Total Pain Research Articles

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.

Efficacy of transdermal flunixin in mitigating castration pain in piglets

Castration is a painful procedure performed in swine and to date, there are no approved products available in the US to alleviate this pain. Previous work evaluating the efficacy of flunixin meglumine has shown promise in mitigating pain in swine, but no work to date has evaluated transdermal flunixin efficacy in mitigating castration pain in piglets. Therefore, the objective of this study was to evaluate the efficacy of transdermal flunixin (TDF) in mitigating castration pain utilizing a previously validated behavioral pain scale. A total of 98 Large White x Duroc cross male piglets from 98 litters were enrolled in this study. Piglets were randomly assigned to the following treatments: (1) TDF plus castration (3.33 mg/kg; CF; n = 24), (2) TDF plus sham castration (3.33 mg/kg; SF; n = 26), (3) topical physiological saline plus sham castration (S; n = 24), or (4) topical physiological saline plus castration (C; n = 24). All treatments were administered 24 h prior to castration. Four-min continuous videos clips were collected 24 h before castration (-24 h), immediately post-castration (0 h), and 24 h post-castration (+24 h). Video clips were then observed and scored by one trained observer using a 4-point pain scale (score 0-3) encompassing the five behavioral domains of the pig acute pain scale (UPAPS). Total pain score averages were analyzed as repeated measures by analysis of variance applying a multilevel model. The UPAPS effectively distinguished varying levels of painful and non-painful states in castrated piglets as observed via deviations in total pain scores across timepoints (P < 0.0001), treatment (P < 0.001) and treatment*timepoint (P < 0.0001). Immediately post-castration (0 h), piglets in the C and CF group demonstrated greater total average pain scores than piglets in the S (P < 0.03) and SF (P < 0.01) groups and castrated piglets treated with TDF demonstrated lower total pain scores (P < 0.05) and required less analgesic intervention immediately post-castration compared to castrated piglets receiving no treatment (P < 0.0001). For C group 54% required rescue analgesia compared to 29%, 8% and 0% for CF, SF and S piglets respectively. Future work should evaluate implementation of this pain management protocol on a wide scale commercial farm setting.

The outcomes of a healing environment and clustering nursing care on premature infants' vital signs, pain, and sleeping

Our study aimed to assess the effects of creating a healing environment and clustering nursing care on premature infants' vital signs, pain, and sleeping. The study had an experimental research design for the control and study group, each with 53 premature infants. We collected the data through the Vital Signs Sheet, Premature Infant Pain Profile, and Neonatal behavioral state. We used T-tests and chi-square tests to assess the differences between groups. There was a highly statistically significant difference between the study and control groups concerning respiration (p-value<0.01) and heart rate, systolic blood pressure, and O2 saturation (p-value<0.05). 90.6% of participants in the study group had a mild total premature infant pain profile, while 37.7% of the control group had a moderate total premature infant pain profile score. Applying a healing environment and clustering nursing care significantly improved respiration, heart rate, oxygen saturation, and systolic blood pressure. Furthermore, it increased sleep time and decreased wake state and pain score.

The influence of early virtual reality intervention on pain, anxiety, and function following primary total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is one of the most popular surgeries in the orthopedic field. One of the reasons for a failed TKA is pain and difficulty to return to normal function. A pain control method that is becoming more and more popular is the use of virtual reality (VR). We aimed to examine VR intervention in the immediate post-operative physiotherapy following TKA. MethodsThis prospective randomized-controlled study recruited a total of 55 patients undergoing primary TKA in a single institute, operated by three surgeons. They were assigned either study group or control group. Both groups were treated with conventional physiotherapy and CPM equipment (Continuous passive motion device), the study group received additional VR modality. Both groups completed a series of questionnaires prior and after the intervention: State-Trait Anxiety Inventory (STAI) questionnaire (used to diagnose anxiety), Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (knee function score). ResultsThe average age was 70 years-old with equal distribution of male and female. Both groups showed a decrease in pain and anxiety following the intervention (p value < 0.05) but there was no difference between the groups (p value > 0.05 for all parameters). The was no difference in the WOMAC scores in the six-month post-operative examination between groups (p-value = 0.653). ConclusionsVirtual reality intervention in the immediate post-operative period following total knee arthroplasty decrease pain and anxiety but did not influence the pain, anxiety, and long-term function results more than conventional physiotherapy.

Clinical Outcomes Following Stereotactic Body Radiation Therapy (SBRT) for Non-Spinal Bone Metastases: A Systematic Review and Meta-Analysis

<h3>Purpose/Objective(s)</h3> There is limited data available on clinical outcomes following stereotactic body radiation therapy (SBRT) for non-spinal bone metastases. As such, we aimed to perform a systematic review and meta-analysis to characterize local control (LC), overall survival (OS), pain control, and toxicity following SBRT. <h3>Materials/Methods</h3> A PICOS/PRISMA/MOOSE selection criterion was utilized to identify studies. Primary outcomes were 1-year LC and incidences of acute and late Grade 3-5 toxicities. The secondary outcomes were 1-year OS and pain control at 3 months. Weighted random effects meta-analyses were conducted to estimate effect sizes. Mixed effects weighted regression models were utilized to assess for correlations between median biologically effective dose (BED₁₀), LC, and toxicity incidence. <h3>Results</h3> We identified 460 patients with 580 non-spinal bone lesions across 9 studies treated with SBRT. The median age was 64 years (range: 36-91). The most common primaries were prostate (28.7%), lung (23.0%), renal cell carcinoma (16.5%), and breast (14.3%). For those on information with weight-bearing status, 424/571 lesions (74.3%) were weight-bearing. The median dose and fractionation were 35 Gy/5 fractions with a median BED₁₀ of 59.5 Gy (range: 26.4-81.6 Gy). The estimated 1-year OS rate was 71.0% (95% CI: 51.7-87.0%). The estimated 1-year LC rate was 94.6% (95% CI: 87.0-99.0%). The estimated combined acute and late Grade 3-5 toxicity rate was 0.5% (95% CI: 0-5.0%). The estimated 3-month combined partial and total pain response rate following SBRT was 87.7% (95% CI: 55.1-100.0%). We did not note a correlation between BED₁₀ and LC, toxicity indigence, or pain-response rates. <h3>Conclusion</h3> SBRT resulted in excellent LC as well and palliative outcomes with minimal related toxicity. Additional dose escalation was not found to be associated with either improved outcomes or additional toxicity. Prospective investigations are warranted to further examine the role of SBRT for patients with non-spinal bone metastases in order to inform the ideal dose/fractionation schema and approaches to planning.

Association of Nerve Block and Opioid Administration for Patellar Surgery

Introduction: Multimodal pain control after orthopaedic surgery is a topic of growing interest in opioid-related risk mitigation. However, little evidence exists in the orthopaedic trauma setting. We aim to analyze the impact of perioperative peripheral nerve blocks (PNB) on opioid pain management in patients undergoing open reduction and internal fixation (ORIF) of patella fractures. Methods: This analysis included 47 patients with isolated patella fractures who underwent ORIF (2017-2021). Our dedicated PNB service provided 28 cases with PNBs. Extracted variables during hospitalization included demographic data, pain scores on visual analog scale (VAS), intra-, and postoperative opioid administration measured as morphine milligram equivalents (MME). Follow-up data included prescription refills, ED visits for pain within 90 days, and VAS pain scores. Chi-squared and logistic regression analyses were performed to evaluate the impact of PNB on opioid based pain management. Results: Patients with a PNB had lower average total MME (126.54±18.96) than those without a PNB (160.62±35.81); however, this was not statistically significant (p = 0.201). Use of PNB was not associated with total prescription refills, ED visits, or pain on VAS for all time points. However, at two-weeks follow-up, patients without PNB had 4x higher odds of receiving a refill (OR:4.13, CI:1.13-15.10). Subgroup analysis revealed no significant association between PNB timing (preoperative/postoperative) and intraoperative, postoperative, or total inpatient MME. Conclusion: With the observed inconsequential effect of PNB, findings suggest that opioid administration in the orthopaedic trauma population is multifaceted. Continued conscious prescribing practices with multimodal pain control should be encouraged to mitigate opioid-related risks.

Association between Serum Vitamin D and Irritable Bowel Syndrome Symptoms in a Sample of Adults.

Vitamin D may be associated with irritable bowel syndrome (IBS) pathways. This cross-sectional study evaluated the associations between serum Vitamin D and IBS symptoms in a sample of Lebanese adults. Participants (n = 230; mean (SD) age: 43.36 (16.05) years, 62.9% females) were adults, free of diseases affecting Vitamin D metabolism, and recruited from a large university and the surrounding community. Serum Vitamin D (25-hydroxyvitamin D) was assessed using an automated chemiluminescence micro-particle immunoassay kit. The Birmingham IBS Symptom Questionnaire total scale, and pain, constipation, and diarrhea subscales were used to study IBS symptoms. Four linear regression analyses were performed, taking respectively the total scale and each of the subscales as the dependent variable. Vitamin D was forced into each model. Covariates included sociodemographic and medical variables, fluid intake, physical activity, sleep quality, stress, and adherence to the Mediterranean diet. Mean (SD) serum Vitamin D was 17.53 (12.40) ng/mL and mean (SD) Birmingham IBS Symptom Questionnaire was 16.98 (15.16) (pain: 20.75 (23.63), constipation: 25.06 (29.99), diarrhea: 9.88 (13.37)). Serum Vitamin D was not associated with the total score, nor with any of the subscales (p > 0.05 for the four regression analyses). Serum Vitamin D was not associated with IBS symptoms in a sample of Lebanese adults, adding to the controversy in this field. Further understanding of the pathophysiological mechanisms involved in Vitamin D and IBS is warranted.

Comparison of clinical and radiographic results of mobile-bearing total ankle arthroplasty between osteoarthritis and rheumatoid arthritis.

Clinical results of mobile-bearing total ankle arthroplasty (TAA) for rheumatoid arthritis (RA) have been reported, but no studies have compared osteoarthritis (OA) and RA. Clinical and radiographic outcomes after at least three years were compared between OA and RA. Eleven ankles with OA and 22 ankles with RA were followed after mobile-bearing TAA (FINE TAS). Clinical outcomes were assessed by AOFAS score. Radiographic outcomes were evaluated by the angular position of the implant, radiolucent lines, migration, and subsidence. Operative and postoperative complications were assessed. There were no significant differences in clinical outcomes, radiographic outcomes, or complications, except the final follow-up AOFAS total score (OA: 89.4 vs RA: 78.2; p=0.044) and pain score (OA: 37.3 vs RA: 30.5; p=0.041) at mean follow-up of 83.4 months. Delayed wound healing occurred in 9.1% in RA and none in OA. Radiolucent lines were observed in 45% of both groups, and implant removal was performed in 9.1% and 18.2% of OA and RA, respectively; there were no significant differences. The final follow-up AOFAS total score and pain score were significantly higher in OA after FINE TAS. There was a discrepancy between radiographic abnormalities and implant removal in both OA and RA.

Virtual reality reduces pain in palliative care–A feasibility trial

BackgroundEffective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms.AimsWe investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs.DesignThis is an observational, single-arm and national single-center feasibility trial.MethodsA one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain.ResultsWe analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone.DiscussionThe present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.

Modeling psychological well-being among abdominal and pelvic cancer patients: The roles of total pain, meaning in life, and coping.

Relationships between pain and well-being are mediated by a variety of factors. This study examines a serial mediating role of meaning in life and coping in the relationship of total pain with psychological well-being in abdominal and pelvic cancer (APC) patients. Total pain is understood in terms of physical, psychological, social, and spiritual components interacting upon one another. Adult patients diagnosed with the APC (N=333) who were undergoing radiotherapy/chemotherapy treatment in two inpatient units of university hospitals completed questionnaires measuring total pain, psychological well-being, meaning in life, and coping. SEM analysis was used to examine serial mediation effects. All the dimensions of total pain were negatively associated with presence of meaning, coping strategies, and psychological well-being. In contrast, the pain dimensions were positively associated with search for meaning. Presence of meaning, search for meaning, emotion- and meaning-focused coping were serial mediators in the relationship between total pain and psychological well-being. Our results strongly suggests that a holistic examination of pain among patients with cancer is important for several reasons. They also indicate that psychological well-being is significantly influenced by the serial interplay of personal meaning structures and coping abilities.

Sexual desire, mood disorders and sleep disturbances in female BMS patients: A controlled study.

Burning mouth syndrome is a chronic orofacial pain with intraoral burning and other oral dysaesthetic symptoms that significantly affects the quality of life. The aim of this study is to evaluate the sexual desire in women with BMS and to investigate the possible related factors. A case-control study was performed. BMS patients were enrolled according to the International Classification of OroFacial Pain criteria. Demographic variables were collected. We evaluated pain with the Numeric Rating Scale (NRS), Visual Analogue Scale (VAS) and Total Pain Rating Index (T-PRI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS-A e HADS-D), sleep disturbances with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and sexual desire using Sexual Desire Inventory (SDI). A total of 50 BMS women and 50 healthy controls were enrolled. Compared with the controls, the BMS patients showed higher scores in the NRS (7,81± 1,71 vs. 0,14± 0.40; p < 0.0001), TPR-I (10,50± 4,86 vs. 0,36± 1,06; p < 0.0001), HADS-A (11,86± 2,85 vs. 3,90± 2,81; p < 0.0001), HADS-D (8,04± 3,18 vs. 1,42± 1,86; p < 0.0001) and PSQI (9,04± 2,62 vs. 4,64± 3,27; p < 0.0001). The mean SDI in the study group was significantly lower compared to healthy controls (32,36± 14,45 vs. 69,70± 19,94; p < 0.0001). No correlation was found between SDI and others items explored. In line with previous studies, anxiety, depression and sleep disturbances are more common in BMS patients than in healthy population. This pilot study demonstrates for the first time an association between BMS and low sexual desire.

Responsiveness and Minimally Important Changes for Persian-version of Patient-Rated Tennis Elbow Evaluation Questionnaire in Patients with Lateral Elbow Tendinopathy Following Physiotherapy Intervention.

Evaluating responsiveness and calculating minimally important change (MIC) for the Persian-version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire following physiotherapy in patients with lateral elbow tendinopathy (LET). We enrolled 82 patients with LET to complete the PRTEE. After completing four weeks of physiotherapy, all patients were reevaluated by the PRTEE. The patients also rated their changes on a 7-point global rating of change scale (GRoC). The receiver operating characteristic (ROC) curve and correlation analysis were used for evaluating the responsiveness. The MIC was determined by determining a desirable cutoff on the ROC curve. The results showed a moderate relationship (Spearman's correlation coefficient= 0.43-0.56) of total PRTEE, pain subscale, and function subscale with the GRoC scale. The total PRTEE, pain subscale, and function subscale revealed an area under the curve of 0.87, 0.82, and 0.83, respectively. We found the MICs 31.33, 14.5, and 15.5 points for total PRTEE, pain subscale, and function subscale, respectively. The Persian-version of the PRTEE questionnaire has acceptable responsiveness and can measure changes in patients with LET following physiotherapy. We advocate using the PRTEE questionnaire in both clinical settings and research.

S834 Improvement in Fatigue With Mirikizumab Therapy Is Associated With Clinical Remission and Pain Improvements but Not With Endoscopic Response in Patients With Moderately-to-Severely Active Crohn’s Disease

Introduction: Fatigue is common in patients (pts) with Crohn’s disease (CD) and negatively impacts quality of life. We previously reported that fatigue improved in pts with CD receiving mirikizumab (miri) in the AMAG study in all treatment arms. The association between changes in clinical and inflammatory markers and changes in fatigue might reveal the mechanism of fatigue relief. Methods: 191 moderately-to-severely active CD pts were randomized 2:1:1:2 into 4 treatment arms (placebo [PBO], 200mg, 600mg, 1000mg miri), administered intravenously every 4 weeks at Weeks (W) 0, 4, 8. At W12 pts were switched from PBO to miri and rerandomized between miri doses based on response. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. Endoscopic response was defined as ≥50% reduction from baseline in total Simplified Endoscopic Activity Score for Crohn’s Disease. For continuous variables, Pearson’s correlation coefficients, 95% confidence intervals, and p-values were calculated. Cohen’s conventions were used to assess strength of correlations. Analysis of covariance was used to assess relationship between change in FACIT-F and endoscopic response at the same timepoint adjusting for baseline FACIT-F values. Data were pooled for all treatment arms including PBO. Results: Mean change in FACIT-F scores for pts with and without endoscopic response at W12 were 8.1 and 7.2, respectively (p=0.33) and at W52 were 13.9 and 13.7, respectively (p=0.54). At W12, change in FACIT-F showed moderate but statistically significant correlation with change at the same timepoint in Crohn’s Disease Activity Index (CDAI) total score, abdominal pain, and stool frequency. Weak but statistically significant correlations were observed with calprotectin, and C-reactive protein (Table). At W52, change in FACIT-F was moderately but significantly correlated with change in CDAI total score, abdominal pain, and stool frequency (Table). Conclusion: Considering the limitation of the posthoc analysis and design of this Phase 2 trial, improvements in fatigue were significantly associated with improvement in CDAI score, abdominal pain, and stool frequency in patients with CD. Although fatigue has been hypothesized to be mediated in part by inflammatory cytokines, our data showed no consistent relationship of improvement in fatigue with changes in objective markers of disease activity, suggesting the possibility of alternative or additional mechanistic processes for fatigue in CD. Table 1. - Correlation of change in FACIT-F with change in clinical measures Week 12 (N=191) Week 52 (N=176) Clinical measure Pearson corr 95% CI p-value Pearson corr 95% CI p-value CDAI total score -0.404 (-0.530, -0.259) < 0.0001 -0.492 (-0.614, -0.346) < 0.0001 SES-CD total score -0.146 (-0.290, 0.004) 0.0572 -0.076 (-0.238, 0.090) 0.3702 Hematocrit (%) -0.039 (-0.194, 0.119) 0.6319 0.152 (-0.016, 0.312) 0.0756 Hemoglobin -0.011 (-0.167, 0.145) 0.8916 0.120 (-0.049, 0.282) 0.1638 Fecal calprotectin (log) -0.269 (-0.419, -0.105) 0.0015 -0.175 (-0.342, 0.003) 0.0544 C-reactive protein (log) -0.165 (-0.310, -0.013) 0.0331 -0.151 (-0.310, 0.016) 0.0756 Abdominal pain average score -0.380 (-0.504, -0.240) < 0.0001 -0.438 (-0.565, -0.292) < 0.0001 Stool frequency average score -0.354 (-0.481, -0.212) < 0.0001 -0.290 (-0.437, -0.128) 0.0006 Abbreviations: CDAI=Crohn’s Disease Activity Index; corr=correlation; N=number of patients in the analysis (including patients with non-missing change scores); FACIT-F=Functional Assessment of Chronic Illness Therapy-Fatigue; SES-CD=Simplified Endoscopic Activity Score for Crohn’s Disease.

Palliative Care and Movement Disorders.

This article reviews the role of palliative care in the treatment of patients with life-limiting neurodegenerative movement disorders. Growing evidence indicates that palliative care significantly improves quality of life and symptom burden for people with Parkinson disease and other serious movement disorders, while reducing caregiver burnout. An emphasis on advance care planning guides goal-directed treatment recommendations. Serious illness communication skills are evidence-based methods of relaying bad medical news to patients and mapping out values and goals in a way that provides comfort, emphasizes patient autonomy, and builds coping and resiliency strategies. Palliative care, when offered alongside primary medical and neurologic teams, provides an extra layer of support for people with serious illnesses. The goal of palliative care is to intensively treat total pain, which includes all of the physical, emotional, social, and spiritual distress caused by serious illness. Serious illness communication skills are key to providing empathic and goal-concordant care.

Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study.

We aimed to investigate whether coexistent self-reported neck pain influences cephalic and extracephalic pain sensitivity in individuals with migraine and tension-type headache (TTH) in relation to diagnosis and headache frequency. A population of 496 individuals completed a headache interview based on ICHD criteria, providing data collected by self-administered questionnaires, assessments of pericranial total tenderness score (TTS) and pressure pain thresholds (PPT). Stimulus-response (SR) functions for pressure vs. pain were recorded. Presence of neck pain in the past year was assessed by the self-administered questionnaire. We categorized participants by primary headache type. We also categorized participants into 3 groups by headache frequency: chronic (≥15) or episodic (<15 headache days/month) headache and controls. TTS, PPTs and the area under the SR curve were compared between subgroups using Generalized Linear Models with pairwise comparisons controlling for age and sex. Individuals with chronic followed by episodic headache had higher TTS than controls (overall p≤0.001). The difference between chronic and episodic headache subgroups was significant in the group with neck pain (p≤0.001) but not in the group without neck pain. In individuals with neck pain, mean TTS was higher in coexistent headache (migraine and TTH), 23.2±10.7, and pure TTH, 17.8±10.3, compared to pure migraine, 15.9±10.9 and no headache 11.0±8.3 (overall p<0.001). Temporal and finger PPTs did not statistically differ among the chronic headache, the episodic headache and controls in individuals with and without neck pain. Temporalis and trapezius SR-functions showed that tenderness was increased in individuals with chronic headache to higher degree than in those with episodic headache, and more so in those with neck pain. Coexistent neck pain is associated with greater pericranial tenderness in individuals with chronic headache and to a lesser degree in those with episodic headache. Sensitization may be a substrate or consequence of neck pain and primary headache, but a longitudinal study would be needed for further clarification.

Humanization: The Solution for Non-PhysicalPain in the Hospital Environment

Getting sick, in general, is an unexpected and frustrating event in people's lives, providing feelings such as anxiety, fear and anguish. Cicely Saunders classifies the set of physical, emotional, environmental, and social sensations that such an event causes as “Total Pain”,whichincludesboththe patient and the companions. In this context, it is essential that the health professional is prepared to welcome the patient and company with a humanized approach, also seeking to solve non-physical pain in the hospital environment. Thus, humanization becomes an indispensable item at all levels of care.

Computer-Aided Histopathological Characterisation of Endometriosis Lesions.

Endometriosis is a common gynaecological condition characterised by the growth of endometrial tissue outside the uterus and is associated with pain and infertility. Currently, the gold standard for endometriosis diagnosis is laparoscopic excision and histological identification of endometrial epithelial and stromal cells. There is, however, currently no known association between the histological appearance, size, morphology, or subtype of endometriosis and disease prognosis. In this study, we used histopathological software to identify and quantify the number of endometrial epithelial and stromal cells within excised endometriotic lesions and assess the relationship between the cell contents and lesion subtypes. Prior to surgery for suspected endometriosis, patients provided menstrual and abdominal pain and dyspareunia scores. Endometriotic lesions removed during laparoscopic surgery were collected and prepared for immunohistochemistry from 26 patients. Endometrial epithelial and stromal cells were identified with Cytokeratin and CD10 antibodies, respectively. Whole slide sections were digitised and the QuPath software was trained to automatically detect and count epithelial and stromal cells across the whole section. Using this classifier, we identified a significantly larger number of strongly labelled CD10 stromal cells (p = 0.0477) in deeply infiltrating lesions (99,970 ± 2962) compared to superficial lesions (2456 ± 859). We found the ratio of epithelial to stromal cells was inverted in deeply infiltrating endometriosis lesions compared to superficial peritoneal and endometrioma lesions and we subsequently identified a correlation between total endometrial cells and abdominal pain (p = 0.0005) when counted via the automated software. Incorporating histological software into current standard diagnostic pipelines may improve endometriosis diagnosis and provide prognostic information in regards to severity and symptoms and eventually provide the potential to personalise adjuvant treatment decisions.

Clinical Outcome of Partial Sensory Rhizotomy in Negative-Exploration Trigeminal Neuralgia and Technical Nuances

Background: Microvascular decompression is considered to be a potential treatment for most trigeminal neuralgia cases with obvious neurovascular conflict. Partial sensory rhizotomy (PSR) is an alternate option in cases of negative investigation for neurovascular conflict, although its effectiveness and technical complexity are still being debated. Objective: To evaluate the therapeutic efficacy of PSR following negative-exploration trigeminal neuralgia (NETN) in terms of pain control, adverse effects from sensory fiber destruction, and patient satisfaction in the short-term or after 1 month, and in the long-term or after 12 months. In addition, technical nuances were highlighted to mitigate the negative effects of PSR. Materials and Methods: The present study enrolled 27 NETN patients, and all were operated by the same neurosurgeon. The patients underwent surgery via a keyhole retromastoid technique, with extensive exploration for any possible intraoperative neurovascular conflict. A modified PSR approach was used to operate on these negative exploration cases, and this entailed cutting fewer than 1/5 of the trigeminal sensory fibers. The short-term or within one month, and long-term or after one-year intervals were used to track all instances. The therapeutic efficacy of employing pain score and subjective sensation in terms of pain control, adverse consequences from sensory fiber destruction, and patient satisfaction were investigated. Results: Eighty-five point two percent of patients reported excellent pain control following PSR, in terms of both pain score and total pain alleviation. Despite having their trigeminal nerve fibers severed, not all of the patients experienced numbness, and 45% of patients recovered to some extent on their own within a year. Only 13% of patients had Anesthesia Dolorosa in the present trial, which could be attributable because only 1/5 of the trigeminal nerve fibers were severed. There was no relationship between pain distribution and pain alleviation efficacy before and after PSR. When PSR was effective, most patients should notice an improvement within a month of the surgery. Conclusion: For patients with negative exploration following keyhole suboccipital craniectomy, PSR proved to be therapeutic and effective in alleviating trigeminal neuralgic pain. The majority of the patients can tolerate the minor side effects from minute nerve destruction well, particularly numbness, which partially resolves on its own with time. Keywords: Negative exploration; Trigeminal neuralgia; Microvascular decompression; Partial sensory rhizotomy; Efficacy

Nerve stimulation guided bilateral pudendal nerve block versus landmark-based caudal block for hypospadias repair in young children: a prospective, randomized, pragmatic trial

IntroductionCaudal block is frequently performed to provide analgesia for hypospadias repair. Literature suggests that pudendal block provides prolonged postoperative analgesia as compared with caudal block in children between 2 and...

The effect of Helfer skin tap technique on hepatitis B vaccine intramuscular injection pain in neonates: A randomized controlled trial

ContextThe aim of neonatal pain management is to reduce pain and help the baby cope with pain. ObjectiveThis study aimed to determine the effect of Helfer skin tap technique (HSTT) on hepatitis B vaccine intramuscular (IM) injection pain in neonetes. DesignRandomized controlled study SettingThis study was conducted with neonatal infants born vaginally in the delivery room of a state hospital in Turkey. ParticipantsThis study was conducted total 60 neonates including 30 in the HSTT group and 30 in the Routine Technique (RT) group. InterventionsParticipants were randomized into the HSTT group and the Routine Technique (RT) group. Main outcome measuresData were collected using a questionnaire form and the Neonatal Infant Pain Scale (NIPS). ResultsWhile the means of the total pain scores in the HSTT group were found to be 1.73 ± 2.04 during injection and 1.73 ± 0.98 after injection, in the RT group, the mean scores were 5.56 ± 0.92 during injection and 4.90 ± 1.25 after injection. The difference between the groups arising in the comparison of means of the total pain scores obtained during and after injection in HSTT and RT groups was determined to be statistically significant (p <0.05). ConclusionIn conclusion, HSTT was proven to be effective in reducing hepatitis B vaccine intramuscular (IM) injection pain in neonates. This study demonstrates that HSTT is associated with reduced pain in newborns during hepatitis B vaccine IM injections.