Successful Pain Management Research Articles

Spinal cord stimulation in a patient with an implantable cardioverter defibrillator for managing chronic chest pain: a case report and literature review.

The simultaneous use of spinal cord stimulation (SCS) and an implantable cardioverter-defibrillator (ICD) is safe and effective in selected patients with refractory chest pain. Our case highlights successful pain management with SCS without compromising ICD function. Careful patient selection, low device settings, and ongoing monitoring are crucial for achieving optimal outcomes.

ID: 336129 Achieving Successful Pain Management through RFA of the Mandibular Nerve in a Patient with Osteonecrosis

ID: 336129 Achieving Successful Pain Management through RFA of the Mandibular Nerve in a Patient with Osteonecrosis

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BackgroundSelf-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain. MethodsThe analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests—the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test—were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis. ResultsAfter adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened. ConclusionGreater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

A smart device application for acute pain service in surgical patients at a tertiary hospital in South Korea: a prospective observational feasibility study.

Pain assessment and patient education are essential for successful postoperative pain management. However, the provision of personnel for performing these tasks is often insufficient. Recently, attempts have been made to implement smartphone applications for educating and monitoring surgical patients. We developed a smartphone application (app) for postoperative pain management, and conducted a feasibility study. This single-center prospective observational study included 60 patients aged < 70 years who underwent elective surgery. This study evaluated the SmartAPS application, which offers tools for postoperative pain assessment and educational materials for pain management. The primary outcome was the active usage rate, defined as responding at least twice daily on postoperative days (PODs) 1 and 2. Additionally, we investigated patient satisfaction with the app and educational videos as well as any challenges encountered during use. Sixty patients were enrolled in the study and active app use was achieved in 56.7% of them. Response rates peaked at 85.0% for pain intensity and 83.3% for opioid-related side effects at 14:00 on POD 1 but dropped to 56.7% and 58.3%, respectively, at 18:00 on POD 2. Among the patients who responded to the survey regarding the app usage, 84.0% reported satisfaction with the app and 80% found it beneficial for managing postoperative pain. Furthermore, 92.0% did not encounter difficulties using the app, indicating a generally positive user experience. Our findings support the utility of the SmartAPS application in acute pain services, highlighting its potential for improving postoperative pain management.

Successful Management of Opioid-refractory Pelvic Cancer Pain Using Continuous Local Anesthetic Infusion via a Tunneled Epidural

Opioid refractory pelvic cancer pain is common and difficult to manage, which often results in analgesic polypharmacy and escalating opioid doses, alongside the use of interventional techniques. However, up-titration of opioids often results in systemic side effects, and interventional procedures have limitations in their duration of action, efficacy, and risk of nerve damage. Therefore, intrathecal pumps have been utilized as a more permanent option for pain management. Their ability to deliver localized therapy using a variety of pharmacological agents makes it an attractive option for cancer pain management. However, they are limited by a need for careful titration, pump volume constraints, and risks of severe side effects. These limitations can be mitigated by targeting the epidural space instead, and we propose the use of a tunneled epidural catheter technique for continuous local anesthetic infusion in opioid-refractory pelvic and abdominal cancer pain. In this case report, we describe a patient with pelvic and abdominal cancer pain due to stage IV sigmoid adenocarcinoma with widespread metastases, who received adequate pain management from a continuous local anesthetic infusion through a tunneled lumbar epidural catheter. Throughout this patient’s hospital admission, their opioid requirements remained the same, and their pain remained well controlled on review in the community one month after discharge. This case demonstrated that epidural catheters with local anesthetic as the sole neuraxial analgesic agent over a short duration could potentially provide preventive analgesia. This case highlights that a local anesthetic tunneled epidural, without addition of neuraxial opioids, is an effective alternative to intrathecal pumps in managing complex cancer pain and has potential for preventive analgesia.

Pain Scores after Open Fetal Spina Bifida Repair and Caesarean Section: A Longitudinal Cohort Study

Introduction: In fetal surgery, successful pain management is crucial for postoperative mobilization, prophylaxis of contractions, and fast recovery. This study analyzed patient’s pain experience after open fetal spina bifida (fSB) repair in comparison to pain scores after the subsequent Caesarean section (C-section). Materials and Methods: Data were collected with a questionnaire given to 91 women, who had fSB repair and then C-section at our center between 2019 and 2022. It comprised 12 questions covering different aspects of pain experience and satisfaction with pain therapy and was answered by 67 women after fSB repair and 53 after C-section. Postoperative pain was rated on a Likert scale from 0 (slight/rarely) to 100 (strongest/always). Outcomes after fSB repair were compared to those after C-section. Additionally, subgroup analysis compared outcomes of women with different pain levels (group 1–5) after fSB repair. Results: Compared to women after C-section women after fSB repair reported significantly higher maximum pain scores (MPS) (p = 0.03), higher sleep disturbance due to pain (p = 0.03), and sedation rates (p = 0.001) as side effect from pain therapy. No differences were found regarding feelings of insecurity (p = 0.20) or helplessness (p = 0.40), as well as involvement in (p = 0.3) and satisfaction with pain therapy (p = 0.5). Subgroup analysis revealed that women with higher MPS after fSB repair were significantly more often non-Caucasians (p = 0.003) and more often affected by pain while lying in bed (p = 0.007) and during mobilization (p = 0.005). Additionally, they reported higher rates of dizziness (p = 0.02) and lower satisfaction rates with pain therapy (p = 0.03). Postoperative complication rate did not differ among groups. Conclusion: Although women after fSB repair reported higher MPS compared to after C-section, the current pain management was generally perceived as satisfactory.

Enhancing pain control in elbow rehabilitation; A case report of variable ropivacaine dosages through Brachial Plexus Catheter

Managing postoperative pain and discomfort during physiotherapy for upper arm injuries, including complex fractures or traumatic amputations, is crucial. Challenges include severe pain, stiffness, and limited range of motion. Physiotherapy is vital for preventing muscle atrophy, promoting joint mobility, and facilitating functional recovery.The successful management of postoperative pain and pain during physiotherapy in a 27-year-old female, who sustained multiple injuries including a displaced distal humerus fracture and a traumatic right-hand amputation, was achieved through the utilization of a continuous brachial plexus block with variable doses of ropivacaine. The patient’s history revealed a complex array of injuries, including a displaced distal humerus fracture and traumatic right-hand amputation, necessitating open reduction and internal fixation for the fracture and subsequent hand debridement. Despite addressing stiffness through capsulectomy, persistent concerns arose regarding postoperative pain and discomfort during physiotherapy sessions. To address these concerns, a continuous supraclavicular catheter was placed under ultrasound guidance, providing effective pain relief and facilitating physiotherapy interventions for optimal recovery. The patient underwent open reduction and internal fixation for the humerus fracture which was subsequently managed with amputation of several fingers and a hand debridement procedure. Following the surgeries, the patient complained of a stiff elbow, which was addressed through capsulectomy. However, concerns persisted regarding postoperative pain and pain during physiotherapy sessions, leading to the decision to place a continuous supraclavicular catheter. The catheter was accurately positioned under ultrasound guidance and tunneled under the skin, providing effective pain relief for seven days. Ropivacaine was administered as per the patient’s requirements, with a background infusion of 0.2% ropivacaine at 8-hour intervals, a 10 ml bolus of 0.2% ropivacaine administered half an hour before physiotherapy, and 10 ml of 0.5% ropivacaine during physiotherapy sessions if pain levels exceeded 4 on the numerical rating scale. This case highlights the utility of continuous brachial plexus blockade for prolonged postoperative analgesia and pain management during physiotherapy in patients with upper extremity injuries.

Psychological/behavioral interventions for emerging adults with chronic pain.

Emerging adults, of whom significant numbers report chronic pain, are characterized as having unique needs and challenges. Psychological/behavioral treatments found to be beneficial for reducing pain outcomes in children and adults are understudied in emerging adults. Following a systematic review of the literature, our objective is to report on quantitative studies of psychological/behavioral interventions for chronic pain in emerging adults. We conducted a search of six databases (Cochrane Central Register of Controlled Trials, Google Scholar, ProQuest, PsycINFO, PubMed, and Web of Science) and reference sections in dissertations and systematic reviews to 4/29/2023. Keywords and phrases were search term combinations of "chronic/persistent pain", "emerging/young adults," and "intervention/treatment" using Boolean logic. Our review resulted in identifying 37 articles, of which 2 duplicates were removed, and 31 were further excluded by a screening process based on various inclusionary and exclusionary criteria. The search yielded four studies on psychological/behavioral interventions (yoga, acceptance and commitment therapy and relaxation), all of which positively affected the pain experience and/or pain-related outcomes. These studies presented issues in design such as not being blinded or randomized, having a small sample size, and potential confounds that were not reported or examined. The low number of studies reveals a large gap in the literature and is a call-to-action to further expand our understanding of effective and safer psychological/behavioral therapies for chronic pain in emerging adults. Successful pain management during this developmental phase may help young adults achieve positive trajectories for personal, occupational, relational, and health aspects of their lives.

Associations of long-term clinical recovery and improved quality of life across ICD-11 chronic pain categories in a real-world registry study.

There is little knowledge of what factors are needed for successful chronic pain management. We aim to identify psychosocial and treatment predictors of clinical recovery and improved quality of life (QOL) at 12-month follow-up across three chronic pain groups, based on the International Classification of Diseases-11: neuropathic pain, secondary non-neuropathic pain, and primary pain. Furthermore, we investigate baseline differences across diagnostic groups. The sample included baseline and 12-month follow-up data from 1056 chronic pain patients from the Oslo University Hospital's Pain Registry. Logistic regression models investigated longitudinal associations between psychosocial and treatment characteristics, and the outcome measures clinical recovery and improved QOL. Characteristics were compared across the diagnostic groups. Increased odds of clinical recovery and improved QOL were seen in patients receiving invasive treatment (OR = 8.04, 95% CI = 3.50-19.40; OR = 5.47, 95% CI = 2.42-12.86), while decreased odds of clinical recovery were seen for secondary non-neuropathic pain patients with pain-related disability (0.05, 95% CI = 0.01-0.29). In comparing baseline characteristics, neuropathic pain patients had lower QOL, and more severe insomnia compared to the other groups. Invasive treatment modalities were strongly associated with clinical recovery and improved QOL. Although this could be due to patient selection, it does warrant further examination as an intervention alternative for chronic pain. Intervention efficacy, risk factors and predictors of clinical recovery across diagnostic groups should be further investigated through longitudinal RCTs. This observational study indicates a potential advantage in sustained recovery for pre-selected individuals with chronic pain who undergo invasive treatments. The relationship between sustained recovery and psychosocial factors differs across neuropathic, secondary non-neuropathic, and primary pain patients. This suggests that employing ICD-11 for classifying patients into mechanistically distinct pain groups could inform the evaluation and management of chronic pain. Furthermore, factors previously identified as negative indicators for long-term outcomes in chronic pain cohorts were not clinically significant in this study.

Successful Pain Management in a Pregnant Woman with a Herniated Intervertebral Disc Using Ultrasound-Guided Epidural Steroid Injection: A Case Report

Successful Pain Management in a Pregnant Woman with a Herniated Intervertebral Disc Using Ultrasound-Guided Epidural Steroid Injection: A Case Report

Knowledge, Attitudes, and Perceived Barriers of Nurses Regarding Pain Management in Emergency Department; a KAP Study.

Adequate knowledge and positive attitude among nurses are essential for successful pain management as a fundamental aspect of patients' rights. This study aimed to assess the knowledge, attitude and perceived barriers of nurses regarding acute pain management in emergency department. In this cross-sectional study, participating nurses were selected using a consecutive sampling technique within a medical university. Data were collected using 4 questionnaires, which consisted of demographic information checklist, Pain Management Principles Assessment Tool (PMPAT), Nurses' Attitude Survey (NAS), and Nurses' practice checklist. The correlation between knowledge, attitude, and barriers with each other and with baseline characteristics of participates were studied. 400 nurses with the mean age of 38.26±10.39 years were studied (63% male). The average knowledge score of studied nurses was 7.38 ± 2.16 (range: 1 -14). All 400 (100%) nurses exhibited a low level of knowledge. The mean attitude score of participants was 58.47± 22.08 (range:26-100). 214 (53.5%) cases had low attitude, 44 (11.0 %) average attitude, and 142 (35.5%) cases exhibited a high attitude score. The mean score of barriers about pain management was 36.48 ± 23.52 (range: 0 - 80). 23 (5.8%) participants answered the perceived barriers as never, 113 (28.3%) as seldom, 71 (17.8%) as sometimes, 133 (33.3%) as often, and 60 (15.0%) as routine. There was an reverse relationship between the knowledge score and perceived barriers of pain management (r=-0.164, p<0.001). No significant relationship was found between the average knowledge score and nurses' attitudes (r = 0.092; p > 0.065). The findings of this study highlight the need for ongoing training and the organization of workshops for nurses due to their low levels of knowledge and attitude. These training sessions should focus on the concept of pain, assessment methods, pain relief, as well as pharmacology and the physiology of pain.

Challenges and Opportunities in Developing Tailored Pain Management Strategies for Liver Patients.

Chronic liver illnesses pose a substantial worldwide health challenge, with various causes that span from viral infections to metabolic problems. Individuals suffering from liver problems frequently face distinct difficulties in pain control, requiring a customized strategy that takes into account both the fundamental disease and the complexities of liver function. The liver, a vital organ responsible for metabolic control and detoxification, is pivotal in multiple physiological processes. Chronic liver illnesses, such as cirrhosis and non-alcoholic fatty liver disease (NAFLD), are marked by a gradual process of inflammation and fibrosis, resulting in reduced liver function. These disorders often come with pain, varying from internal discomfort to intense abdominal pain, which impacts the quality of life and general well-being of patients. The review explores the complex aspects of pain perception in liver illnesses, including inflammation, modified neuronal signaling, and the influence of comorbidities. It highlights the significance of a detailed comprehension of the pain experience in individuals with hepatic conditions for the implementation of successful pain management treatments. In addition, the review emphasizes the difficulties involved in treating pain in this group of patients, such as the possible complications linked to commonly prescribed pain relievers and the necessity for collaboration between hepatologists, pain specialists, and other healthcare professionals. Moreover, it examines new possibilities in the domain, such as the significance of innovative pharmacological substances, non-pharmacological treatments, and personalized medicine strategies designed for specific patient characteristics. This study thoroughly analyzes the difficulties and possibilities involved in creating personalized pain management approaches for individuals with liver conditions. Its purpose is to guide physicians, researchers, and healthcare providers, enabling them to implement more efficient and patient-focused interventions. As our comprehension of liver-related pain progresses, the potential for enhancing the quality of life for persons with chronic liver disorders through tailored pain management measures becomes more and more encouraging.

Efficacy of Yashtimadhu ghrit matra basti in post-operative management of Ano-rectal Cases – A case Series

Background- Exploitation of analgesics is becoming an advent scenario in the current practice of both medical and surgical cases. Adopting a less complicated and a wholesome beneficial modality for post operative analgesia is the need of the hour. In this case series, focus has been placed on yashti ghrit matra basti as the intervention for pain and wound management of post-operative cases of chronic fissure in ano associated with internal haemorrhoids. Objective- The current study was aimed at post operative analgesia and wound management with yashti ghrit matra basti in ano-rectal cases. Material &amp; Methods-The method adopted here was Lord’s anal dilatation followed by excision of sentinel tags or ligation haemorrhoidectomy according to the case presentation, followed by yashti ghrit mastra basti as primary ayurvedic intervention for post operative analgesia and wound healing. Results -It is found that the planned treatment gave a positive response as post operative analgesia and also played an adjuvant role in wound healing. Conclusion-This case series provides the successful pain and wound management of post-operative ano-rectal cases with a promising ayurvedic intervention.

Ehlers-Danlos Syndrome - living with chronic pain. Current knowledge of the disease

Ehlers Danlos Syndrome (EDS) is a group of the most common inherited connective tissue disorders. The main symptoms of this syndrome are excessive skin flexibility, joint hypermobility and blood vessels fragility. The diagnosis is based on clinical symptoms, but to confirm the type of EDS, it is necessary to identify the collagen-encoding gene or protein interacting with it. The group of Ehlers and Danlos diseases include fourteen types, the most common are classic, vascular, hypermobile, arthrochalasis, kyphoscoliotic and dermatosparaxis. [15] Connective tissue plays a key role in the process of movement, constituting the main component of bones, joint cartilage, tendons, ligaments and intervertebral discs. In addition, connective tissue is a part of every internal organ including the intestines and parenchymal organs and the cardiovascular system.[19] For this reason, patients with EDS show symptoms of many diseases, including respiratory, muscular, skeletal and vascular. Women suffering from EDS often struggle with complications during their pregnancies. Psychological and emotional issues are also common.[6] However, the most noticeable and debilitating symptom of EDS is pain, which is often severe and chronic. The pain occurs in approximately 90% or more of EDS patients.[8] Successful pain management in patients with EDS is a major challenge for specialists. The treatment involves non-steroidal anti-inflammatory drugs, acetaminophen, opioids and physiotherapy. Also marijuana, traditional chinese treatments, herbal remedies are considered to reduce the severity of the symptoms. [9] During the creation of this article, the authors analyzed the clinically relevant knowledge of EDS treatment and management based on research published on Pubmed.

Pain management in pediatric age. An update.

Differently from the adult patients, in paediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, a selection of appropriate pain assessment tools should consider the age, the cognitive level, the presence of eventual disability, the type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drug pharmacokinetics should facilitate a better management of childhood pain. The objective of this update is to discuss the current practice and the recent advances in pediatric pain management. Using PubMed and the Cochrane Library we conducted an extensive literature analysis on pediatric pain assessment and commonly used analgesic agents in this kind of patients. According to our results, a multimodal analgesic regimen provides a better pain control and a functional outcome in children. Cooperation and communication among the anaesthesiologist, the surgeon and the paediatrician remains essential for successful anaesthesia and pain management in childhood.

Genicular nerve block for emergency department patient: a successful management of subacute osteoarthritic knee pain.

The genicular nerve block (GNB) performed under ultrasound is a common procedure in the perioperative and outpatient setting for the treatment of surgical knee pain and osteoarthritis. It provides motor-sparing analgesia to the knee, making it a potential alternative to other modes of pain management in the emergency department (ED). We present an elderly woman with acute-on-chronic osteoarthritic knee pain which was relieved for a week after a GNB during her ED visit. In patients with knee pain, the ultrasound guided GNB has the potential to provide short-term analgesia for patients with pain refractory to other modes of analgesia. The GNB shows promise as a reliable contribution to a multimodal approach to pain management in the ED setting.

Evaluation and Control of Pain in Clinical Settings

Background: Pain is a subjective and an unpleasant sensory and emotional experience associated with actual or potential tissue damage or injury. It can also occur without actual tissue damage, even though the patient refers to it. Pain is a conscious experience, an interpretation of the nociceptive input influenced by memories, emotional, pathological, genetic, and cognitive factors. Pain promotes defensive action and future avoidance behaviour, which requires associating defensive behaviour with resultant changes in pain. Pain has been a predominant health concern for mankind since the dawn of recorded history, and pain control is one of the cardinal objectives of the practice of medicine. It is the most common symptom of disease reported to physicians; more than 80 % of all patients who present to hospitals and clinics do so because of pain. Pain affects the general health, psychological health, social and economic well-being of an individual. The annual cost of uncontrolled chronic pain in the general population is in amount of hundreds of billions of dollars. Objective: The work discussed the evaluation tools and protocols, strategies for pain control, and future therapeutic drug targets for pain and analgesia. Method: The literature search used for the narrative review employed electronic databases in the search for relevant research articles, and they included scopus, pubmed, medline, google scholar, and the directory of open access journals. Others were the use of standard textbooks and the review of references of identified journal articles. Articles on pain and analgesia were identified and reviewed for selection. The keywords used in the search were: ‘’Pain evaluation, Pain assessment, Pain control, Pharmacotherapy of pain, Pain management, Types and characteristics of pain, Aetiology/ Cause of pain, Classification of pain, Severity of pain, Measurement of pain intensity, Pain evaluation tools, and Novel therapeutic drug targets for pain’’. The exclusion criteria used, included articles not written in English and those articles that hinged the clinical management of pain on herbal and alternative medicines (e.g., acupuncture, homeopathy etc.). Result: One hundred and ninety-seven works, ranging from published journal articles to non-journal articles were identified. A total of 82 research works, monographs and textbooks were selected. The works were extracted and reviewed after screening of the titles and abstracts, and in compliance with the inclusion/ selection criteria. Conclusions: Clinical pain is a serious public health concern. Pain evaluation is a multi-strategic observational assessment of a patients’ pain experience. The tools (self-report, behavioural and physiological) for pain evaluation have been demonstrated to be clinically effective in assessing acute pain. Pain evaluation is crucial and clinically useful for an effective and successful pain management. Pharmacotherapy is a critical component in the clinical management of pain, including acute, chronic and acute-on-chronic pain.

Women's experiences with implementation of the physiologic birth program in Iran: a qualitative content analysis study.

Increased rate of caesarean section (CS) without medical indication is a global concern. According to the guidelines of the World Health Organization (WHO), the physiologic birth program is one of the strategies for reducing the rate of unnecessary caesarean sections. The aim of this study is to explain women's experiences with the implementation of the physiologic birth program in Iran. This study is a part of a mixed-method study involving 15 targeted semi-structured interviews individually conducted with women attending physiologic birth classes between January 2022 and June 2022. Interviews continued until data saturation was achieved. Data were analyzed using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman, using MAXQDA10 software. Analysis of the findings of the study led to the emergence of 2 themes, 4 categories, and 10 subcategories. The first theme was the positive experiences of the women ("satisfaction with pregnancy" and "making the childbirth process pleasant"), and the second theme was their negative experiences with physiologic birth ("challenges and limitation of physiologic birth program" and "lack of high-quality obstetric services in the public health system"). The results of this study showed that childbirth preparation classes reduced women's fear and stress and enhanced their positive attitude toward vaginal delivery by preparing them for childbirth. Also, effective communication with midwives and their support along with efficient implementation of physiologic birth techniques led to successful pain management and satisfaction with the birth process. Policymakers should implement strategies to remove limitations and make this program accessible to all women.

Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study

PurposeA prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care. Design and methodsThis study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis. ResultsParents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account. ConclusionsMost children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales. Practice implicationsChild's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

DETECTING LOW BACK PHYSIOTHERAPY EXERCISES AND POSTURES WITH INERTIAL SENSORS AND MACHINE LEARNING

Physiotherapy is a critical element in successful conservative management of low back pain (LBP). The aim of this study was to develop and evaluate a system with wearable inertial sensors to objectively detect sitting postures and performance of unsupervised exercises containing movement in multiple planes (flexion, extension, rotation).A set of 8 inertial sensors were placed on 19 healthy adult subjects. Data was acquired as they performed 7 McKenzie low-back exercises and 3 sitting posture positions. This data was used to train two models (Random Forest (RF) and XGBoost (XGB)) using engineered time series features. In addition, a convolutional neural network (CNN) was trained directly on the time series data. A feature importance analysis was performed to identify sensor locations and channels that contributed most to the models. Finally, a subset of sensor locations and channels was included in a hyperparameter grid search to identify the optimal sensor configuration and the best performing algorithm(s) for exercise classification. Models were evaluated using F1-score in a 10-fold cross validation approach.The optimal hardware configuration was identified as a 3-sensor setup using lower back, left thigh, and right ankle sensors with acceleration, gyroscope, and magnetometer channels. The XBG model achieved the highest exercise (F1=0.94±0.03) and posture (F1=0.90±0.11) classification scores. The CNN achieved similar results with the same sensor locations, using only the accelerometer and gyroscope channels for exercise classification (F1=0.94±0.02) and the accelerometer channel alone for posture classification (F1=0.91±0.03).This study demonstrates the potential of a 3-sensor lower body wearable solution (e.g. smart pants) that can identify proper sitting postures and exercises in multiple planes, suitable for low back pain. This technology has the potential to improve the effectiveness of LBP rehabilitation by facilitating quantitative feedback, early problem diagnosis, and possible remote monitoring.