first group was consisted of participants with brescia-cimino fistula, the second group was consisted of participants with snuff-box fistula, and the third group was consisted of participants with antecubital fistula. The of all 22 participants were assigned to each group in the intervention group. Acupressure was applied 3 minute before needle placement in the fistula area of the participants in the intervention group. No intervention was made in the control group in the study. Data were collected usıng Descriptive Information Form and pain scale (Numeric Analog Scale-NRS). NRS was used to determine the severity of acute pain experienced by patients during fistula needle insertion. Since the data of the study showed normal distribution, the data were analyzed with parametric tests. The independent sample t-test was used to examine the homogeneity of the data between the two groups. Spearman correlation analyses were used to compare categorical variables. Statistical significance was assumed at p &amp;lt;0,05. Results In the study, the groups are similar to each other (p&amp;gt;0.05). In the study, the mean age of the participants in the intervention group was 60.50±15.19, and 40.9% of them were in the 61-75 age group. The mean duration of hemodialysis was 7.31±3.31 (min:1-max:20). Of the participants, 43.9% had antecubital, 33.3% had a brescia-cimino fistula and 27.7% had a snuff-box fistula. The mean age of the participants in the control group was 60.84±15.34 years, and 33.8% of them were in the 61-75 age group. The mean duration of hemodialysis was 7.27±4.29 (min:1-max:20). 35.4% of the participants had antecubital, 30.8% had brescia-cimino fistula and 33.8% had snuff-box fistula. While there was no decrease in the severity of acute pain during fistula needle insertion in the participants in the control group, a significant decrease was found in the mean acute pain severity scores experienced by the patients in the intervention group, where acupressure was applied to the Hegu (LI4) acupuncture point (p&amp;lt;0.05, Table 1). In the study, there was a difference within the groups in terms of the mean acute pain severity scores of different fistula areas in the intervention group but, there was no difference in acute pain severity scores between the groups in three different fistula areas. Conclusion The results of this study support that acupressure applied to the Hegu acupuncture point was effectiveness in reducing acute pain at fistula needle insertion in different dialysis fistula area. In addition, the results of the study provide a practical and cost-effective reference for dialysis nurses in acute pain management.

Some features of oral mucosal disease symptoms and clinical manifestations in patients with chronic inflammatory bowel disease

Relevance. The work presents the results of a comprehensive dental examination of patients with vermilion and oral mucosa proper (OM) diseases associated with manifestations of Crohn's disease (CD) and ulcerative colitis (UC).Aim. To determine the cause-related features of complaints and clinical manifestations of vermilion and OM diseases.Material and methods. The comprehensive dental examination included the analysis of complaints, history, and assessment of the vermilion and OM condition and the nociceptive pain severity score according to the Visual Analog Scale (VAS).Results and discussion. In CD and UC, the vermillion diseases clinically manifested in 51.43% and 42.85% of subjects (p &lt; 0.01), OM chronic trauma – in 40.0% and 31.43% (p &lt; 0.05), chronic recurrent aphthae – in 48.47% (p &lt; 0.001) and 31.43% (p &lt; 0.01), glossitis – in 62.86% (p &lt; 0.001) and 25.71% (p &lt; 0.01), glossodynia – in 31.43% (p &lt; 0.01) and 17.15% (p &lt; 0.05) of cases. The main complaints of patients with the detected OM pathology included unpleasant sensations, like rawness and soreness, on taking irritating foods in 100% and 65.71% and talking in 31.43% and 25.71% of cases, dry mouth in 51.43% and 25.71% of cases. The burning mouth syndrome was in 31.43% and 17.15% of patients.Conclusion. The vermilion and the oral mucosal diseases often prevail associated with the clinical course of Crohn'sdisease compared to patients with UC. The VAS pain severity score hinges on CD and UC course (p &lt; 0.055). The variety of clinical manifestations of the vermillion and oral mucosal diseases directly depends on CD and UC, a criterion for developing an integrated approach to their diagnosis and implementing recommendations for their prevention and treatment in practical health care.

Use of Myeloma Patient Outcome Scale (MyPOS) to gauge the effectiveness of palliative management in patients with multiple myeloma: Experience from a large tertiary academic center in India.

e24137 Background: A diagnosis of Multiple Myeloma (MM) can carry significant physical, social, functional and emotional repercussions. There is a lack of data on Baseline Quality of Life (QOL) in patients with MM and effectiveness of palliative management in the Indian context, especially after the advent of newer chemo-immunotherapeutic agents and autologous stem cell transplant (ASCT). Myeloma Patient Outcome Scale (MyPOS) is the first questionnaire developed specific for MM patients. Objectives and Methods: To evaluate symptom burden and quality of life in MM patients admitted to the medical oncology ward. To assess change in quality of life and symptoms as well as analgesic requirements on telephonic follow up after one and three months from index admission. After institutional ethical clearance, MM inpatients were prospectively enrolled. Clinical and treatment related details were recorded. MyPOS questionnaire was administered as well as a detailed pain assessment using Brief Pain Inventory (BPI) was carried out at baseline, 1 and 3 months. Results: 82 out of 100 MM patients consented for recruitment (Mean age- 52 +/- 9yrs; Male- 55%). Mean duration of the disease since diagnosis was less than 1 year (0.86 years), with a mean International staging system (ISS) score of 2. Up to half (37/82, 45%) of the patients received ASCT in addition to chemotherapy. The baseline Global MyPOS Score was 58 +/- 8.8 while the mean Pain severity (MPS) and interference (MPI) scores were 25+/-8 and 43+/-10 respectively. The most painful region was the back. Only Tramadol was sufficient for a small minority (6/82, 7.4%), most required oral morphine. Most patents had significant interval improvement in their pain and QOL scores with a p less than 0.01 on follow-up (MyPOS at 1 month and 3 month were 81+/-6 and 78+/-5, MPS were 21+/-13 and 17+/-1.1, MPI were 38+/-2.2 and 37+/-2.1 respectively). Conclusions: Adequate pain management can significantly improve quality of life in MM patients. Use of standardized questionnaires such as MyPOS is a quintessential tool for the palliative specialist in order to gauge therapeutic efficacy.

Health-related quality of life (HRQoL) and pain outcomes for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) who received abiraterone (abi) and olaparib (ola) versus (vs) abi and placebo (pbo) in the phase III PROpel trial.

5012 Background: PROpel (NCT03732820) met its primary endpoint and showed significantly prolonged investigator-assessed rPFS with abi + ola vs abi + pbo at primary analysis (data cut-off [DCO]: 7/30/21; median 24.8 vs 16.6 months (m); hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54–0.81; P&lt;0.001). HRQoL (based on The Functional Assessment of Cancer Therapy-Prostate [FACT-P] total score) was not different when ola was combined with standard-of-care abi. We present data at the final prespecified overall survival (OS) DCO (10/12/22). Methods: PROpel is a randomised, double-blind trial in 1L mCRPC. Time to pain progression (TTPP) was based on the Brief Pain Inventory-Short Form (BPI-SF) Item 3 ‘worst pain in 24 hours’ and opiate analgesic use (analgesic quantification algorithm) score. Time to first symptomatic skeletal related event (SSRE) was time to use of therapy to prevent/relieve skeletal symptoms, new bone fractures, spinal compression or surgery on bone metastases. HRQoL was assessed by change from baseline (BL) in FACT-P total and subscale scores, BPI-SF pain severity, pain interference and worst pain score between arms using a mixed model for repeated measures. Results: At median follow-up of 33.6 m with abi + ola and 32.1 m with abi + pbo, 17.0% pts (68/399) in the abi + ola arm and 15.1% pts (60/397) in the abi + pbo arm had pain progression (PP) events. The % of pts who had not experienced PP with abi + ola vs abi + pbo was 76.9% vs 77.2% at 24 m and 70.7% vs 71.0% at 36 m. No meaningful difference in TTPP was observed (16% maturity, HR 1.06, 95% CI 0.75–1.50, P=0.75 [nominal], median not reached [NR] either arm). The % of pts who had not had a SSRE with abi + ola vs abi + pbo was 86.1% vs 82.2% at 24 m and 80.8 vs 78.5% at 36 m. No meaningful difference in time to SSRE was observed (12% maturity, HR 0.82, 95% CI 0.55–1.22, P=0.32 [nominal], median NR vs NR). Least-squares mean changes from BL between arms in BPI-SF pain severity (difference, −0.06; 95% CI −0.23–0.12), pain interference (difference, −0.12; 95% CI −0.31–0.06), worst pain score (difference, −0.12; 95% CI −0.35–0.11) and FACT-P total score (difference, −0.54; 95% CI –3.00–1.92) suggest no clinically meaningful difference in HRQoL with abi + ola vs abi + pbo. Least-squares mean change from BL values for FACT-P subscale scores were consistent with FACT-P total score result. Conclusions: PROpel demonstrated a significant delay in rPFS for pts receiving abi + ola vs abi + pbo. Most pts in the trial did not experience a PP event. Abi + ola showed no difference in HRQoL (assessed by FACT-P total and subscale scores, BPI-SF domain and worst pain scores) vs abi + pbo, suggesting pts can derive clinical benefit from abi + ola while maintaining a similar HRQoL compared with a current standard-of-care treatment. Clinical trial information: NCT03732820 .

The prevalence and factors associated with acute postoperative pain in elective gynecologic surgical patients at two referral hospitals in Addis Abeba, Ethiopia, 2021: a cross-sectional study.

This study aimed to determine the prevalence and factors associated with acute postoperative pain. A cross-sectional study was conducted at Minilik and Zewditu Referral hospitals from October to December 2021 and chart review and face-to-face interviews were the methods of data collection. The pain was measured at the 2, 12, and 24h postoperatively through a numerical rating scale, and the pain was categorized as no pain (score=0), mild pain (score 1-3), moderate pain (score 4-6), or severe pain (score 7-10). All independent variables with P less than or equal to 0.2 in the univariable logistic regression were reanalyzed with multivariable logistic regression at 95% CI to determine predictive factors and a P-value of less than 0.05 was considered statistically significant. In the study period, a total of 368 eligible patients were involved, out of this 11 patients were discharged before 24h, four patients refuse to participate two incomplete documentation and one patient was ICU admitted, therefore 350 patients were involved with a response rate of 95.1%. Among those patients 73.1% of respondents' experience at least one episodes of moderate to severe postoperative pain within the first 24h. Preoperative anxiety (AOR: 2.2, 95% CI: 1.2, 5.1), urban residency (AOR: 2.3, 95% CI: 1.2, 50), participants who have not formal education (AOR: 2.5, 95% CI: 1.3, 4.1), surgical patients without pre-emptive analgesia (AOR: 2.7, 95% CI: 1.3, 3.6), abdominal incision greater than 10cm (AOR: 3.5, 95% CI: 2.1, 7.2), and surgical duration greater than or equal to 60min (AOR: 2.3, 95% CI: 1.1, 3.1) were factors associated with acute postoperative pain following elective gynecologic surgery. In this study, the overall incidence of moderate to severe postoperative pain after gynecologic surgery was unacceptably high, and patients undergoing gynecologic surgical procedures suffer sufficient postoperative pain need of intervention.

Acceptability of Online Yoga Among Individuals With Chronic Conditions and Their Caregivers: Qualitative Study.

The online delivery of yoga interventions rapidly expanded during the COVID-19 pandemic, and preliminary studies indicate that online yoga is feasible across multiple chronic conditions. However, few yoga studies provide synchronous online yoga sessions and rarely target the caregiving dyad. Online chronic disease management interventions have been evaluated across conditions, life spans, and diverse samples. However, the perceived acceptability of online yoga, including self-reported satisfaction and online delivery preferences, is underexplored among individuals with chronic conditions and their caregivers. Understanding user preferences is essential for successful and safe online yoga implementation. We aimed to qualitatively examine the perceived acceptability of online yoga among individuals with chronic conditions and their caregivers who participated in an online dyadic intervention that merged yoga and self-management education to develop skills (MY-Skills) to manage persistent pain. We conducted a qualitative study among 9 dyads (>18 years of age; individuals experiencing persistent moderate pain) who participated in MY-Skills online during the COVID-19 pandemic. The intervention consisted of 16 online, synchronous yoga sessions over 8 weeks for both dyad members. After the completion of the intervention, participants (N=18) participated in semistructured telephone interviews for around 20 minutes, discussing their preferences, challenges, and recommendations for improved online delivery. Interviews were analyzed by using a rapid analytic approach. MY-Skills participants were, on average, aged 62.7 (SD 19) years; were primarily women; were primarily White; and had a mean of 5.5 (SD 3) chronic conditions. Both participants and caregivers reported moderate pain severity scores (mean 6.02, SD 1.3) on the Brief Pain Inventory. The following three themes were identified related to online delivery: (1) participants indicated a preference for the intervention to be in person rather than online because they were distracted in the home setting, because they felt that in-person yoga would be more engaging, because the yoga therapist could physically correct positions, and because of safety concerns (eg, fear of falling); (2) participants indicated good acceptability of online MY-Skills delivery due to convenience, access, and comfort with being in their home; and (3) recommendations for improving online delivery highlighted a need for additional and accessible technical support. Both individuals with chronic conditions and their caregivers find online yoga to be an acceptable intervention. Participants who preferred in-person yoga did so due to distractions in the home and group dynamics. Some participants preferred in-person corrections to ensure correct positioning, while others felt safe with verbal modifications in their homes. Convenience and access were the primary reasons for preferring online delivery. To improve online delivery, future yoga studies should include specific activities for fostering group engagement, enhancing safety protocols, and increasing technical support. ClinicalTrials.gov NCT03440320; https://clinicaltrials.gov/ct2/show/NCT03440320.

Development and Validation of the Dystonia-Pain Classification System: A Multicenter Study.

Dystonia is associated with disabling nonmotor symptoms like chronic pain (CP), which is prevalent in dystonia and significantly impacts the quality of life (QoL). There is no validated tool for assessing CP in dystonia, which substantially hampers pain management. The aim was to develop a CP classification and scoring system for dystonia. A multidisciplinary group was established to develop the Dystonia-Pain Classification System (Dystonia-PCS). The classification of CP as related or unrelated to dystonia was followed by the assessment of pain severity score, encompassing pain intensity, frequency, and impact on daily living. Then, consecutive patients with inherited/idiopathic dystonia of different spatial distribution were recruited in a cross-sectional multicenter validation study. Dystonia-PCS was compared to validated pain, mood, QoL, and dystonia scales (Brief Pain Inventory, Douleur Neuropathique-4 questionnaire, European QoL-5 Dimensions-3 Level Version, and Burke-Fahn-Marsden Dystonia Rating Scale). CP was present in 81 of 123 recruited patients, being directly related to dystonia in 82.7%, aggravated by dystonia in 8.8%, and nonrelated to dystonia in 7.5%. Dystonia-PCS had excellent intra-rater (Intraclass Correlation Coefficient - ICC: 0.941) and inter-rater (ICC: 0.867) reliability. In addition, pain severity score correlated with European QoL-5 Dimensions-3 Level Version's pain subscore (r = 0.635, P < 0.001) and the Brief Pain Inventory's severity and interference scores (r = 0.553, P < 0.001 and r = 0.609, P < 0.001, respectively). Dystonia-PCS is a reliable tool to categorize and quantify CP impact in dystonia and will help improve clinical trial design and management of CP in patients affected by this disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

B-45 | The Use of Virtual Reality to Optimize Patient Comfort During Transcatheter Aortic Valve Replacement

The use of sedating anxiolytic and pain medications is ubiquitous in the United States in patients undergoing transcatheter aortic valve replacement (TAVR). We hypothesize the use of a virtual reality headset (VRH) can lower patient perception of anxiety and pain and improve overall patient experience whilst limiting the use of sedating medications. A feasibility study was performed among patients undergoing TAVR. Use of sedating medications was managed by an anesthesiologist. Patients underwent pre and post procedure surveys with State-Trait Anxiety Inventory 6 Score to assess anxiety and the Wong-Baker FACES Score to assess pain. During the procedure, patients had the option to choose their preferred environment from immersive beach, space, underwater, or nature experiences. In total, 14 patients were enrolled in our study with 4 opting to discontinue the VRH for various reasons including claustrophobia and weight of the headset. For the 10 patients who completed the study, 7 had improvement in their anxiety scores post TAVR (Figure 1, Panel C). The average overall patient experience was excellent at 8.45/10. Post procedural pain scores for the majority of patients was 0 and the most severe pain score 4/10. All 10 patients stated they would use the technology again in future procedures. Use of a VR headset by patients undergoing TAVR appears feasible and does not interfere with care provided by the medical team. Future study will focus on comparisons of anesthetic use and patient satisfaction with vs without use of VRH.

Intravenous Injection of Equine Mesenchymal Stem Cells in Dogs with Articular Pain and Lameness: A Feasibility Study.

Osteoarthritis is a frequently occurring joint disorder in veterinary practice. Current treatments are focused on pain and inflammation; however, these are not able to reverse the pathological condition. Mesenchymal stem cells (MSCs) could provide an interesting alternative because of their immunomodulatory properties. The objective of this study was to evaluate the potential of a single intravenous (IV) injection of xenogeneic equine peripheral blood-derived MSCs (epbMSCs) as treatment for articular pain and lameness. Patients with chronic articular pain were injected intravenously with epbMSCs. They were evaluated at three time points (baseline and two follow-ups) by a veterinarian based on an orthopedic joint assessment and an owner canine brief pain inventory scoring. Thirty-five dogs were included in the safety and efficacy evaluation of the study. Results showed that the epbMSC therapy was well tolerated, with no treatment-related adverse events and no increase in articular heat or pain. A significant improvement in lameness, range of motion, joint effusion, pain severity, and interference scores was found 6 weeks post-treatment compared with baseline. This study demonstrates that future research on IV administration of epbMSCs is warranted to further explore its possible beneficial effects in dogs with chronic articular pain and lameness. Clinical Trial gov ID: EC_2018_002.

Comparing Effects of Rhythmic Breathing and Lidocaine Spray on Pain Intensity During Needle Insertion Into Arteriovenous Fistula in Hemodialysis Patients: A Randomized Controlled Trial.

Hemodialysis patients suffer from pain caused by needle insertion into the fistula site. Non-pharmacological methods may be associated with acceptable effects. The present study aimed to compare the effects of two interventions on pain intensity during needle insertion into the arteriovenous fistula in hemodialysis patients. This self-controlled, single-blind clinical trial was conducted on 54 hemodialysis subjects with arteriovenous fistula in Mashhad in 2021. In this regard, the patients were selected according to the inclusion criteria and randomly assigned to two groups (lidocaine spray and rhythmic breathing). In each group, pain intensity was assessed based on the visual analogue scale (VAS) before the intervention, followed by measuring the post-intervention pain intensity during three consecutive hemodialysis sessions every other day. Regarding the lidocaine spray group, two puffs of 10% lidocaine spray (20 mg) were sprayed on the needle insertion site five minutes before cannulation. However, the patients in another group took a long deep breath through the nose with three numbers, held their breath in the lungs for three numbers, and slowly exhaled through the mouth with three numbers two minutes before cannulation. The data were analyzed using SPSS software version 20, and Mann-Whitney U, Wilcoxon, chi-squared, and paired t-tests were run. In this study, P < 0.05 was considered significant. The results represented a significant decrease in the pain severity scores of both rhythmic breathing (P = 0.023) and lidocaine spray (P < 0.001) groups after the intervention. Moreover, a more significant difference was observed between pre-and post-intervention pain intensity scores in the group treated with lidocaine spray (1.16 ± 1.56) compared to the other group (0.508 ± 1.25). The lidocaine spray group had a larger difference in the pre-and post-intervention pain intensity scores than the rhythmic group; however, the difference was not significant. The rhythmic breathing can be used by nurses as a non-pharmacological method with low complications in hemodialysis departments because of declining pain.

Utilization of Whole Health and Longitudinal Outcomes After Screening Positive for Possible Depression Documented in Veterans Health Administration's Electronic Health Record.

Objectives: Depression is common among Veterans. Veterans Health Administration (VHA) is transforming into a Whole Health system of care that includes holistic treatment planning, well-being programs, and health coaching. This evaluation explores the impact of Whole Health on improving symptoms of depression among Veterans who screen positive for possible depression diagnosis. Materials and Methods: We examined a cohort of Veterans who started using Whole Health after screening positive for possible depression (having a PHQ-2 score ≥3) at 18 VA Whole Health sites. We compared Whole Health users with non-Whole Health users on their follow-up PHQ-2 scores (9-36 months after baseline), using propensity score matching with multivariable regression to adjust for baseline differences. Results: Of the 13,559 Veterans screening positive for possible depression on the PHQ-2 and having a follow-up PHQ-2, 902 (7%) began using Whole Health after their initial positive PHQ-2. Whole Health users at baseline were more likely than non-Whole Health users to have posttraumatic stress disorder or acute stress (43% vs. 29%), anxiety (22% vs. 12%), ongoing opioid use (14% vs. 8%), recent severe pain scores (15% vs. 8%), or obesity (51% vs. 40%). Both groups improved at follow-up, with mean PHQ-2 scores decreasing from 4.49 to 1.77 in the Whole Health group and 4.46 to 1.46 in the conventional care group, with the Whole Health group significantly higher at follow-up. Also, the proportion continuing to screen positive at follow-up trended higher in the Whole Health group (26% and 21%, respectively). Conclusions: After screening positive for depression, Veterans with more mental and physical health conditions were more likely to subsequently use Whole Health services, suggesting that Whole Health is becoming a tool used in VHA to address the needs of complex patients. Nevertheless, the Whole Health group did not improve compared to the Conventional Care group. Results add to the growing body of literature that Whole Health services may play an important role among patients with complex symptom presentations by promoting self-management of symptoms and targeting "what matters most" to Veterans.

Prevalence of chronic pain in hemodialysis patients and its correlation with C-reactive protein: a cross-sectional study

End-stage renal disease (ESRD) is a common chronic disease worldwide that requires hemodialysis. Patients may face chronic pain and poor quality of life. Therefore, a better understanding of these variables in hemodialysis patients is essential to provide a good intervention. We aim to determine how common chronic pain is in hemodialysis patients and its correlation with sociodemographics, C-reactive protein (CRP), calcium, phosphorus, albumin, and parathyroid hormone. A cross-sectional study of hemodialysis patients was conducted in Palestine. Data collection took place between November 2020 and May 2021. We used the brief pain inventory score to assess chronic pain, and lab tests detected CRP levels. Data were collected using a convenience sampling technique. There were two hundred sixty-one patients in the present study. The mean age of the patients was 51 years, with 63.6% being men. 47.1% of them reported having chronic pain. Gender (p = 0.011), social status (p = 0.003), educational status (p = 0.010), and number of chronic diseases (p = 0.004) indicated a significant relationship with the severity score of pain. Furthermore, sex (p = 0.011), social status (p = 0.003), and number of chronic diseases (p = 0.002) were significantly associated with the pain interference score. Additionally, Person’s test indicated significant correlations between CRP and pain severity (p < 0.001) and with pain interference (p < 0.001). Albumin was significantly and negatively correlated with pain severity (p = 0.001) and pain interference (p < 0.001). Multiple linear regression analysis revealed that patients who had a higher CRP level and many chronic diseases were more likely to have a higher pain severity score. However, pain severity was the only predictor for pain interference. Our results suggest that there is a significant correlation between the existence of chronic pain in hemodialysis patients and increased CRP levels. However, further investigations are needed with a larger number of patients in more than one dialysis unit to confirm this correlation and management of chronic pain in patients with HD.

Early outcomes of mantis pharmacomechanical thrombectomy system combined with catheter-directed thrombolysis for treatment of acute iliofemoral deep vein thrombosis

Aim: The purpose of this research was to investigate the early outcomes of pharmacomechanical thrombectomy (PMT) with the Mantis device and adjunctive catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep vein thrombosis (IFDVT). Material and Methods: Twenty patients with symptomatic acute IFDVT were successfully treated with the Mantis rotational thrombectomy device and CDT, between August 2020 and March 2021. Patients' demographical, clinical and follow-up data were obtained and analysed retrospectively. Villalta and Pain Severity scores were utilized to assess the patients for the occurrence of post-thrombotic syndrome (PTS). Results: The procedural success rate was 100%. All cases presented early clinical improvement. No device related complications were encountered. Reocclusion was observed in 3 (15%) patients. Pre-procedural median pain score was 7 (range: 6–8) and 1 (range: 0–7) at 12-month following thrombectomy (P &lt; .001). Pre-procedural median Villalta score was 7 (range: 3–11) and 1 (range: 0–13) at 12-month following thrombectomy (P&lt;.001). At 12-month follow-up, no PTS was reported in 15 (75%) patients, mild PTS was reported in 2 (10%) patients, moderate PTS was reported in 2 (10%) patients and no severe PTS was observed. Conclusion: The Mantis PMT system with CDT seems to be an efficient treatment approach for acute IFDVT with encouraging early results.