Total Pain Intensity Research Articles

Investigating the interplay of chronic pain intensity and psychosocial factors in adult women: A pilot study from Türkiye

In this cross-sectional study, the authors investigated the relationships between chronic pain intensity and quality of life, pain coping strategies, and pain beliefs levels in 405 adult women. The participants with a mean age of 48.8 ± 5.08 generally defined chronic pain intensity as moderate pain (x̅=7.17, sd = 2.01). There was a weak positive relationship between chronic pain intensity and the worrying dimension, one of the passive coping strategies, and a weak negative relationship with the retreating dimension. A weak negative relationship was identified between chronic pain intensity and pain beliefs levels, both organic beliefs and psychological beliefs sub-dimensions. The multivariate model identified by regression analysis explained 21.2% of the total chronic pain intensity variance. Our findings suggest that while chronic pain is undoubtedly a complex and multifaceted experience, understanding the psychosocial aspects of a person's life can shed valuable light on their pain levels and how they cope with them.

The evaluation of effective rate and pain intensity of root canal treatment in primary teeth-a retrospective study.

Two-visit root canal treatment for children reduce the time of visits and the by-chair time in comparison with the three-visit root canal treatment. However, it is not clear whether two-visit root canal treatment increase the risk of complications. This study aimed to evaluate the clinical effects and post-operative pain intensity after the root canal treatment between two-visit and three-visit groups in primary molars from children.106 patients were screened for eligibility, of which 74 went back to the preservation visit. Therefore, 74 primary molars from 74 children that diagnosed with chronic pulp and periodontal tissue diseases in the clinics of pediatric dentistry were retrospectively analyzed, in which 37 in the two-visit group and 37 in the three-visit group. The total effective rate and postoperative pain intensity were assessed after treatment and all statistical data were carried out with SPSS software.The average age of children in the two-visit and three-visit groups was 6.4 and 7.0, respectively, with no significant difference (p = 0.056). The two-visit group consisted of 59.5% male and 40.5% female children, while the three-visit group consisted of 56.8% male children and 43.2% female children (p = 0.813). Two months after treatment, the total effective rate in the three-visit group was 97.30%, a little higher than that in the two-visit group (94.59%), but with no significant difference (p = 0.201). Besides, there was also no significant difference in pain intensity between the two-visit and three-visit groups (p = 0.692). Therefore, there were no significant difference of total effective rate and pain intensity in root canal treatment between the two-visit and three-visit groups in primary molars from children.

Correlation Between Pain Intensity and Quality of Recovery After Video-Assisted Thoracic Surgery for Lung Cancer Resection.

The Quality of Recovery-15 (QoR-15) questionnaire provides a multifaceted assessment of postoperative recovery, and the resulting score is recommended as an endpoint in clinical studies focused on postoperative pain. We aimed to investigate the correlation between the QoR-15 score and postoperative pain intensity in surgical patients. Adult patients who underwent video-assisted thoracoscopic surgery (VATS) for lung cancer resection and were enrolled in a prospective registry or in a previous prospective study were included in this study. Baseline and perioperative data, including the results of assessment using the Korean version of the QoR-15 (QoR-15K) questionnaire at 48 hours postoperatively, were collected from the database. Correlations between the QoR-15K total score, questionnaire dimensions, and postoperative pain intensity at 48 hours postoperatively were determined using the Spearman correlation coefficient (ρ). We analyzed a total of 137 eligible patients. Significant negative correlations were noted between the QoR-15K total score and pain intensity at rest (ρ = -0.45, 95% confidence interval [CI]: -0.57 - -0.31, P < 0.001) and during coughing (ρ = -0.55, 95% CI: -0.65 - -0.42, P < 0.001) at 48 hours postoperatively. The pain dimension and pain intensity at 48 hours postoperatively showed significant correlations with physical comfort, emotional state, and physical independence dimensions. Multivariable logistic regression revealed a significant negative association between the pain score at 24 hours postoperatively and good or excellent postoperative recovery. The results support the impact of postoperative pain on the overall postoperative quality of recovery in patients who underwent VATS for lung cancer resection. Moreover, the QoR-15K score may be considered as a primary endpoint in clinical studies on postoperative pain control.

Court-Type Thai Traditional Massage for Patients with Intractable Peripheral Neuropathic Pain: a Randomized Controlled Trial

Objective: Neuropathic pain management involves both pharmacological and non-pharmacological interventions. Despite this, no prior research has demonstrated the efficacy of court-type Thai traditional massage (CTTM) for neuropathic pain relief. This study aimed to investigate the potential benefits of CTTM in alleviating neuropathic pain. Materials and Methods: A preliminary single-blind randomized controlled trial was conducted on 28 participants with peripheral neuropathic pain, who were equally assigned to 2 groups. Both groups received standard drug treatment; however, the intervention group additionally received CTTM and hot herbal compression, while the active control group only received HHC. The adjuvant treatments were administered twice weekly for 4 weeks (V1-V8). A follow-up was conducted 4 weeks posttreatment (V9). Outcome measures were assessed at V1, V4, V8, and V9 using a numerical rating scale and the Thai versions of the Neuropathic Pain Symptom Inventory, the Brief Pain Inventory, and the EQ‑5D‑5L health questionnaire. Results: The data revealed that the intervention and active control groups had statistically significant differences in their pain intensity scores (P &lt; 0.001), total neuropathic pain intensity scores (P = 0.001), and utility of health scores (P = 0.007) during the follow-up period. When comparing outcomes between V1 and V8, the groups exhibited significant differences in pain reduction (P = 0.003) and quality of life (P = 0.027). Conclusion: This study provides initial evidence supporting the potential benefits of CTTM in alleviating peripheral neuropathic pain and improving quality of life. Future research should further investigate the application of CTTM in managing peripheral neuropathic pain conditions.

The effects of an SPM-enriched marine oil and bioavailable curcumin combination on inflammation-associated discomfort in generally healthy individuals: a virtual open-label pilot study

BackgroundAcute inflammation is the body’s immediate and well-coordinated response to injury, which if not resolved can lead to a state of chronic inflammation and is an important component of aging-associated pathologies and chronic diseases. Resolution of inflammation has been shown to be highly regulated by several endogenous specialized pro-resolving mediators which are metabolized from dietary omega-3 and -6 fatty acids. The aim of this pilot study was to validate the use of a combination of a specialized pro-resolving (SPM) enriched marine oil supplement and a highly bioavailable curcumin supplement to reduce pain/discomfort in healthy adults.MethodsThis was a virtual (remote), single-arm open-label study in healthy adults with mild to moderate pain. Twenty-nine individuals were provided with an SPM-enriched marine oil supplement (enriched for three SPM precursors) and a highly bioavailable curcumin supplement to be taken daily for 60 days. The Short-Form McGill Pain Questionnaire (SF-MPQ), Short-Form 36 (SF-36) Health Survey and Medical Symptoms Questionnaire (MSQ) were used to evaluate safety, tolerability and efficacy in reducing pain/discomfort of inflammation.ResultsThe SF-MPQ showed significant improvement in all aspects of the questionnaire, especially in total pain, pain intensity and pain severity within 30 days of supplementation. Significant improvements were also observed in the physical health domain of the SF-36 health survey, particularly in the areas of pain and physical functioning at both days 30 and 60. No adverse events related to the study materials were reported during the study.ConclusionIn conclusion, the combination of anti-inflammatory and pro-resolving supplements may provide a complementary approach for targeting pain/discomfort associated with inflammation.Trial registrationClinicalTrials.gov, NCT04819646. Registered 29 March 2021 – Retrospectively registered.

‘Painting my pain’: the use of pain drawings to assess multisite pain in women with primary dysmenorrhea

BackgroundTo verify the use of pain drawing to assess multisite pain in with primary dysmenorrhea (PD) and to assess its divergent validity, test–retest reliability, intra- and inter-rater reliability and measurement errors.MethodsCross-sectional study. Adult women with self-reported PD three months prior to the study. Women answered the Numerical Rating Scale (NRS) and the pain drawing during two consecutive menstruations. The pain drawings were digitalized and assessed for the calculation of total pain area (%). Intra- and inter-rater reliability and the test–retest reliability between the first and the second menstruations were assessed with the intraclass correlation coefficient (ICC). Measurement errors were calculated with the standard error of measurement (SEM), smallest detectable change (SDC) and the Bland–Altman plot. Spearman correlation (rho) was used to check the correlation between the total pain area and pain intensity of the two menstruations.ResultsFifty-six women (24.1 ± 3.1 years old) participated of the study. Their average pain was 6.2 points and they presented pain in the abdomen (100%), low back (78.6%), head (55.4%) and lower limbs (50%). All reliability measures were considered excellent (ICC > 0.75) for the total pain area; test–retest SEM and SDC were 5.7% and 15.7%, respectively. Inter-rater SEM and SDC were 8% and 22.1%, respectively. Correlation between total pain area and pain intensity was moderate in the first (rho = 0.30; p = 0.021) and in the second menstruations (rho = 0.40; p = 0.002).ConclusionWomen with PD presented multisite pain, which could be assessed with the pain drawing, considered a reliable measurement.

The effects of a short-term perioperative duloxetine treatment on post-colectomy pain: A randomized, controlled clinical trial

Study objectiveTo test the hypothesis that duloxetine reduces postoperative morphine consumption and pain intensity in patients undergoing major colonic surgeries. DesignSingle-center, prospective, double-blinded, randomized, controlled trial. SettingTertiary university hospital, from December 2019 to September 2021. PatientsSixty 18–85 years old, ASA I – III patients undergoing elective open major colonic surgeries were randomly allocated into duloxetine (duloxetine) or placebo (placebo) groups (n = 30 per group). InterventionsDuloxetine 60 mg or placebo was administered orally 2 h before and 24 h after surgery. MeasurementsPCA morphine consumption, surgical pain at rest, and movement measured on 10-cm visual analog scales (VAS), Ramsay sedation scores, and the incidence of adverse effects potentially associated with duloxetine were assessed at patients' admission to the post-anesthesia care unit (PACU), 6, 24, and 48 h postoperatively (PO). Main resultsAfter adjusting for age, BMI, ASA physical status, education level, and incision type, no differences were found between groups in PCA morphine consumption 24 PO h (duloxetine = 5.44 ± 2.06 mg; placebo = 10.33 ± 2.06 mg, p = 0.62) or 48 h PO (duloxetine = 9.18 ± 2.06 mg, placebo = 12.93 ± 2.06, p = 1). Pain at rest also did not differ between groups at 24 h PO (duloxetine = 1.76 ± 0.67 cm; placebo = 1 ± 0.67 cm, p = 1) or at 48 h PO (duloxetine = 0.84 ± 0.67 cm; placebo = 0.49 ± 0.67 cm, p = 1). Similarly, groups did not differ regarding pain on movement at 24 h PO (duloxetine = 2.09 ± 0.68 cm; placebo = 1.80 ± 0.68, p = 1) or at 48 h PO (duloxetine = 1.16 ± 0.68 cm; placebo = 0.88 ± 0.68 cm, p = 1). Sedation scores and adverse effects also did not differ between groups. ConclusionUnder this study's conditions, short-term duloxetine did not reduce total opioid consumption or pain intensity during the initial 48 h following major colon surgery.

Comparison of the efficacy of pharmacological and nonpharmacological treatments in women with primary dysmenorrhea: randomized controlled parallel-group study.

To compare the effectiveness of pharmacological (PT) and nonpharmacological treatments (NPT) in women with primary dysmenorrhea (PD) and determine the most effective treatment method. We enrolled 85 PD participants with PD who were randomly classified into five groups: pharmacological groups; naproxen sodium (NS) and micronized purified flavanoid fraction (MPFF), nonpharmacological groups; motor imagery focused pelvic floor exercise (MOPEXE) and acupressure, and no treatment group; control. Initial assessment was conducted in all groups on the first day of the menstrual cycle. After the end ofthe third menstrual cycle, the specialist physiotherapist and the obstetrician conducted a final evaluation. Intensity and nature of pain were evaluated with the Short-Form McGill Pain Questionnaire (SF-MPQ), and menstrual attitudes and behaviors were evaluated using the Menstruation Attitude Questionnaire (MAQ). In the total pain dimension scores, which are the sum of the affective dimension of pain and sensory dimension scores, the pre-post treatment difference was the highest in the mean of the total pain dimension. The highest was for MOPEXE (15.12 ± 4.44), followed by MPFF (7.53 ± 6.8); acupressure (7.47 ± 5.28) and NS (4.47 ± 4.91) showed more significant change than the control group (p = 0.001). The mean difference in visual analog scale (VAS) scores was highest in MOPEXE (4.53 ± 1.5), followed by acupressure (2.35 ± 1.66); MPFF (1.88 ± 1.73) and NS (1.65 ± 1.84) scores were more significant than the control group (p = 0.001). Regarding total pain intensity, the highest was MOPEXE (2.59 ± 0.94), followed by MPFF (1.18 ± 0.88); acupressure (1.06 ± 0.83) and NS (0.82 ± 1.01) scores were more significant compared to the control group (p = 0.001). There was no significant change in the pre-post difference values in the MAQ subparameters: menstruation as deliberate event, menstruating as bothersome event, menstruation as natural event, anticipation and prediction of the onset of menstruation, and denial of any effects of menstruation; menstruation as a natural event resulted in insignificant changes in parameters (p = 0.579, p = 0.074, p = 0.892, p = 0.056, p = 0. 377). PT and NPT methods in the study were effective in coping with PD-associated pain. MPFF was more effective than the NS group in terms of relieving pain. In terms of pain, MOPEXE and acupressure groups were as effective as PT. The most effective of these treatment methods was the MOPEXE group created by the researcher.

A Randomized Controlled Trial Evaluating the Analgesic Effect of the Combination of Methadone With Morphine for Cancer Related Pain.

Although opioids play an indispensable role in the management of cancer-related pain, inadequate pain relief still occurs. The primary objective of this study was to evaluate whether the combination of a low dose of methadone with morphine promotes a reduction in opioid consumption; the secondary objectives were if the association promotes lower pain intensity, and adverse effects (AEs). A sample if 41 patients with cancer-related pain in palliative setting were included. Patients were starting the third step of the analgesic ladder, and 1 group (n=21) achieve methadone (2.5 mg/12 h) in combination with morphine/methadone, and another group (n=20) received morphine alone. Both groups could use morphine (5 mg) as needed to maintain pain intensity <4, and adjuvant in stable dose. The following outcomes were evaluated: total morphine dose, pain intensity, and AEs. There was no difference in the number of adjuvants, and the dose of morphine used. Pain intensity was significantly lower in the morphine/methadone group after 2 weeks, with no statistically significant difference at other timepoints. There was no difference between groups in the AEs. Low dose of methadone in combination with morphine provided faster pain control as compared with morphine alone, and although this study was not powered to show differences in AEs, we did not notice a difference.

Effect of rehabilitation program on Dyspnea, Exercise capacity and Psychological wellbeing among COVID19 patient at Qena respiratory hospital

Abstract Background: COVID-19 is a contagious beefily infectious respiratory disease; it's a public health emergency that performs varying degrees of respiratory, physical and psychological dysfunction. Aim of the study: to evaluate the effect of the rehabilitation program on dyspnea, physical activities and psychological wellbeing among patients with COVID19. Methods: quasi-experimental pretest-posttest study. The study was carried out in intensive care (ICU) and post COVID recovery unit at Qena Respiratory Hospital. A convenience sample of 50 adult patients from both sexes. The study tools; Tool 1: Self-reports Assessment Questionnaire. Tool 2: International Physical Activity Scale Tool 3: psychological symptoms scale. Tool 4: Clinical data base: includes laboratory investigation of lung function and ABGs, addition to chest tomography. Results: A significant statistically difference was found regarding symptoms associated total pain, pain intensity, dyspnea scores, physical activities, and psychological wellbeing of the studied sample between the pre and post assessment at the first week and second week post discharge and after the implementation of the rehabilitation program with p= 0.001. Conclusion: implementation of the rehabilitation program had statistically significant improvement in dyspnea scores, physical activities, anxiety, depression, pulmonary function, and laboratory investigations among patients with COVID 19. Recommendation: rehabilitation programs should be designed and implemented as individualized programs following a comprehensive evaluation.

Digital Pain Mapping and Tracking in Patients With Chronic Pain: Longitudinal Study.

BackgroundDigital pain mapping allows for remote and ecological momentary assessment in patients over multiple time points spanning days to months. Frequent ecological assessments may reveal tendencies and fluctuations more clearly and provide insights into the trajectory of a patient’s pain.ObjectiveThe primary aim of this study is to remotely map and track the intensity and distribution of pain and discomfort (eg, burning, aching, and tingling) in patients with nonmalignant spinal referred pain over 12 weeks using a web-based app for digital pain mapping. The secondary aim is to explore the barriers of use by determining the differences in clinical and user characteristics between patients with good (regular users) and poor (nonregular users) reporting compliance.MethodsPatients (N=91; n=53 women) with spinal referred pain were recruited using web-based and traditional in-house strategies. Patients were asked to submit weekly digital pain reports for 12 weeks. Each pain report consisted of digital pain drawings on a pseudo–three-dimensional body chart and pain intensity ratings. The pain drawings captured the distribution of pain and discomfort (pain quality descriptors) expressed as the total extent and location. Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptor selection, and Jaccard similarity index. Validated e-questionnaires were completed at baseline to determine the patients’ characteristics (adapted Danish National Spine Register), disability (Oswestry Disability Index and Neck Disability Index), and pain catastrophizing (Pain Catastrophizing Scale) profiles. Barriers of use were assessed at 6 weeks using a health care–related usability and acceptance e-questionnaire and a self-developed technology-specific e-questionnaire to assess the accessibility and ease of access of the pain mapping app. Associations between total extent, pain intensity, disability, and catastrophizing were explored to further understand pain. Differences between regular and nonregular users were assessed to understand the pain mapping app reporting compliance.ResultsFluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity (P<.001), suggesting that the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and nonregular users. Regular users were younger (P<.001) and reported a larger total extent of pain than nonregular users (P<.001).ConclusionsThis is the first study to examine digital reports of pain intensity and distribution in patients with nonmalignant spinal referred pain remotely for a sustained period and barriers of use and compliance using a digital pain mapping app. Differences in age, pain distribution, and current pain intensity may influence reporting behavior and compliance.

Timeline of pain before dementia diagnosis: a 27-year follow-up study.

This study examines the importance of length of follow-up on the association between pain and incident dementia. Further objective was to characterize pain trajectories in the 27 years preceding dementia diagnosis and compare them with those among persons free of dementia during the same period. Pain intensity and pain interference (averaged as total pain) were measured on 9 occasions (1991-2016) using the Short-Form 36 Questionnaire amongst 9046 (women = 31.4%) dementia-free adults aged 40 to 64 years in 1991; 567 dementia cases were recorded between 1991 and 2019. Cox regression was used to assess the association between pain measures at different time points and incident dementia and mixed models to assess pain trajectories preceding dementia diagnosis or end point for dementia-free participants. Results from Cox regression showed moderate/severe compared with mild/no total pain, pain intensity, and pain interference not to be associated with dementia when the mean follow-up was 25.0, 19.6, 14.5, or 10.0 years. These associations were evident for a mean follow-up of 6.2 years: for total pain (hazard ratio = 1.72; 95% confidence intervals = 1.28-2.33), pain intensity (1.41; 1.04-1.92), and pain interference (1.80; 1.30-2.49). These associations were stronger when the mean follow-up for incidence of dementia was 3.2 years. Twenty-seven-year pain trajectories differed between dementia cases and noncases with small differences in total pain and pain interference evident 16 years before dementia diagnosis (difference in the total pain score = 1.4, 95% confidence intervals = 0.1-2.7) and rapidly increasing closer to diagnosis. In conclusion, these findings suggest that pain is a correlate or prodromal symptom rather than a cause of dementia.

Assessment of postoperative health functioning after knee arthroplasty in relation to pain catastrophizing: a 6-month follow-up cohort study.

BackgroundKnee arthroplasty (KA) is a typically successful surgical procedure commonly performed to alleviate painin participants with end-stage knee osteoarthritis. Despite its beneficial effects, a significant proportion of individuals with KA continue experiencing persistent pain and functional limitations. The purpose of this study was to assess the postoperative outcomes after KA in relation to postoperative pain catastrophizing.MethodsParticipants were recruited at a domiciliary physiotherapy service, using a prospective, observational, hypothesis-generating cohort design. Participants were divided into two groups based on their Pain Catastrophizing Scale (PCS) total score (50th percentile), which resulted in high and low PCS groups. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, quality of life, walking speed, physical performance, range of motion, and pain were measured. Outcome measures were collected at baseline (1 week postoperatively) and at follow-up (1, 3, and 6 months postoperatively).ResultsA total of 60 participants (21 total KA and 39 unicompartmental KA) were recruited. Individuals with a higher degree of pain catastrophizing showed significantly higher WOMAC total scores at every follow-up, indicating poorer health functioning (p < 0.01). Similarly, the high PCS group showed higher WOMAC pain, stiffness and disability subscale scores (p < 0.05), poorer quality of life (p < 0.01), and poorer physical performance (p < 0.05) at every follow-up. In addition, the high PCS group achieved a slower walking speed at baseline and at 3 months follow-up (p < 0.05), and a higher degree of pain at rest, on walking and on knee flexion at every follow-up (p < 0.01, p < 0.05 and p < 0.05, respectively) except for walking pain at 3 months follow-up. No significant differences were observed between groups in range of motion, except for active knee extension at the 6-month follow-up (p < 0.05). Effect size was large at 1 month follow-up in WOMAC total score (r = 0.578) and pain intensity during knee flexion (r = 0.529). Longitudinal analyses revealed different improvement trends during the rehabilitation process between groups, with a lack of significant improvements in the high PCS group between the 3- and 6-month follow-up in WOMAC total score, WOMAC pain, WOMAC disability, quality of life, physical performance, active knee extension and resting pain (p > 0.05).ConclusionThe results of the present study suggest that participants with high postoperative pain catastrophizing might have poorer outcomes during the rehabilitation process after KA. Future work should seek to clarify if this relationship is causal.

Chronic Pain One to Five Years after Heart Transplantation

We know that pain has far-reaching detrimental effects across various life-domains and also affects health related quality of life after solid organ transplantation. However, the extent to which heart recipients experience chronic bodily pain in the years after heart transplantation is a neglected field. Pain is reported to be a major problem after other types of solid organ transplantation. Neither the prevalence nor consequences of chronic pain after heart transplantation have been fully explored or understood. Therefore, the aim was to present a multidimensional assessment of self-reported pain one to five years after heart transplantation and its relationship with transplant specific well-being. This nationwide, cross-sectional cohort study is part of the Self-management after thoracic transplantation study. A total of 79 heart recipients, who were due for their annual follow-up at one (n=28), two (n=17), three (n=11), four (n=17) and five years (n=5) after heart transplantation were included. We used three instruments; the Pain-O-Meter (POM), which provides information about pain intensity, sensation, location and duration and the Organ Transplant Symptom and Wellbeing Instrument (OTSWI) and the Psychological General Wellbeing Instrument. The overall prevalence of pain was 57% after 1 year, 76 % after 2 years, 73 % after 3 years, 35 % after 4 years and 50 % after 5 years. Women experienced higher pain intensity than men. The three most common pain locations were feet, back and legs. Heart recipients with pain reported lower transplant specific and psychological well-being as well as higher symptom distress from other symptoms than pain. Those who was back to work reported less pain than those not working. Heart recipients with high general fatigue reported more pain than those less fatigued and there was a relationship between general fatigue, physical fatigue, reduced activity and total pain intensity score. The more fatigue the more pain. Chronic bodily pain up to 5 years after heart transplantation reduces perceived well-being. Heart recipients with pain report higher symptom distress than those without pain. Screening for pain, especially among female heart recipients should be mandatory.

Postpartum ağrının emzirme öz-yeterliliğine etkisi

Purpose: This study was carried out to identify the effect of postpartum afterpain on breastfeeding self-efficacy.Materials and Methods: This was a descriptive study. The sample consisted of 376 postnatal women who met the criteria for participation in the study. The participants were administered the Personal Information Form, The Short-Form McGill Pain Questionnaire, The Short-Form Breastfeeding Self-Efficacy Scale. Results: The mean total score received from the breastfeeding self-efficacy by the postpartum women was found to be 36.88±8.54 (min:14, max:70). The mean scores of the sensory and affective pain, total pain intensity, and visual analoque scale were found to be 33.53±4.18 (min:0, max:45), 2.60±1.39 (min:0, max:5), 6.23±1.91 (min:0, max:10), respectively. In this study, the breastfeeding self-efficacy was found to be higher in the women who were 35 years and over, found their social support adequate, planned their current pregnancy, received prenatal care, expressed their willingness to breastfeed, had no breastfeeding problem. The self-efficacy of breastfeeding is low for women who experienced postpartum abdominal pain, who described the frequency of pain as ‘continuous, continuous and constant’, and who stated that they needed analgesia. A statistically significant negative correlation was determined between the postpartum women’s breastfeeding self-efficacy scores and their postpartum afterpain scores. The postpartum women with afterpain were found to have low levels of breastfeeding self-efficacy.Conclusion: Postpartum pain negatively affects breastfeeding self-efficacy. Controlling pain contributes to the effective implementation of the breastfeeding process.

Quantifying Pain Associated With Rib Fractures

IntroductionRib fractures are a major problem in trauma patients, and the associated pain is not well understood. Measuring total pain experience, duration, and intensity could facilitate comparisons of treatments. This study was intended to evaluate the feasibility of quantifying pain over the course of an admission and identify factors associated with increased pain experience in adults with rib fractures. MethodsPatients admitted to a level I trauma center with rib fractures between 2015 and 2017 were included. Maximum pain score (verbal or nonverbal) was captured for each hospital day. Total pain was defined as the sum of the area under the curve (AUC) of the max pain scores plotted against time. A general linear model was used to determine demographic, injury, and clinical predictors of the pain AUC. ResultsWe identified 3713 patients. Increased pain experienced (greater AUC) was associated with age group 40-59 y compared with 18-39 y (B = 6.1, P = 0.002); Injury Severity Score 9-14 (B = 11.5, P < 0.001) and ≥16 (B = 36.9, P < 0.0001); patients with flail chest versus multiple rib fractures (B = 17.1, P < 0.001); and patients who underwent rib fixation (B = 20.7, P = 0.004). Decreased pain experience was observed for male gender (B = −3.7, P = 0.032) and blunt mechanism of injury (B = −13.7, P < 0.0001). ConclusionsThis study demonstrates the feasibility of measuring patients' total pain experience over the duration of their admission. Pain is a subjective but relevant measure of patients' experience. Our study identifies a number of predictive factors, some expected and some unexpected. Increased overall experience pain following fixation may be the result of severe pain before intervention.

PROMIS Patient Reported Pain Outcomes Compared With Numerical Pain Score Before and After Ankle Surgery

Category:Patient Reported OutcomesIntroduction/Purpose:Patient reported outcomes (PRO) are important for measuring clinical changes after surgical intervention. This study compares PROMIS pain intensity, PROMIS pain interference, and a zero-to-ten numerical pain score (NPS) before and after three common ankle surgeries to test the hypothesis that pain improvement is measurable by each scale. In addition, the effects size (ES) of each scale is compared to help determine which scale may provide the most power to detect an improvement in pain.Methods:PRO scores were routinely collected during clinic visits between 2015 and 2018. Over 175 patients who had undergone total ankle replacement, subtalar fusion, or lateral ankle ligament stabilization were identified in the electronic health record using the surgical billing codes for these procedures. The most recent preoperative and postoperative PROs for these patients were compared by Mann-Whitney U, and effect size was calculated using Cohen’s d.Results:For total ankle replacement, NPS, pain intensity, and pain interference all improved (p<0.05) with ES 1.29, 0.95, and 0.63 respectively. For subtalar fusion, NPS, and pain interference improved (p<0.05) with ES 0.86 and 0.54; pain intensity (p=0.21) was unchanged with ES 0.30. For lateral ankle ligament stabilization, NPS, and pain interference improved (p<0.05) with ES 0.49 and 0.59; pain intensity (p=0.49) was unchanged with ES 0.19.Conclusion:While both NPS and PROMIS pain interference consistently demonstrated improvements after common ankle surgeries, NPS is preferable given its single question format and greater effect size in two of the three procedures studies. PROMIS pain intensity did not routinely measure changes in our surgical population questioning its utility.

A randomized controlled trial comparing tapentadol with oxycodone in non-breastfeeding women post elective cesarean section

Background: Tapentadol may allow greater pain relief with reduced “opioid load” compared to oxycodone. Its use has not been studied in the obstetric population. The objective of this study was to compare the efficacy and side effect profile of tapentadol with oxycodone in patients who received spinal anesthesia for elective cesarean section. The trial was registered with EU Clinical Trials Register with CT number 2016-001621-33.Methods: This was a multicenter, randomized controlled trial. Randomized patients (n = 68) received either 50 mg tapentadol or oxycodone 10 mg 12 hourly postoperatively. The primary endpoint was the sum of pain intensity difference over the first 48 hours of treatment (SPID48). Secondary outcomes included time to rescue medications, SPID36, total pain relief (TOTPAR) scores, patient satisfaction scores, sum of total pain relief and pain intensity difference (SPRID) scores, time to rescue medications and side effects experienced. An analysis of covariance model with baseline pain intensity score as a covariate was used for statistical analysis.Results: There was no significant difference in the primary endpoint of SPID48 with adjusted mean difference -11.45 (95% CI -35.35, 12.45) p = .34). Oxycodone showed significantly greater SPID36 scores compared to tapentadol with increased time to rescue medication. Side effects experienced were similar between groups.Conclusion: Tapentadol did not provide superior pain control or improved tolerability compared to oxycodone post cesarean section. Results should be interpreted however with consideration of administration of intrathecal opioids to all patients in this study and debate over the optimal dose of tapentadol for acute pain.Trial registration: EU Clinical Trials Register identifier: 2016-001621-33.

Association between Acute Postoperative Pain and Recovery of Independent Walking Ability after Surgical Treatment of Hip Fracture.

The intensity of pain after surgical treatment of hip fracture has a negative effect on functional recovery. However, the effects of acute postoperative pain on the recovery of walking ability after the surgery remain unclear. This study aimed to investigate the association between acute postoperative pain and the recovery of functional gait among patients who had independent walking ability prior to hip fracture. This was an observational study that included 41 patients with a mean age of 81.3±7.3 years who underwent surgical treatment for traumatic hip fracture at a general hospital. The primary outcome was the time to recovery of independent gait postsurgery. Based on the median time to recovery, patients were classified into an early independent walking group and an independent walking group. Stepwise logistic regression analysis was performed to identify predictive factors of the time to recovery of independent walking. The median time to recovery of independent gait was 24 days (range, 7-50 days). In total, 20 patients were classified in the early independent walking group and 21 in the independent walking group. On logistic regression analysis, the total pain intensity, reported during activities of daily living (ADL) on postoperative days 5 and 6, and the knee extensor strength were predictive of the time to recovery of independent walking. The degree of recovery of gait function of patients surgically treated for hip fracture was found to be predicted by the pain intensity measured during ADL and the knee extensor strength assessed in the acute phase. Effective management of acute pain after surgical treatment of hip fracture may help improve functional recovery of gait.

A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+ cohort.

BackgroundSeveral studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population.ObjectiveThis cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldest-old ages using a new method (APSs) to assess the location of pain on the body.Materials and methodsThe sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed.ResultsApproximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75–79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain.ConclusionOur results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.