Subjective Experience Of Pain Research Articles

Prevalence and associated factors of health anxiety in patients with temporomandibular disorders

AbstractObjectivesTo investigate the prevalence and associated factors of health anxiety (HA) in patients with Temporomandibular Disorders (TMDs) using the 8‐item Whiteley Index (WI‐8) scale.Materials and MethodsThree hundred and twenty‐nine TMDs patients completed the Visual Analog Scale (VAS), WI‐8, Jaw Functional Limitation Scale‐8 (JFLS‐8), Patient Health Questionnaire‐9 (PHQ‐9), and Generalized Anxiety Disorder‐7 (GAD‐7) scales. Clinical examinations were conducted following the Diagnostic Criteria for TMDs Axis I.ResultsThe prevalence of HA among TMDs patients was 18.54%. Patients with HA had higher scores of VAS‐current (p = 0.026), VAS‐maximum (p = 0.024), VAS‐average (p = 0.030), JFLS‐8 (p < 0.001), GAD‐7 (p < 0.001) and PHQ‐9 (p < 0.001), lower maximum mouth opening (p = 0.016), lower proportion of structure‐related TMDs (p = 0.028), and higher proportion of pain‐related TMDs (p < 0.001) compared to those without HA. The correlation coefficient was 0.61 (p < 0.001) between WI‐8 and GAD‐7 and 0.64 (p < 0.001) between WI‐8 and PHQ‐9.ConclusionApproximately one‐fifth of patients with TMDs experienced HA. HA was associated with pain perception, functional limitations, depressive, and anxiety symptoms in individuals with TMDs. HA may contribute to heightened subjective pain experiences rather than structural changes in the TMJ.

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.

The psychophysiology of music-based interventions and the experience of pain.

In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.

Efficacy of Lidocaine Spray for Pain Reduction during Colposcopy-Directed Cervical Biopsies: A Randomized Controlled Trial.

Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score. Results: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (<0.001), and tended to decrease, though not significantly (p = 0.06), when compared with the control group. No complication with the intervention was observed. Conclusions: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure.

Adverse Childhood Experiences and Chronic Low Back Pain In Adulthood: The Role of Emotion Regulation

Chronic low back pain (cLBP) is characterized by biopsychosocial determinants that collectively result in substantial burden at the individual, community, and healthcare system levels. A growing body of literature suggests that childhood adversity is longitudinally associated with the development and maintenance of various chronic pain conditions in adulthood. Little research has investigated the psychological processes that might underlie the association between adverse childhood experiences (ACEs) and cLBP. Emotion regulation comprises a substantive part of the subjective experience of pain and may be a potential mechanism through which ACEs contribute to cLBP etiology and maintenance. Thus, the current study examined the extent to which emotion dysregulation mediated the relationship between ACEs and pain severity (pain at rest and movement-evoked pain) in adults with cLBP. Participants included 183 adults (53.0% female, 62.5% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants self-reported on ACEs, pain, difficulties in emotion regulation, depression, and completed brief physical function tasks. In data analytic models, sociodemographic variables were included as covariates. Mediation analyses revealed that emotion regulation mediated the relationship between ACEs and cLBP severity at rest (indirect effect = 0.15 (95% CI [0.06 to 0.25]) and with movement (indirect effect = 1.50 (95% CI [0.69 to 2.57]). Findings suggest ACEs are linked to cLBP severity in adulthood though difficulties in emotion regulation. This aligns with research demonstrating that childhood maltreatment can lead to difficulties in emotion regulation which perpetuate over the lifespan to impact adult health outcomes. Trial RegistrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ERASED - ClinicalTrials.gov ID: NCT03338192). PerspectiveThis study presents emotion dysregulation as a psychological pathway through which childhood adversity may contribute to chronic low back pain in adulthood. This work may bolster our understanding of social experiences as risk factors for chronic pain, while identifying targets for clinical intervention.

Is it possible to extract primary maxillary molars without palatal injection?: a controlled clinical trial

ObjectivesThe absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times.Materials and methodsA single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS).ResultsIn terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05).ConclusionsWhile the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction.Clinical relevanceExtraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.

Effects of functional polymorphisms of opioid receptor mu 1 and catechol-O-methyltransferase on the neural processing of pain.

Pain is reconstructed by brain activities and its subjectivity comes from an interplay of multiple factors. The current study aims to understand the contribution of genetic factors to the neural processing of pain. Focusing on the single-nucleotide polymorphism (SNP) of opioid receptor mu 1 (OPRM1) A118G (rs1799971) and catechol-O-methyltransferase (COMT) val158met (rs4680), we investigated how the two pain genes affect pain processing. We integrated a genetic approach with functional neuroimaging. We extracted genomic DNA information from saliva samples to genotype the SNP of OPRM1 and COMT. We used a percept-related model, in which two different levels of perceived pain intensities ("low pain: mildly painful" vs "high pain: severely painful") were employed as experimental stimuli. Low pain involves a broader network relative to high pain. The distinct effects of pain genes were observed depending on the perceived pain intensity. The effects of low pain were found in supramarginal gyrus, angular gyrus, and anterior cingulate cortex (ACC) for OPRM1 and in middle temporal gyrus for COMT. For high pain, OPRM1 affected the insula and cerebellum, while COMT affected the middle occipital gyrus and ACC. OPRM1 primarily affects sensory and cognitive components of pain processing, while COMT mainly influences emotional aspects of pain processing. The interaction of the two pain genes was associated with neural patterns coding for high pain and neural activation in the ACC in response to pain. The proteins encoded by the OPRM1 and COMT may contribute to the firing of pain-related neurons in the human ACC, a critical center for subjective pain experience.

Alcohol use and the pain system.

The World Health Organization's epidemiological data from 2016 revealed that while 57% of the global population aged 15years or older had abstained from drinking alcohol in the previous year, more than half of the population in the Americas, Europe, and Western Pacific consumed alcohol. The spectrum of alcohol use behavior is broad: low-risk use (sensible and in moderation), at-risk use (e.g., binge drinking), harmful use (misuse) and dependence (alcoholism; addiction; alcohol use disorder). The at-risk use and misuse of alcohol is associated with the transition to dependence, as well as many damaging health outcomes and preventable causes of premature death. Recent conceptualizations of alcohol dependence posit that the subjective experience of pain may be a significant contributing factor in the transition across the spectrum of alcohol use behavior. This narrative review summarizes the effects of alcohol at all levels of the pain system. The pain system includes nociceptors as sensory indicators of potentially dangerous stimuli and tissue damage (nociception), spinal circuits mediating defensive reflexes, and most importantly, the supraspinal circuits mediating nocifensive behaviors and the perception of pain. Although the functional importance of pain is to protect from injury and further or future damage, chronic pain may emerge despite the recovery from, and absence of, biological damage (i.e., in the absence of nociception). Like other biological perceptual systems, pain is a construction contingent on sensory information and a history of individual experiences (i.e., learning and memory). Neuroadaptations and brain plasticity underlying learning and memory and other basic physiological functions can also result in pathological conditions such as chronic pain and addiction. Moreover, the negative affective/emotional aspect of pain perception provides embodied and motivational components that may play a substantial role in the transition from alcohol use to dependence.

Minimally Invasive Surgery vs Open Approach to First Metatarsophalangeal Joint Arthrodesis: A Comparison of Surgical Outcomes

Category: Midfoot/Forefoot; Other Introduction/Purpose: Minimally invasive surgery (MIS) is becoming increasingly popular among foot and ankle orthopaedic surgeons, as it has been shown to have limited complication rates and faster recovery times. Although there is robust data on MIS to treat hallux valgus, few studies have evaluated the role of MIS for 1st metatarsophalangeal (MTP) fusion to treat hallux rigidus - the most common arthritis of the foot. Hallux rigidus affects 2.5% of the U.S. population over age 50. Given this disease prevalence, it is important to characterize outcomes following MTP fusion procedures to optimize surgical approaches. In this retrospective cohort study, we aim to compare (1) patient-reported pain, (2) rate of successful fusion, and (3) rate of complications between groups who underwent open or MIS 1st MTP arthrodesis. Methods: This retrospective cohort study was conducted by evaluating clinical metrics, surgical outcomes, and radiographic data through chart review of 78 patients (25 male, 53 female), who underwent a 1st MTP fusion procedure at a large urban academic medical center from July 2015 through January 2023. 71 patients had a diagnosis of hallux rigidus, with other common diagnoses including hammertoe (24), hallux valgus (24), additional arthritides (11), and metatarsalgia (11). Two patients were excluded from our analysis due to lack of sufficient orthopaedic follow-up preventing evaluation of joint fusion. Pre- and post-operative pain scores were recorded on a 0-10 scale, though some notes documented subjective experience of pain (e.g., “minimal”). Complications were identified using post-operative clinic notes. The following radiographic data were included: hallux valgus angle, intermetatarsal angle, Coughlin classification, presence of arthritis, pre-operative sesamoid position, fusion construct materials, and success of fusion. Results: Of the 80 1st MTP fusion surgeries (two patients received both left and right foot operations), 51 were open and 29 were minimally invasive. There was no significant difference in the change in pre- to post-operative pain between the two groups (p=0.39). MIS patients had a higher successful fusion rate (100.0%) when compared to open surgery patients (94.1%), though this difference was insignificant (p=0.55). There was no significant difference in overall complication rates between MIS and open surgery groups (p=0.79). However, the MIS patients did not have any cases of deep infection or wound dehiscence and all (5/5) of their complications were related to hardware removal after fusion, whereas half of the complications (5/10) for the open surgery patients were related to infection and wounds. Conclusion: This retrospective analysis of 78 patients treated for hallux rigidus with 1st MTP fusion surgery showed no significant difference in rates of successful fusion and complications among patients who received an MIS procedure compared to an open surgery. There was no difference in patient-reported pain improvement between the two groups. Our main limitation is provider specialization, as only one surgeon in this study performed the MIS cases. Further studies should be done to obtain higher-level evidence to elucidate potential benefits of MIS over open surgery for 1st MTP arthrodesis.

Mindful attention is inversely associated with pain via mediation by psychological distress in orthopedic patients.

Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state, such as distress. This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and whether psychological distress scores function as a mediation path. During routine visits to a single orthopedic clinic in East Los Angeles, California, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool [UPAT]), mindful attention (Five-Facet Mindfulness Questionnaire [FFMQ]), and psychological distress (Depression, Anxiety, Stress Scale [DASS]). We used Pearson correlations to examine relationships between FFMQ and UPAT scores and mediation analyses to test indirect effects of DASS scores as a mediation path. The average age of the sample was 54 years (range 18-98 years), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were the shoulder (72%), elbow (21%), and clavicle or wrist (7%). Ninety-one percent reported mild or greater pain in the prior 2 weeks (mean = 4.2 ± 2.5, range 0-10), and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (β = -0.22, P < .01), mediated through DASS scores. DASS subscale scores for depression (β = -0.10, P = .02) and stress (β = -0.08, P = .04) but not anxiety (β = -0.03, P = .33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores. We find statistical support to suggest that distress-particularly depressed mood and stress-mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.

PAIN THRESHOLD PARADOX IN SCHIZOPHRENIA: A NARRATIVE REVIEW BASED ON THE LASTEST NEUROSCIENCE.

Pain is one of the basic defense responses of living organisms. Although the threshold for pain perception varies from person to person, there is no doubt that pain reduces a person's quality of life. Assessing the subjective experience of pain is especially important in the treatment of patients with schizophrenia. In light of recent advances in neuroscience, we discuss pain thresholds in patients with schizophrenia. A narrative review of pain thresholds in patients with schizophrenia was conducted. We electronically searched the PubMed and Google Scholar databases for articles in English with "pain," "schizophrenia," "neural circuits," and "neurotransmitters" in the title or abstract, for the period January 2000 through June 2022. A seemingly contradictory phenomenon has been noted with regard to pain thresholds in patients with schizophrenia. One phenomenon is a high pain threshold for nociceptive stimuli, and the other is a low pain threshold in chronic pain. As a result, a pain threshold paradox has been observed. Many schizophrenia patients appear to have an excess of dopamine in the mesolimbic system, which stimulates both the descending pain inhibitory pathway and the salience network. As a result, a pain threshold paradox has been observed, in which the threshold for acute nociceptive pain is high and the threshold for chronic pain is low.

The Impact of COVID-19 on Parkinson’s Disease: A Case-Controlled Registry and Questionnaire Study on Clinical Markers and Patients’ Perceptions

Introduction. Parkinson’s disease (PD) is a neurodegenerative disease with motor and nonmotor symptoms. Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives. To explore how COVID-19 affects motor, nonmotor, and general health aspects of PD and to map how PD patients perceive their change in symptoms since falling ill with COVID-19. Method. The study was descriptive, case-controlled, and based on both registry and questionnaire data. At baseline, the controls were matched on age, sex, and disease severity. Information on the severity of the disease, nonmotor symptoms, motor symptoms, and general health was retrieved from the Swedish Registry for PD. Registry data from a COVID-19 group ( n = 45 ) and a control group ( n = 73 ), as well as questionnaires from a COVID-19 group ( n = 24 ) and a control group ( n = 42 ), were compared. Results. We did not find that SARS-CoV-2 infection affects any major aspect of nonmotor symptoms, motor symptoms, general health, and perception of change in PD patients’ post-COVID-19. Compared to controls, the COVID-19 group reported a more positive subjective experience of pain and quality of life and a perception of change post-COVID-19 regarding general motor function, sleep quality, and mood (all p &lt; 0.05 ). Conclusion. Although SARS-CoV-2 infection does not seem to affect PD symptoms in any major respect, the subjective experience of several aspects of life in PD patients might be slightly improved post-COVID-19 compared to a control group. The findings warrant further investigations due to the small sample size and possible survivorship bias.

Women's autonomy for managing labour pain in a relational context: An interpretive description study.

To describe how women perceived relational autonomy for decision-making during childbirth pain and illuminate influencing factors. Most women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. We used an interpretative description approach to conduct this study. A purposive sample of ten women who reported pain during childbirth participated in semi-structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. Circumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision-making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision-making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. Women regarded their relationships and communication with care providers as foundational to relational autonomy in decision-making about pain management during childbirth. Study findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision-making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. Women who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection.

ID: 222114 Effects of High Frequency Spinal Cord Stimulation as Measured by Autonomic Tone and fMRI

We investigated high frequency spinal cord stimulation (HF-SCS) efficacy in 1) reducing autonomic output as measured by galvanic skin response (GSR) levels during anticipation of and exposure to noxious thermal stimuli in while undergoing functional magnetic resonance imaging of the brain, and 2) altering subjective experience of pain as measured by the Short Form McGill Pain Questionnaire (SF-MPQ-2) and a modified Brief Pain Inventory Short Form (BPI-SF).

Developing Biomarkers for Chronic Low Back Pain Using Arterial Spin Labeling (P9-6.005)

<h3>Objective:</h3> In this study, we aim to 1) utilize Arterial Spin Labeling (ASL) to develop neurophysiological characterization of the subjective chronic pain experience, and 2) explore the feasibility of incorporating ASL in routine clinical scans. <h3>Background:</h3> Over 100 million people in the US suffer from chronic pain. This leads to tremendous burden on individuals and society. However, as the mechanisms for chronic pain are unclear, robust diagnostic and prognostic methods remain limited. Our previous research using resting-state fMRI revealed changes in low-frequency fluctuations in nucleus accumbens (NAc) when low back pain became chronic. We hypothesize that physiological changes in NAc in chronic pain also affect local blood perfusion. <h3>Design/Methods:</h3> ASL is a non-invasive perfusion-based MRI technique that can quantify cerebral blood flow (CBF). We collected resting-state ASL data from 43 patients with chronic low back pain (CLBP) and 33 healthy controls (HC) on a research scanner, as well as 11 CLBP patients and 10 HC on a clinical scanner. Brain perfusion maps were generated to quantify the CBF and relative CBF (rCBF). <h3>Results:</h3> Compared to HC, CLBP patients had significantly higher rCBF in the NAc (<i>p</i>=0.046). However, multivariate analysis revealed sex and age as main contributors to this difference in our preliminary clinical dataset. NAc rCBF increased with age and decreased with female sex. We also observed linear correlation between CBF from the clinical scanner and the research scanner in grey matter and white matter (<i>p</i>=0.0008 and 0.001; <i>r</i>₂=0.57 and 0.55, respectively). <h3>Conclusions:</h3> Our preliminary ASL results show consistency with prior fMRI findings in identifying NAc as a biomarker for chronic pain. Altered NAc activity in chronic pain may be involved in the motivational and hedonic aspect of chronic pain. This pilot study also supports the potential of utilizing ASL in clinical care for chronic pain patients. <b>Disclosure:</b> Ms. Yuan has nothing to disclose. Madalina Tivarus has nothing to disclose. Miss Tahsin has nothing to disclose. Mr. Alldritt has nothing to disclose. Dr. Geha has nothing to disclose.

"Out of This World": Norwegian Women's Experiences of Medical Abortion Pain.

Medical abortion has rapidly become the dominant abortion method in western countries. Pain is a known adverse effect; however, few studies have explored women's subjective experience of medical abortion pain. To explore Norwegian women's experiences of pain when performing a medical abortion at home. We recruited 24 women through an advertisement on Facebook and conducted semi-structured, face-to-face interviews. The interviews were transcribed verbatim and the data were analyzed using a phenomenological hermeneutical method. Our findings consisted of two main themes: 1) Being in pain or becoming pain, and 2) Being caught off guard and struggling to cope. Participants described undergoing severe pain, comparable to giving birth, during the medical abortion. Unprepared for the type and intensity of the pain, they felt anxious and insecure. Pain is physical, but it also has important psychological, social, and existential dimensions. Our culture (in)forms our thoughts and feelings about our pain, affecting our ability to endure suffering. The participants' experiences of abortion pain prompt timely questions concerning gendered socio-cultural and existential meanings connected to pain, specifically in relation to female reproductive functions. Women need realistic information about the type and intensity of abortion pain, as well as evidence-based pain medication. Psychological factors may affect the experience of abortion pain and should therefore be taken into account in abortion care.

Lived Experiences of Chronic Pain Patients Attending Follow-up Visits at a Pain Clinic During the COVID-19 Pandemic in Thailand

Objective: The whole world stopped turning, for most countries, due to shutdowns during coronavirus pandemics, with the exception of chronic pain patients. More than 40 years of unprecedented service changes in the pain clinic, under the COVID-19 era, could cause major impacts on patients living with chronic pain. We conducted this in-depth interview to evaluate how COVID-19 affected pain in patients with chronic pain.Material and Methods: Face-to-face, in-depth interviews with tape recordings were used to explore the informants’ perspective, so as to capture their own words, thoughts, perceptions, feelings and experiences under the COVID-19 prevention and control measures. Field-notes and detailed memos were also recorded during the interview. The key informants consisted of 17 chronic pain patients, who came for follow-up visits at the pain clinic during the third and fourth waves of the COVID-19 pandemic. The qualitative content analysis method was employed to analyze the verbatim transcription of the interview recordings to identify themes and patterns.Results: The findings revealed the key informants viewed COVID-19 as being closely tied with the perception of to what extent it impacted on maintaining their usual pain treatment and care as accessed. The key informants’ feelings of fear and worry were not generated from the effects of COVID-19 on their physical health, but were from the healthcare services changes and restrictions they faced. The ‘new normal’; as such social distancing, was viewed as similar and congruence with their long-lasting normal lifestyles. Talking about COVID-19 is a lot less interesting without talking about pain. The key informants preferred taking the risk of catching COVID-19, rather than coming back for untreated pain. The door-to-door pain medication delivery service provided a sense of uncertainty and could not replace the therapeutic feelings of a sense of heartwarming, care and safety generated while having face-to-face meetings with a doctor as well as acts of kindness and compassion from the pain clinic staff.Three themes emerged from the findings: 1) the COVID-19 pandemic poses a threat to perceived stability on pain control; 2) embracing the ‘new normal’ in the world of chronic pain patients; and 3) a silver lining in the midst of the COVID-19 pandemic.Conclusion: The way patients experienced the COVID-19 pandemic well reflects individual differences in the subjective experience of pain and individual needs of chronic pain patients. Changing of healthcare services utiliza­tion at pain clinics during the COVID-19 pandemic should be therefore concerned not only with the continuum of pain treatments, but also congruent to the care needs of chronic pain patients.

State-of-the-art Applications of Patient-Reported Outcome Measures in Spinal Care.

Patient-reported outcome measures (PROMs) assign objective measures to patient's subjective experiences of health, pain, disability, function, and quality of life. PROMs can be useful for providers in shared decision making, outcome assessment, and indicating patients for surgery. In this article, we provide an overview of the legacy PROMs used in spinal care, recent advancements in patient-reported outcomes, and future directions in PROMs. Recent advances in patient-reported outcome assessments have included standardization of measurement tools, integration of data collection into workflow, and applications of outcome measures in predictive models and decision-making tools. Continual appraisal of instruments and incorporation into artificial intelligence and machine learning analytics will continue to augment the delivery of high-value spinal care.

Associação entre nível de independência funcional e percepção subjetiva da dor em idosos no pós-operatório de artroplastia de quadril

ABSTRACT Hip replacement (HR) is a surgery that replaces the injured joint with a prosthesis. The postoperative period can reduce functional independence and affect the subjective experience of pain in older adults. This study evaluated the association between the level of functional independence and the subjective experience of pain in older adults who underwent HR. This cross-sectional descriptive quantitative association study used the functional independence measure (FIM) to assess the level of functional independence and the visual analogue scale (VAS) to analyze the subjective experience of pain. Spearman’s correlation test was used to evaluate the association between FIM and VAS and simple linear regression to analyze the influence of one variable on another (p≤0.05). This study evaluated 48 older adults, with a mean age of 71.5±9 years, of which 37.5% (n=18) were men and 62.5% (n=30) were women. The mean VAS and FIM values were 3.5 (±1.6) and 107 (±17.82), respectively, and they had a significant and inverse association (p=0.006; r=−0.389; R2=0.142). This study showed an inversely proportional relationship between the subjective experience of pain and the level of functional independence in older patients who underwent HR. Therefore, health professionals should pay more attention to pain in these patients in order to optimize their functional recovery and increase their functional independence.

Association between the level of functional independence and the subjective experience of pain in older adults after hip replacement

RESUMO A artroplastia de quadril (AQ) é um procedimento cirúrgico que consiste na substituição da articulação lesionada por uma prótese. O pós-operatório pode reduzir a independência funcional e repercutir na percepção subjetiva da dor em idosos. O estudo avaliou a associação entre o nível de independência funcional e a percepção subjetiva da dor em idosos submetidos à AQ. Trata-se de um estudo transversal, descritivo, quantitativo e de associação. A medida de independência funcional (MIF) foi utilizada para avaliar o nível de independência funcional, e a escala visual analógica (EVA) foi empregada para avaliar a percepção subjetiva da dor. O teste de correlação de Spearman foi utilizado para verificar a associação entre a MIF e a EVA, e uma regressão linear simples, para analisar a influência de uma variável sobre a outra (p≤0,05). Um total de 48 idosos foram avaliados, com média de idade de 71,5±9 anos, em que 37,5% (n=18) pertenciam ao sexo masculino e 62,5% (n=30) ao feminino. A avaliação da EVA mostrou uma média de 3,5 (±1,6), enquanto a MIF, 107 (±17,82). Observamos uma associação significante e inversa com p=0,006 e com r de −0,389, com R2 de 0,142. Este estudo mostrou que há uma relação inversamente proporcional entre a sensação subjetiva da dor e o nível de independência funcional de idosos no pós-operatório de AQ. A partir disso, é necessário que os profissionais da saúde deem mais atenção ao quadro álgico desses idosos, visando otimizar sua recuperação funcional a fim de aumentar sua independência funcional.