Pain Sequelae Research Articles

Work Related Pain in Gynecologic Surgeons - A National Survey.

The objectives of the study are to 1) ascertain the prevalence of work-related pain amongst gynecologic surgeons, 2) describe risk factors and sequelae of pain and 3) assess the need for an ergonomic curriculum. Survey study. The survey was electronically administered. Gynecologic surgery subspecialists and fellows in training were included, as well as Ob/Gyn Specialists who perform gynecologic surgery. A 38-question anonymous survey was developed from available ergonomic literature and had three main sections 1) demographic information, 2) pain history and 3) ergonomic education. 305 gynecologic surgeons participated. 76.7% identified as female. Most respondents were Minimally Invasive Gynecologic Surgeons (64.6%) with a primary surgical modality of conventional laparoscopy (65.6%). 95.7% of respondents reported pain during or after surgery. Female surgeons (p = .018), shorter surgeons (OR = 2.4, 95% CI [1.1, 5.4]), and those with a smaller glove size (p = .025) were more likely to report severe pain. Surgeons who reported worse pain were more likely to seek treatment (p = .007) and take time off from operating (p < .001). 79.4% of respondents report engaging in a variety of interventions to treat surgery-related pain. Due to pain, 23.9% report changing surgical modality and 62.5% of surgeons are concerned about their ability to operate in the future. 61.3% of surgeons did not feel confident in their ability to ergonomically set up their operating room. 98.0% recommend formal ergonomic training for residents. Surgeons are at risk for work-related pain. Gynecologic surgeons are an understudied population with specific ergonomic challenges. In this national survey of high-volume gynecologic surgeons of various subspecialities, we report a high rate of surgery-related pain, significant clinical and nonclinical sequelae of pain, and demonstrate a need for implementing and improving ergonomic training for Obstetrics and Gynecology trainees.

Combined Surgical Technique of Hyperselective and Partial Motor Neurectomies for Spastic Equinus, Equinovarus, and Claw Toe Deformities.

Patients with spastic equinus, equinovarus, and claw toe deformities can experience marked pain and functional limitations in the ability to weight-bear comfortably, ambulate efficiently, or mobilize independently. Seen in 80% of patients with cerebral palsy and 18% of patients with stroke (1, 2), the spastic foot and ankle deformities, and its secondary sequelae of static joint contractures, osseous changes, and chronic pain, are unfortunately common. Adult and pediatric patients undergoing combined hyperselective and selective partial motor neurectomies for varus or claw toe deformities were reviewed. Patient demographics and complications were recorded. Pre- and postoperative Modified Ashworth Scale scores were compared. Twenty-three patients (16 adults and seven pediatric) met inclusion criteria and were included in analysis. At early 6-month follow-up, the mean preoperative Modified Ashworth Score of 2.8 in adult patients and 3.0 in pediatric patients decreased to 0.6 postoperatively. Complications in three adult patients included one patient with temporary dysesthesias to the plantar foot, one with a popliteal abscess requiring incision and drainage, and one superficial wound dehiscence that was managed conservatively. A combined technique of hyperselective and partial motor neurectomies are effective in decreasing tone in the correction of spastic foot and ankle deformities in both adult and pediatric patients in short-term 6-month follow-up.

Study Protocol for the Healing Opioid Misuse and Pain Through Engagement Trial: Integrated Treatment for Individuals With Co-occurring Chronic Pain and Opioid Use Disorder.

Chronic pain and opioid use disorder (OUD) are public health crises and their co-occurrence has led to further complications and public health impacts. Provision of treatments for comorbid chronic pain and OUD is paramount to address these public health crises. Medications for OUD (MOUD) are gold standard treatments for OUD that have also demonstrated benefit in pain management. However, clinics that provide MOUD for chronic pain or OUD often lack behavioral treatments to address the challenges experienced by individuals with both conditions. Developing and implementing a behavioral treatment that complements MOUD may better equip clinics to provide comprehensive care to the growing proportion of clients who present with comorbid chronic pain and OUD. In the Healing Opioid misuse and Pain through Engagement (HOPE) Trial, we are using an effectiveness-implementation hybrid design to examine the benefits of an integrated behavioral treatment and to determine the feasibility of implementing the integrated treatment into clinics that provide MOUD. The treatment integrated 2 evidence-based treatments-Acceptance and Commitment Therapy and Mindfulness-Based Relapse Prevention-to target the emotional, behavioral, and physiological sequelae of OUD and chronic pain. Implementation feasibility will include assessing changes in implementation readiness and identifying facilitators and barriers to implementing the integrated treatment among all personnel employed in clinics that provide MOUD. This commentary offers an overview of the study and design and details adaptations we made to our study protocol, based largely on clinic personnel time constraints and variable clinic procedures during the COVID-19 pandemic.

The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage

Chronic pain and functional limitations secondary to nerve injuries are a major barrier to optimal recovery for patients following high-energy extremity trauma. Given the associated skeletal and soft tissue management challenges in the polytraumatized patient, concomitant nerve injuries may be overlooked or managed in delayed fashion. Whereas previous literature has reported rates of peripheral nerve injuries at <10% in the setting of high-energy extremity trauma, in our experience, the incidence of these injuries has been much higher. Thus, we sought to define the incidence, pain sequelae, and functional outcomes following upper extremity peripheral nerve injuries in the combat-related limb salvage population. We performed a retrospective review of all patients who underwent limb salvage procedures to include flap coverage for combat-related upper extremity trauma at a single institution between January 2011 and January 2020. We collected data on patient demographics; perioperative complications; location of nerve injuries; surgical interventions; chronic pain; and subjective, patient-reported functional limitations. A total of 45 patients underwent flap procedures on 49 upper extremities following combat-related trauma. All patients were male with a median age of 27 years, and 96% (n= 47) of injuries were sustained from a blast mechanism. Thirty-three of the 49 extremities (67%) sustained associated nerve injuries. The most commonly injured nerve was the ulnar (51%), followed by median (30%) and radial/posterior interosseous (19%). Of the 33 extremities with nerve injuries, 18 (55%) underwent surgical intervention. Nerve repair/reconstruction was the most common procedure (67%), followed by targeted muscle reinnervation (TMR, 17%). Chronic pain and functional limitation were common following nerve injury. Upper extremity peripheral nerve injury is common following high-energy combat-related trauma with high rates of chronic pain and functional limitations. Surgeons performing limb salvage procedures to include flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible. Therapeutic IV.

Chronic Pain andChildhood Adversity Experiences Among U.S. Military Personnel.

Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood adversity (CA) within the veteran, adult, and pediatric populations. Given the need to maximize soldier resiliency, an examination of the link between CA and chronic pain in an active duty population for a better understanding that informs treatment options is warranted. The analytic sample comprised 32 men and 8 women drawn from a retrospective review of 203 intake assessments at an interdisciplinary pain management center. We identified a group (CA) of 20 patients who reported a history of pre-adolescent sexual abuse or living in an "abusive" childhood home and compared it with a control group (no-CA) of 20 patients, matched for age, gender, pain history duration, and pain problem. Validated measures were used to assess pain intensity, interference in functioning and well-being, emotional sequelae of pain as reflected in symptoms of depression and anxiety, and pain-related catastrophic thinking. Data were analyzed using descriptive statistics and independent samples t-test analyses. Differences in current, worst, and average pain ratings were non-significant between groups. The CA group reported significantly greater effect of pain on mood (mean: 6.20 versus 4.25, P < .02) and showed a trend toward higher pain interference in functioning (mean: 17.70 versus 15.05, P = .053). The CA patients had significantly more serious depression (mean: 12.65 versus 4.50, P < .001) and anxiety symptoms (mean: 10.60 versus 2.35, P < .001) and significantly higher pain catastrophizing tendency (mean: 30.05 versus 20.50, P < .03). Overall, the findings suggest that childhood trauma should be considered by providers when treating depression and anxiety in soldiers with chronic pain. Being mindful of trauma-informed care may have implications, perhaps, for cases perceived as treatment resistant.

WTP5.8 An International Multispecialty Survey of Work-Related Musculoskeletal Pain in Laparoscopic Surgeons

Abstract Aims Maintenance of uncomfortable body positions during laparoscopic surgery may lead to work-related musculoskeletal disorders in surgeons. Increasing laparoscopic surgical adoption worldwide necessitates understanding of the nature &amp; extent of the impact on surgeons’ physical health. Methods An international open online survey of multispecialty laparoscopic surgeons was undertaken in 2022, with support from ASGBI. This was designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There were no incentives offered or paid advertising. Questions included assessment of surgical experience, incidence, nature, and sequelae of pain. Results There were 259 respondents from 9 specialties across 32 different countries, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration (&amp;gt;4hrs vs &amp;lt;1hr) and a greater number of years in practice (&amp;gt;15yrs vs &amp;lt;5yrs) were both associated with a significantly higher pain prevalence (p&amp;lt;0.01 &amp; p=0.041 respectively). Surgeons with a pre-existing injury were significantly more likely to report pain than those without (p=0.029). Early retirement due to pain was being considered by 20%, particularly those performing longer operations. Thirty-five percent of surgeons sought treatment for laparoscopic induced pain, ranging from analgesia to surgery. Conclusions The physical impact of performing laparoscopic surgery is significant and consistent across specialties and countries. Particular at-risk groups are those with prior injuries and longer operation times. Innovations such as robotic surgery and improved ergonomic education need further evaluation as to whether they may mitigate against these issues.

Comparison of Two Dexamethasone Intervention Time Points in Reducing Post-Operative Sequelae of Mandibular Fracture Osteosynthesis

Background: Mandibular fracture osteosynthesis comes with mechanical and thermal assaults to surrounding tissues resulting in the sequelae of pain, trismus, and oedema. Dexamethasone is known to reduce these sequelae; pain, swelling and trismus, with varying outcomes, and the lack of a standardized regimen for its optimal effect in maxillofacial surgery remains a cause of concern to researchers.&#x0D; Objective: To compare two dexamethasone intervention time points in reducing post-operative sequelae of mandibular fracture osteosynthesis&#x0D; Methods: A total of 102 subjects with mandibular body fractures in the age bracket of 20-60 years were recruited into the study and divided into preoperative, intraoperative, and control groups. 4mg of dexamethasone was injected via the submucosal route into the intact mucogingival area below the fracture line, one hour before making the incision in the preoperative group, at the time of the incision for the intraoperative group, and injection of the same volume of 0.9% normal saline preoperatively for the control group. Following osteosynthesis, postoperative sequelae, and complications were assessed on postoperative days 1, 3, and 7.&#x0D; Results: There was a reduction in pain, swelling, and trismus in both test groups compared to the control with a significant reduction observed in the intraoperative group.&#x0D; Conclusion: Our results showed that the administration of 4mg submucous dexamethasone reduces postoperative sequelae after mandibular fracture osteosynthesis with the intraoperative administration resulting in a significant reduction in postoperative pain.&#x0D;

Effect of Pre-Treatment with Ketorolac Tromethamine on Post-operative Pain Following Periodontal Surgery: A Randomized Crossover Clinical Trial

Background: Periodontal surgeries are often followed by post-operative pain and discomfort which is a major concern to both the clinician and the patient. Every effort is being made to reduce the post-operative pain, one amongst them being the pre-operative medication with NSAIDS like ketorolac tromethamine. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response hence it may be advantageous in reducing post-operative pain and discomfort. Thus, the efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was evaluated. Material &amp; Methods: Two groups of 15 patients each were selected for the study. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group doesn’t received any drug. Combination of Diclofenac sodium 50 mg &amp; Paracetamol 325mg tablets was provided as “rescue analgesic. The visual analog scale modified with using numerical rating scales and Wong-Baker Faces Pain Rating Scale was used to estimate pain. Postoperative pain was assessed hourly for the first 12 h on the day of surgery, and 4 times daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results: Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to no premedication group. Incidence and amount of rescue medication consumption was small in ketorolac groups. No adverse reactions related to preoperative medication were observed. Conclusion: The results of this study showed that 20-mg ketorolac administered immediately before periodontal surgery was effective for alleviating the early postoperative painful sequelae, affected delayed pain levels and postoperative rescue analgesic consumption.

The Efficacy of Different Nerve Blocks on Postoperative Pain and Sequelae in Patients Undergoing Abdominoplasty: A Network Meta-Analysis.

Although abdominoplasty is growing in popularity, it still results in considerable postoperative pain, which prolongs recovery. The aim of this network meta-analysis was to combine evidence about different regional nerve blocks to examine their effectiveness in the management of postoperative pain sequelae and recovery following abdominoplasty. An electronic literature search in the MEDLINE (PubMed; National Institutes of Health, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), Cochrane Library (London, UK) and US National Institutes of Health Ongoing Trials Register electronic databases (Bethesda, MD) was conducted from inception to July 2022. Inclusion criteria were the presence of intervention and control groups; data derived from controlled studies evaluating nerve blocks after abdominoplasty, in terms of analgesia needs, complications, and patient satisfaction; and publication in peer-reviewed journals. The quality of studies was assessed via Cochrane's risk-of-bias tool. A frequentist random-effects network meta-analysis was conducted for all outcomes of interest. A total of 12 studies, containing 543 patients with no differences in age, sex, BMI, and comorbidities, met the inclusion criteria. Transversus abdominis plane blocks have been found to reduce 24-hour and 48-hour opioid consumption (-3.70 and -5.01 weighted mean difference, respectively). In addition, the nerve blocks reviewed effectively prolonged the time to first rescue analgesia request, were safe in terms of complications, and were associated with high satisfaction rates. Nerve blocks emerge as an effective and safe adjunct for adequate pain management following abdominoplasty. This meta-analysis provides an evidence-based strategy to optimize the current analgesia regimens following abdominoplasty.

Study protocol of the TEC-ORL clinical trial: a randomized comparative phase II trial investigating the analgesic activity of capsaicin vs Laroxyl in head and neck Cancer survivors presenting with neuropathic pain sequelae

BackgroundNeuropathic pain is common in cancer survivorship and is one of the most distressing symptoms for patients previously treated for head and neck cancer. Persistent neuropathic pain, when it is ongoing and uncontrolled, has a detrimental effect and erodes patients’ quality of life. Patients treated for head and neck cancer are chronic opioid users to manage their post-treatment pain, which may entail an increased risk of addiction and overdose. We propose to evaluate the analgesic activity of high-concentration capsaicin patches for the treatment of head and neck cancer survivors presenting with neuropathic pain sequelae.MethodsTEC-ORL is a parallel, multicenter randomized comparative phase II study evaluating whether Capsaïcin patches (Qutenza®) reduce neuropathic pain when compared to Amitriptyline (Laroxyl®) in head and neck cancer survivors presenting with neuropathic pain sequelae. The primary efficacy outcome is the rate of patients with a pain reduction of at least two points at 9 months compared to baseline. Assuming that 5% of patients become lost to follow-up, 130 patients will need to be randomized to detect a 25% improvement (i.e., standard: 25%, experimental: 50%) using a one-sided chi-square test with an alpha of 0.05%. According to the recommendations for comparative phase II trials, the target differences and type I error rates are relaxed. Randomized patients will either be treated with a capsaicin 8% (Qutenza®) patch applied at three time intervals in the experimental arm or with Amitriptyline (Laroxyl®) (oral solution 40 mg/ml) taken for 9 months at the recommended daily dose of 25 mg to 75 mg in the control arm.DiscussionTEC-ORL is a randomized comparative phase II trial designed to comprehensively evaluate the analgesic activity of capsaicin compared to Laroxyl in Head and Neck Cancer survivors presenting with neuropathic pain sequelae.Trial registrationClinicalTrials.gov identifier: NCT04704453 Date of registration: 2021/01/13.

A Comprehensive Review: Chronic Pain Sequelae in the Presence of Ehlers-Danlos Syndrome.

Patients diagnosed with Ehlers-Danlos syndromes (EDS), and especially those with the hypermobility subtype, often experience a diverse range of acute and chronic pain conditions throughout their lifetime. These can present in a variety of different phenotypes and comorbidities, making it difficult to develop structured treatment protocols. This review seeks to summarize the current literature to address old and novel treatments for EDS. Historically, medications and surgery have been used to treat patients with EDS but with low efficacy. Newer therapies that have shown promising effects for both decreasing pain and increasing quality of life include physical/occupational therapy, transcutaneous electrical nerve stimulation units, trigger point injections, low-dose naltrexone, and laser therapy. In addition, addressing the psychosocial aspects of pain with EDS through methods like cognitive behavioral therapy and patient education has shown to be vital in minimizing pain. Most research also emphasizes that pain management should not only focus on pain reduction, but on helping reduce symptoms of hypermobility, central sensitization, and fatigue to make an impactful difference. Research on pain in EDS is still limited with good clinical practice guidelines often limited by poor sample size and lack of clinical studies. Treatment options should be structured based on the specific type of pain pathology and presenting symptoms of each patient and their comorbidities. Future research should attempt to prioritize larger sample sizes, clear definitions of EDS subtypes, randomized trials for treatment efficacy, and more studies dedicated to non-musculoskeletal forms of pain.

Protocol for mindfulness-oriented recovery enhancement (MORE) in the management of lumbosacral radiculopathy/radiculitis symptoms: A randomized controlled trial

IntroductionLumbosacral radiculopathy/radiculitis (LR) or “sciatica” is a commonly intractable sequelae of chronic low back pain (LBP), and challenges in the treatment of LR indicate that persistent pain may have both mechanical and neuropathic origins. Mindfulness-based interventions have been demonstrated to be effective tools in mitigating self-reported pain in LBP patients. This paper describes the protocol for a randomized controlled trial (RCT) evaluating the effects of the specific mindfulness-based intervention Mindfulness-Oriented Recovery Enhancement (MORE) on LR symptoms and sequelae, including mental health and physical function. MethodsParticipants recruited from the Portland, OR area are screened before completing a baseline visit that includes a series of self-report questionnaires and surface electromyography (sEMG) of the lower extremity. Upon enrollment, participants are randomly assigned to the MORE (experimental) group or treatment as usual (control) group for 8 weeks. Self-reported assessments and sEMG studies are repeated after the intervention is complete for pre/post-intervention comparisons. The outcome measures evaluate self-reported pain, physical function, quality of life, depression symptoms, trait mindfulness, and reinterpretation of pain, with surface electromyography (sEMG) findings evaluating objective physical function in patients with LR. To our knowledge, this is the first trial to date using an objective measure, sEMG, to evaluate the effects of a mindfulness-based intervention on LR symptoms. HypothesesWe hypothesize that MORE will be effective in improving self-reported pain, physical function, quality of life, depression symptoms, mindfulness, and reinterpretation of pain scores after 8 weeks of mindfulness training as compared to treatment as usual. Additionally, we hypothesize that individuals in the MORE group with abnormal sEMG findings at baseline will have improved sEMG findings at their 8-week follow-up visit.

Acute Lower Back Pain after Intralesional Injection of Collagenase Clostridium histolyticum for Peyronie's Disease.

The safety label for collagenase Clostridium histolyticum was updated to include postinjection acute lower back pain as an adverse event observed with intralesional therapy for Peyronie's disease. Incidence and causality are unknown. We assessed frequencies and temporal associations for this adverse event in a large cohort. Data on all men undergoing collagenase injections for Peyronie's disease at our institution from October 2015 through December 2020 were retrospectively assessed. The study included 330 patients, 300 completing at least 1 full course (8 injections). Measured outcomes included incidence and timing of back pain, and associations with demographics and comorbidities. Of 330 patients, 19 (5.8%) experienced at least 1 episode of postinjection acute lower back pain. Of 300 who completed at least 1 full course of 8 injections, 4 (1.3%) reported back pain within the 8-injection course. A subset underwent additional rounds (16 or 24 injections). Back pain increased to 8.7% (13/149) during a second round, 6.9% (3/43) during a third. No association was found with age, diabetes or back pain history. Most cases occurred shortly after injection; all were self-limited or resolved with a single dose of ketorolac. This single-center, retrospective analysis suggests that intralesional collagenase injections for Peyronie's disease may cause acute lower back pain in up to 6% of patients. Patients may benefit from counseling regarding this risk. Incidence rises with additional rounds of treatment. Prospective safety data regarding >8 injections do not exist. No patient had long-term sequelae of back pain.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

A Systematic Review on the Effect of Physical Therapist Delivered Ergonomic Intervention on Workers in a Physically Taxing Workplace

Background: Musculoskeletal injuries have increased in the past decade, and this has caused a sequela of pain and missed work time due to injuries. The aim of this study was to determine the effect of physical therapist delivered ergonomic intervention on workers in a physically taxing workplace. A systematic review was performed, which evaluated changes in pain and functional status of injured workers when ergonomic interventions were delivered by physical therapists. Methods: A literature search of ProQuest Central, Science Direct, PubMed, Taylor and Francis and EbscoHost was conducted using PEDro guidelines. The search limits and selection criteria were employed. A systematic review of literature using PEDro guidelines was used. In total, six RCTs met the selection criteria. Conclusion:Moderate to strong mixed evidence exists to show the effect physical therapist can have on providing workplace solutions to improve function and decreases pain with employees in a physically taxing workplace

Pain and Nausea Intensity, Social Function, and Psychological Well-Being among Women with Metastatic Breast Cancer.

Advances in diagnostics and therapeutics have improved prognosis for metastatic breast cancer (MBC). Yet, treatment and disease burden-including experiences of pain and nausea-present practical and emotional challenges. To better support patients and enhance quality of life, deeper understanding of the pathways linking physical and psychological health is needed. To this end, we examined associations of pain and nausea with depression and anxiety among women with MBC. In doing so, we highlighted social function as a potentially important mechanism in this relationship. This observational, cross-sectional study included 148 predominantly non-Hispanic White, highly educated women living with MBC. Multivariate regression models demonstrated that more intense pain and nausea were significantly associated with higher levels of depression and anxiety (p < .001). Causal mediation analyses confirmed significant indirect effects whereby decreases in social function associated with pain and nausea contributed to depression and anxiety. Thus, our findings illustrate decreased social function as one pathway through which pain and nausea contribute to escalation of depression and anxiety. Our results, therefore, underscore the importance of supporting social function among women with MBC to potentially reduce psychological sequelae of pain and nausea.

Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury.

BACKGROUNDSevere craniocerebral injury (STBI) is a critical physical trauma caused by a sudden external force acting on the head. The condition is complex and changeable, and disability and mortality rates are high. Although the life of STBI patients can be saved through treatment, the sequelae of consciousness, speech, cognitive impairment, stiffness, spasm, pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family. In the past, routine nursing was often used to treat/manage STBI; however, problems, such as improper cooperation and untimely communication, reduced therapeutic effectiveness.AIMTo investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.METHODSFrom January 2019 to December 2020, 126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center. These patients were retrospectively selected as the research participants in the current study. The study participants were then divided into a control group (61 cases) and a study group (65 cases). The control group was treated with routine nursing. The study group adopted the proposed care bundle. The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale (GCS) were used to evaluate neurological function before and after emergency treatment. After 3 mo of rehabilitation, experimental outcomes were assessed. These included the GCS, Barthel Index, complication rate, muscle strength grade and satisfaction.RESULTSThere was no significant difference in gender, age, cause of injury and GCS between the two groups. After emergency, the National Institutes of Health Stroke Scale/Score of the study group (10.23 ± 3.26) was lower than that of the control group (14.79 ± 3.14). The GCS score of the study group (12.48 ± 2.38) was higher than that of the control group (9.32 ± 2.01). The arrival time of consultation in the study group was 20.56 ± 19.12, and the retention time in the emergency room was 45.12 ± 10.21, which were significantly shorter than those in the control group. After 3 mo of rehabilitation management, the GCS and Barthel Index of the study group were 14.56 ± 3.75 and 58.14 ± 12.14, respectively, which were significantly higher than those of the control group. The incidence of complications in the study group (15.38%) was significantly lower than that in the control group (32.79%). The proportion of muscle strength ≥ grade III in the study group (89.23%) was significantly higher than that in the control group (50.82%). The satisfaction of patients in the study group was significantly higher than that in the control group.CONCLUSIONCare bundles are used to optimize the nursing process. During first-aid, care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time. In early rehabilitation, they can effectively improve the consciousness of STBI patients, improve the activities of daily living, reduce the risk of complications, accelerate the recovery of muscle strength and improve their satisfaction.

Pain Interference and Conscientiousness in Older Adults

Pain interference increases with age and occurs when pain interrupts daily activities. Individuals vary in their amount of interference at a given level of pain. Conscientiousness is a personality trait characterized by diligence, perseverance, and goal-directedness, and is associated with fewer unhealthy behaviors and better health, including less pain and fewer functional limitations. This study tested three hypotheses on the relationships between pain, Conscientiousness, and pain interference among community-dwelling older adults (N=210) in a longitudinal study. At semi-annual interviews, participants reported their pain and interference. Conscientiousness was measured at baseline and follow-up. Multilevel models tested the between- and within-person relationships among study variables. Greater pain predicted more interference (person: γ01=.541, SE=.042, p<.0001; visit: γ10 =.495, SE=.014, p<.0001) but higher Conscientiousness decreased interference (γ02=-.156, SE=.064, p<.025). There was an interaction between Conscientiousness and pain: At higher levels of pain, older adults higher in Conscientiousness experienced much less interference than their less conscientious peers (γ11=-.199, SE=.089, p<.025). Older age at baseline predicted a greater decrease in Conscientiousness over the study period (b=-0.013, t(91)=-2.07, p<.05). Conscientiousness reduces the negative impact of pain on daily function. This protective effect may reflect perseverance and commitment to valued activities, consistency with proactive health behaviors, or other attitudes and behaviors that reduce the likelihood of psychosocial sequelae of pain. Overall, the sample decreased in Conscientiousness over time; however, the direction and amount of change varied considerably. These results refine existing knowledge of personality in old age and implicate personality factors as a potential target for pain management.

A Randomized Clinical Hypnosis Pilot Study: Improvements in Self-Reported Pain Impact in Adults with Sickle Cell Disease.

Sickle cell disease (SCD) is characterized by recurrent painful vasoocclusive crises. Current evidence focuses on the frequency of acute pain crises resulting in emergency department use and nonplanned inpatient hospital admissions; yet few studies focus on pain sequelae outside the healthcare system or how individuals self-manage their chronic SCD-related pain. This study investigated the feasibility of a biobehavioral intervention as an adjunct nonpharmacological therapy to assist in the self-management of chronic pain. A randomized, controlled clinical trial of hypnosis was conducted in outpatients with SCD (n = 31). Patient-reported outcomes (PROs) administered at baseline, five, and twelve weeks from both groups included pain frequency, intensity, and quality (Pain Impact Scale (PIQ) and Numerical Rating Scales); anxiety (State-Trait Anxiety Inventory), coping strategies (Coping Strategies Scale), sleep (Pittsburgh Sleep Quality Index (PSQI)), and depression (Beck Depression Inventory (BDI)). The same PROs were collected at weeks seventeen and twenty-four from the control group after the crossover. No significant group by time interaction effects were found in any of the PROs based on the repeated-measures mixed models. The PIQ and PSQI scores decreased over time in both groups. Post hoc pairwise comparisons with the Bonferroni adjustment indicated that the mean PIQ score at baseline decreased significantly by week 12 (p = 0.01) in the hypnosis group. There were no significant changes across time before and after the crossover in any of the PROs in the control group. As suggested by these findings, pain impact and sleep in individuals with SCD may be improved through guided mind-body and self-care approaches such as hypnosis.

Pain Management in Children During the COVID-19 Pandemic.

Purpose of ReviewFor many children, the SARS-CoV-2 pandemic has impacted the experience and treatment of their pain. This narrative review draws from the pain literature and emerging findings from COVID-19 research to highlight potentially meaningful directions for clinical consideration and empirical inquiry in the months and years to come.Recent FindingsCOVID-19 has been linked to diffuse acute pains as well as chronic pain sequelae. Contextual factors known to increase vulnerability for pain and associated functional disability have been exacerbated during the pandemic. Beyond these salient concerns has been the remarkable resilience demonstrated by patients and providers as healthcare systems have sought to harness creativity and innovative digital solutions to support optimal child wellbeing throughout this crisis.SummaryOngoing research is needed to elucidate the short- and long-term effects of the pandemic on children’s pain and to consider how the delivery of treatment via digital technology has impacted existing paradigms of pain management.