Usual Pain Research Articles

Implicit motor imagery performance is impaired in people with chronic, but not acute, neck pain.

BackgroundPeople with chronic neck pain have impaired proprioception (i.e., sense of neck position). It is unclear whether this impairment involves disruptions to the proprioceptive representation in the brain, peripheral factors, or both. Implicit motor imagery tasks, namely left/right judgements of body parts, assess the integrity of the proprioceptive represention. Previous studies evaluating left/right neck judgements in people with neck pain are conflicting. We conducted a large online study to comprehensively address whether people with neck pain have altered implicit motor imagery performance.MethodsPeople with and without neck pain completed online left/right neck judgement tasks followed by a left/right hand judgement task (control). Participants judged whether the person in the image had their head rotated to their left or right side (neck task) or whether the image was of a left hand or a right hand (hand task). Participants were grouped on neck pain status (no pain; <3 months—acute; ≥3 months—chronic) and pain location (none, left-sided, right-sided, bilateral). Outcomes included accuracy (primary) and response time (RT; secondary). Our hypotheses—that (i) chronic neck pain is associated with disrupted performance for neck images and (ii) the disruption is dependent on the side of usual pain, were tested with separate ANOVAs.ResultsA total of 1,404 participants were recruited: 105 reported acute neck pain and 161 reported chronic neck pain. When grouped on neck pain status, people with chronic neck pain were less accurate than people without neck pain (p = 0.001) for left/right neck judgements, but those with acute neck pain did not differ from those without neck pain (p = 0.14) or with chronic neck pain (p = 0.28). Accuracy of left/right hand judgements did not differ between groups (p = 0.58). RTs did not differ between groups for any comparison. When grouped on neck pain location, people were faster and more accurate at identifying right-turning neck images than left-turning neck images, regardless of history or location of pain (p < 0.001 for both); people with no pain were more accurate and faster than people with bilateral neck pain (p = 0.001, p = 0.015) and were faster than those with left-sided neck pain (p = 0.021); people with right-sided neck pain were more accurate than people with bilateral neck pain (p = 0.018). Lastly, there was a significant interaction between neck image and side of neck pain: people with right-sided neck pain were more accurate at identifying right-sided neck turning images than people with left-sided neck pain (p = 0.008), but no different for left-sided neck turning images (p = 0.62).ConclusionsThere is evidence of impaired implicit motor imagery performance in people with chronic neck pain, which may suggest disruptions to proprioceptive representation of the neck. These disruptions seem specific to the neck (performance on hand images intact) but non-specific to the exact location of neck pain.

Development and clinical feasibility testing of the Pain Treatment Planning Questionnaire

Abstract Background Chronic pain is common in people with bleeding disorders and can complicate clinical management, impair quality of life, and contribute to disability. People living with bleeding disorders often seek advice on pain management from the bleeding disorder treatment team; however, lack of condition-specific assessment tools to guide clinical communication about pain are a barrier to care. Aims To develop and examine the clinical feasibility of a patient-reported outcome (PRO) tool designed to facilitate pain assessment and support clinical communication about pain for adults attending outpatient bleeding disorder clinics. Methods Tool development involved patient cognitive interviews and item refinement by a multidisciplinary clinician and patient working group. Clinical feasibility of the tool was evaluated with a survey of a small clinical sample in an outpatient bleeding disorder clinic. The Pain Treatment Planning Questionnaire (PTPQ) contains 28 items on the pain experience and treatments used to manage or prevent pain. Results Participants completing the feasibility testing (n=42, 62% male) reported mild mean pain scores (usual pain μ=2.4, SD=2.0) with the majority (57.1%) reporting persistent pain in the past 30 days. Median PTPQ completion time was five to seven minutes and mean item response rate was 95.2%. The majority (95.2%) of participants found the questionnaire easy to understand, reported no difficulty understanding items, and recommended no changes to the questionnaire. Conclusions Preliminary testing among a small sample in a clinical setting suggests that the PTPQ is a clinically feasible, acceptable, condition-specific PRO pain assessment tool for adult patients with bleeding disorders. Further testing is required to determine if the PTPQ affects treatment decision-making and patient outcomes.

Influencing Factors for Joint Perception After Total Hip Arthroplasty: Asian Cohort Study

BackgroundPerceiving replaced joints as natural is one of the best scenario after total hip arthroplasty (THA). We investigated the distribution of and influencing factors for patient’s joint perception after THA in Asian cohort, which is not well known. MethodsWe mailed a questionnaire to Asian patients who had undergone THA in our institution between 2012 and 2016, and this study included 318 Asian patients. The questionnaire assessed patient’s joint perception, Oxford Hip Score (OHS), Short Form-12 Health Survey (SF-12) physical, mental, and role component summaries, and satisfaction score. Leg length discrepancy and global femoral offset before and after THA were measured using radiographs. The patients were divided into 2 groups with patient’s joint perception: natural and artificial perception groups. OHS, SF-12, satisfaction, leg length discrepancy, and global femoral offset were compared between natural and artificial perception groups, and which factors significantly influenced joint perception were determined. ResultsOf the 318 patients, 165 patients (51.8%) perceived their replaced joint as a natural joint. OHS, SF-12 physical and role component summaries, and satisfaction score in natural perception group were significantly higher than those in artificial perception group, without significant difference in SF-12 mental component summary. Multivariate analysis showed that less of usual pain, easier to get in or out of a car, and osteoarthritis in the contralateral hip were positively associated with natural joint perception after THA. ConclusionThis study indicated to surgeons that pain relief and improvement in getting in or out of a car after THA could lead to even better patient’s joint perception.

Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment.

To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. Prospective individual data were collected over 1 to 3 days for each participant. Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). Experts' pain evaluations indicated that residents' usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week. J Am Geriatr Soc 68:794-802, 2020.

First bite syndrome: clinical study of six cases and review of the literature

Objective:The aim of this study is to explore the etiology, diagnosis and treatment of first bite syndrome（FBS）. Method:Clinical data of six patients with FBS were analyzed retrospectively. There were 4 cases of parapharyngeal space tumor resection complicated with FBS, 1 case of parotidectomy of deep lobe parotid gland tumor complicated with FBS, and 1 case of no definite cause. Analgesic treatments such as ibuprofen and tramadol capsules were given, in combination with carbamazepine （200 mg, 3 times a day） for four weeks. Result:The severity of symptoms decreased in five cases, 2-16 months after treatment. While another one had no amelioration during 10 months' follow-up. Conclusion:FBS is one of the possible complications of surgery of the upper cervical region, especially parotid deep lobe tumor resection, which should be distinguished from the usual postoperative pain. The cause of the disease may be related to intraoperative injury to the sympathetic plexus of the parotid gland. Currently, there is no standard treatment method, but the symptoms are usually relieved within a few months.

Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up.

This study addresses the problem of long-term opioid use by chronic pain patients. The study involved a secondary analysis of unanalyzed data from a published study of 2 versions of cognitive-behavioural therapy-based interdisciplinary treatment for chronic pain. In this study, we examined whether the use of opioids by 140 chronic pain patients could be ceased sustainably over 12 months after participation in the comprehensive interdisciplinary pain management program aimed at enhancing pain self-management. On admission to the treatment, there were no significant differences between those patients taking or not taking opioids on usual pain, pain interference in daily activities, pain-related disability, depression severity, as well as in pain cognitions. After the treatment, the use of opioids was significantly reduced, both in numbers taking any and in mean doses, and these gains were maintained over the 12-month follow-up. Finally, cessation of opioids during treatment was associated with more substantial and consistent improvements in usual pain, depression severity, pain interference, pain-related disability, and pain cognitions, relative to those who reduced their opioids but did not cease them. These findings support the idea of using training in pain self-management strategies as a viable alternative to long-term opioid use by patients with chronic pain.

The Pediatric American Pain Society Patient Outcomes Questionnaire (Pediatric APS-POQ): Development and Initial Psychometric Evaluation of a Brief and Comprehensive Measure of Pain and Pain Outcomes in Hospitalized Youth

Pediatric pain assessment in the hospital traditionally involves the patient's self-report of pain intensity using a numeric rating scale, which does not capture the complexity of the pain experience. No valid, comprehensive measure of pain in hospitalized youth exists. This study was designed to develop and conduct initial psychometric testing of the Pediatric American Pain Society Patient Outcomes Questionnaire (Pediatric APS-POQ), a comprehensive patient-reported measure of pain and pain outcomes in hospitalized youth. A multidisciplinary group of pediatric pain researchers and clinicians collaborated to adapt the adult APS-POQ Revised to pediatrics, including a patient-report and parent proxy version. The adapted measures were administered to 218 pediatric inpatients (age M = 13.4 years, 56% female) and 214 of their parents (80% mothers) at 4 US children's hospitals. The measure was feasible to administer within the inpatient setting and was acceptable and understandable to pediatric patients and their parents. Internal consistency was adequate for both patient-report and parent proxy (α = 0.77). Confirmatory factor analysis supported the following 6 domains, consistent with the adult measure: pain intensity, functional interference, emotional response, side effects, perceptions of care, and usual pain. Additional research is needed to further support the reliability and validity of this measure in diverse clinical populations. PerspectiveTo reduce the impact of pain on hospitalized youth, pediatric pain assessment must move beyond ratings of pain intensity. The Pediatric APS-POQ provides a brief but comprehensive assessment of pain and pain outcomes in hospitalized children and adolescents, which will allow for greater individualization in hospital-based pain management and quality improvement purposes.

PMD61 PATIENT REPORTED OUTCOME MEASUREMENT: USING EQ-5D-3L PROFILES TO ASSESS QUALITY OF LIFE OF TOTAL KNEE REPLACEMENT PATIENTS

(1)Assess patients’ quality of life before and after total primary knee replacement using EQ-5D-3L profiles. (2)Demonstrate the information gained from disaggregated Patient Reported Outcome Measures instead of utility or other summary scores. Patient and clinical outcomes data from two multicentre studies were re-analysed, focusing on descriptions of patients’ quality of life using the EQ-5D-3L. 1,879 patients were included from 4 countries(USA, UK, Australia, New Zealand) operated on by the same surgeons using two different knee replacement systems. Descriptive analyses included levels (no, some, severe problems) within EQ-5D dimensions (Mobility, Self-Care, Usual Activities, Pain & Discomfort, Anxiety & Depression) and profiles (combinations of dimensions and levels) at baseline and 3 follow-up points, including changes over time and differences between implants and countries. Regression analysis quantified the relationship between the EQ-5D-3L components and the EQ VAS. Problems with Mobility, Usual Activities and Pain & Discomfort, in that order, were most frequent for pre-operative patients. There were large improvements in every dimension after surgery, but the time that this was observed differed: for Mobility, Self-Care and Anxiety & Depression, most of the improvement occurred during the first year; for Usual Activities and Pain & Discomfort, over two years. Additionally, 56% of patients reported no problems with pain & discomfort, 70% with usual activities and 79% with mobility. Analysing profiles, 85% of patients experienced an unequivocal improvement, 5.9% had no change, 3.5% worsened and 5.6% a mixed change at two years follow-up. Anxiety & Depression had the greatest impact on EQ VAS scores; while Mobility and Usual Activities were also important; Usual Activities was particularly important post-surgery. The methods revealed insights that PROMs summary scores obscure, including how conditions and treatments impact on different aspects of patients’ quality of life and their relative importance to self-assessed quality of life overall.

Efficacy of Auricular Neurostimulation in Adolescents With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial

Auricular neurostimulation therapy, in which a noninvasive device delivers percutaneous electrical nerve field stimulation (PENFS) to the external ear, is effective in pediatric patients with functional abdominal pain disorders. Preclinical studies showed that PENFS modulates central pain pathways and attenuates visceral hyperalgesia. We evaluated the efficacy of PENFS in adolescents with irritable bowel syndrome (IBS). We analyzed data from pediatric patients with IBS who participated in a double-blind trial at a tertiary care gastroenterology clinic from June 2015 through November 2016. Patients were randomly assigned to groups that received PENFS (n = 27; median age, 15.3 y; 24 female) or a sham stimulation (n = 23; median age, 15.6 y; 21 female), 5 days/week for 4 weeks. The primary endpoint was number of patients with a reduction of 30% or more in worst abdominal pain severity after 3 weeks. Secondary endpoints were reduction in composite abdominal pain severity score, reduction in usual abdominal pain severity, and improvement in global symptom based on a symptom response scale (-7 to+7; 0 = no change) after 3 weeks. Reductions of 30% or more in worst abdominal pain were observed in 59% of patients who received PENFS vs 26% of patients who received the sham stimulation (P = .024). The patients who received PENFS had a composite pain median score of 7.5 (interquartile range [IQR], 3.6-14.4) vs 14.4 for the sham group (IQR, 4.5-39.2) (P = .026) and a usual pain median score of 3.0 (IQR, 3.0-5.0) vs 5.0 in the sham group (IQR, 3.0-7.0) (P = .029). A symptom response scale score of 2 or more was observed in 82% of patients who received PENFS vs 26% of patients in the sham group (P ≤ .001). No significant side effects were reported. Auricular neurostimulation reduces abdominal pain scores and improves overall wellbeing in adolescents with IBS. PENFS is a noninvasive treatment option for pediatric patients with functional bowel disorders. ClinicalTrials.gov no: NCT02367729.

Virtual Reality for Pain Management in Patients with Heart Failure: Study Rationale and Design

BackgroundPatients with advanced heart failure commonly experience acute and/or chronic moderate to severe pain related to disease, treatment, or both. While pain management strategies typically focus on drug therapies, non-pharmacological interventions may prove beneficial without risk of significant clinical side effects or contraindications. One novel strategy, virtual reality, has been shown to improve pain control in addition to usual pharmacological interventions. MethodsThis is a prospective, two-armed, single center randomized controlled pilot study of a virtual reality intervention in 128 hospitalized subjects with ACC/AHA stage C or stage D heart failure who self-report pain rated 4/10 or greater compared to an active control, two-dimensional guided imagery. The primary outcome is change in self-reported pain score measured by the Brief Pain Inventory (Short Form). Secondary end points include changes in self-reported distress, quality of life, and satisfaction with pain management. ConclusionThis randomized controlled study aims to provide empiric data to support application and expansion of novel technologies such as virtual reality to augment usual pharmacological pain management strategies in hospitalized patients with heart failure.

Role of Intravenous Ketamine as Adjuvant to Opioids in Refractory Cancer Pain: Case Report

Cancer pain is caused by continuous tissue injury, which may be due to surgery, infiltration of the surrounding organs including nerves, as well as from mucositis after chemo- or radiotherapy. The pain experienced by cancer patients needs a multimodal approach, including ketamine. Nerve involvement, chronic opioid therapy and continuous nociceptive input cause hyperalgesia. Chronic stimulation of the dorsal root neurons leads to hyperalgesia and resistance (tolerance) to μ opioid analgesics (hyperalgesia-tolerance). The NMDA receptor antagonist ketamine reverses tolerance to morphine. The management of cancer patient’s pain with ketamine as an adjuvant to opioids is presented in case reports of two patients with cancer-related neuropathic pain, in which pain proved untreatable with the usual conventional pain therapies. Ketamine was administered IV route, in addition to morphine and the pain was controlled successfully in these patients. No side-effects were noted except drowsiness which responded to a reduction in the opioids dose.

P37 Exploring the experience of pain flares in adolescent inflammatory and non-inflammatory musculoskeletal disorders: a phenomenological study

Abstract Background Adolescents with inflammatory and non-inflammatory rheumatic musculoskeletal disorders (RMD) experience acute exacerbations in pain, referred to as pain flares in the adult literature. But little remains known about what pain flares are, why they occur, how they are managed and what lasting effects they have during adolescence. This study explored the lived experience of pain flares in adolescents with RMD. Methods Adolescents with juvenile idiopathic arthritis (JIA) or chronic idiopathic pain syndromes (CIPS) were recruited from a UK tertiary paediatric and adolescent rheumatology centre. Data were collected using semi-structured interviews and visual aids, and analysed using interpretative phenomenological analysis. Results Participants were eight females and two males aged between 13 and 17 years (M = 14.7, SD = 1.25). Four participants had JIA and six had CIPS. All participants experienced periods when pain deviates from their usual variation in pain, but none reported using the term pain flare to describe these experiences. These experiences were conceptualised as a journey of change from their 1) daily life with pain, 2) pre-flare period, 3) flare period, to their 4) post-flare period. 1) In daily life, adolescents report a level of pain that is usual for them which they manage and continue their daily routines around. 2) Pain, at times, increased beyond usual levels and adolescents reported noticing when a pain flare was coming on (e.g. due to physical exertion). They employed strategies for managing the pre-flare period, however, if they did not succeed in preventing a flare, or when flares occurred without a trigger or controllable cause, pain began to intrude on their lives. 3) All pain flares were described as an increase in the intensity of their usual pain, and were also associated with an increase in the location, duration and/or quality of pain; an increase in other unpleasant symptoms such as fatigue, psychological symptoms, headaches and/or sickness; and a reduction in physical, emotional, cognitive and/or social functioning. The frequency of flares was variable, ranging from weekly flare events to less than two a year. Flares were generally short lived, lasting a few hours to a few days. The majority of flares were managed with parental input, with adolescents seeking medical support when a flare was perceived to be associated with infection in JIA. 4) As flares were brought under control, the pain returned to usual levels but the psychological symptoms outstayed the pain. Participants took actions to regain the level of normality experienced in daily life. Conclusion Participants had varying interpretations of what constitutes a flare, but the key finding was that flares are not only an increase in pain intensity, but other features are also required to change. These findings help to differentiate flares from normal variation in pain. Conflicts of Interest The authors declare no conflicts of interest.

Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial

Objective: The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). Design: Randomized controlled trial. Setting: Outpatient care units. Subjects: Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups. Interventions: Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. Main measures: The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. Results: Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25–P75): 6 (3.25–9.81) vs. 15.5 (11.28–20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25–P75): 2 (1–2.51) vs. 5 (3.33–6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group. Conclusion: This study’s findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.

Gabapentin for Perioperative Pain Management for Uterine Aspiration: A Randomized Controlled Trial.

To evaluate the effect of oral gabapentin in conjunction with usual oral pain management regimens of lorazepam, ibuprofen, oxycodone, and acetaminophen for surgical abortion on pain 5 minutes postprocedure. This was a randomized, double-blind, placebo-controlled trial of patients from 6 0/7-14 6/7 weeks of gestation scheduled to undergo surgical abortion at the Duke Family Planning Clinic. Participants were administered 600 mg of oral gabapentin compared with placebo with usual oral pain management. Pain score was assessed using a 100-mm visual analog scale, with the primary outcome being pain score 5 minutes after the procedure. The effect of gabapentin was assessed using a linear regression model controlling for baseline pain. We also measured pain perception 24 hours after the procedure. Secondary outcome measures included anxiety, side effects, and usage of opiate pain medication in the 24-hour postoperative period. Out of 113 women screened for this study; 96 women were recruited, enrolled, and randomized to study treatment arm from August 2016 to June 2018. Pain at 5 minutes after the procedure was similar between the gabapentin and placebo groups ((Equation is included in full-text article.)=3.40; 95% CI -8.20 to 15.0; P=.56). Gabapentin and placebo were well tolerated, with no statistically significant difference in side effects or anxiety levels. Although prescription of opioids after the procedure was not standardized among patients, 73% of women received a short-term prescription for oxycodone. A lower percentage of women in the gabapentin group self-reported taking opioids in the 24 hours postprocedure (18% vs 47%; odds ratio 0.26; 95% CI 0.09-0.75). The addition of gabapentin to usual oral pain management regimens with paracervical block did not reduce postoperative pain for patients undergoing outpatient surgical abortion. Although the addition of gabapentin was well tolerated and reduced oral opiate use 24 hours postprocedure, it did not affect the experience of pain during and immediately after the procedure. ClinicalTrials.gov, NCT02725710.

Immersive Virtual Reality as an Adjunctive Non-opioid Analgesic for Pre-dominantly Latin American Children With Large Severe Burn Wounds During Burn Wound Cleaning in the Intensive Care Unit: A Pilot Study

Background/Aim: Using a within-subjects, within-wound care design, this pilot study tested for the first time, whether immersive virtual reality (VR) can serve as an adjunctive non-opioid analgesic for children with large severe burn wounds during burn wound cleaning in the ICU, in a regional burn center in the United States, between 2014–2016.Methods: Participants included 48 children from 6 years old to 17 years of age with >10% TBSA burn injuries reporting moderate or higher worst pain during no VR on Day 1. Forty-four of the 48 children were from developing Latin American countries. Patients played adjunctive SnowWorld, an interactive 3D snowy canyon in virtual reality during some portions of wound care, vs. No VR during comparable portions of the same wound care session (initial treatment condition randomized). Using Graphic Rating scales, children's worst pain ratings during “No VR” (treatment as usual pain medications) vs. their worst pain during “Yes VR” was measured during at least 1 day of wound care, and was measured for up to 10 study days the patient used VR.Results: VR significantly reduced children's “worst pain” ratings during burn wound cleaning procedures in the ICU on Day 1. Worst pain during No VR = 8.52 (SD = 1.75) vs. during Yes VR = 5.10 (SD = 3.27), t(47) = 7.11, p < 0.001, SD = 3.33, CI = 2.45–4.38, Cohen's d = 1.03 (indicating large effect size). Patients continued to report the predicted pattern of lower pain and more fun during VR, during multiple sessions.Conclusion: Immersive virtual reality can help reduce the pain of children with large severe burn wounds during burn wound cleaning in the Intensive Care Unit. Additional research and development is recommended.

Nurse-led post-thoracic surgery pain management programme: its outcomes in a Nigerian Hospital.

The overarching aim of this study was to investigate the effects of a nurse-led pain management programme on pain intensity, side effects of treatment, shoulder range of motion and length of stay after thoracic surgery. Post-thoracic surgical pain is a major source of stress and distress for patients. It has profound effects ranging from increased risks in developing chronic post-thoracic surgery pain to an increased length of stay after surgery. The post-thoracic surgical pain management in the Nigerian context is based on the traditional approach that is dependent on the attending medical and nursing staff. The study was a quasi-experimental design (two-group post-test only). The study was conducted in a Nigerian hospital. Forty-two patients were recruited and consecutively assigned into either the usual pain management group or the intervention group after they had met the inclusion criteria. Data were collected utilizing the following: (1) the modified McGill Pain Questionnaire; (2) a Numeric Rating Scale; (3) the documentation form for thoracic surgery pain management outcomes and (4) a goniometer. The findings indicated that pain intensity, nausea and drowsiness were significantly reduced among the patients in the experimental group than the control group, while the duration of stay after surgery and the shoulder range of motion were not different between the groups. This study's results suggest that the intervention in question for patients undergoing thoracic surgery had a positive effect on reducing pain intensity, nausea and drowsiness but not the shoulder range of motion and length of stay after surgery. Nursing policymakers may need to give a serious consideration to the revision of policies related to the nursing education curriculum as well as the in-service training curriculum regarding pain management by nurses especially after surgery. Likewise, future research on other populations employing an improved methodology as well as utilizing up-to-date evidence by nurses across different hospitals may be necessary.

HEALTH-RELATED QUALITY OF LIFE IN CONTROLLED, UNCONTROLLED OR RESISTANT HYPERTENSION IN AMBULATORY TREATED PATIENTS – THE POL-FOKUS STUDY

Objective: The aim of the study was to evaluate relationship between prevalence and characteristics of uncontrolled and resistant hypertension (RHT) and perceived health status as well as health-related quality of life (HRQL) in large cohort of ambulatory treated hypertensive patients. Design and method: In a sub-study of the cross-sectional questionnaire-based observational the Pol-Fokus study we included 3094 hypertensive patients (1327 men and 1767 women, mean age 62.0 ± 12.1 years, BMI 29.0 ± 4.7 kg/m2) attending a routine visit in primary or specialist care. To be included patients had to be > 18 years old and treated for at least 12 months with antihypertensive drugs. We defined hypertension control as blood pressure (BP) levels both <140 mmHg/<90 mmHg. RHT was defined as BP >140/90 mmHg despite using 3 antihypertensive drugs, including diuretic. Demographical and clinical data were obtained to analysis. HRQL was assessed by the EuroQol 5D questionnaire (EQ5D). Results: In entire group coronary disease (stable angina or MI) was diagnosed in 1195 (38.6%) subjects, brain ischemia (stroke or TIA) in 246 (8%), heart failure in 442 (14.3%), diabetes in 620 (20%), renal failure in 147 (4.8%), hypercholesterolemia in 1609 (52%), COPD in 234 (7.6%), OSA in 154 (5%), and depression in 494 (16%). Uncontrolled hypertension was observed in 1583 pts (51,2%), among them 873 pts (28.2%) fulfilled criteria of RHT. In patients with controlled hypertension HRQL was higher than in those with UHT (EQ5D score: 69.4 ± 17.5 vs 64.9 ± 17.4 points, p<0.001) and higher than in those with RHT (59.9 ± 12.6 points, p < 0.001). HRQL in RHT women was lower than in men. This relationship was still significant also in multivariate analysis. Patients with RHT reported more problems with usual care, pain and depressed mood than patients with BP control in the EQ5D test (p < 0.01). Among patients with RHT multimorbidity was more common than in patients without RHT high lower (43.7% vs. 11.9%; p < 0.001). Conclusions: RHT is associated with markedly lower HRQL, especially in women. Overlap of additional diseases is related to worse blood pressure control and to worse HRQL in RHT patients.

(307) The Role of Fluctuations in Pain Acceptance, Coping, and Catastrophizing in the Daily Lives of People with Chronic Pain and Spinal Cord Injury

The experience of chronic pain can be influenced by choice of coping skills, the presence of catastrophizing, and the degree of acceptance of chronic pain. Neither the independent contributions of coping, catastrophizing, and acceptance of the pain experience nor the relative variability of these factors on a day-to-day basis are well understood. Thus, this study aimed to examine the role of daily changes in pain acceptance, coping, and catastrophizing in the daily lives of people with chronic pain and spinal cord injury (SCI). We collected seven days of end-of-day diary assessments of pain acceptance, pain coping, and pain catastrophizing, and five additional criterion variables of interest – pain interference, social participation, depressive symptoms, and positive affect and well-being in 124 individuals. In multilevel random effects modeling (controlling for age, gender, mobility, and pain intensity), pain acceptance, coping, and catastrophizing were each independently associated with some, but not all, of the daily criterion variables. Both acceptance and catastrophizing demonstrated similarly robust and consistent associations with outcomes, whereas pain coping demonstrated weaker and less consistent relationships with outcomes. Days of higher than usual catastrophizing were related to same-day lower positive affect and well-being and higher pain interference and depressed mood. Days of high pain acceptance were associated with higher same-day social participation and lower pain interference and depressed mood. Interestingly, when people reported higher than usual pain coping, they also reported higher same-day depressed mood. The findings suggest that psychosocial interventions targeting both pain catastrophizing and pain acceptance may be beneficial in terms of pain, mood, and social outcomes for those with chronic pain. Individuals may engage in more behavioral coping strategies to manage pain when experiencing negative mood. Further research examining the complex dynamics of adaptive and maladaptive responses to pain in daily life is warranted.

(324) Characterizing Expectations for Functional Outcomes in Emergency Department Patients with Musculoskeletal Pain

Over 13% of Emergency Department (ED) visits are for musculoskeletal pain, but little is known about ED patients’ expectations for pain management and pain-related functional outcomes. This cross-sectional study surveyed adults seeking care at an academic ED with a primary complaint of neck, back or extremity pain. Survey data included the previously validated Patient Centered Outcomes Questionnaire to rate pain interference with activities on a scale of 0 (none) to 100 (worst imaginable) across usual, desired, successful, and expected outcome levels, as well as patient-reported use of various pharmacological and non-pharmacological modalities for pain relief. Responses were analyzed from 106 patients, with mean age 42.4 years (SD 15.6); 52% female; 63% African American and 27% Caucasian. For primary location of pain, 46% identified back, 32% leg, 13% arm, and 11% neck. Median duration of pain was 3 days (IQR 1-7), and 36% reported previous episodes of this pain. Reported median usual pain interference with activities in the past week was 66 (IQR 40-94). Patients desired a median 100% reduction (IQR 89-100%) in interference, but considered 77% reduction successful (IQR 49-100%), and only expected a 52% reduction (IQR 9-91%) after treatment. Most patients were willing to take opioid (73%) and non-opioid (79%) pain medications, despite only 32% having taken an opioid and 55% having taken a non-opioid for pain. Most were also willing to engage in non-pharmacological treatments including direct/passive modalities such as heat, cold packs, acupuncture, and massage (84%); indirect/psychosocial modalities such as music, prayer and meditation (80%); and physical/active modalities such as yoga, exercise, and physical therapy (66%). However, current use of non-pharmacological modalities only ranged from 36-50%. This foundational data highlights an opportunity to incorporate patient perspectives in setting treatment goals and expanding treatment options for integrated, multi-modal pain management in the ED.

Test-retest reliability of the ASES-p shoulder scale

Shoulder disorders are common musculoskeletal problems. The self-assessed ASES questionnaire (ASES-p) is one of the most widely used tools for evaluating shoulder function. Its 11 items are divided in a function (10 items) and pain (1 item) dimension, assigned between 0 and 50 points each. Their sum is the scale's total score, with higher values indicating better health status. The current work explores the test-retest reliability of the Spanish version of the ASES-p score values. The scale was administered twice to a sample of subjects with various shoulder pathologies, via telephone interviews performed at 3-7 days apart. Exact agreement was calculated on an item and score basis. Score variability was assessed with the 95% limits of agreement method (LoA). N = 161 subjects were initially contacted, and a total of 82 stable health status subjects provided valid test-retest replies. "Do usual sport" was the only item with missing data. Exact agreement oscillated between 67 and 89% per item. The 95% LoA ranged between -5.9 and 6.9 points for function; -13.2 to 11.9 for pain and -10.3 to 10.1 for the total ASES-p score. Test-retest reliability in stable patients was considered acceptable for the function and total scores, but not for pain. This may reflect usual pain behaviour, but it also implies that the pain evaluation should be further studied. The ASES-p pain subscore should not be used as the single measure for monitoring shoulder pain. Revisiting the "do usual sports" item may increase the scale's applicability.