Self-reported Pain Research Articles

Do Physical Activities Prevent the Occurrence of Bothersome Pain?

We examined the associations between physical activity (PA)-measured through self-reported walking and vigorous activities-and pain occurrence (self-reported bothersome pain or frequent pain medication use), and persistent pain (pain occurring for two consecutive years). This analysis used a large, nationally representative sample of 2279 older adults from the National Health and Aging Trends Study of 2015-2018, and applied generalized estimating equation regression with propensity score weighting. Approximately 70% and 50% of the participants reported walking and vigorous activities respectively at baseline. The cumulative incidence over the 3-year follow-up time was approximately 60%, and was similar across PA groups. The risk of pain occurrence or persistent pain did not differ by walking or by vigorous activity status (relative risks ranged from 0.97 to 1.20, and the 95% CIs included one). While pain occurrence was common among older adults, our analysis did not find it to be associated with PA.

Use of Local Anesthesia in Adolescent and Adults Undergoing Cleft Lip Repair or Revision: A Systematic Review.

This study aims to assess the safety and efficacy of solely using local anesthetics for cleft lip repair and/or revision in adolescent and adult patients. Systematic review. Clinical studies describing the use of local anesthetics in cleft lip repair procedures. A literature search was conducted using PubMed, Google Scholar, and Embase following the PRISMA 2025 guidelines. Inclusion criteria were studies focusing exclusively on local anesthetic techniques in adolescent or adult patients undergoing cleft lip procedures. Non-English studies, studies involving patients under the age of 10, or those undergoing cleft palate or other otolaryngological procedures were excluded. Risk of bias was addressed by using a modified Downs and Black checklist. Review of local anesthetic use alone for adult and adolescent patients undergoing cleft lip repair or revision. The main studied outcomes were any reported general perioperative complications, the necessity of switching to general anesthesia, patients' self-reported pain during the surgery, wound dehiscence, wound infection, and the need for postoperative narcotics for pain control. The included studies demonstrated consistent evidence supporting the sole use of local anesthesia for cleft lip repair and revision, with absence of wound dehiscence or infection. Most patients reported minimal to no pain and required no general anesthesia during the procedures. The current literature supports the safety and efficacy of local anesthesia alone for cleft lip repair and revision procedures. This modality offers a promising approach in resource-limited countries where access to general anesthesia is often limited.

The process of pain assessment in people with dementia living in nursing homes: a scoping review.

Pain is a common symptom in people with dementia living in nursing homes, but cognitive impairment, including language and communication difficulties, challenges pain assessment and the ability to self-report pain. This study aimed to identify and summarize patterns, advances, and gaps in research literature describing pain assessment in people with dementia living in nursing homes. We conducted a scoping review following Arksey and O'Malley's methodological framework. Systematic searches were conducted in CINAHL, Embase, MEDLINE, and PsycINFO. We included studies describing pain expressions in people with dementia and/or healthcare personnel assessment of pain in people with dementia, in a nursing home context. Charted data included demographics, methodological descriptions, ethical and quality assessment and relevant findings. Relevant findings were summarized using thematic analysis, and an overview of patterns, advances, and gaps in the research literature is presented. Thirty-nine studies were included. The results describe three patterns: (1) pain awareness; (2) suspected pain and (3) pain mapping. Collectively, these patterns constitute a process of pain assessment, integrating pain expressions of people with dementia. Important perspectives on self-reporting are touched upon in several of the included studies, though direct descriptions of attempts to capture the residents' own experience of pain are sparse. This scoping review provides a comprehensive description of pain assessment in people with dementia living in nursing homes as a process in three steps. We identified several knowledge gaps in the understanding of this process and provide concrete recommendations for further research. The results underpin the importance of pain assessment approaches that incorporate the flexibility to meet residents' varying and potentially fluctuating ways of communicating pain. This scoping review is registered in the Open Science Framework (https://osf.io/8kaf5/).

The problem of pain in systemic lupus erythematosus: A comprehensive analysis of pain distribution using the CHOIR body map and PROMIS measures.

Our study investigates the associations between pain distribution, biopsychosocial factors, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures in patients with systemic lupus erythematosus (SLE). Employing self-reported pain body maps, we aim to characterize the distribution of pain and its impact on biopsychosocial measures. We retrospectively analyzed the electronic health records (EHR) of 332 adult patients with SLE attending pain clinics at an academic medical center. The study included demographics, pain distribution assessed via self-reported body maps, and PROMIS assessments of biopsychosocial experiences. We used linear regression models adjusted for age and sex to investigate associations between pain distribution and PROMIS outcomes. Men, on average, indicated pain in 3.2 regions, whereas women reported pain in 5.6 regions. Women predominantly highlighted the hip, buttock, and leg region, whereas men primarily emphasized the shoulder and arm region. We found a positive correlation between pain widespreadness and worse PROMIS measures, including pain interference, behavior, fatigue, depression, anxiety, sleep disturbance, and social isolation. Additionally, widespread pain was associated with lower physical function, emotional support, and satisfaction in roles and activities. Female patients reported higher levels of pain and PROMIS measures compared to males. Our findings highlight the multidimensional impact of pain on SLE patients' lives underscoring the need for holistic pain management approaches. The intricate associations between pain distribution and biopsychosocial factors emphasize the importance of considering spatial dimensions of pain in clinical interventions. Further research is warranted to explore effective interventions addressing psychosocial aspects of pain in SLE, aiming to enhance patient symptom management and quality of life.

Missing the mark(ers): circulating endothelial cells and endothelial-derived extracellular vesicles are elevated in sickle cell disease plasma.

Sickle cell disease (SCD) is a devastating hemolytic disease, marked by recurring bouts of painful vaso-occlusion, leading to tissue damage from ischemia/reperfusion pathophysiology. Central to this process are oxidative stress, endothelial cell activation, inflammation, and vascular dysfunction. The endothelium exhibits a pro-inflammatory, pro-coagulant, and enhanced permeability phenotype. We used flow cytometry to enumerate circulating endothelial cells (CECs, CD31+/CD45-/CD146+) in SCD and normal healthy control blood samples. Furthermore, we assessed CEC subtypes, including circulating endothelial progenitor cells (EPCs, CD31+/CD45-/CD146+/CD133+) and mature CECs (mCECs, CD31+/CD45-/CD146+/CD133-) with mCECs further subdivided into resting CECs (rCECs, VCAM-1-) and activated CECs (aCECs, VCAM-1+). As compared to healthy controls, total CECs and mCECs were elevated in SCD blood as compared to healthy control blood. Using the same markers along with size-based gating, we also used flow cytometry to enumerate endothelial-derived extracellular vesicles (EEVs) in plasma. We assessed EEV subtypes based on VCAM-1 expression, including activated EEVs (aEEVs, CD31+/CD45-/CD146+/CD133-/VCAM-1+) and resting EEVs (rEEVs, VCAM-1 negative), presumably derived from activated and resting endothelial cells, respectively. aEEVs were elevated in SCD patient plasma as compared to healthy controls. Importantly, in SCD patients, total EEVs and aEEVs were increased during self-reported pain crisis as compared to steady state. Plasma markers of endothelial cell activation including soluble E-selectin, P-selectin, VCAM-1, and ICAM-1 were elevated in SCD plasma. These data highlight strategies to detect SCD-related endothelial cell activation and demonstrate that endothelial cell activation markers may be useful to evaluate curative and non-curative therapies in SCD patients.

Distal and Proximal Influences on Self-Reported Oral Pain and Self-Rated Oral Health Status in Saudi Arabia: Retrospective Study Using a 2017 Nationwide Database.

Oral health significantly influences overall well-being, health care costs, and quality of life. In Saudi Arabia, the burden of oral diseases, such as dental caries and periodontal disease, has increased over recent decades, driven by various lifestyle changes. To explore the associations between proximal (direct) and distal (indirect) influences that affect oral pain (OP) and self-rated oral health (SROH) status in the Kingdom of Saudi Arabia (KSA) using an adapted conceptual framework. This retrospective cross-sectional study used data from a national health survey conducted in KSA in 2017. The sample included adults (N=29,274), adolescents (N=9910), and children (N=11,653). Sociodemographic data, health characteristics, and access to oral health services were considered distal influences, while frequency and type of dental visits, tooth brushing frequency, smoking, and consumption of sweets and soft drinks were considered proximal influences. Path analysis modeling was used to estimate the direct, indirect, and total effects of proximal and distal influences on OP and SROH status. The mean age of adult respondents was 42.2 years; adolescents, 20.4 years; and children, 10.58 years. Despite OP reports from 39% of children, 48.5% of adolescents, and 47.1% of adults, over 87% across all groups rated their oral health as good, very good, or excellent. A higher frequency of tooth brushing showed a strong inverse relationship with OP and a positive correlation with SROH (P<.001). Frequent dental visits were positively associated with OP and negatively with SROH (P<.001). Sweet consumption increased OP in adolescents (β=0.033, P=.007) and negatively affected SROH in children (β=-0.086, P<.001), adolescents (β=-0.079, P<.001), and adults (β=-0.068, P<.001). Soft drink consumption, however, was associated with lower OP in adolescents (β=-0.034, P=.005) and improved SROH in adolescents (β=0.063, P<.001) and adults (β=0.068, P<.001). Smoking increased OP in adults (β=0.030, P<.001). Distal influences like higher education were directly linked to better SROH (β=0.046, P=.003) and less OP (indirectly through tooth brushing, β=-0.004, P<.001). For children, high household income correlated with less OP (β=-0.030, P=.02), but indirectly increased OP through other pathways (β=0.024, P=.003). Lack of access was associated with negative oral health measures (P<.001). Among the KSA population, OP and SROH were directly influenced by many proximal and distal influences that had direct, indirect, or combined influences on OP and SROH status.

Etiology and correlates of alcohol misuse in early midlife.

Early midlife individuals (ages 30-40) experience demographic shifts that may influence the remainder of adult life. Although new or persistent alcohol misuse is common during this period, early midlife is understudied in alcohol use literature. We examined the heritability of alcohol misuse; the associations between alcohol misuse and sociodemographic factors, physical health, and well-being; and whether these associations were robust in cotwin comparisons. Participants were 1446 Finnish twin pairs and 748 nonpaired Finnish twins with mean age 34 years. The alcohol misuse index was a composite measure of frequency of use, intoxication, heavy episodic drinking, and alcohol problems assessed with the Malmö-modified Michigan Alcoholism Screening Test and the Rutgers Alcohol Problem Index. Early midlife correlates included relationship status and length, family formation, unemployment status, education level, self-rated health, pain, sleeping difficulties, life satisfaction, psychological health, and other substance use. We employed a sex-limitation model to estimate early midlife heritability. Linear and fixed effects regression models were used for individual and cotwin comparison analyses, respectively. Additive genetic (A) and unique environmental (E) components of alcohol misuse variance differed across sex (Females: A = 62%, E = 38%; Males: A = 49%, E = 51%). In individual-based analyses, higher scores on the alcohol misuse index were associated with lower relationship stability, financial situation, education level, self-rated health, physical fitness, life satisfaction and psychological health, and higher self-reported pain, sleep difficulties, unemployment rates and other substance use (R2 = 0.008-0.12). Associations remained significant in cotwin comparison analyses (R2 = 0.004-0.10) except for financial situation and education level. There is evidence of sex differences in the etiological factors that influence early midlife drinking. After controlling for confounding familial factors, associations between alcohol misuse and poorer early midlife functioning largely remained, suggesting that alcohol misuse may play a role in poorer functioning across several outcomes.

Exploring the association of metabolic factors and chronic musculoskeletal pain over a period of 10years - the Doetinchem Cohort Study.

To examine (a) the association between metabolic factors and chronic musculoskeletal pain (CMP), (b) metabolic predictors of CMP 10years later, and (c) the association and evolution of metabolic factors across different CMP trajectory groups. Data from the longitudinal Doetinchem Cohort Study were used. We used round 4 (2003-2007), with 4519 participants aged 36-75years, as the baseline for the present study, with follow-up measurements in round 5 (2008-2012), and 6 (2013-2017), including self-reported pain and metabolic factors, which were measured either via self-report or physical assessment. For the three research aims, (a) generalized linear mixed-effects models, (b) binary logistic regression analyses and (c) linear mixed-effects models were used. (a) Female sex, higher age, presence of diabetes, higher BMI, lower diastolic blood pressure (BP), and elevated cystatin C were significantly associated with CMP in multivariable logistic analyses. (b) Female sex and elevated BMI were predictors of CMP 10years later. (c) Those pain-free for 10years had the lowest BMI levels compared to other CMP groups (development, recovery, persistent, and recurrent CMP). BMI was higher in the persistent CMP group than in the development and recovery groups. The pain-free group had higher diastolic BP compared to those in the persistent CMP group. Participants in the persistent CMP group had higher Cystatin C levels than the free, development and recovery CMP groups. Regarding the evolution of metabolic factors over time, BMI, glucose and diastolic BP evolved differently across the CMP trajectory groups. Our findings indicate the importance of metabolic factors, especially BMI, in the onset and progression of CMP. These findings underscore the need to consider metabolic health in the prevention and treatment of CMP. Key Points • Metabolic factors are associated with the presence of chronic musculoskeletal pain. • Female sex and elevated BMI are predictive of musculoskeletal pain (MP) 10 years later. • Metabolic factors evolve differently over time across different pain trajectory groups, with variations in BMI, glucose, and diastolic blood pressure.

Development of a gender-specific European job exposure matrix (EuroJEM) for physical workload and its validation against musculoskeletal pain.

The aim was to develop a gender-specific European job exposure matrix (EuroJEM) for occupational physical workload and study its predictive validity for musculoskeletal pain in four European cohorts. National, gender-specific JEM from Finland, France, Norway and Sweden, based on self-reported exposure information, were evaluated for similarities in exposures, exposure definitions, and occupational coding. The EuroJEM harmonized five exposures: heavy lifting, faster breathing due to heavy workload, kneeling/squatting, forward bent posture, and working with hands above shoulder level. Our expert panel addressed disagreements and missing information to reach consensus on exposure levels across occupations. To assess predictive validity of the EuroJEM, we examined associations between the harmonized exposure measures and self-reported musculoskeletal pain across the four cohorts. The EuroJEM provides semi-quantitative exposure estimates for 374 ISCO-88 (COM) occupational codes. Five categories of exposure were defined by the proportion of workers exposed within each occupation. Comparable and statistically significant associations were found between EuroJEM exposures and low back, shoulder, and knee pain across all cohorts and genders, except for knee pain among women in the Finnish cohort. For instance, in both genders heavy lifting, faster breathing due to heavy workload, and forward bent posture were statistically significantly associated with low-back pain in all four cohorts, with OR ranging from 1.25-2.18 (men) and 1.23-2.04 (women). Despite differences in study populations and outcome definitions, good predictive validity was observed in each national cohort, suggesting that EuroJEM can be an effective tool for exposure assessment in large-scale European epidemiological studies.

The relationship between lifecourse traumatic events and pain in an older rural South African population: A cross-sectional study.

Pain in older adults is an increasing concern in low- and middle-income countries (LMICs), with literature suggesting an association with past traumatic events (TEs) in high-income settings. We aim to investigate this relationship in a population-representative sample of older adults with high burden of TEs in a rural South African community. The Health and Aging in Africa: A longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study collected data pain intensity, using the Brief Pain Inventory, and TEs with a 16-item questionnaire, from 2411 participants aged 40-79 in 2014-15. We used logistic regression models to test the association between TE exposure and self-reported pain status. TE experience was near-universal (99.1% experience of at least one), while 9.0% of participants reported current pain, of which 86.6% was moderate/severe. In multivariable regression, increased odds of moderate/severe pain was associated with more TEs of any kind (OR 1.08; 95%CI 1.02-1.15 per additional TE) and with past exposure to disasters, accidents and illnesses (men and women), violence in the community (women only) and social/family environment problems (men only)-but not with childhood or war-related TEs. TEs were associated with pain even within a rural resource-limited setting where trauma experiences were extremely common. However, associations varied by TE type and sex. Interventions to prevent pain in older adults need to be targeted to block specific mechanisms that vary within even at-risk populations.

Clinical proof-of-concept results with a novel TRPA1 antagonist (LY3526318) in 3 chronic pain states.

Transient receptor potential ankyrin 1 (TRPA1) is implicated in physiological and pathological nociceptive signaling, but the clinical benefit of TRPA1 antagonists in chronic pain is not clearly demonstrated. LY3526318 is an oral, potent, and selective novel TRPA1 antagonist. The Chronic Pain Master Protocol was used to evaluate the safety and efficacy of LY3526318 in 3 randomized, placebo-controlled, proof-of-concept studies in knee osteoarthritis pain (OA), chronic low back pain (CLBP), and diabetic peripheral neuropathic pain (DPNP). Participants were randomized (1:2, placebo:LY3526318, 250 mg daily) into an 8-week double-blinded period. At 4 weeks, participants treated with LY3526318 transitioned to a placebo. The primary endpoint was the self-reported daily pain intensity measured using a Numerical Rating Scale (NRS) at 4 weeks. All endpoints were collected for up to 8 weeks. Change from baseline in average weekly NRS was analyzed using Bayesian mixed model repeated measures in the OA (N = 160), CLBP (N = 159), and DPNP (N = 154) studies. Baseline characteristics were balanced between treatment arms. Mean NRS change from baseline to week 4 did not differ significantly between placebo and LY3526318; however, a numerical improvement was observed in the CLBP, not in the OA or DPNP populations. Safety analysis integrated across studies enhanced understanding of the safety profile of LY3526318. LY3526318 showed a potential drug-induced hepatotoxic effect posing a risk for clinical development. No other safety signals were identified. LY3526318 showed potential for different responses among chronic pain indications and patient subpopulations, highlighting challenges in developing TRPA1 antagonists but supporting their value as a target in managing chronic pain.

Relationship between pain severity and self-perceived health among United States adults: A cross-sectional, retrospective database study.

Self-perceived health is related to outcomes such as morbidity and mortality. However, little is known about the relationship between pain severity and self-perceived health, which could be useful to know to help improve health. This study assessed the association of pain severity and other contributing factors with self-perceived health among United States adults. This cross-sectional, retrospective database study used 2019 Medical Expenditure Panel Survey data and included United States adults aged ≥18 years who responded to the pain item in the survey. The independent variable was self-reported pain severity, and the dependent variable was self-perceived health. Various potentially confounding variables were controlled for in the analysis. Adjusted logistic regression models were used to identify statistical associations between each variable and self-perceived health. The complex survey design was maintained, while nationally representative estimates were obtained. Among the sample of 17,261 United States adults, 88.1% (95% confidence interval, 87.4%-88.8%) reported excellent, very good, or good self-perceived health, while 11.9% (95% confidence interval, 11.2%-12.6%) reported fair or poor self-perceived health. In adjusted analyses, there were significant associations between fair or poor self-perceived health and any level of pain severity versus no pain, age 40 to 64 versus 18 to 39 years, male versus female, Hispanic versus non-Hispanic, high school diploma or less versus more than high school, unemployed versus employed, poor, near poor, or low versus middle or high income, fair or poor versus excellent, very good, or good mental health, exercising <5 times versus ≥5 times per week, smoker versus nonsmoker, and ≥2 versus <2 comorbid conditions. This study found that greater levels of pain severity (and several other variables) were associated with greater odds of reporting fair or poor self-perceived health. These associations provide greater insight into the variables associated with self-perceived health, which may be useful targets to improve health.

Appendix: The effects of physician stigma and hesitancy with opioids on patient pain care in the United States: A survey study

Objectives: Determine if physician stigma toward patients with chronic pain or opioid use disorder or physician hesitancy prescribing opioids adversely affects patient pain care. Explore the demographics associated with stigma and hesitancy. Design: Survey, 25 questions. Setting: Physician faculty at medical schools (80 percent), private physician Facebook® groups (15 percent), and others (5 percent), all specialties. Participants: N = 352 attending United States physicians. Main outcome measure: Physician self-reported patient pain care quality. Results: Subjectively worse patient pain care was not found to be associated with stigma but had a borderline association with hesitancy (p = 0.046). Subjectively worse pain care was associated with less knowledge and experience with opioids (odds ratio [OR] 4.1, 95 percent confidence interval [CI] 3.0-5.6), practicing in the Midwest region (OR 2.1, 95 percent CI 1.2-3.4), and specialty: emergency (OR 53, 95 percent CI 20-139), other internal (OR 15, 95 percent CI 6.6-34), and general medicine (OR 12, 95 percent CI 5.4-26) compared to pain medicine. Physician stigma was more likely to be high in males (OR 2.5, 95 percent CI 1.5-4.3) and medium in physicians over 55 (OR 2.5, 95 percent CI 1.5-4.5). Compared to medium stigma, those with low stigma (General Linear Model (GLM) 0.35, 95 percent CI 0.18-0.52) and high stigma (GLM 0.22, 95 percent CI 0.01-0.44) were both more hesitant to prescribe opioids. More hesitancy was associated with less knowledge and experience (GLM 0.14, 95 percent CI 0.05-0.22) and physicians under 55 (GLM 0.24, 95 percent CI 0.08-0.40). Conclusions: Although physician stigma was not found to affect patient pain care adversely, self-reporting bias and/or questionnaire issues may account for this. Physician specialty and knowledge and experience with opioids were important factors.

Effect of intracervical block on self-reported intrauterine device insertion pain: a single-center prospective survey study

Objective The study aimed to determine the incidence of self-reported pain during office-based intrauterine device (IUD) placement. Methods The study included patients who had IUD placement at our clinic from April 1, 2023, to March 31, 2024 with no prior history of vaginal delivery, who were between the ages of 14 and 48 years, did not have cervicitis, and were not pregnant. Informed consent was obtained, a prequestionnaire was completed, the IUD was placed in accordance with clinician preference, and a postquestionnaire was administered. Results Thirty-seven patients answered the question about expected pain. Two (5%) reported that their pain during IUD placement was none, 22 (59%) reported that pain was better than expected, 10 (27%) reported that pain was just as bad as expected, two (5%) reported pain was worse than expected, and one (3%) indicated that their pain during IUD placement was much worse than expected. Thirty-three patients received an intracervical or paracervical block, and five patients did not receive an intracervical or paracervical block; these groups reported visual analog pain scores of 35 ± 25 mm and 58 ± 14 mm, respectively (P = 0.22). Conclusion Approximately 8% of patients in our study reported worse or much worse than expected pain with IUD placement. Patients who received an intracervical or paracervical block reported less pain, but this difference was not statistically significant. Paracervical or intracervical blocks can decrease perceived pain with IUD insertion, increasing contraceptive options for those who are concerned about painful insertions; however larger studies are needed.

Virtual Reality as Active Distraction in Laceration Repair: A Game Changer?

We conducted an unblinded, randomized control trial to determine if immersive virtual reality (VR) goggles decrease pain and fear scores in children undergoing laceration repair in the pediatric emergency department (PED) compared to the standard of care. Secondary outcomes included duration of procedure, physical holding, anxiolytic usage, and desire to use VR goggles again. Ninety-one patients aged 6-17 years in a PED with simple lacerations sutured by PED staff completed surveys. Eligible patients were randomized to receive either VR or standard of care. Guardians and providers also completed surveys. Self-reported pain scores were assessed by the Wong-Baker Faces Pain Scale and fear scores by Children's Fear Scale. There were significant reductions in pain and fear scores for VR goggles compared to standard of care. Patients rated their mean pain score as 3.7 in controls and 2.3 in the VR group, and mean fear score of 3.0 and 2.2. The likelihood of physical holding was significantly lower among those who used VR goggles (adjusted odds ratio = 0.34, 95% confidence interval [0.13-0.92], P = 0.033). The likelihood of receiving anxiolytics was lower among the 12- to 17-year-olds (adjusted odds ratio = 0.27, 95% confidence interval [0.11-0.69], P = 0.006). There was no significant difference in the procedure duration (P = 0.06). A total of 97.9% of parents, 93.6% of patients, and 95.7% of providers would use VR again. Virtual reality goggles are an effective tool for distraction for simple laceration repairs. Their use leads to decreased pain and fear. Children who used VR goggles did not require to be held as often for sutures. There was no significant difference in anxiolytics or duration of procedure.

Parental Assessment of Postsurgical Pain in Infants at Home Using Artificial Intelligence-Enabled and Observer-Based Tools: Construct Validity and Clinical Utility Evaluation Study.

Pain assessment in the infant population is challenging owing to their inability to verbalize and hence self-report pain. Currently, there is a paucity of data on how parents identify and manage this pain at home using standardized pain assessment tools. This study aimed to explore parents' assessment and intervention of pain in their infants at home following same-day surgery, using standardized pain assessment tools. This prospective study initially recruited 109 infant boys undergoing circumcision (same-day surgery). To assess pain at home over 3 days after surgery, parents using iOS devices were assigned to use the PainChek Infant tool, which is a point-of-care artificial intelligence-enabled tool, while parents using Android devices were assigned to use the Observer-Administered Visual Analog Scale (ObsVAS) tool. Chi-square analysis compared the intervention undertaken and pain presence. Generalized estimating equations were used to evaluate outcomes related to construct validity and clinical utility. Receiver operating characteristic analysis assessed pain score cutoffs in relation to the intervention used. A total of 69 parents completed postsurgery pain assessments at home and returned their pain diaries. Of these 69 parents, 24 used ObsVAS and 45 used PainChek Infant. Feeding alone and feeding with medication were the most common pain interventions. Pain presence over time reduced. In the presence of pain, an intervention was likely to be administered (χ22=21.4; P<.001), with a medicinal intervention being 12.6 (95% CI 4.3-37.0; P<.001) times more likely and a nonmedicinal intervention being 5.2 (95% CI 1.8-14.6; P=.002) times more likely than no intervention. In the presence of intervention, score cutoff values were ≥2 for PainChek Infant and ≥20 for ObsVAS. A significant effect between the use of the pain instrument (χ21=7.2, P=.007) and intervention (χ22=43.4, P<.001) was found, supporting the construct validity of both instruments. Standardized pain scores were the highest when a medicinal intervention was undertaken (estimated marginal mean [EMM]=34.2%), followed by a nonmedicinal intervention (EMM=23.5%) and no intervention (EMM=11.2%). Similar trends were seen for both pain instruments. Pain was reduced in 94.5% (224/237) of assessments where parents undertook an intervention. In 75.1% (178/237) of assessments indicative of pain, the score changed from pain to no pain, with PainChek Infant assessments more likely to report this change (odds ratio 4.1, 95% CI 1.4-12.3) compared with ObsVAS assessments. The use of standardized pain assessment instruments by parents at home to assess pain in their infants can inform their decision-making regarding pain identification and management, including determining the effectiveness of the chosen intervention. In addition to the construct validity and clinical utility of PainChek Infant and ObsVAS in this setting, feeding alone and a combination of feeding with medication use were the key pain intervention strategies used by parents.

The Clinical Assessment of Eccentric and Concentric Stepping Kinetics has Utility in Older African American Men with Knee Arthritis.

Stair navigation is physically demanding for individuals with knee osteoarthritis and may result in movement asymmetries that can be quantified using kinetic analysis and force-time parameters. Thus, the purpose of this cross-sectional study was to determine if kinetic force-time parameter asymmetries are present in individuals with knee osteoarthritis and associated with functional outcomes. Forty-six older male veterans (61.6±5.6 years) participated. More and less involved legs were defined using the Kellgren and Lawrence (KL) scale and self-reported pain. Kinetics were measured with the Neurocom® Step Up and Over test and quantified with the lift-up index, impact index, movement time, and stair-stepping smoothness. Smoothness was calculated from the level of intermittency in acceleration and deceleration during the concentric and eccentric test movements. Smoothness was the only force-time parameter to demonstrate an asymmetry. Greater smoothness values were observed for the less-involved leg (p<0.001, 95% CI: 1.22 to 3.64, d=1.17) and were positively associated with gait speed (more-involved: r=0.47, p<0.01; lessinvolved: r=0.53, p<0.01), Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptom (more-involved: r=0.31, p<0.05; less-involved: r=0.39, p<0.01) and ADL (more-involved: r=0.32, p<0.05; less-involved: r=0.39, p<0.05) subscales, and isokinetic knee extension strength (more-involved: r=0.31, p<0.05; less-involved: r=0.42, p<0.01). Stair-stepping smoothness was diminished in the more involved leg and was associated with worse gait speed, patient-reported outcomes, and knee strength. This observation may reflect compromised motor control associated with decreased strength and greater disease severity in the more-involved leg.

Recognition and assessment of pain in people with advanced dementia.

Pain is highly prevalent among older adults, equally affecting people with dementia and those without cognitive impairments. As dementia progresses, patients often develop difficulties in communication and it may impact their ability to self-report pain. Therefore, it is essential that nurses working with dementia patients understand how to recognise, assess and manage pain in this population. This article explores how pain affects people with dementia, especially those who cannot communicate their discomfort, and discusses how pain may present in these individuals. The article also offers guidance on assessing pain using observational tools. It highlights the importance of knowing the person and the valuable information provided by family caregivers. A hypothetical case study is used to consider some of the common issues in community nursing.

Relationships Between Self-Reported Pain and Optimism Among Community-Dwelling Older Adults.

Measures of life outlook in older adults have been investigated in connection to pain, as both pain management and outlook are important factors of successful aging. We hypothesized that higher pain is associated with lower optimism among community-dwelling older adults. We utilized data from the UC San Diego Successful Aging Evaluation (SAGE), a prospective longitudinal cohort study initiated in 2010, to evaluate the relationship between pain and optimism in 378 community-dwelling adults aged ≥50 years. We used the revised Life Orientation Test (LOT-R) to measure optimism and three pain subscales-PROMIS Pain Interference, PROMIS Pain Intensity, and MOS 36-Item Short-Form Health Survey (SF-36)-as pain measures. Regression analyses reveal negative relationships between pain and optimism for all three pain scales, with regression coefficients of -0.277 (p < .0001), -0.246 (p < .0001), and 0.269 (p < .0001) respectively. This indicates value in considering physical and psychological elements in future intervention research to promote healthy aging.

Effect of Patient Age on Decisional Regret After Laparoscopic Hysterectomy.

To compare long-term decision regret between younger (30 years or younger) and older (31-49 years) patients who underwent laparoscopic hysterectomy for benign disease. We conducted a matched retrospective cohort study to analyze patients who underwent laparoscopic hysterectomies for benign indications from 2009 to 2016. Respondents completed surveys including two validated decision regret scales: one measuring surgical decision regret and the other measuring loss-of-fertility regret. Participant aged was dichotomized as 30 years or younger and 31-49 years. Chi square, Fisher exact, and Wilcoxon rank sum tests and logistic regression were used to compare groups. Two hundred eighty-seven participants were successfully contacted, and 241 completed the survey (84.0%). Seventy-seven respondents (32.0%) were aged 30 years or younger, and 164 (68.0%) were aged 31-49 years. The average time since surgery was 7.2 years (±2.2 years; range 3.7-12.1 years). Participants aged 30 years or younger regretted both undergoing surgery (32.5% vs 9.1%, P<.001; OR 4.8, 95% CI, 2.3-9.8) and loss of fertility (39.0% vs 13.4%, P<.001, OR 4.1, 95% CI, 2.2-7.8) at significantly higher rates than participants aged 31-49 years. Overall, 83.1% of younger participants agreed that hysterectomy was the right choice compared with 97% of older participants (P<.001). Higher rates of surgical and loss-of-fertility regret were seen in participants with self-reported pelvic pain (P=.003, P=.011), preoperative diagnosis of endometriosis (P=.037, P=.046), and postoperative complications (P=.043, P<.001). Although time since hysterectomy did not affect rate of surgical regret (P=.138), participants further from their hysterectomies had lower rates of loss-of-fertility regret (P=.003). Patient age remained significantly associated with both surgical regret (adjusted OR 2.9 (95% CI, 1.3-6.5) and loss-of-fertility regret (adjusted OR 2.8 (95% CI, 1.3-6.0) on multivariable logistic regression. Participants aged 30 years or younger were more likely to regret their decision to undergo hysterectomy than participants aged 31-49 years, regardless of parity, prior sterilization, or previous treatment.