Usual Pain Research Articles

AN ANALYSIS OF THE PATIENT REPORT OUTCOMES OF A JOINT CNS / AHP NEURO-ONCOLOGY CLINIC ON PATIENTS QUALITY OF LIFE

Abstract AIMS Velindre Cancer Centre established a successful model of collaborative working between CNS and AHP services for neuro-oncology patients to holistically support their complex needs throughout treatment. Building on this success, the clinic has introduced a recognised reliable and valid patient reported outcome measure (PROM) to be completed pre and post clinic intervention. This is in addition to the patient reported experience measure that is already established within the pathway. This PROM will enable an analysis of the clinics impact on patients quality of life. METHOD A quantitative methodology will be utilised to enable a objective evaluation of the impact of the clinic on patients quality of life. An EQ-5D-5L PROM is completed with patients prior to their involvement with the clinic enabling an overview of key aspects related to quality of life including mobility, self-care, participation in usual activities, pain and anxiety / depression. Following interventions within the clinic, patient are provided with a post treatment EQ-5D-5L to enable a comparison of these key indicators of quality of life. RESULTS The data will build on the resounding success of collaborative working between CNS and AHP’s in the neurooncology MDT clinic. An analysis of the pre and post data will demonstrate the impact of having access to this unique and integrated way of working, enabling patient access to specialist timely support throughout their treatment. CONCLUSION This innovative model of working is now established in the patient pathway and findings from patient experience measures have recognised that patients experience of the clinic is extremely highly valued. Findings from this additional dataset will further evidence the impact on patients quality of life. It will add to findings from a proposed gap analysis to evidence the benefits of developing an outreach service for this patient cohort.

Safety and Usefulness of Intracoronary Acetylcholine 200 μg Into the Left Coronary Artery as Vasoreactivity Testing: Comparisons With Intracoronary Acetylcholine Maximum 100 μg.

We retrospectively analyzed the usefulness and safety of intracoronary acetylcholine (ACh) 200 μg into the left coronary artery (LCA) as vasoreactivity testing compared with intracoronary ACh 100 μg. We recruited 1433 patients who had angina-like chest pain and intracoronary ACh testing in the LCA, including 1234 patients with a maximum ACh 100 μg and 199 patients with a maximum ACh 200 μg. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis, usual chest pain, and ischemic electrocardiogram (ECG) changes. The incidence of coronary constriction ≥ 90%, usual chest pain, and ischemic ECG changes with a maximum ACh of 100 μg was markedly higher than that with a maximum ACh of 200 μg. The frequency of unusual chest pain in patients with a maximum ACh of 200 μg was higher than that in those with a maximum ACh of 100 μg (13% vs. 3%, p < 0.001). In patients with rest angina, positive spasm of maximum ACh 100 μg was significantly higher than that of maximum ACh 200 μg, whereas there was no difference regarding positive spasm in patients with atypical chest pain between the two ACh doses. Major complications (1.38% vs. 1.51%, p = 0.8565) and the occurrence of paroxysmal atrial fibrillation (1.81% vs. 2.63%, p = 0.6307) during ACh testing in the LCA were not different between the two maximum ACH doses. Intracoronary ACh 200 μg into the LCA is clinically useful and safe for vasoreactivity testing when intracoronary ACh 100 μg dose not provoke spasms.

Evaluation of Patellar Dysplasia and Postoperative Pain After Mini-Open, Thin-Flap Trochleoplasty: A Retrospective Analysis of 75 Consecutive Cases.

The association between inherent patellar anatomy and postoperative pain after trochleoplasty in patients with patellar instability is poorly understood. The study purpose was to evaluate outcomes after mini-open, thin-flap trochleoplasty. The hypothesis was that more severe patellar dysplasia would be correlated with increased postoperative pain after trochleoplasty. Case series; Level of evidence 4. Patients with patellar instability who underwent mini-open, thin-flap trochleoplasty in combination with other individualized procedures between 2013 and 2022 were included. Patellar dysplasia was evaluated by calculating the Wiberg index at the widest and most distal cartilaginous parts of the patella on preoperative magnetic resonance imaging. At the postoperative follow-up, participants completed the visual analog scale for usual pain (VAS-U), Banff Patellofemoral Instability Instrument 2.0 (BPII), global rating of change scale, and an evaluation of their current symptom state. Redislocations and complications were recorded. The correlation between the Wiberg index and the VAS-U was calculated with the Spearman rho. Between-group analyses based on demographic and pathoanatomic features were conducted using the Mann-Whitney U test, independent-samples t test, and chi-square test. Included were 75 knees in 63 patients (median age at surgery, 19.1 years; IQR, 16-22 years) with a median follow-up of 44 months (IQR, 23.8-83.2 months). The median BPII score was 78.2 (IQR, 54.8-92.5), with 88% reporting an improvement in knee function relative to before surgery, but 21.1% remained dissatisfied with their current knee symptom state. New episodes of patellar dislocation were seen in 3 knees (4%), and 14 knees (18.7%) underwent reoperation with either revision surgery (n = 7; 9.3%) or arthroscopic synovectomy (n = 7; 9.3%). A weak positive, nonsignificant correlation was found between increased postoperative pain and a higher Wiberg index, both at the widest (r S = 0.16; P = .23) and most distal (r S = 0.02; P = .89) parts of the patella. Significantly worse VAS-U scores were seen in female versus male patients (P = .013). Good patient-reported results with a low risk of redislocation were seen in the study cohort, but reoperation rates were high, and 21% of the patients remained dissatisfied with their current symptom state. More pronounced patellar dysplasia (increased Wiberg index) had only a poor association with more severe postoperative pain in the current study.

Bayesian Networks for Prescreening in Depression: Algorithm Development and Validation.

Identifying individuals with depressive symptomatology (DS) promptly and effectively is of paramount importance for providing timely treatment. Machine learning models have shown promise in this area; however, studies often fall short in demonstrating the practical benefits of using these models and fail to provide tangible real-world applications. This study aims to establish a novel methodology for identifying individuals likely to exhibit DS, identify the most influential features in a more explainable way via probabilistic measures, and propose tools that can be used in real-world applications. The study used 3 data sets: PROACTIVE, the Brazilian National Health Survey (PesquisaNacionalde Saúde [PNS]) 2013, and PNS 2019, comprising sociodemographic and health-related features. A Bayesian network was used for feature selection. Selected features were then used to train machine learning models to predict DS, operationalized as a score of ≥10 on the 9-item Patient Health Questionnaire. The study also analyzed the impact of varying sensitivity rates on the reduction of screening interviews compared to a random approach. The methodology allows the users to make an informed trade-off among sensitivity, specificity, and a reduction in the number of interviews. At the thresholds of 0.444, 0.412, and 0.472, determined by maximizing the Youden index, the models achieved sensitivities of 0.717, 0.741, and 0.718, and specificities of 0.644, 0.737, and 0.766 for PROACTIVE, PNS 2013, and PNS 2019, respectively. The area under the receiver operating characteristic curve was 0.736, 0.801, and 0.809 for these 3 data sets, respectively. For the PROACTIVE data set, the most influential features identified were postural balance, shortness of breath, and how old people feel they are. In the PNS 2013 data set, the features were the ability to do usual activities, chest pain, sleep problems, and chronic back problems. The PNS 2019 data set shared 3 of the most influential features with the PNS 2013 data set. However, the difference was the replacement of chronic back problems with verbal abuse. It is important to note that the features contained in the PNS data sets differ from those found in the PROACTIVE data set. An empirical analysis demonstrated that using the proposed model led to a potential reduction in screening interviews of up to 52% while maintaining a sensitivity of 0.80. This study developed a novel methodology for identifying individuals with DS, demonstrating the utility of using Bayesian networks to identify the most significant features. Moreover, this approach has the potential to substantially reduce the number of screening interviews while maintaining high sensitivity, thereby facilitating improved early identification and intervention strategies for individuals experiencing DS.

Validity and Reliability of an Arabic Version of the Survey Instrument for Natural History, Aetiology and Prevalence of Patellofemoral Pain Studies: A Cross-Sectional Study.

Knee pain, specifically patellofemoral pain (PFP), may lead to limitations in physical activity and social participation. Identifying knee pain that is attributed to PFP is not an easy job for healthcare professionals. To overcome this issue, The Survey Instrument for Natural History, Aetiology and Prevalence of Patellofemoral Pain (SNAPPS), which is a self-reporting questionnaire instrument, was designed to identify PFP in many languages. However, the Arabic version of the SNAPPS is not validated yet. This study was performed to assess the validity and reliability of the Arabic version of the SNAPPS (A-SNAPPS). A cross-sectional study was conducted to achieve the study goals. To assess reliability, 38 participants were asked to complete the A-SNAPPS two times on the same day with a 30 min break in between. Convergent validity of the A-SNAPPS was assessed by exploring the correlations of the SNAPPS total score with the visual analogue scale (VAS) scores, including VAS for usual pain, VAS for worst pain, and VAS for pain during activities such as jumping, running, ascending and descending stairs, and squatting. The validity test findings suggested that SNAPPS has a strong correlation with the VAS during ascending and descending stairs (r = 0.71) and moderate correlations during jumping (r = 0.54) and squatting (r = 0.57). The test-retest reliability ICC was 0.92, indicating a very strong test-retest reliability of the A-SNAPPS. The A-SNAPPS was cross-culturally adapted and validated, demonstrating very strong reliability.

Designer Receptor Exclusively Activated by Designer Drug (DREADD)-Mediated Activation of the Periaqueductal Gray Restores Nociceptive Descending Inhibition After Traumatic Brain Injury in Rats.

Traumatic brain injury (TBI) patients frequently experience chronic pain that can enhance their suffering and significantly impair rehabilitative efforts. Clinical studies suggest that damage to the periaqueductal gray matter (PAG) following TBI, a principal center involved in endogenous pain control, may underlie the development of chronic pain. We hypothesized that TBI would diminish the usual pain control functions of the PAG, but that directly stimulating this center using a chemogenetic approach would restore descending pain modulation. We used a well-characterized lateral fluid percussion model (1.3 ± 0.1 atm) of TBI in male rats (n = 271) and measured hindpaw mechanical nociceptive withdrawal thresholds using von Frey filaments. To investigate the role of the PAG in pain both before and after TBI, we activated the neurons of the PAG using a Designer Receptor Exclusively Activated by Designer Drug (DREADD) viral construct. Immunohistochemical analysis of brain tissue was used to assess the location and confirm the appropriate expression of the viral constructs in the PAG. Activation of the PAG DREADD using clozapine N-oxide (CNO) caused hindpaw analgesia that could be blocked using opioid receptor antagonist, naloxone, in uninjured but not TBI rats. Due to the importance of descending serotonergic signaling in modulating nociception, we ablated spinal serotonin signaling using 5,7-DHT. This treatment strongly reduced CNO-mediated anti-nociceptive effects in TBI but not uninjured rats. To define the serotonergic receptor(s) required for the CNO-stimulated effects in TBI rats, we administered 5-HT7 (SB-269970) and 5-HT1A (WAY-100635) receptor antagonists but observed no effects. The selective 5-HT2A receptor antagonist ketanserin, however, blocked CNO's effects in the DREADD expressing TBI but not DREADD expressing sham TBI animals. Blockade of alpha-1 adrenergic receptors with prazosin also had no effect after TBI. Descending pain control originating in the PAG is mediated through opioid receptors in uninjured rats. TBI, however, fundamentally alters the descending nociceptive control circuitry such that serotonergic influences predominate, and those are mediated by the 5-HT2A receptor. These results provide further evidence that the PAG is a key target for anti-nociception after TBI.

Postoperative Pain Following Eye Enucleation: A Prospective Observational Study.

Background and Objectives: Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. Materials and Methods: This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT®). Patients received usual pain therapy in an unstandardized individual manner. Results: Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0-8), 3.29 ± 3.24 (range, 0-8) on the day of surgery, 4.67 ± 1.90 (range, 2-10) on day 1, 3.25 ± 1.39 (range, 1-6) on day 2, and 2.71 ± 1.30 (range, 1-6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0-10) preoperatively, 4.04 ± 3.78 (range, 0-10) on the day of surgery, 5.75 ± 2.01 (range, 2-10) on day 1, 4.25 ± 1.89 (range, 2-10) on day 2, and 3.88 ± 1.54 (range, 2-8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Conclusions: Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information.

EFFETS DE LASSOCIATION DE LEXERCICE PHYSIQUE ET DU MASSAGE SUEDOIS SUR LA SCIATALGIE CHEZ LES FEMMES DE YAOUNDE (CAMEROUN)

Background: Sciatica is a common chronic musculoskeletal disorder among women in developing countries. However, management strategies for this condition in these regions are often inadequate. Objective: The aim of this study was to evaluate the effectiveness of a therapeutic programme combining Swedish massage and physical exercise on the symptoms of sciatica in women in the city of Yaounde in Cameroun. Methodology : This was a cross-sectional study of 30 women suffering from sciatica. The women were divided equally into three groups. The first (G1) was made up of women who only took physical exercise, the second (G2) of those who only received Swedish massage sessions and the third (G3) of those who received both physical exercise and Swedish massage. Results : The results show an overall decrease in anthropometric parameters. This decline was most marked in G3 (ΔG3 = -3.21%) and G1 (ΔG1 = -10.10%), for body mass and bone mass respectively. G2 showed the greatest reductions in water mass (ΔG2 = -16.97%), fat mass (ΔG2 = -21.19%) and muscle mass (ΔG2 = -8.76%). The results then show an overall improvement in pain parameters. This observation was more marked in G2, irrespective of the parameter considered. On the other hand, G1 showed the best result for pain at the present time (ΔG1 = -73.57%), while G2 showed the greatest improvements for usual pain (ΔG3 = -52.24%) and most intense pain (ΔG3 = -64.06%). Finally, the results indicate an overall reduction in the consequences of pain. This reduction was more marked in G2, but G3 showed the best results in terms of social relationships. Conclusion : In conclusion, physical exercise and Swedish massage promoted remission of most of the symptoms of sciatica in the subjects studied, especially when these two methods were combined.

2020 Improving pain management in non-verbal patients

Abstract Introduction Identification of pain generally relies on patient self-reporting of symptoms. Patients with limited communication, advanced dementia or learning disabilities are unable to self-report pain. This results in pain being under-recognised and under-treated. Consequences of this are serious and include physical and psychological distress, longer length of stay and worse outcomes.1 Methods Abbey Pain Score (APS) [Figure 1] was introduced on a single Healthcare of the Older Person ward.2,3 It was used as the primary means of assessing pain in non-verbal patients (NVP) in place of the usual verbal pain scale (scored 0-10). [Figures 2 and 3] Ward-based teaching for all doctors, nurses and healthcare assistants was conducted before introduction of the APS. Data was collected for 20 consecutive NVP. Figure 1: Abbey Pain Score (Six items observed &amp; Score) Vocalisation: 0-3; Facial expression: 0-3; Change in body language: 0-3; Behavioural change: 0-3; Physiological change: 0-3; Physical changes: 0-3. Scoring scale: No Pain (0-2); Mild Pain (3-7); Moderate Pain (8-13); Severe (14+). Results At baseline we identified that pain as a symptom was missed in 54 % of NVP using the verbal pain score. With introduction of APS this dropped only slightly at 3 months but there was an increased uptake in scoring NVP on APS. With persistent engagement there was a significant decline in number of patients with un-managed pain needs. Figure 3: Abbey pain score (All patients with any pain) Baseline Pre-intervention: 21 / 39 (54 %); Post-intervention (3 months): 10 / 20 (50 % Post-intervention (12 months): 1 / 19 (5 %) Conclusion ABP is an effective means of addressing pain in NVP. It is simple to implement and can lead to significant improvements in patient care.

Estimating health state utilities in Duchenne muscular dystrophy using the health utilities index and EQ-5D-5L

BackgroundThe progression of Duchenne muscular dystrophy (DMD) is characterized by loss of ambulation, respiratory insufficiency, cardiomyopathy, and early mortality. DMD profoundly impacts health-related quality-of-life (HRQoL). However, few health state utility data exist; published utilities tend to be derived from small samples for a limited number of health states and are often based on caregiver-reported patient health status. This study estimated utility values for varied clinical and functional health states in DMD, based on patient-reported health status.MethodsIndividuals with DMD in the US aged 12–40 years completed the EQ-5D (5-level) and Health Utilities Index (HUI) preference-based instruments. Based on responses to a clinical questionnaire, participants self-classified into functional health states according to level of lower and upper limb function, use of respiratory support, and presence of cardiomyopathy. Mean [standard deviation (SD)] utility and EQ-5D visual analogue scale (VAS) scores were estimated according to health state; and median (interquartile range) attribute levels calculated to understand which domains of health are most severely affected in DMD.ResultsOf 63 males with DMD, mean (SD) age was 19.8 (6.1) years and 11 (17.5%) were ambulatory. Mean (SD) utility values were 0.92 (0.08; HUI2), 0.84 (0.20; HUI3), and 0.84 (0.13; EQ-5D) for ambulatory patients without cardiomyopathy (n = 10). For non-ambulatory patients with moderately impaired upper limb function, night and daytime ventilation without cardiomyopathy, mean (SD) utilities were 0.49 (0.07) for the HUI2, 0.16 (0.15) for the HUI3 and 025 (0.14) for the EQ-5D. Mean (SD) VAS scores for the same health states were 91 (9) and 83 (21), respectively. In addition to impairments in mobility/ambulation, and self-care, attributes like usual activities and pain also showed notable effects of DMD.ConclusionsIn DMD, although a relationship between disease progression and HRQoL is observed, there is large variability in utility within functional health states, and across instruments. Utility values for less severe non-ambulatory health states described by level of upper limb function are novel. These utility values, derived based on direct patient feedback rather than from caregiver report, are relevant to individuals of varying functional statuses and augment scarce DMD-specific utility data.

Abstract 14662: What Factors Contribute to the Presence of Coronary Microvascular Dysfunction in Patients With Non-Obstructive Coronary Artery Disease?

Introduction: In recent years, there has been growing interest in coronary microvascular dysfunction (CMD). Several risk factors have been discussed as causes of CMD, but there are still many unknowns. Hypothesis: In this study, we evaluated clinical risk factors for CMD in patients with chest pain with non-obstructive coronary artery disease (INOCA). Methods: Sixty-two patients who were able to undergo comprehensive coronary angiography at the time of chest pain screening were included in the study. Patients with a history of heart failure were excluded. Comprehensive angiography excluded patients with organic coronary artery stenosis (%stenosis&gt;50%) and was performed with the spasm provocation test using acetylcholine (ACh) to induce coronary spasm and with a pressure wire to evaluate CMD. Positive coronary spasm was defined as the presence of usual chest pain or electrocardiographic changes and &gt;90% coronary artery constriction on angiograms in response to ACh provocation. In addition, a coronary spasm within one section of the American Heart Association’s classification was defined as a focal spasm. CMD was defined as the presence of coronary flow reserve (CFR) &lt; 2.0 or an index of microcirculatory resistance (IMR) ≥ 25 obtained from a pressure wire. The clinical background leading to CMD was investigated and evaluated by logistic analysis. Results: Of 62 patients with INOCA, 26 (42%) had CMD. The results are shown in the table. Conclusions: These results suggested that factors contributing to CMD in INOCA patients were diverse: women, smoking, focal spasm, and elevated NTproBNP level. It is necessary to identify the cause of CMD before treatment in such patients.

Effect of Dyspnea, Quality of Life, and Well-being in Postacute COVID-19 Patients: A Prospective Cohort Study

ABSTRACT Context: The persistence of respiratory symptoms beyond 4 weeks otherwise known as postacute COVID-19 symptoms has been reported to significantly affect the clinical outcome, quality of life (QOL), and well-being of patients’ postinfection. Aims: The study aims to determine the pattern of postacute COVID-19 dyspnea symptoms, QOL, and well-being and its association at month 1 and 6 following COVID-19 infection. Settings and Design: A prospective cohort study of two COVID-19 hospitals in Malaysia was conducted. Subjects and Methods: Patients were followed up from admission, discharge, and 6 months after. A standard questionnaire assessed demographics, Modified Medical Research Council (mMRC) dyspnea score, QOL EQ-5D-5L scale (mobility, ability to self-care, ability to perform usual activity, pain, and anxiety), and the World Health Organization (WHO)-5 well-being index. Statistical Analysis Used: Wilcoxon signed-rank, Kruskal–Wallis, and Pearson correlation tests were used. Results: The mMRC, ED-5D-5L, and WHO-5 scores worsened during admission and slowly resolved over the 6 months (n = 388). mMRC scores positively correlated with EQ-5D-5L scores for mobility, self-care, ability to perform usual activity, pain, and anxiety (visit 1 and 6, P = 0.00) during the 1st and 6th months. Higher mMRC and EQ-5D-5L scores indicate worsening dyspnea and QOL. mMRC demonstrated a negative correlation with WHO-5 scores (visit 1: r = −0.30 and visit 6: r = −0.39, P = 0.00), which indicated worsening dyspnea and lower mental well-being. A higher WHO-5 well-being index was associated with lower EQ-5D-5L scores (visit 1 and 6, P = 0.00), demonstrating lowered patient’s well-being with worsening QOL. Conclusions: As such, appropriate health-care support and monitoring of patients, postdischarge is essential to optimize patient outcome.

Social Anxiety, Social Support, and Quality of Life in Patients With Epilepsy at a Tertiary Care Hospital in Saudi Arabia.

Objectives The objectives of this study were to measure the prevalence of social anxiety disorder and its association with quality of life (QoL) in patients with epilepsy (PWE) in King Khalid University Hospital, Riyadh City, Saudi Arabia. Methodology A self-administrated, online, questionnaire-based, cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia on PWE 18 years of age and above from February 2021 to January 2022. Social anxiety and the five domains of QoL were measured using the validated Arabic versions of the Liebowitz social anxiety scale and European quality-of-life 5-dimensions 3-levels (EQ-5D-3L), respectively. Information was collected on sociodemographic characteristics, social support, and adverse life events. Results This study included 246 patients, of which approximately 25% and 15% had mild/moderate and severe/very severe levels of social anxiety, respectively. Severe social anxiety was significantly associated with poor QoL domains, namely, restricted mobility (2.65 [1.00, 6.99]), inability to perform usual activities (3.88 [1.61, 9.36]), pain or discomfort (3.21 [1.38, 7.48]), and anxiety and depression (5.77 [2.45, 13.61]). Similarly, the lack of social support was also significantly associated with poor QoL, such as restricted mobility (2.42 [1.12, 5.22]), restricted self-care (3.64 [1.18, 11.17]), inability to perform usual activities (2.86 [1.42, 5.75]), pain/discomfort (2.53 [1.38, 4.66]), and anxiety and depression (1.93 [1.04, 3.57]). Females showed higher odds for restricted mobility (2.79 [1.29, 6.03]) and low education with limited self-care (7.38 [1.49, 36.71]). Conclusion Patients with epilepsy reported high levels of social anxiety that have a negative effect on their QoL. Healthcare providers should be able to provide counseling to the patient and their family members. In addition, social support is important to improve their mobility and socialization with friends and neighbors.

Rehabilitation Nurses’ Knowledge About Pain in Older Adults in Malta

PurposeRehabilitation nurses require adequate knowledge about pain to improve patient experience and quality of care. We explored nurses’ knowledge and attitudes towards pain in older adults in a large rehabilitation hospital in Malta. DesignA cross-sectional study. MethodsIn total, 130 nurses received a short survey, which gathered sociodemographic data, information regarding usual pain management, and prior education on pain. A modified version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) with 18 questions was used, alongside the 24-item Pain in the Older Adults’ Knowledge Survey (POAKS). Non-parametric tests identified factors associated with KASRP and POAKS scores. ResultsOverall, 89 nurses completed the survey (response rate 68%). The median modified KASRP score was 50% (IQR 3.00), with only two nurses achieving the proposed “adequate” score of >80%. The median POAKS score was 79% (IQR 4.00). The only determinant of performance was nationality, with Maltese nurses performing better in POAKS than non-Maltese nurses (median 20.00 (3.00) vs. 16.50 (5.00); p = .003), indicating a possible language-related performance issue. Nurses scored poorly in some questions relating to analgesia administration, particularly opioids, as well as pain indicators and pain assessment. ConclusionsRehabilitation nurses have fair knowledge of pain management in older people but require further education, particularly in opioid indications for pain management, pain expression, and assessment.

Desktop Virtual Reality Offers a Novel Approach to Minimize Pain and Anxiety during Burn Wound Cleaning/Debridement in Infants and Young Children: A Randomized Crossover Pilot Study.

Although most scald burn injuries involve children under six, because of the challenges of using head mounted displays with young children there is very little research exploring the use of VR in children under six. The current clinical pilot study measured the analgesic effectiveness of our new desktop VR system (with no VR helmet) in children under six during burn wound care (a within-subjects design with randomized treatment order). Between December 2021-April 2022, nine children with burn injuries (10 months to 5 years age, mean = 18 months) participated. The mean burn size was 10% Total Body Surface Area, range 2-22%. Using nurse's ratings, VR significantly reduced children's pain during burn wound care by 40% on the observational Faces, Legs, Activity, Crying, and Consolability (FLACC) pain scale. Specifically, non-parametric within-subject sign tests compared nurse's ratings of the young patients' pain during burn wound care using usual pain medications with no VR = 6.67, (SD = 2.45) vs. adjunctive Animal Rescue World VR (VR = 4.00, SD = 2.24, p < 0.01). The observational Procedure-Behavior Checklist (PBCL) nurse's scale measured a 34% reduction in anxiety with VR as compared to pharmacologic treatment alone (p < 0.005). Similarly, when using single graphic rating scales the patients' parents reported a significant 36% decrease in their child's pain during VR (p < 0.05), a 38% (p < 0.005) decrease in their child's anxiety during VR, and a significant increase in patients' joy during VR. It can be concluded that during burn wound care with no distraction (traditional pain medications), children under 6 years old experienced severe pain during a 10 min burn wound cleaning session. During burn wound care combining desktop virtual reality and traditional pain medications, the same pediatric patients experienced only mild pain during burn wound cleaning/debridement. VR significantly reduced the children's pain and anxiety during burn wound care.

Intercostal Cryoablation During Video-Assisted Lung Resection Can Decrease Postoperative Opioid Use.

Pain requiring opioid use remains an issue even with minimally invasive thoracic surgery. The objective of this study was to investigate the effectiveness of intercostal nerve cryoablation (CRYO) for pain control in adult patients undergoing pulmonary resection. A retrospective analysis of patients undergoing pulmonary resection by uniportal video-assisted thoracic (uVATS) approach was undertaken. Patients treated with our usual pain regimen (STANDARD) were compared with those who additionally received CRYO. STANDARD includes intercostal bupivacaine, patient-controlled analgesia (24 h), ketorolac (48 to 72 h), and tramadol. Intraoperative CRYO was performed on 5 intercostal levels. The primary aim was to compare pain scores (range, 0 to 10) and morphine equivalent dosages (MED). Secondary outcomes included length of stay, chest tube duration, presence of an air leak, and adverse events. A p value <0.05 was considered significant. There were 49 patients (34 female, 15 male). The median age was 74 (37 to 90) years. Procedures included lobectomy (n = 32), segmentectomy (n = 7), and wedge resections (n = 10). There were 23 (46.9%) CRYO and 26 (53.1%) STANDARD patients. Baseline characteristics were similar. Mean length of stay (2.9 vs 3.5 days), chest tube duration (2.2 vs 1.8 days), and adverse events (9 of 23 vs 7 of 26) were similar. There were no complications attributable to CRYO. Pain scores were not significantly different on postoperative days (POD) 1 to 4. MED was significantly reduced after CRYO on POD 1 (5 vs 47.24), POD 2 (10.93 vs 25.04), POD 3 (8.13 vs 21.7), and POD 4 (7.08 vs 19.17). CRYO can be performed safely during pulmonary resection and can decrease in-hospital opioid use. The results from this retrospective study will need to be validated in future prospective studies.

(002) Neuroproliferative Vestibulodynia as a Cause of Persistent Genital Arousal Disorder: A First-Ever Case Series

Abstract Introduction Persistent Genital Arousal Disorder (PGAD), a condition of unwanted, unremitting feelings of genital arousal, is associated with significant morbidity including catastrophizing, depression, anxiety, and/or suicidal ideation. There are multiple diverse triggers of PGAD that may originate in one or more of five regions in a patient: end organ, pelvis/perineum, cauda equina, spinal cord, and/or brain. Regarding the contributions to PGAD in the end-organ region, it is hypothesized that vestibulodynia may be a trigger for PGAD. The vestibule has unique sensory qualities, as this region receives sensory innervation from branches of both the somatic pudendal and visceral pelvic nerves. Objectives Neuroproliferative vestibulodynia is a disorder of excess deposition of mast cells with resultant excess c-afferent nociceptors in the vestibule. To the best of our knowledge, vestibulodynia, specifically neuroproliferative vestibulodynia, has not been reported in the literature as a cause of PGAD. The purpose of this study was to report on four women with lifelong PGAD suspected of having neuroproliferative vestibulodynia. Methods These women underwent: i) a detailed biopsychosocial assessment including sex therapy and diagnostic testing, evaluation of baseline PGAD intensity, vulvoscopy, cotton swab testing of the vestibule, PGAD intensity post-cotton swab test, and vestibular anesthesia testing (VAT); ii) treatment by complete vestibulectomy with vaginal advancement flap reconstruction; iii) staining of vestibular tissue with CD 117 (for mast cells) (Figure 1) and PGP 9.5 (for nerves) (Figure 2) and iv) measurement of clinical outcome with patient global impression of improvement. The VAT was performed with a topical anesthetic carefully applied to the vestibule between Hart’s line and the hymen. Complete anesthesia was assessed by cotton swab testing. Pre- and post-VAT intensity levels were compared. Results These patients had lifelong PGAD with a history of frequent masturbation at a very young age and feelings of catastrophizing, depression, anxiety, and/or suicidal ideation. Three patients had experienced sexual trauma, eating disorders, and had stressful relationships with family members. All four used various SSRI medications for depression/anxiety disorders and PGAD management from a young age. The youngest patient presented at 13 years with a presumptive diagnosis, primarily based on VAT, of neuroproliferative vestibulodynia. Surgery was delayed until she stopped growing at age 18. The other three presented at ages 20, 24, and 24. All four had full, although temporary, resolution of PGAD symptoms post-VAT. Each underwent a complete vestibulectomy with vaginal advancement flap procedure; the mean age at time of surgery was 22 +/− 3 years. Stained vestibular tissues showed in excess of 20 mast cells and nerves per high power field, consistent with neuroproliferative vestibulodynia. Curiously, post-operatively, none of the patients required the usual post-op opioid pain medications typical of patients undergoing vestibulectomy. While all four still experience mild PGAD symptoms when stressed, their PGAD symptoms are very much improved post-op with significant symptom resolution, with a mean follow-up of 11 months, range 4 – 26. Conclusions This is the first case series to document that neuroproliferative vestibulodynia is a treatable cause of PGAD, although more research is needed. Disclosure No.

Interdisciplinary pain rehabilitation and sexual functioning: Treatment outcomes and patient preferences.

Sexual dysfunction is common for patients experiencing chronic pain. Prior research is limited on how treatment for chronic pain affects patients' sexual functioning. This study reports pre-/post-treatment measures of self-reported sexual functioning among individuals presenting for chronic pain treatment at an interdisciplinary pain rehabilitation program (IPRP) and reports patient treatment preferences. This study uses detailed treatment measures across multiple domains of sexual functioning to describe the prevalence and correlates of self-reported sexual functioning among individuals with chronic pain presenting for and discharging from treatment at an IPRP (N = 71). Domains include sexual interest, satisfaction with sexual functioning, vaginal lubrication, vaginal discomfort, and erectile function. Patients also completed a multiple-choice treatment preferences questionnaire created for this study. Results from this study show a high prevalence of sexual dysfunction in chronic pain populations (51.5%) and show no significant difference in sexual functioning after completing outpatient treatment, except for a significant improvement in sexual satisfaction for males only. Results from the patient treatment preferences questionnaire indicate that most patients (83.3%) thought their pain was important to address within the context of an IPRP; however, many patients (58.7%) did not think their treatment addressed sexual functioning. In addition, many patients (34%) would prefer to discuss sexual functioning with their primary care provider or pelvic floor physical therapist. Findings demonstrate that usual multidisciplinary pain management treatment is not sufficient to address patients' concerns with sexual functioning. Additional creative strategies will need to be studied on how to best treat these overlapping problems. Implications and future research directions are discussed.

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

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

Citrullus colocynthis, an effective treatment for gouty arthritis

BackgroundGouty arthritis is widespread throughout the globe. This disorder leaves the patient with severe pain so that none of the usual pain remedies can help it. The present study was undertaken to investigate the therapeutic effect of Citrullus colocynthis on it to introduce a simple, effective, and economical approach to treatment. MethodIn this randomized clinical trial, 60 patients diagnosed with gout were included, and divided into control and experimental groups. A purine diet was applied for both groups; the treatment was a capsule containing 300 mg grounded dried Citrullus colocynthis, and the placebo was an identical capsule containing starch; both were given for one month, three times a day. Data were collected by demographic questionnaire, health history form, the visual analog scale of pain, and laboratory assessment of serum uric acid. Independent t-test, paired t-test, and repeated measures analysis of variance were used to analyze the data. ResultsThere was a significant difference in the mean scores of pain intensity in the experimental group before and after intervention (P < 0.001). The mean of serum uric acid decreased in both groups, but was statically described only in the intervention group the data were strongly significant (P < 0.001). In the control group, this figure decreased from 890.88 ± 23.65 to 824.88 ± 19.05 owing to the prescribed diet (P = 0.057). ConclusionAlthough diet can play an important role in reducing serum uric acid, the treatment requires considering both immune reaction and serum uric acid as it was approached by administering herbal medicine of Citrullus colocynthis by reducing both perceived pain and serum uric acid.