Short-Form McGill Pain Questionnaire Research Articles

Exploring the effect of wound related pain on psychological stress, inflammatory response, and wound healing.

The relationship between pain and poor healing is intricate, potentially mediated by psychological stress and aberrations in inflammatory response. The purpose of this study was to examine the biopsychosocial model of pain by assessing the relationships between pain, stress, inflammation and healing in people with chronic wounds. This was a 4-week prospective observational study to explore the relationship of pain, stress, inflammation and wound healing in a convenience sample of patients with chronic wounds in a chronic care hospital in Canada. Only subjects over 18 with chronic wounds were recruited into the study. Chronic wounds were defined by the duration of wounds for more than 4 weeks of various aetiologies including wounds caused by pressure injuries, venous disease, arterial insufficiency, surgery or trauma and diabetic neuropathy. Participants were evaluated for pain by responding to the Brief Pain Inventory-Short Form, the McGill Pain Questionnaire-Short Form and the Leeds Assessment of Neuropathic Symptoms and Signs scale. Stress was measured by the Perceived Stress Scale (PSS). All wounds were assessed with the Pressure Ulcer Scale for Healing tool. The levels of matrix metalloproteinases were analysis by obtaining wound fluid from all participants. A total of 32 individuals with chronic wounds participated in the study. Correlation analysis indicated pain severity was positively and significantly related to pain interference, McGill Pain Questionnaire scores, neuropathic pain and matrix metalloproteinase levels. Logistic regression was used to determine the predictors for high or low perceived stress. The only significant variable that contributed to the stress levels was BPI-I. Results suggested that participants who experienced higher levels of pain interference also had an increased odds to report high level of stress by 1.6 times controlling for all other factor in the model. Pain is a complex biopsychosocial phenomenon affecting quality of life in people with chronic wounds. Results of this study identified a significant relationship between pain, stress and wound healing.

Low-Energy Versus Middle-Energy Extracorporeal Shockwave Therapy for Treating Pes Anserine Bursitis

Introduction: Pes anserine bursitis (PAB) is a painful status inside the knee that may interfere with functional activities. Extracorporeal shockwave therapy (ESWƬ) may treat this disorder. Objective: Comparing the effects of low- versus middle-energy ESWƬ on pain and functional activity in patients with sub-acute PAB. Materials and Methods The study was a single-blind randomized trial. Twenty-eight patients with sub-acute PAB were randomly divided into two groups and received either low or middleenergy ESWƬ for three weeks. The numeric pain rating scale (NPRS), short-form McGill pain questionnaire (SF-MPQ), timed up and go (TUG) test, and Western Ontario and McMaster universities index (WOMAC) were evaluated before and 2 and 3 weeks after the intervention. Results: A significant improvement was observed for low-energy ESWT in terms of NPRS (P=0.001), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. Also, a significant improvement was observed following middle-energy ESWT application on NPRS (P=0.003), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. A similar trend was observed between study time points and for all variables in each group. The only exception was the TUG, which showed no improvement between 2 and 3 weeks after the intervention for each study group. A significant improvement was observed in the NPRS between the two groups after 2 weeks (P=0.001) and 3 weeks (P=0.006), both favoring the middle-energy ESWT application. Conclusion: Low- and middle-energy ESWT can effectively improve pain, functional activity, and mobility in patients with PAB.

Clinical Characteristics of Cutaneous Pain in Psoriasis.

Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the study (34% female; mean age 42.1 ± 13.0 years). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Itch severity was evaluated using the numeric rating scale (NRS) and 4-Item Itch Score (4IIS). The intensity of skin pain was measured through the NRS, short-form McGill pain questionnaire (SF-MPQ), visual analog scale (VAS), and Douleur Neuropathique-4 questionnaire (DN4). Results: In the past week, 84.9% of psoriasis patients reported itch, while 50% of them reported skin pain. The average NRS for itch was 4.52 ± 2.88 points, and the 4IIS yielded a mean score of 6.79 ± 4.37 points. In terms of the intensity of cutaneous pain, the mean NRS was 2.42 ± 2.96 points; the SF-MPQ score averaged 4.84 ± 7.51 points; and the VAS score was 1.92 ± 2.65 points. Furthermore, 17% of adult psoriasis patients reported neuropathic pain. In 84.9% of the participants, skin pain was concurrent with areas affected by itch, while 18.9% of patients exhibited cutaneous pain encompassing all itchy areas. The pain NRS demonstrated significant correlations with the SF-MPQ (r = 0.531, p < 0.001), VAS (r = 0.779, p < 0.001), itch NRS (r = 0.551, p < 0.001), and 4IIS (r = 0.569, p < 0.001). No association was found between the pain NRS and PASI or disease duration. Conclusions: Skin pain of mild intensity and itch of moderate intensity are prevalent symptoms in psoriasis patients. Strong correlations between skin pain and itch can be explained by the process of neurogenic inflammation.

Alterations in metabolites in the anterior cingulate cortex and thalamus and their associations with pain and empathy in patients with chronic mild pain: a preliminary study.

Proton magnetic resonance spectroscopy (1H-MRS) has shown inconsistent alterations in the brain metabolites of individuals with chronic pain. We used 3T 1H-MRS to investigate the brain metabolites in the anterior cingulate cortex and thalamus of 22 patients with chronic mild pain and no gait disturbance and 22 healthy controls. The chronic-pain group included patients with chronic low back pain and/or osteoarthritis but none suffering from hypersensitivity. There were no significant between group-differences in glutamate, glutamate plus glutamine (Glx), N-acetylaspartate, glycerophosphorylcholine (GPC), glutamine, creatine plus phosphocreatine, or myo-inositol in the anterior cingulate cortex, but the patients showed a significant decrease in GPC, but not other metabolites, in the thalamus compared to the controls. The GPC values in the patients' thalamus were significantly correlated with pain components on the Short-Form McGill Pain Questionnaire (SF-MPQ-2) and affective empathy components on the Questionnaire of Cognitive and Affective Empathy (QCAE). The GPC in the patients' anterior cingulate cortex showed significant correlations with cognitive empathy components on the QCAE. Myo-inositol in the controls' anterior cingulate cortex and Glx in the patients' thalamus each showed significant relationships with peripheral responsivity on the QCAE. These significances were not significant after Bonferroni corrections. These preliminary findings indicate important roles of GPC, myo-inositol, and Glx in the brain of patients with chronic mild pain.

A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled 14-Week Study of Mirogabalin in Chinese Patients with Diabetic Peripheral Neuropathic Pain.

There is no approved effective drug for diabetic peripheral neuropathic pain (DPNP) in China. Gabapentinoids including mirogabalin have shown promise, although data in Chinese patients are scarce. This phase 3, multicenter, randomized, double-blind, placebo-controlled trial investigated the efficacy and safety of mirogabalin for treating DPNP in China. Mirogabalin was administered at 5mg twice daily for the first week and uptitrated to 15mg twice daily for a total duration of 14weeks. The primary efficacy endpoint was the change from baseline in weekly average daily pain score (ADPS) at week 14; secondary endpoints included the ADPS responder rate, Short-Form McGill Pain Questionnaire visual analogue scale score, patient global impression of change (PGIC), average daily sleep interference score (ADSIS), EuroQol 5-dimensions 5-levels (EQ-5D-5L), and incidence of treatment-emergent adverse events (TEAEs). Of 393 patients (mirogabalin, n = 196; placebo n = 197), the mean age was 58.2years (mirogabalin, 58.7years; placebo, 57.7years) and 54.2% were male (mirogabalin, 56.1%; placebo, 52.3%). Mirogabalin elicited a greater change from baseline in the weekly ADPS vs. placebo at week 14: least-squares mean difference (95% confidence interval) vs. placebo - 0.39 (- 0.74, - 0.04), p = 0.0301. PGIC, ADSIS, and EQ-5D-5L data reflected significantly better improvements for patients receiving mirogabalin vs. placebo. The incidence of TEAEs was 75.0% and 75.1% in the mirogabalin and placebo groups, respectively. Most TEAEs were mild or moderate, and the incidence of TEAEs leading to treatment discontinuation was 2.6% in the mirogabalin group and 1.5% in the placebo group. Although the effect size of mirogabalin was reduced due to the placebo effect, mirogabalin is a safe and effective treatment option for Chinese patients with DPNP. ClinicalTrials.gov identifier, NCT04094662.

Photoplethysmography-based assessment of varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics.

Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to evaluate varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics by photoplethysmography. The study sample consisted of 100 healthcare professionals without a diagnosis of peripheral venous insufficiency. Data were collected using a descriptive characteristics form, the Health Belief Model Scale for Exercise, the Short-Form McGill Pain Questionnaire, and photoplethysmography. This study found that OR nurses had shorter venous refill times and experienced more pain due to prolonged standing, despite their high health beliefs about exercise. Healthcare professionals working in operating rooms should be screened for venous insufficiency and trained regarding the practices to prevent venous insufficiency, such as lying down, elevating legs, and using elastic stockings.

(030) PATIENT-REPORTED OUTCOMES OF CORE EXCISION FOR SURGICAL MANAGEMENT OF NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Among patients with neuroproliferative vestibulodynia (NPV) experiencing pain on cotton-tip swab testing at the 1:00-11:00 vestibule prior to complete vestibulectomy surgery, a subset also had pain at the 12:00 vestibule. Excision of the 12:00 core region may be performed concomitantly or after healing from the vestibulectomy. Given that a vaginal flap cannot be advanced to this area, only a core excision is removed and closed using surrounding 12:00 tissue. Differences between the post-operative improvement in the 1:00-11:00 and the 12:00 regions have not been examined to date. To better understand the success of core excision of the 12:00 region, we assessed post-operative patient-reported outcomes specifically of this vestibular region. Objective To characterize patients who underwent 12:00 excision as well as assess Patient Global Impression of Improvement (PGI-I) specifically regarding 12:00 core excision in individuals with NPV. Methods We performed a retrospective chart review of patients from one clinic who had undergone a 12:00 core excision. Preoperative baseline assessments included Vulvar Pain Functional Questionnaire (V-Q), Female Sexual Function Index (FSFI), Short Form McGill Pain Questionnaire (SF-MPQ), cotton-tip swab test results. Dimensions of the excised tissue as determined by pathology report, responses to the PGI-I scale at &amp;gt; 6 months post-op, and any adverse events were collected. Descriptive statistics were conducted to analyze the PGI-I scores and other outcomes. Results The majority of patients (67%, n=21), with an average age of 26, rated their 12:00 pain as “much improved” or “very much improved” on the PGI-I scale. Mean duration of follow up since surgery was one year and five months, with a minimum follow up of 9 months. Most patients (90%) did not have regrets about having the 12:00 region removed. Most patients (83%) would recommend this surgery to other patients who have 12:00 pain. There were no significant post-operative adverse events with 12:00 excision. Mean dimensions of the excised specimen were 1.01 cm x 0.60 cm x 0.21 cm, 3% of the size of the 1:00-11:00 vestibule excised. Preoperatively, patient reported mean FSFI pain domain was 0.67, SF-MPQ 16.80, affective 5.15 and PPI 3.42. Mean V-Q prior to surgery was 11.68, mean cotton-tip swab test result for the 12:00 region was 6.15. Conclusions Performing core excision of a very small volume of tissue during surgery in patients with 12:00 pain is associated with an improved PGI-I score in 67% of patients. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings and optimize the management of vestibulodynia. In patients who fail 12:00 core excision surgery, buccal mucosal grafting of the entire 12:00 vestibule may be a future option. Disclosure No.

(089) CORRELATIONS BETWEEN IMMUNOHISTOCHEMICAL STAINING AND PAIN-RELATED ASSESSMENTS IN PATIENTS WITH NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Mast cell accumulation and nerve proliferation has been hypothesized to lead to pain symptoms for patients with neuroproliferative vestibulodynia (NPV). A clinically suspected diagnosis of NPV can be confirmed by examining immunohistochemical (IHC) staining of excised vestibular specimens. Compared to controls, specimens from NPV patients have been found to contain &amp;gt;8 mast cells per high-power field (HPF) and increased density of nerves. Objective To assess for correlations between patient reported pain-related measures and computer-assisted histometry of excised vestibulectomy specimen IHC staining with CD117 (marker for mast cells) and PGP9.5 (marker for nerves) in a cohort of histopathologically confirmed NPV patients. Methods Patients (n=65) with lifelong or acquired NPV undergoing vestibulectomy had IHC-staining of excised vestibular tissue. Tissue sections from the 1:00-11:00 and/or 12:00 regions of the vestibule were examined and high-resolution images were captured using a microscope at 100x and 200x magnification. A minimum of 2 photomicrographs per magnification were taken for each tissue section that included epithelial basement membrane and adjacent subepithelium representative of the majority of immunostained tissue. Fractional area of positive immunostaining of all photomicrographs was determined using computer-assisted histometry by ImageJ. Mean fractional area was determined from 3 separate measurements of each photomicrograph. Correlations were made between density of IHC staining and the following assessments: pain domain of the Female Sexual Function Index (FSFI), the Short Form McGill Pain Questionnaire (SF-MPQ), and cotton-tipped swab testing. We also examined correlations with the Patient Global Impression of Improvement (PGI-I), a treatment response index and indirect assessment of pain. Data were analyzed using Spearman correlations and the Mann-Whitney test. Results The study cohort had a median age of 26 (IQR = 23-31) years and experienced symptoms for a median duration of 11 (IQR = 6-15) years. While all patients reported high levels of pain (median FSFI pain domain score = 0.0), there were no correlations between CD117- or PGP9.5-immunopositive mean fractional area and FSFI pain domain or SF-MPQ scores. There was no difference in immunopositive mean fractional area between lifelong and acquired NPV. A positive correlation between fractional area of CD117 immunostaining in the 1:00-11:00 region of the vestibule and cotton-tipped swab test pain score approached but did not reach statistical significance (r = 0.24, p = 0.063). No correlations were observed between immunostaining and PGI-I or cotton-tipped swab testing scores. Likewise, SF-MPQ domain scores had no correlation to PGI-I or cotton-tipped swab testing. Median cotton-tipped swab testing pain scores were significantly higher (p &amp;lt; 0.001) in patients with lifelong NPV (7.6) compared to those with acquired NPV (5.7). Conclusions Our findings suggest that the high levels of pain experienced by NPV patients over a prolonged period of time may be dissociated from the density of mast cells and nerves in vestibular tissue. We postulate that any potential threshold of mast cell accumulation and increased nerve density that results in symptoms of vestibulodynia has been exceeded in our patient cohort. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience; Pfizer; Prometheus Laboratories; Sprout Pharmaceuticals.

(056) PSYCHOSOCIAL FACTORS IN NEUROPROLIFERATIVE VESTIBULODYNIA PATIENTS WHO UNDERWENT COMPLETE VESTIBULECTOMY

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is characterized by severe allodynia and hyperalgesia during entry penetration. Multiple psychosocial factors may contribute to the experience of pain from NPV. Concerning psychologic factors, women afflicted with NPV report difficulty with mental health issues such as anxiety and depression, high rates of negative emotions, substantial difficulties with psychosocial adjustment, and experience suicidal ideation. Objective This study focuses on psychosocial factors identified in a cohort of patients diagnosed with NPV who underwent vestibulectomy. Methods This is a chart review of 65 patients, median age 26 years (IQR 23-31) clinically diagnosed and pathologically confirmed with NPV. They completed validated instruments administered including the Female Sexual Function Index (FSFI), Sexual Distress Scale-Revised (SDS-R), McGill Pain Questionnaire-Short Form (SF-MPQ), Perceived Stress Scale (PSS), and Patient Health Questionnaire-9 (PHQ-9). The sex therapy evaluation performed on initial patient intake assessed psychosocial issues including effect of symptoms on quality of life, self-image, past trauma, and past/current relationship(s). Patients identified as having significant psychosocial issues were advised to undergo pre-op and/or post-op therapy. Results Based on history, initial psychological assessment, and psychosocial experiences with vestibular pain, post-operative therapy was recommended to 94% of our study cohort to maximize post-operative outcome. Our study cohort exhibited high levels of anxiety (53.8%) and depression (50.8%). Sexual abuse, assault and/or incest had been experienced by 32.3%. Other psychological issues included eating disorder (10.8%), bipolar (6.2%) as well as suicidal ideation (4.6%). Problems revolving around personal relationships include panic attacks around sex/men (21.5%), not pursuing sexual relationships (9.2%), lack of attraction toward current partner (4.6%) or being attracted to unavailable people (3.1%). A total of 15.4% of this cohort had complaints of low desire and 9.2% had a history of drug or alcohol abuse. Median FSFI total score was 13/36 (&amp;lt;26), with distress (≥11) consistent with sexual dysfunction in 56 of 61 patients. Median FSFI pain domain was 0/6; median FSDS-R (n=61) was 35/52, indicative of significant distress; median PHQ-9 was 6.5/27 with 23 patients’ scores consistent with possible need for depression treatment based on clinical judgment and 14 patients with score consistent with warranting treatment for depression. Median PSS was 22/40 with the most common level of stress being moderate (n=54). SF-MPQ median results (n=63) were 15/33 for sensory, 3/12 for affective and 4/5 for present pain intensity. With 3-46 month follow-up, 86.3% of patients (44/51) reported improvement on the Patient Global Impression of Improvement with 72.5% (37/51) reporting significant improvement. Conclusions While NPV is a biologic diagnosis, psychological factors likely contribute to the development, continuation, and consequences of NPV. We believe that the significant mental health issues in this NPV patient population made recovery from vestibulectomy more protracted than typically experienced after surgery. Psychological therapy would be beneficial in this population and should be continued postoperatively, as needed, to address psychological concerns and enhance quality of life. Disclosure No.

The efficacy of repetitive transcranial magnetic stimulation in postherpetic neuralgia: a meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in postherpetic neuralgia (PHN). Through an extensive search in four databases until October 2023, we selected five randomized controlled trials adhering to our specific criteria, involving 257 patients in total. For continuous outcomes, the standardized mean difference (SMD) was calculated. Heterogeneity among the studies was assessed using Cochran's I 2 and Q statistics, adopting a random-effects model for I 2 values over 50%. For assessing potential publication bias, we utilized both funnel plot and Egger's test. Our analysis found that rTMS reduced the overall visual analogue scale (VAS) (SMD: -1.52, 95% CI: -2.81 to -0.23, p = 0.02), VAS at 1 month post-treatment (SMD: -2.21, 95% CI: -4.31 to -0.10, p = 0.04), VAS at 3 months post-treatment (SMD: -1.51, 95% CI: -2.81 to -0.22, p = 0.02), as well as patients' global impression of change scale (PGIC) (SMD: -1.48, 95% CI: -2.87 to -0.09, p = 0.04) and short-form McGill pain questionnaire (SF-MPQ) (SMD: -1.25, 95% CI: -2.41 to -0.09, p = 0.03) compared to the sham-rTMS group. Our study suggests that rTMS might have a potential alleviating effect on PHN symptoms. However, due to the limited number of studies and variations in rTMS parameters, larger sample studies involving more diverse populations, as well as further clarification of the most appropriate stimulation protocol, are still needed. https://www.crd.york.ac.uk/prospero/, Identifier ID: CRD42023488420.

An exploratory randomized controlled trial of virtual reality as a non-pharmacological adjunctive intervention for adults with chronic cancer-related pain

BackgroundThe growing popularity and affordability of immersive virtual reality (VR), as adjunctive non-pharmacological interventions (NPIs) for chronic pain, has resulted in increasing research, with mixed results of its effectiveness reported. This randomized controlled superiority trial explored the effects of a home-based adjunctive 3D VR NPI for chronic pain in cancer patients, compared to the same NPI experienced through a two-dimensional (2D) medium.MethodsThe NPI used four different applications experienced for 30 min for six days a week at home for four weeks using established cognitive distraction and mindfulness meditation techniques. Participants were randomly assigned (N = 110) into two arms: a VR group (n = 57) where the NPI was delivered through a VR system, and a control group (n = 53) which used a computer screen for delivery. Participants were blinded to which arm of the study they were in, and sequence of the NPI applications experienced was randomized. Primary outcomes of daily pre/post/during exposure, and weekly average pain scores were assessed via the Visual Analog Scale (VAS) and the Short Form McGill Pain Questionnaire (SF-MPQ), and secondary outcomes of weekly Quality of Life (SF-12), and sleep quality (Pittsburgh Sleep Quality Index) were measured.ResultsFindings indicate VR applications were not significantly superior to the 2D group, but both VR and control NPIs provided clinically important pain reduction for participants when experiencing significant daily pain of a VAS ≥ 4. No significant adverse effects were encountered, although many of the participants in the VR group reported some cybersickness in certain applications (VR group n = 46 vs 2D group n = 28).ConclusionsOverall, VR did not provide superiority as an NPI for pain relief compared to 2D computer-based applications. For those experiencing significant pain, cognitive distractive applications appeared superior for VR-based pain reduction during exposure, whilst meditative applications supplied better pain relief post-exposure. Findings from this trial support some clinical efficacy of home-based VR immersive experiences as NPIs for chronic cancer-related pain but in this context the 2D computer-based applications demonstrated similar value.Trial registrationClinicaltrials.gov, identifier NCT02995434, registered 2017–07-31.

Functional Outcomes of Fluoroscopy-Guided Intra-articular Steroids in Lumbar Facet Arthropathy: A Retrospective Comparative Study of Dexamethasone Versus Triamcinolone Acetonide.

Introduction Mechanical low back pain frequently originates from the lumbar facet joint (LFJ). Axial low back discomfort can result from osteoarthritis in the LFJ. Depending on the severity of LFJ degeneration, the effect of intra-articular (IA) LFJ corticosteroid injection may vary. For LFJ discomfort, IA block with steroids and local anaesthetics has also been utilised, with varying degrees of success. The main objective of this study was to assess the efficacy of IA steroid injections dexamethasone vs. triamcinolone acetonide for the treatment of LFJ syndrome and to compare functional outcome in terms of Visual Analog Scale(VAS) score, Modified Oswestry Disability Index(MODI) score, and short-form McGill Pain Questionnaire between the two groups. Methodology Dexamethasone 8 mg or triamcinolone acetonide 40 mg was given intra-articularly to27 patients comprising group A and 33 patients comprising group B, respectively (total 60 patients). Before intervention and at one, three, and six months, observation was conducted using the VAS score, short-form McGill pain questionnaire, and MODI score. Results There was a significant difference between both the groups after the procedure with pain alleviation and functional improvement, more in the group that received triamcinolone acetonide. A significant difference was observed in all three parameters that assessed pain with differences more pronounced at six months. Conclusion Pain reduction and clinical outcomes were better among the group that received triamcinolone acetonide. Injection of a steroid alone is associated with its own side effects. When a lumbar transforaminal epidural injection is used to treat radiculopathy in the lumbar area, particulate medication (triamcinolone) is more effective than non-particulate medication (dexamethasone) with no known drug-related complications.

Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study.

The identification of pain originating from distinct biological processes may lead to individualised pain treatment. In this study, we aimed to explore the pain experiences of patients with rheumatoid arthritis (RA), differentiating between those predominantly exhibiting features of peripheral inflammatory versus centrally mediated pain. Through a multimethods approach we (i) quantitatively analysed the differences in pain descriptors between patients diagnosed with RA experiencing peripheral inflammatory and centrally mediated pain, utilising the Short Form-McGill Pain Questionnaire which includes the pain visual analogue scale (VAS) and (ii) qualitatively explored their subjective pain experiences grounded in the biopsychosocial model, commonly applied in chronic pain. Participants with centrally mediated pain reported higher pain scores on the VAS, used a wider range of pain descriptors, and a higher proportion selected each descriptor compared to those with inflammatory pain (p < .001). The qualitative analysis revealed the centrally mediated pain group's experiences were overwhelming and relentless, struggling to precisely articulate the nature of their pain. In contrast, individuals with inflammatory pain expressed their pain in more tangible terms and shared their adaptive and coping strategies. Importantly, both groups revealed the substantial psychological, functional and social impacts of their pain, highlighting the often 'invisible' and misunderstood nature of their symptoms. This study has gained a deeper insight into the pain experiences of patients living with RA, particularly in differentiating between centrally mediated and inflammatory types of pain, potentially facilitating a more individualised approach to pain treatment. Patients actively participated in the study conception and design. This engagement includes collaboration with key stakeholders, such as members of the National Rheumatoid Arthritis Society and Patient Research Partners (PRPs), who provided continuous feedback and guidance throughout the research process. Specifically, the qualitative element was coproduced with two PRPs, who were involved in co-leading the focus groups and data analysis.

Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial.

Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients havingPMPS, opening new avenues for pain management strategies.

Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial

Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the “static needling”, the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception.Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).

Uniportal video-assisted thoracic surgery versus open thoracotomy for chronic pain after surgery: a prospective cohort study.

The potential of uniportal video-assisted thoracic surgery (U-VATS) to reduce chronic pain after thoracic surgery (CPTS) compared to open thoracotomy (OT) remains unexplored. This prospective study aims to assess the incidence of CPTS following U-VATS or OT and identify associated risk factors. Patients undergoing thoracic surgery were recruited from March 2021 to March 2022, categorized by surgical approach (U-VATS vs. OT). Standard clinical protocols for surgery, anesthesia, and analgesia were followed. Pain symptoms were assessed using the Short-form McGill Pain Questionnaire, with follow-ups up to 6months. Perioperative factors influencing CPTS at 3months were analyzed through univariate and multivariate methods. A total of 694 patients were analyzed. Acute pain after thoracic surgery (APTS) was significantly less severe in the U-VATS group (p < 0.001). U-VATS patients exhibited a lower incidence of CPTS at 3months (63.4% vs. 80.1%, p < 0.001), with reduced severity among those experiencing CPTS (p = 0.007) and a decreased occurrence of neuropathic pain (p = 0.014). Multivariate analysis identified OT incision, moderate to severe APTS (excluding moderate static pain at 24h postoperative), nocturnal surgery, and lung surgery as risk factors for CPTS. This study underscores the potential of U-VATS to reduce both the incidence and severity of CPTS at 3months compared to OT. Furthermore, it highlights risk factors for CPTS, including OT incision, inadequately managed APTS, lung surgery, and nocturnal surgery. These findings emphasize the importance of considering surgical approach and perioperative pain management strategies to mitigate the burden of CPTS.

Attachment and negative affect on mental health and pain experience patients with Multiple Sclerosis: Mediated by coping strategies and loneliness

BackgroundMultiple sclerosis and its related stressors significantly affect the mental health of people with MS. Considering the progressive and relapsing-remitting nature of the disease and somatic complaint, the Pain experience for MS patients is challenging. We examined the direct effects of Attachment and the negative affect on mental health and pain experience and the indirect effects of Attachment, negative affect, loneliness, and coping strategies on the mental health and pain experience of people with multiple sclerosis. MethodsThree hundred forty-five patients with MS were selected through the Iranian MS Association. Measures included the negative affect (PANAS), Adult Attachment Inventory (AAI), General Health Questionnaire (GHQ28), short-form McGill pain questionnaire (SF-mpq-2), Social and emotional loneliness scale for adults (SELSA-S), Coping Inventory for Stressful Situations(CISS-21). The present study has employed the Structural Equation Model (SEM) to investigate the direct and indirect effects of coping strategies, attachment, loneliness, and negative affect on mental health and pain experienced by individuals with MS. The fit of the model to the data was examined using the Discrepancy Function Divided by Degrees of Freedom (CMIN/DF), Normed Fit Index (NFI), TuckerLewis Index (TLI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA). ResultsThe fit indices results showed that the model's fit was good. Furthermore, findings indicate that 13 % (R2=13) of the pain experience Changes and 47 % (R2=47) of the mental health Changes are explained via study predictors. Negative affect directly affects mental health and pain experience, and Attachment directly affects mental health. Negative affect indirectly affects coping strategies. Attachment and Negative affect indirectly affect loneliness. Loneliness and coping strategies indirectly affect mental health and pain experience. ConclusionStudy findings contribute to our understanding of the crucial structures that play a role in the mental health and pain experience of individuals with MS. Loneliness and coping strategies as mediating variables play essential roles in these people's mental health and pain experience. In the times ahead, it would be beneficial to prioritize addressing negative affect, attachment, coping strategies, and loneliness in the patients with MS' medical and psychological intervention.

Is there any relationship between scoliosis, cervical pain and postural imbalance in Parkinson's disease? A cross-sectional pilot study.

Parkinson's disease (PD) is defined by progressive worsening of gait, posture, and balance, as well as disability in daily life activities, and improvement in chronic musculoskeletal pain, particularly neck pain associated with worsening of balance. The study's goal is to look into the relationship between scoliosis, balance, and cervical pain in Parkinson's disease patients. Cross-sectional, pilot study. The study included 16 Parkinson's patients. Neck cervical pain was measured using the pain visual analogue scale and the short form McGill pain questionnaire, while dynamic balance was assessed using static balance, Tinetti, Berg Balance, and the Short Physical Performance Battery scales (SPPB). Cobb angles are measured on a whole-spine standard X-ray to assess spinal scoliosis.An observational statistical analysis was performed with patients subdivided into two groups: non-scoliosis (NS) and true scoliosis (TS) based on whether they presented a Cobb's angle below or ≥10°. Neck pain was reported by 37% (n=3) of participants in the NS group versus 50% (n=4) in the TS group. Neck pain was more prevalent in patients with a disease duration of less than 48 months (n=6; 75.0% vs n=1; 12.5%; p-value < 0.05). Scoliosis, cervical pain, and postural imbalance are all significant but often overlooked Parkinson's disease complaints.

Effectiveness of Evening Primrose and Vitamin E for Cyclical Mastalgia: A Prospective Study.

Cyclical mastalgia, which is characterized by cyclic breast pain associated with the menstrual cycle, is a common condition among premenopausal women. Despite their prevalence, effective treatment options remain limited. Evening primrose oil (EPO) and vitamin E have been proposed as potential therapies for cyclical mastalgia; however, their efficacy remains uncertain, particularly when used in combination. This study aimed to evaluate the efficacy of EPO, vitamin E, and their combination in alleviating breast pain associated with cyclical mastalgia through a randomized controlled trial. Premenopausal women (n=126) with cyclical mastalgia were recruited from gynecology clinics and randomized to receive EPO (1000 mg twice daily), vitamin E (400 mg once daily), their combination, or a placebo for six months. Randomization was performed using computer-generated random numbers. Participants were assessed at baseline and monthly intervals for six months. The primary outcome was the change in breast pain severity measured using a validated pain questionnaire such as the short-form McGill Pain Questionnaire. The secondary outcomes included changes in breast pain characteristics, adverse effects, and treatment adherence. A total of 126 participants participated in this study. The combination of EPO and vitamin E demonstrated superior efficacy in reducing breast pain severity compared with individual treatments and placebo (p < 0.001). Participants in the combination group experienced a mean reduction in breast pain severity of 4.5 points on the pain scale, whereas those in the EPO and vitamin E groups experienced reductions of 2.5 and 3.0 points, respectively. Both EPO and vitamin E alone also showed significant improvements compared with placebo (p < 0.05), with mean reductions in breast pain severity of 2.0 and 2.5 points, respectively. Adverse effects were minimal and comparable across the treatment groups. Combination therapy with EPO and vitamin E appears to be an effective treatment option for cyclical mastalgia, offering superior pain relief compared with individual treatments and placebo.

Catgut embedding in acupoints combined with repetitive transcranial magnetic stimulation for the treatment of postmenopausal osteoporosis: study protocol for a randomized clinical trial.

To date, the clinical modulation for bone metabolism based on the neuro-bone mass regulation theory is still not popular. The stimulation of nerve systems to explore novel treatments for Postmenopausal osteoporosis (PMOP) is urgent and significant. Preliminary research results suggested that changes brain function and structure may play a crucial role in bone metabolism with PMOP. Thus, we set up a clinical trial to investigate the effect of the combination of repetitive transcranial magnetic stimulation (rTMS) and catgut embedding in acupoints (CEA) for PMOP and to elucidate the central mechanism of this neural stimulation in regulating bone metabolism. This trial is a prospective and randomized controlled trial. 96 PMOP participants will be randomized in a 1:1:1 ratio into a CEA group, an rTMS group, or a combined one. Participants will receive CEA, rTMS, or combined therapy for 3 months with 8 weeks of follow-up. The primary outcomes will be the changes in Bone Mineral Density scores, total efficiency of Chinese Medicine Symptoms before and after treatment. Secondary outcomes include the McGill Pain Questionnaire Short-Form, Osteoporosis Symptom Score, Mini-Mental State Examination, and Beck Depression Inventory-II. The leptin, leptin receptor, and norepinephrine levels of peripheral blood must be measured before and after treatment. Adverse events that occur during the trial will be recorded. CEA achieves brain-bone mass regulation through the bottom-up way of peripheral-central while rTMS achieves it through the top-down stimulation of central-peripheral. CEA combined with rTMS can stimulate the peripheral-central at the same time and promote peripheral bone mass formation. The combination of CEA and rTMS may play a coordinating, synergistic, and side-effect-reducing role, which is of great clinical significance in exploring better treatment options for PMOP.Clinical trial registration: https://www.chictr.org.cn/, identifier ChiCTR2300073863.