Severe Pain Intensity Research Articles

Effect of Ubrogepant vs Placebo on Pain and the Most Bothersome Associated Symptom in the Acute Treatment of Migraine

Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist under investigation for acute treatment of migraine. To evaluate the efficacy and tolerability of ubrogepant compared with placebo for acute treatment of a single migraine attack. Phase 3, multicenter, randomized, double-blind, placebo-controlled, single-attack, clinical trial (ACHIEVE II) conducted in the United States (99 primary care and research clinics; August 26, 2016-February 26, 2018). Participants were adults with migraine with or without aura experiencing 2 to 8 migraine attacks per month. Ubrogepant 50 mg (n = 562), ubrogepant 25 mg (n = 561), or placebo (n = 563) for a migraine attack of moderate or severe pain intensity. Co-primary efficacy outcomes were pain freedom and absence of the participant-designated most bothersome migraine-associated symptom (among photophobia, phonophobia, and nausea) at 2 hours after taking the medication. Among 1686 randomized participants, 1465 received study treatment (safety population; mean age, 41.5 years; 90% female); 1355 of 1465 (92.5%) were evaluable for efficacy. Pain freedom at 2 hours was reported by 101 of 464 participants (21.8%) in the ubrogepant 50-mg group, 90 of 435 (20.7%) in the ubrogepant 25-mg group, and 65 of 456 (14.3%) in the placebo group (absolute difference for 50 mg vs placebo, 7.5%; 95% CI, 2.6%-12.5%; P = .01; 25 mg vs placebo, 6.4%; 95% CI, 1.5%-11.5%; P = .03). Absence of the most bothersome associated symptom at 2 hours was reported by 180 of 463 participants (38.9%) in the ubrogepant 50-mg group, 148 of 434 (34.1%) in the ubrogepant 25-mg group, and 125 of 456 (27.4%) in the placebo group (absolute difference for 50 mg vs placebo, 11.5%; 95% CI, 5.4%-17.5%; P = .01; 25 mg vs placebo, 6.7%; 95% CI, 0.6%-12.7%; P = .07). The most common adverse events within 48 hours of any dose were nausea (50 mg, 10 of 488 [2.0%]; 25 mg, 12 of 478 [2.5%]; and placebo, 10 of 499 [2.0%]) and dizziness (50 mg, 7 of 488 [1.4%]; 25 mg, 10 of 478 [2.1%]; placebo, 8 of 499 [1.6%]). Among adults with migraine, acute treatment with ubrogepant compared with placebo led to significantly greater rates of pain freedom at 2 hours with 50-mg and 25-mg doses, and absence of the most bothersome migraine-associated symptom at 2 hours only with the 50-mg dose. Further research is needed to assess the effectiveness of ubrogepant against other acute treatments for migraine and to evaluate the long-term safety of ubrogepant among unselected patient populations. ClinicalTrials.gov Identifier: NCT02867709.

Complex regional pain syndrome in the young male population: a retrospective study of 200 Korean young male patients.

BackgroundThe aim of this study was to investigate the clinical characteristics of complex regional pain syndrome (CRPS) in young male patients in South Korea, especially focusing on the association with military service.MethodsFrom January 2007 to May 2017, we investigated the electronic medical records of 430 consecutive patients, aged 18 to 30 years, who visited Seoul National University Hospital Pain Center, with a suspected diagnosis of CRPS at the initial visit. The following patient details were available for analysis: demographic and disease-related variables, relevance to military service, medications, and the treatment modalities received.ResultsOut of 430 patients, 245 (57.0%) were diagnosed with CRPS, of which, 200 were male patients and 45 were female patients. Of the male patients, 95 (47.5%) developed CRPS during military service. CRPS during military service was more likely to result from sprain/strain, and the incidence of CRPS was significantly higher in the lower extremities in patients from the military service group than in those from the non-military service group. During the follow-up period, 37.9% of male CRPS patients (n = 61/161) were treated successfully. Patients with moderate to severe initial pain intensity, and diagnosed during their military service, showed better outcomes.ConclusionsOur results demonstrated that manifestation of CRPS in the young Korean population was more common in male and among those male CRPS patients, about half the cases developed during the military service period.

Less Severe Preoperative Synovitis is Associated With Higher Self-reported Pain Intensity 12 Months After Total Knee Arthroplasty-An Exploratory Prospective Observational Study.

Synovitis is one of the possible pain generators in osteoarthritis (OA) and is associated with upregulation of proinflammatory cytokines, which can lead to worsening of the postoperative pain. This exploratory study aimed to investigate the association between perioperative synovitis and self-reported pain 12 months after total knee arthroplasty (TKA) in patients with OA. Twenty-six knee OA patients were included in this analysis. The perioperative volume of synovitis in predefined locations was assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Perioperative synovitis was assessed histologically from biopsies of the synovium. Highest pain intensity within the last 24 hours (Visual Analog Scale, VAS, 0 to 100) was assessed before and 12 months after TKA. Patients were divided into a low-pain intensity (VAS≤30) and a high-pain intensity (VAS>30) group on the basis of 12 months postoperative VAS. The high-pain intensity group had significantly lower perioperative contrast-enhanced-synovitis (P=0.025), DCE-synovitis (P<0.04), and a trend toward lower histologically assessed synovitis (P=0.077) compared with the low-pain intensity group. Perioperative synovitis scores were inversely correlated with pain intensity 12 months after TKA (P<0.05), indicating that more severe perioperative synovitis is associated with less severe pain intensity at 12 months. Higher degrees of perioperative synovitis scores are found to be associated with less postoperative pain 12 months after TKA. Further, correlation analysis revealed that less severe perioperative CE-MRI and DCE-MRI synovitis was associated with higher pain intensity 12 months after TKA, suggesting that CE-MRI and DCE-MRI synovitis grades could be used as imaging markers for prediction of chronic postoperative pain after TKA.

Hospitalized patients\u2019 pain experience before and after the introduction of a nurse-based pain management programme: a separate sample pre and post study

BackgroundMany patients suffer from unrelieved pain in hospital settings. Nurses have a pivotal role in pain management. Hence, a nurse-based pain management programme may influence how hospitalized patients experience pain. In this study we investigated hospitalized patients’ experience of pain before and after the introduction of a two-component nurse-based pain management programme.MethodsA quasi-experimental design with a separate sample pretest-posttest approach was conducted on a convenience sample of 845 patients (Survey 1: N = 282; Survey 2: N = 283; Survey 3: N = 280) admitted to the four inpatient units (medical, surgical, maternity, and gynecology) of a university medical center. Data were collected at baseline, before the intervention six weeks after pain management education, and finally immediately after four months of rounding using an interviewer-administered questionnaire adopted from a Brief Pain Inventory and the American Pain Society Patient Outcome Questionnaire.ResultsAll the samples had similar sociocultural backgrounds. The proportion of patients who reported average moderate and severe pain intensity in the last 24 h were 68.8% in Survey 1, 72.8% in Survey 2 and then dropped to 48.53% in Survey 3 whereas those who reported moderate and severe pain intensity at the time of interview were 53.9% in Survey 1, 57.1% in Survey 2 and then dropped to 37.1% in Survey 3. The mean pain interference with the physical and emotional function was generally reduced across the surveys after the introduction of the nurse-based pain management programme. These reductions were statistically significant with p < 0.05.ConclusionsThough the survey findings must be taken with caution, they demonstrate that the nurse-based pain management programme positively influenced patient-reported pain intensity and functional interference at the university medical center. This shows the potential clinical importance of the programme for hospitalized patients.

Prevalence and severity of low back- and pelvic girdle pain in pregnant Nepalese women

BackgroundLow back pain (LBP) and pelvic girdle pain (PGP) are commonly reported during pregnancy and are known to affect pregnant women’s well-being. Still, these conditions are often considered to be a normal part of pregnancy. This study assesses the prevalence and severity of LBP and/or PGP among pregnant Nepalese women, as well as exploring factors associated with LBP and PGP.MethodsA cross-sectional study with successive recruitment of pregnant women was conducted at two district hospitals in Nepal from May 2016 to May 2017. The data was collected using self-reported questionnaires. Univariate and multivariate logistic regression were used to assess the associations between independent variables and LBP and/or PGP.ResultsA total of 1284 pregnant women were included in the study. The reported prevalence of pregnancy-related LBP and/or PGP was 34%. Pain intensity was high with a mean score (standard deviation) of 6 (2). The median (25th-75th percentiles) disability scores according to the total Pelvic Girdle Questionnaire and Oswestry Disability Index were 20 (10–32) and 30 (21–38), respectively. Even though only 52% of the women believed that the pain would disappear after delivery, concern about LBP and/or PGP was reported to be low (median 2 (0–4) (Numeric Rating Scale 0–10)). In the final model for women with LBP and/or PGP the adjusted odds ratios were for body mass index (20–24, 25–30, > 30) 0.7 (95% confidence interval (CI), 0.44–1.21), 1.1 (95% CI, 0.66–1.83), and 1.5 (95% CI, 0.78–2.94) respectively, for pelvic organ prolapse symptoms 6.6 (95% CI, 4.93–8.95) and for women with educated husbands (primary or secondary, higher secondary or above) 1.1 (95% CI, 0.53–2.16) and 1.7 (95% CI, 0.84–3.47), respectively.ConclusionsPregnant Nepalese women commonly report LBP and/or PGP. The women experienced low disability despite severe pain intensity and poor beliefs in recovery after delivery.

Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial

Rimegepant, a small molecule calcitonin gene-related peptide receptor antagonist, has shown efficacy in the acute treatment of migraine using a standard tablet formulation. The objective of this trial was to compare the efficacy, safety, and tolerability of a novel orally disintegrating tablet formulation of rimegepant at 75 mg with placebo in the acute treatment of migraine. In this double-blind, randomised, placebo-controlled, multicentre phase 3 trial, adults aged 18 years or older with history of migraine of at least 1 year were recruited to 69 study centres in the USA. Participants were randomly assigned to receive rimegepant (75 mg orally disintegrating tablet) or placebo and instructed to treat a single migraine attack of moderate or severe pain intensity. The randomisation was stratified by the use of prophylactic medication (yes or no), and was carried out using an interactive web response system that was accessed by each clinical site. All participants, investigators, and the sponsor were masked to treatment group assignment. The coprimary endpoints were freedom from pain and freedom from the most bothersome symptom at 2 h postdose. The efficacy analyses used the modified intention-to-treat population, which included all patients who were randomly assigned, had a migraine attack with pain of moderate or severe intensity, took a dose of rimegepant or placebo, and had at least one efficacy assessment after administration of the dose. The safety analyses included all randomly assigned participants who received at least one dose of study medication. This study is registered with ClinicalTrials.gov, number NCT03461757, and is closed to accrual. Between Feb 27 and Aug 28, 2018, 1811 participants were recruited and assessed for eligibility. 1466 participants were randomly assigned to the rimegepant (n=732) or placebo (n=734) groups, of whom 1375 received treatment with rimegepant (n=682) or placebo (n=693), and 1351 were evaluated for efficacy (rimegepant n=669, placebo n=682). At 2 h postdose, rimegepant orally disintegrating tablet was superior to placebo for freedom from pain (21% vs 11%, p<0·0001; risk difference 10, 95% CI 6-14) and freedom from the most bothersome symptom (35% vs 27%, p=0·0009; risk difference 8, 95% CI 3-13). The most common adverse events were nausea (rimegepant n=11 [2%]; placebo n=3 [<1%]) and urinary tract infection (rimegepant n=10 [1%]; placebo n=4 [1%]). One participant in each treatment group had a transaminase concentration of more than 3 × the upper limit of normal; neither was related to study medication, and no elevations in bilirubin greater than 2 × the upper limit of normal were reported. Treated participants reported no serious adverse events. In the acute treatment of migraine, a single 75 mg dose of rimegepant in an orally disintegrating tablet formulation was more effective than placebo. Tolerability was similar to placebo, with no safety concerns. Biohaven Pharmaceuticals.

Erector spinae plane block as a rescue analgesia technique in a patient with HeartMate 3 ventricular assist type device

Introduction: Heart failure represents a public health problem involving high morbidity and mortality. For advanced stages of the disease the use of ventricular assist devices (VADs) has been implemented as destination therapy. The perioperative management of patients with VADs may result in multiple challenges, with optimal pain management being one of those challenges. Objective: To describe the use of erector spinae plain (ESP) block as a rescue analgesia technique in a patient undergoing HeartMate 3 type VAD implantat. Methods: Case report and subject review. Results: The case discussed is a patient with ischemic cardiomyopathy and severe ventricular dysfunction, undergoing a HeartMate 3 type VAD implant as destination therapy, under general anesthesia and postoperative analgesia protocol with fentanyl and acetaminophen. During the postoperative period the patient developed acute pain of severe intensity (visual analogue scale [VAS]: 8-10/10), that led to the use of a regional rescue technique-ESP block-that showed satisfactory results with optimal analgesia control (VAS: 1-3/10). Conclusion: The ESP block was a safe and effective option as part of a postoperative analgesia strategy for a patient with a HeartMate 3 type VAD implant.

Hubungan antara Nyeri Fraktur dengan Kualitas Tidur Pasien yang di Rawat Inap

&#x0D; This study aims to determine the relationship between fracture pain and sleep quality. This research was conducted in the Seruni room of Dr. M. Yunus Bengkulu and in the Seruni room at Bhayangkara Hospital TK III Bengkulu. The research design used was correlational using a cross sectional approach. The results of the univariate analysis showed that (73.3%) respondents had poor sleep quality and (60%) had severe fracture pain intensity. The results of bivariate analysis with correlation test obtained p-value = 0.002 (p &lt;0.05). In conclusion, there is a relationship between fracture pain and the sleep quality of patients hospitalized at the hospital in Bengkulu Province.&#x0D; &#x0D; Keywords: Fracture Pain, Sleep Quality

Differential efficacy of non-invasive vagus nerve stimulation for the acute treatment of episodic and chronic cluster headache: A meta-analysis.

BackgroundTwo randomized, double-blind, sham-controlled trials (ACT1, ACT2) evaluated non-invasive vagus nerve stimulation (nVNS) as acute treatment for cluster headache. We analyzed pooled ACT1/ACT2 data to increase statistical power and gain insight into the differential efficacy of nVNS in episodic and chronic cluster headache.MethodsData extracted from ACT1 and ACT2 were pooled using a fixed-effects model. Main outcome measures were the primary endpoints of each study. This was the proportion of participants whose first treated attack improved from moderate (2), severe (3), or very severe (4) pain intensity to mild (1) or nil (0) for ACT1 and the proportion of treated attacks whose pain intensity improved from 2–4 to 0 for ACT2.ResultsThe pooled population included 225 participants (episodic: n = 112; chronic: n = 113) from ACT1 (n = 133) and ACT2 (n = 92) in the nVNS (n = 108) and sham (n = 117) groups. Interaction was shown between treatment group and cluster headache subtype (p < 0.05). nVNS was superior to sham in episodic but not chronic cluster headache (both endpoints p < 0.01). Only four patients discontinued the studies due to adverse events.ConclusionsnVNS is a well-tolerated and effective acute treatment for episodic cluster headache.Trial registrationThe studies were registered at clinicaltrials.gov (ACT1: NCT01792817; ACT2: NCT01958125).

Evaluation of the Effect of Mefenamic Acid Alone and Combination with Fennel (Foenicullum Vulgare) on Primary Dysmenorrhoea

Primary dysmenorrhea refers to painful menstrual cramps of uterus led to considered gynecological complaint. Menstrual discomfort was reported in half to four-fifth of females and one-fourth reported sever dysmenorrhea. Newer combination of herbal products like Fennel and Mefenamic acid becoming popular and replacing conventional NSAIDs/ OCPs therapy for their major adverse effect. The aim of this study was to compare the effect of Mefenamic acid alone and combination with Fennel (Foenicullum Vulgare) on primary dysmenorrhoea. This interventional study was conducted among randomly selected 100 female workers with age range 18-25 years of two Garments Factories at Demra, Dhaka during July 2014 to June with the complaints of moderate to severe pain intensity and bleeding of primary dysmenorrhea. There were two group, group A (50 women) were treated with Cap Mefenamic Acid 250 mg once daily and group B (50) were with Cap Mefenamic Acid 250 mg once daily and fennel supplementation 10 ml three times daily. The mean age of respondents was 21.60 ± 2.59 and menarche age was 13.92±1.15 year. Mean duration of the menstrual cycle and cycle length were 6.24±1.66 and 27.36±3.63 days respectively. Mean onset age of Dysmenorrhea 16.16±1.81 year and intensity of dysmenorrhea (VAS-Visual Analogue Scale) 6.5±1.6. Group A had no any special experience on pain relief sensation by taking Mefenamic Acid alone, whereas Group B gathered better experience after administration of Cap Mefenamic Acid with fennel supplementation. Moreover, according to result of the analysis, comparison with bleeding tendency was also not shown the significant difference. One more important thing is that these two group faced some adverse effect of those medication such as group A had no complaints of allergic reaction, visual and neurologic disturbance where 2% had gastro-intestinal upset and 2% had respiratory distress in Group A; on the other hand, 2% had allergic reaction, 2% had visual symptom and respiratory distress had 4% cases in Group B. Mefenamic acid with fennel can decrease the severity of dysmenorrhea. However, any intervention might be found out to treat dysmenorrhea with less adverse effects is highly desired.&#x0D; Bangladesh Med J. 2019 May; 48 (2): 38-43

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

Pain-related factors in older adults.

Pain is an evident factor affecting the quality of life in all age groups. The objective was to examine the prevalence of self-reported SF-36 bodily pain and pain-related factors in community-dwelling older adults. One thousand four hundred and twenty adults aged 62-86 years self-reported SF-36 bodily pain during the previous month. For the analysis, four pain groups were formed (group I [0-45, moderate to very severe pain intensity and interference], group II [47.5-70], group III [77.5-90], and group IV [100, no pain at all]). Additional questionnaire-provided data regarding education, wealth, life habits, and morbidity, as well as clinical data were considered. The overall pain prevalence was 78% (SF-36 bodily pain score <100). The prevalence of cohabiting, as well as the years of education and household income were found to decrease with an increasing SF-36 bodily pain score. The prevalence of a BMI of over 30 and of central obesity emerged as the highest in group I. Morbidities were found to be most prevalent in group I. A high prevalence of intense and interfering pain was reported. Multiple factors that were found to relate to pain have previously been demonstrated to associate with social exclusion. Increasing attention should be paid to distinguishing these factors in patients with pain, as well as targeted pain assessment and measures to improve the sense of community among older adults. There is a lack of large studies that examine a wide scale of pain-related factors in the older adult population. To distinguish subjects with multiple such factors would help medical professionals to target their attention to patients at a high risk of chronic pain.

Differences in Pain Intensity of Tumors Spread to the Anterior versus Anterolateral/Lateral Portions of the Vertebral Body Based on CT Scans.

We investigated whether the intensity of cancer pain differs for malignant tumors that have spread to anterior or anterolateral/lateral portions of the vertebral body. We hypothesize that tumor spread to the anterolateral/lateral vertebral body elicits more serious pain due to increased irritation of the spinal nerve. The selection criteria were as follows: (1) advanced or metastatic solid tumor; (2) radicular pain without extremity weakness; (3) malignant lesions anteriorly, anterolaterally, or laterally located at the vertebral body either spread locoregionally or over a greater distance via metastasis based on CT scan diagnosis; and (4) patient needs to use opioids for pain relief. Severe spinal pain intensity was defined as spinal pain for which patients required either strong opioids or spinal irradiation for relief. Eighty-six patients were enrolled in the study. Bone lesions were mainly osteolytic. Thirty-nine tumors spread to the vertebral body in the anterior direction, and 47 in the anterolateral/lateral direction. Severe pain intensity related to vertebral body lesions was due to anterolateral/lateral spread, primary sites of nonurothelial carcinoma, metastatic vertebral lesions, multiple lesions within a vertebrum, and location within the cervical-thoracic spine. In conclusion, patients with tumor spread to the anterolateral/lateral portion of vertebrae bodies based on CT scan diagnosis experienced severe cancer pain. These patients needed strong opioids or palliative spinal irradiation for pain relief.

P030: Acute pain resolution after an emergency department visit: a 14-day trajectory analysis

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

(113) Sleep Deficiency and Disability in Adolescents with Chronic Abdominal Pain

Children with chronic pain commonly report comorbid sleep deficiency. However, research has been limited in pediatric chronic abdominal pain (CAP) populations. This study sought to characterize the etiology of sleep deficiency in adolescents with CAP and examine the associations between sleep and functioning. The sample included 21 adolescents 14 to 18 years old with CAP (female=85.7%, mean age=16.5 years). CAP is defined by abdominal pain present for two or more months, experienced at least four times per month, and not explained by another condition. Self-reported sleep measures provided information on insomnia symptoms and disability. Adolescents also wore an actigraph for 7 days. The average pain intensity was 5.33 (SD=2.0), and reported disability of 37.8 (SD=17.0), comparable to adolescents with other pain conditions e.g. chronic headaches. Moderately severe insomnia symptoms were reported by 33.4% of adolescents, with night time sleep duration of 7 hours 17 minutes (SD=52 min), with efficiency of 87.3% (SD=5.4%) and wake time after sleep onset of 67 minutes (SD=39 min). We found that greater insomnia symptoms (r=.571, p=0.007), poorer sleep quality (r=-.593, p=0.005) and shorter sleep duration (r=-.464, p=0.03) were associated with greater disability. Regression analyses revealed that more severe insomnia symptoms (t=2.455, p=0.025) and higher pain intensity (t=2.492, p=0.023) were associated with greater pain related disability (F2,18=8.946, p=0.002). Moreover, shorter sleep duration (t=-2.473, p=0.02) and higher pain intensity (t=3.20, p=0.005) were associated with greater disability (F2,18=9.012, p=0.002). Findings highlight that comorbid insomnia symptoms and shorter sleep duration were associated with greater disability in adolescents with CAP, supporting the importance of targeting sleep as core interventions in treatment.

Analysis of risk factors for depression among patients with chronic low back pain in an orthopaedic clinic of a Nigerian teaching hospital.

Depression compounds the burden of chronic low back pain and has implications on the outcome of treatment. Published reports demonstrated a strong association between depression and chronic low back pain. However, there is very scanty data on predisposing factors for depression among these patients. To determine the risk factors for depression among patients with chronic low back pain in a Nigerian orthopaedic clinic setting. Three hundred (300) eligible, consenting and consecutive patients with chronic low back pain in orthopaedic clinic of Federal Teaching Hospital Abakaliki Nigeria were interviewed with Population and Pain Characteristics Questionnaire, General Health Questionnaire (GHQ-12) and Major Depressive Episode of Mini-International Neuropsychiatric Interview (M.I.N.I) over a period of 34 months. Statistically significant factors that emerged from Pearson chi-square test of association were entered into logistic regression analysis to evaluate the risk of each factor when adjusted to other factors.Depression was observed in 61(20.3%) of the patients interviewed. Seven factors for depression among these patients emerged from chi square test of association. Logistic regression analysis identified alcohol consumption, severe pain intensity, hypertension co-morbidity and prior traditional healer care as the independent risk factors for depression among the patients. The independent risk factors for depression identified in this study calls for maintaining a high level of suspicion in the patients with these risk factors to facilitate early recognition of depression, and a high priority accorded to them in the measures aimed at addressing depression for a good therapeutic outcome.

Are trajectories of neck–shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study

ObjectivesThe study aimed to determine the extent to which latent trajectories of neck–shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over...

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

Acute Pain Resolution After an Emergency Department Visit: A 14-Day Trajectory Analysis

The objective of the study is to evaluate the acute pain intensity evolution in emergency department (ED) discharged patients, using group-based trajectory modeling. This method identifies patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. This was a prospective cohort study of ED patients aged 18 years or older, with an acute pain condition (≤2 weeks), and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (numeric rating scale of 0 to 10) and pain medication use. Among the 372 included patients, 6 distinct post-ED pain intensity trajectories were identified. Two started with severe levels of pain; one remained with severe pain intensity (12.6% of the sample) and the other ended with a moderate pain intensity level (26.3%). Two other trajectories had severe initial pain; one decreased to mild pain (21.7%) and the other to no pain (13.8%). Another trajectory had moderate initial pain that decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day period (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and opioid consumption. Acute pain resolution after an ED visit seems to progress through 6 different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

Predictors of allodynia in persons with migraine: Results from the Migraine in America Symptoms and Treatment (MAST) study.

Cutaneous allodynia is a common clinical feature of migraine that has been associated with reduced efficacy of acute migraine treatments and an increased risk of disease progression. Identify factors associated with allodynia in a sample of adults with migraine. An online survey panel was used to identify adults with migraine who averaged at least 1 monthly headache day over the previous 3 months. Data on sociodemographics, headache frequency, headache pain intensity, migraine symptom severity, medication use, depression and anxiety, and cutaneous allodynia (via the Allodynia Symptom Checklist) were obtained. Binary logistic modeling predicted the presence of allodynia. Odds ratios and 95% confidence intervals (CI) were calculated. In total, 15,133 individuals with migraine met the eligibility criteria. Mean age was 43.1 years, 73.0% were female, and 81.0% were Caucasian. Allodynia was present in 39.9%. The fully adjusted model, controlling for sociodemographics and headache features, demonstrated that allodynia was significantly associated with a higher migraine symptom severity score (odds ratio 1.17, confidence interval 1.15, 1.19) and more severe pain intensity (odds ratio 1.11, confidence interval 1.08, 1.14); probable depression and/or anxiety (odds ratio 1.83, confidence interval 1.67, 2.00); and overuse of acute medication (odds ratio 1.23, confidence interval 1.09, 1.38). A higher number of monthly headache days increased the likelihood of allodynia, but the effect was attenuated in the fully adjusted model. In a representative sample of US adults with migraine, there were significant associations between allodynia and headache frequency and intensity, anxiety and/or depression, symptom severity, and acute medication overuse.