A review of chronic pain impact on patients, their social environment and the health care system

Satellite Glial Cells in Pain Research: A Targeted Viewpoint of Potential and Future Directions

Chronic pain is known to be caused by sensitization within the pain circuits. An imbalance occurs between excitatory and inhibitory transmission that enables this sensitization to form. In addition to neurons, the contribution of central glia, especially astrocytes and microglia, to the pathogenesis of pain induction and maintenance has been identified. This has led to the targeting of astrogliosis and microgliosis to restore the normal functions of astrocytes and microglia to help reverse chronic pain. Gliosis is broadly defined as a reactive response of glial cells in response to insults to the central nervous system (CNS). The role of glia in the peripheral nervous system (PNS) has been less investigated. Accumulating evidence, however, points to the contribution of satellite glial cells (SGCs) to chronic pain. Hence, understanding the potential role of these cells and their interaction with sensory neurons has become important for identifying the mechanisms underlying pain signaling. This would, in turn, provide future therapeutic options to target pain. Here, a viewpoint will be presented regarding potential future directions in pain research, with a focus on SGCs to trigger further research. Promising avenues and new directions include the potential use of cell lines, cell live imaging, computational analysis, 3D tissue prints and new markers, investigation of glia–glia and macrophage–glia interactions, the time course of glial activation under acute and chronic pathological pain compared with spontaneous pain, pharmacological and non-pharmacological responses of glia, and potential restoration of normal function of glia considering sex-related differences.

Construct validity and reproducibility of the Prescription Opioid Misuse And Abuse Questionnaire (POMAQ)

OBJECTIVE

The Prescription Opioid Misuse and Abuse Questionnaire was developed to identify prescription opioid abuse and misuse among patients with chronic pain, however, evidence of construct validity and reproducibility is needed.

METHODS

Chronic pain patients were recruited from five Department of Defense Military Health System clinics across the United States. Construct validity was examined using subjective clinician-reported and patient-reported measures as well as objective information (e.g. hair/urine drug screens and electronic medical records). Test-retest reliability was assessed across 2 timepoints among a subgroup of patients with stable chronic pain.

RESULTS

Of 3,263 screened patients, 938 (28.7%) met eligibility and were enrolled; 809 (86.2%) completed the Prescription Opioid Misuse and Abuse Questionnaire. Construct validity was supported by comparison to other validated questionnaires and hair and urine screens which yielded high agreements with patient reports on the Prescription Opioid Misuse and Abuse Questionnaire. Electronic medical record data supported patients' Prescription Opioid Misuse and Abuse Questionnaire responses regarding physician and emergency room visits and opioid refills. The Prescription Opioid Misuse and Abuse Questionnaire had excellent test-retest reliability; the percentage agreement between the two Prescription Opioid Misuse and Abuse Questionnaire administrations was high (>90%) for most questions.

DISCUSSION

Results suggest that the Prescription Opioid Misuse and Abuse Questionnaire is a valid and reproducible tool that can be used to assess the presence of prescription opioid misuse and abuse among patients with chronic pain.

Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force

Objectives

The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers' current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients.

Methods

A voluntary 27-item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists.

Results

Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents' patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%).

Significance

The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.

The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative

OBJECTIVE

Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites.

METHODS

Outcomes were assessed using agreed-upon measures of patient-reported pain intensity, pain interference across various domains, pain catastrophizing, and sleep.

RESULTS

A total of 931 patients enrolled in the selected VA interdisciplinary pain programs, with 84.1% of participants completing the full course of treatment. Overall, all programs showed significant improvements from pretreatment to posttreatment in nearly all patient-reported outcomes. The effect sizes ranged from medium to large. Notably, the results demonstrate that positive outcomes were typical despite differences in structure and resources across programs.

CONCLUSIONS

The adverse impacts of opioid use have highlighted the importance of chronic pain treatment approaches that emphasize team-based care focused on functional improvements. This study represents the first and largest analysis of outcomes across chronic pain rehabilitation programs and demonstrates the need for increased access to similar comprehensive approaches to pain management across the health care system. Further, it suggests that a variety of structures may be effective, encouraging flexibility in adopting this interdisciplinary approach.

A Meta-Analysis of Group-Based Pain Management Programs: Overall Effect on Quality of Life and Other Chronic Pain Outcome Measures, with an Exploration into Moderator Variables that Influence the Efficacy of Such Interventions

OBJECTIVES

Group-based pain management programs (GPMPs) have been found to significantly improve quality of life and other pain outcome measures in patients with chronic musculoskeletal pain. The aims of this meta-analysis were to reevaluate the overall effect of GPMPs on various pain outcomes for individuals experiencing chronic musculoskeletal conditions and to explore moderator variables that potentially contribute to the overall efficacy of GPMPs.

METHODS

Using the R package called metaphor and RevMan, we estimated the overall effectiveness of GPMPs on various pain outcome measures. The differential effectiveness of GPMPs was examined by conducting a mixed-effects meta-analytic model using various study-level characteristics. Moderator analyses included three content moderator variables and seven format moderator variables. Receiver operating characteristic curves investigated optimal points in some of the moderator variable analysis results.

RESULTS

Significant overall main effects of GPMPs were found on all the explored outcome measures in this study (P < 0.05). In moderator analyses, it was found that the structure of GPMPs, rather than the content, significantly improved outcomes (P < 0.05). Receiver operating characteristic curve analyses identified the optimal number of GPMP sessions and number of participants per group.

DISCUSSION AND CLINICAL RELEVANCE

GPMPs have a statistically significant overall effect on all explored pain outcome measures. The investigation into content and structural moderators suggests that certain GPMP design factors have a greater effect on pain outcomes than do content factors. Therefore, GPMP structural designs appear to be important in reducing pain and improving quality of life for patients with chronic pain and warrant further investigation.

Validity of the Somatic Complaints Scales of the MMPI-2-RF in an Outpatient Chronic Pain Clinic

Chronic pain has become a significant medical issue. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a broadband psychological test that has been validated for use across various medical settings and can aid in the assessment and treatment planning of chronic pain. In the current investigation, it was hypothesized that the somatic complaints scales of the MMPI-2-RF would demonstrate good convergent validity from a structured psychodiagnostic interview and other measures of pain and somatization, and lack gender bias. Patients (n = 200) who produced valid MMPI-2-RFs in an outpatient chronic pain clinic were included in the study. Patients were also administered the Modified Somatic Perception Questionnaire (MSPQ), Pain Disability Index (PDI), and the Structured Clinical Interview for DSM-IV-TR (SCID). Zero-order and partial correlations (controlling for gender) were calculated between MMPI-2-RF scale scores and other criteria. Stepdown hierarchical regression analyses were used to detect bias. By and large, higher scale scores on the somatic/cognitive scales of the MMPI-2-RF were modestly or substantially correlated with MSPQ scores, PDI scores, and SCID Somatization symptom count, even after controlling for gender. Regression analyses suggested that the MMPI-2-RF scale scores were not biased as a function of gender. These findings support the validity of specific MMPI-2-RF scales to help identify somatization and psychosocial functioning among patients with chronic pain. Identification of somatization early within the course of treatment of chronic pain may help focus treatment targets, including referrals for psychological interventions such as cognitive behavior therapy for chronic pain.

Efficacy and Safety of 10 kHz Spinal Cord Stimulation for the Treatment of Chronic Pain: A Systematic Review and Narrative Synthesis of Real-World Retrospective Studies

10 kHz spinal cord stimulation (SCS) is increasingly utilized globally to treat chronic pain syndromes. Real-world evidence complementing randomized controlled trials supporting its use, has accumulated over the last decade. This systematic review aims to summarize the retrospective literature with reference to the efficacy and safety of 10 kHz SCS. We performed a systematic literature search of PubMed between 1 January 2009 and 21 August 2020 for English-language retrospective studies of ≥3 human subjects implanted with a Senza® 10 kHz SCS system and followed-up for ≥3 months. Two independent reviewers screened titles/abstracts of 327 studies and 46 full-text manuscripts. In total, 16 articles were eligible for inclusion; 15 reported effectiveness outcomes and 11 presented safety outcomes. Follow-up duration ranged from 6-34 months. Mean pain relief was >50% in most studies, regardless of follow-up duration. Responder rates ranged from 67-100% at ≤12 months follow-up, and from 46-76% thereafter. 32-71% of patients decreased opioid or nonopioid analgesia intake. Complication incidence rates were consistent with other published SCS literature. Findings suggest 10 kHz SCS provides safe and durable pain relief in pragmatic populations of chronic pain patients. Furthermore, it may decrease opioid requirements, highlighting the key role 10 kHz SCS can play in the medium-term management of chronic pain.

Prevalence of Psychological Symptoms in Community-Dwelling Chinese American Patients with Chronic Cancer Pain

Cancer is common among older Chinese American immigrants. Psychological distress may be associated with cancer pain, yet prior studies have not examined this relationship. We conducted a secondary analysis of 514 Chinese Americans with cancer-related pain. Patients completed validated questionnaires, including the Chinese Health Questionnaire-12 (CHQ-12). Analyses evaluated associations among sociodemographics, acculturation, psychological distress, and pain variables. Most patients had low acculturation and socioeconomic levels. Overall, 51.9% of patients reported moderate-severe psychological distress, 35.8% reported worst pain intensity ≥7/10 over the previous week and 41.2% had high pain-related distress. Higher CHQ-12 scores were associated with younger age (β = -0.13); lower educational level (β = -0.12); birthplace in China (β = -0.18); lack of a caregiver (β = -0.10); higher worst pain intensity (β = 0.15); and higher pain-related distress (β = 0.28; all p < 0.05; R² = 0.23). Chinese American cancer patients with chronic pain experience high psychological distress, which is associated with pain characteristics and other social factors.

The Effect of Healthy Lifestyle Promotion Intervention on Quality of Life in Cyclic Mastalgia via Individual Counseling: A Randomized Controlled Clinical Trial

Background

Despite high number of visited cases, there are no certain therapeutic guidelines for mastalgia. Generally pain is associated with poor quality of life in all dimensions. The present study aimed to investigate the effect of healthy lifestyle promotion intervention on the quality of life in cyclic mastalgia.

Methods

This study was a randomized controlled trial (RCT) conducted on women suffering from cyclic mastalgia at the age of 20 and older before menopausal age referred to the health centers of Karaj,Iran from September 2017 to August 2018. The participants were randomly assigned to intervention (N=40) and control groups (N=40). Intervention was carried out in two 46-minute sessions and two 90-minute sessions for the intervention group. The quality of life was assessed before and after the intervention in both groups using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The data were analyzed through SPSS statistical software(version 21) using independent sample t-test, Chi-square,and Paired t-test. Besides, P<0.05 was considered as statistically significant.

Results

Before the intervention, both groups were matched in terms of marital status, educational level, occupation, history of breastfeeding, and mean scores of quality of life (P>0.05). After the intervention, the mean score of life quality in physical, social, environmental, and general health dimensions in the intervention group increased significantly compared to the control group (P&gt;0.001). This difference was not statistically significant in the mental health dimension (P=0.086).

Conclusion

The present study indicated that healthy lifestyle promotion intervention could improve the quality of life of women with cyclic mastalgia.Trial Registration Number: IRCT2017100236513N1.

Association between depression, anxiety, and insomnia with musculoskeletal pain source: a multi-center study

Background

Musculoskeletal pain syndrome (MPS) is one of the modern diseases. Musculoskeletal pain (MP) may develop at any age and impact physical and mental health. This study aimed to evaluate the association between anxiety, depression, and insomnia with musculoskeletal pain source. This cross-sectional study was conducted on 450 patients with musculoskeletal pain. Goldberg depression (GB), Beck Anxiety Inventory (BAI), and Morin Insomnia Severity Index (ISI) questionnaires were used to collect data. Participants have divided into two groups: individuals with unknown musculoskeletal pain sources and individuals with known musculoskeletal pain sources. Anxiety, depression, and insomnia scores were compared between the two groups. For statistical analysis of data mean (SD), frequency (%), Chi-square, Mann-Whitney test, and Logistic regression models were used. All analysis was performed using SPSS 26.

Results

In this study, 39.4% of the participants were in severe depression, 31.1% in severe anxiety, 34.7% in the no clinically significant, and 32.9% in the sub-threshold insomnia group. There was a significant difference between the severity of anxiety and insomnia in the two groups with the known and unknown pain sources (p < 0.05). However, the score of depression (OR = 1.00, 95% CI 0.99–1.01), anxiety (OR = 1.00, 95% CI 0.99–1.02), and insomnia (OR = 1.01, 95% CI 0.98–1.03) was not related to the pain source.

Conclusion

There was a statistically significant relationship between anxiety and insomnia severity with musculoskeletal pain source. According to the high prevalence of depression, anxiety, and depression in both groups with known and unknown musculoskeletal pain sources, the cooperation of orthopedists, rheumatologists, and physical therapists with psychiatrist can be useful in improving the condition of patients.

Development and Validation of a Prediction Model for 6-Month Societal Costs in Older Community Care-Recipients in Multiple Countries; the IBenC Study

This study aims to develop and validate a prediction model of societal costs during a period of 6-months in older community care-recipients across multiple European countries. Participants were older community care-recipients from 5 European countries. The outcome measure was mean 6-months total societal costs of resource utilisation (healthcare and informal care). Potential predictors included sociodemographic characteristics, functional limitations, clinical conditions, and diseases/disorders. The model was developed by performing Linear Mixed Models with a random intercept for the effect of country and validated by an internal-external validation procedure. Living alone, caregiver distress, (I)ADL impairment, required level of care support, health instability, presence of pain, behavioural problems, urinary incontinence and multimorbidity significantly predicted societal costs during 6 months. The model explained 32% of the variation within societal costs and showed good calibration in Iceland, Finland and Germany. Minor model adaptations improved model performance in The Netherland and Italy. The results can provide a valuable orientation for policymakers to better understand cost development among older community care-recipients. Despite substantial differences of countries’ care systems, a validated cross-national set of key predictors could be identified.

Cogstate Brief Battery: Cognition and the feigning of cognitive impairment in chronic pain

Chronic pain (CP) is often associated with cognitive impairment. The Cogstate Brief Battery (CBB), a computerized assessment battery, has been studied in several neuropsychiatric disorders but not in CP. Since feigning of cognitive impairment is common in CP, the current study aimed to assess the CBB's utility in differentiating CP patients (n = 64) from healthy participants (n = 33), as well as to assess the effect of simulating cognitive impairment by CP patients on performance in the battery. CP outpatients were randomly assigned to one of two groups: (a) Patients performing the CBB to the best of their ability. (b) Patients simulating cognitive impairment. Independent-samples t-tests indicated that three of four CBB tasks successfully differentiated CP patients from matched healthy controls. Additionally, an analysis of covariance (ANCOVA) indicated that CP patients who simulated cognitive impairment performed more poorly in all four CBB tasks, with the detection task having the strongest discrimination capacity. This is the first study to point toward the usefulness and sensitivity of the CBB for assessment of cognition and detection of feigned cognitive impairment in CP. Further studies are required to validate these preliminary findings and assess the CBB's utility in daily clinical practice.

The Experience of New Graduate Registered Nurses as Managers of Pain

BACKGROUND

Beginning their post-licensure clinical practice can be a challenging time for new registered nurses. Pain management is considered an essential responsibility for nurses, requiring pain management that is prompt, safe and effective. Research is needed to examine the experiences of new registered nurses as they adjust to their new role using what they have already learned about pain and pain management.

PURPOSE

To examine the lived experiences of new registered nurses, who have been in the role less than a year, as they transition into their registered nurse role as a manager of pain utilizing what they have learned about pain and pain management in the undergraduate program and/or continuing professional development.

DESIGN

This research was a phenomenological study in which interviews were audio-recorded and transcribed verbatim.

PARTICIPANTS/SETTING

Eight new graduate registered nurses employed less than a year at a 415-bed regional hospital were interviewed.

METHODS

Content analysis guidelines were used for the analyses of texts.

RESULTS

Themes of navigating relationships, the practice of pain management and disconnect between school and real life were developed from the analyses of texts.

CONCLUSIONS

Knowledge generated from this study can be used to better understand the experience of new graduate registered nurses regarding pain management and enhance pain management curricula in undergraduate nursing education and continuing professional development.

Pain as a predictor of frailty over time among older Mexican Americans

The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were nonfrail at baseline. Data were from a prospective cohort study of 1545 community-dwelling Mexican Americans aged ≥67 years from the Hispanic Established Populations for the Epidemiological Study of the Elderly (1995/1996-2012/2013). Frailty was defined as meeting 2 or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, and slowness. The independent predictor was self-reported pain. Covariates included age, sex, marital status, education, comorbid conditions, body mass index, Mini-Mental State Examination, depressive symptoms, and limitation in activities of daily livings. General equation estimation was performed to estimate the odds ratio of frailty as a function of pain. A total of 538 participants (34.8%) reported pain at baseline. The prevalence of frailty among those with pain ranged from 24.4% in wave 3 to 41% in wave 8. The odds ratio of becoming frail over time as a function of pain was 1.71; 95% confidence interval: 1.41 to 2.09 after controlling for all covariates. Older age, hip fracture, high depressive symptoms, and activities of daily living disability were also associated with higher odds of becoming frail over time. Female participants and those with higher levels of education and high Mini-Mental State Examination scores were less at risk. In conclusion, pain was a significantly predictor of frailty. Early assessment and better management of pain may prevent early onset of frailty in older Mexican Americans.

Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain

Context

Chronic pain accounts for one of the most common reasons patients seek medical care. The financial burden of chronic pain on health care is seen by direct financial cost and resource utilization. Many risk factors may contribute to chronic pain, but there is no definite risk. Managing chronic pain is a balance between maximally alleviating symptoms by utilizing a therapeutic regimen that is safe for long-term use. Currently, non-opioid analgesics, NSAIDs, and opioids are some of the medical treatment options, but these have numerous adverse effects and may not be the best option for long-term use. However, Lidocaine can achieve both central and peripheral analgesic effects with relatively few side effects, which may be an ideal compound for managing chronic pain.

Evidence Acquisition

This is a Narrative Review.

Results

Infusion of lidocaine (2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide), an amino-amide compound, is emerging as a promising option to fill the therapeutic void for treatment of chronic pain. Numerous studies have outlined dosing protocols for lidocaine infusion for the management of perioperative pain, outlined below. While there are slight variations in these different protocols, they all center around a similar dosing regimen to administer a bolus to reach a rapid steady state, followed by infusion for up to 72 hours to maintain the therapeutic analgesic effects.

Conclusions

Lidocaine may be a promising pharmacologic solution with a low side effect profile that provides central and peripheral analgesia. Even though the multifaceted mechanism is not entirely understood yet, lidocaine may be a promising novel remedy in treating chronic pain in various conditions.

Prevalence of chronic pain in opioid-maintained patients using the capture-recapture method: a nationwide population-based study

Few studies all based on classical surveys have provided prevalence estimates of chronic pain (CP) in opioid-maintained patients (OMPs) but often had a limited patient sample size and a great variability in the prevalence estimates. This study sought to assess the prevalence of CP in the exhaustive population of OMPs using the capture-recapture method applied to the French nationwide health care database. Capture-recapture methods are increasingly used to estimate the prevalence of chronic conditions but have never been used in the specific context of CP in OMPs. Three large medical-administrative sources were used: the prescription drug database (A-list), the national hospital discharge database (M-list), and the pain center database (C-list). Between 2015 and 2016, 160,429 OMPs aged 15 years and older were identified and age- and sex-matched with 160,429 non-OMPs. All patients treated with analgesic drugs for ≥6 months (A-list) or diagnosed with CP (M- and C-list) were included. Capture-recapture analyses were performed to yield CP estimates with their 95% confidence intervals using log-linear models. In 2015 to 2016, 12,765 OMPs and 2938 non-OMPs with CP were captured. Most patients were male (67%) in OMPs and non-OMPs; median ages for OMPs and non-OMPs were 46 (interquartile range: 38-51) and 48 (41-53) years, respectively. The CP prevalence estimated in OMPs and non-OMPs ranged from 23.6% (14.9-46.2) to 32.1% (28.6-36.3) and from 7.28% (3.98-18.4) to 9.32% (7.42-12.1), respectively. This first study on CP in the exhaustive population of OMPs using the capture-recapture method demonstrated a high prevalence of CP in OMPs, 3- to 4-fold than in the general population.

Inhibition of Different Pain Pathways Attenuates Oxidative Stress in Glial Cells: A Mechanistic View on Neuroprotective Effects of Different Types of Analgesics

Neuropathic pain results from trauma or diseases affecting the central nervous system (CNS) and triggers a cascade of events in different CNS parts that eventually lead to oxidative injury. This study was aimed to investigate the protective effects of some selected analgesics in neuropathic pain-induced oxidative damage in the isolated glial cells of the rat brain. In this experiment, rats were randomly divided into 5 main groups. Rats in group 1 received no medication, whereas rats in groups 2 to 5 received ASA (aspirin), celecoxib, morphine, and etanercept daily, respectively. Each main group divides into 3 subgroups: normal, sham, and neuropathic pain model rats. The glial cells of the rat brain were isolated at different time points. Our results demonstrate that neuropathic pain induces ROS generation as the major cause of mitochondrial membrane potential collapse (%∆Ψm) and lysosomal membrane rupture, which result in oxidative damage of the glial cells. In addition, ASA and celecoxib had protective effects on the neuropathic pain-induced oxidative stress markers, including ROS production, mitochondrial membrane potential collapse, and lysosomal membrane leakiness at different time points. Furthermore, the oxidative damage markers were significantly decreased by morphine and etanercept in all investigated days. Since arachidonic acid metabolites and TNF-α are produced during neuropathic pain and inflammation, it can be concluded that the inhibition of the substances production or inhibition of the ligands binding with their receptors would help to decrease the destructive effects of neuropathic pain in the glial cells of rat brain.

Adipose-Derived Mesenchymal Stromal Cells in Regenerative Medicine: State of Play, Current Clinical Trials, and Future Prospects

Significance: Wound healing is a complex process involving pain and inflammation, where innervation plays a central role. Managing wound healing and pain remains an important issue, especially in pathologies such as excessive scarring (often leading to fibrosis) or deficient healing, leading to chronic wounds. Recent Advances: Advances in therapies using mesenchymal stromal cells offer new insights for treating indications that previously lacked options. Adipose-derived mesenchymal stromal cells (AD-MSCs) are now being used to a much greater extent in clinical trials for regenerative medicine. However, to be really valid, these randomized trials must imperatively follow strict guidelines such as consolidated standards of reporting trials (CONSORT) statement. Indeed, AD-MSCs, because of their paracrine activities and multipotency, have potential to cure degenerative and/or inflammatory diseases. Combined with their relatively easy access (from adipose tissue) and proliferation capacity, AD-MSCs represent an excellent candidate for allogeneic treatments. Critical Issues: The success of AD-MSC therapy may depend on the robustness of the biological functions of AD-MSCs, which requires controlling source heterogeneity and production processes, and development of biomarkers that predict desired responses. Several studies have investigated the effect of AD-MSCs on innervation, wound repair, or pain management separately, but systematic evaluation of how those effects could be combined is lacking. Future Directions: Future studies that explore how AD-MSC therapy can be used to treat difficult-to-heal wounds, underlining the need to thoroughly characterize the cells used, and standardization of preparation processes are needed. Finally, how this a priori easy-to-use cell therapy treatment fits into clinical management of pain, improvement of tissue healing, and patient quality of life, all need to be explored.

Differential modulation of thermal preference after sensitization by optogenetic or pharmacological activation of heat-sensitive nociceptors

Common approaches to studying mechanisms of chronic pain and sensory changes in pre-clinical animal models involve measurement of acute, reflexive withdrawal responses evoked by noxious stimuli. These methods typically do not capture more subtle changes in sensory processing nor report on the consequent behavioral changes. In addition, data collection and analysis protocols are often labour-intensive and require direct investigator interactions, potentially introducing bias. In this study, we develop and characterize a low-cost, easily assembled behavioral assay that yields self-reported temperature preference from mice that is responsive to peripheral sensitization. This system uses a partially automated and freely available analysis pipeline to streamline the data collection process and enable objective analysis. We found that after intraplantar administration of the TrpV1 agonist, capsaicin, mice preferred to stay in cooler temperatures than saline injected mice. We further observed that gabapentin, a non-opioid analgesic commonly prescribed to treat chronic pain, reversed this aversion to higher temperatures. In contrast, optogenetic activation of the central terminals of TrpV1+ primary afferents via in vivo spinal light delivery did not induce a similar change in thermal preference, indicating a possible role for peripheral nociceptor activity in the modulation of temperature preference. We conclude that this easily produced and robust sensory assay provides an alternative approach to investigate the contribution of central and peripheral mechanisms of sensory processing that does not rely on reflexive responses evoked by noxious stimuli.

Wearable Devices: Current Status and Opportunities in Pain Assessment and Management

INTRODUCTION

We investigated the possibilities and opportunities for using wearable devices that measure physical activity and physiometric signals in conjunction with ecological momentary assessment (EMA) data to improve the assessment and treatment of pain.

METHODS

We considered studies with cross-sectional and longitudinal designs as well as interventional or observational studies correlating pain scores with measures derived from wearable devices. A search was also performed on studies that investigated physical activity and physiometric signals among patients with pain.

RESULTS

Few studies have assessed the possibility of incorporating wearable devices as objective tools for contextualizing pain and physical function in free-living environments. Of the studies that have been conducted, most focus solely on physical activity and functional outcomes as measured by a wearable accelerometer. Several studies report promising correlations between pain scores and signals derived from wearable devices, objectively measured physical activity, and physical function. In addition, there is a known association between physiologic signals that can be measured by wearable devices and pain, though studies using wearable devices to measure these signals and associate them with pain in free-living environments are limited.

CONCLUSION

There exists a great opportunity to study the complex interplay between physiometric signals, physical function, and pain in a real-time fashion in free-living environments. The literature supports the hypothesis that wearable devices can be used to develop reproducible biosignals that correlate with pain. The combination of wearable devices and EMA will likely lead to the development of clinically meaningful endpoints that will transform how we understand and treat pain patients.

Self-Medication for Chronic Pain Using Classic Psychedelics: A Qualitative Investigation to Inform Future Research

Background: Chronic Pain is among the leading causes of disability worldwide with up to 60% of patients suffering from comorbid depression. Psychedelic-assisted therapy has recently been found effective in treating a host of mental health issues including depression and has historically been found to be useful in treating pain. Reports of self-medication for chronic pain using psychedelic drugs have been widely documented, with anecdotal evidence indicating widespread success in a range of pathologies. Aims: In preparation for an upcoming trial, to better understand how those with lived experience of chronic pain self-medicate with psychedelic drugs, and to establish, in detail, their therapeutic protocols and practices for success. Methods: As part of patient-involvement (PI) for an upcoming trial in this population, 11 individuals who reported self-medicating with psychedelic drugs took part in a 1-h semi-structured discussion, which was then transcribed and thematically analyzed. Results: Across a range of psychedelic substances and doses, reported pain scores improved substantially during and after psychedelic experiences. Two processes, Positive Reframing and Somatic Presence, were reliably identified as playing a role in improvements in mental wellbeing, relationship with pain, and physical (dis)comfort. Inclusion of other strategies such as mindfulness, breathwork, and movement were also widely reported. Due to the data's subjective nature, this paper is vulnerable to bias and makes no claims on causality or generalisability. Together, these results have been used to inform study design for a forthcoming trial. Conclusion: This pre-trial PI work gives us confidence to test psychedelic therapy for chronic pain in a forthcoming controlled trial. The results presented here will be instrumental in improving our ability to meet the needs of future study participants.

The Perception of Undergraduate Dental Students Toward a Clinical Learning Environment at School of Dentistry and Oral Health, Fiji National University, Fiji

BACKGROUND

The clinical learning environment is one of the key factors for undergraduate dental students to excel in their academic career. There has been no previous study in Fiji regarding dental students' perception of their learning environment.

AIM

This study aimed at investigating the perception of undergraduate dental students toward the clinical learning environment at the School of Dentistry and Oral Health (SDOH), Fiji.

MATERIALS AND METHODS

This is a cross-sectional prospective study conducted among 157 undergraduate dental students, all of whom were selected from three undergraduate dental programs. The modified 24-item Dental Clinical Learning Environment Inventory (DECLEI) was used to assess students' perceptions. The mean DECLEI score was interpreted as follows: ≤19.9 is very poor perception, 20-39.9 is poor perception, 40-59.9 is moderate perception, 60-79.9 is good perception, and >80 is excellent perception toward the clinical learning environment. A correlation test was used to examine the relationship between independent variables and DECLEI scores. P < 0.05 was considered as level of significance.

RESULTS

The response rate was 82.8%. Majority of the participants (76.9%) were in the age range of 20-29 years, were females (72.3%), and were Fijians of Indian descent (75.4%). The mean DECLEI score was 70.83 ± 9.11 which could be interpreted as a good perception toward the clinical learning environment. Age and gender had a statistically significant negative correlation with DECLEI scores (P < 0.05).

CONCLUSION

The dental clinical learning environment at SDOH can be perceived as "good"; however, issues related to patients' missing appointment were highlighted.

Pain influences food preference and food-related memory by activating the basolateral amygdala in rats

The amygdala has been demonstrated to contribute to pain-related behavior and food preference. Here, the effect of pain on food preference and food-matched visual-cue memory, in the presence or absence of a basolateral amygdala (BLA) lesion, has been evaluated using a novel innovative apparatus and protocol. Forty adult male Wistar rats were randomly divided into five groups (n = 8) as follows: control, pain, ibuprofen + pain, BLA lesion, BLA lesion + pain groups. Bilateral lesions of the BLA were produced by passing a current of 1.5 mA for 7 s. Pain was induced on the right hind paw of the rats by sub-plantar injection of 50 μl of 2.5% formalin. The animals were encountered with four different meals including wholemeal, wholemeal + sugar, white flour, and biscuit. Each test session consisted of six trials with inter-trial intervals of 15 min. The number of visits to each meal zone and port, the amount of time spent in each food zone and port, traveled distance in each food zone, food consumption per each visit and the total food consumption were recorded. The control group showed a high biscuit preference and low white flour preference. Rats suffering BLA lesion and rats in the BLA lesion + pain group exhibited a shifted preference curve. They had a bias toward eating wholemeal + sugar rather than white flour and biscuit. This group also showed an impaired spatial memory. In conclusion, our findings suggest that the BLA may be involved in pain-induced food preference and food-matched visual-cue memory.

Quality of life in chronic pain patients: Illness- and wellness-focused coping as moderators

Chronic pain is a health problem that significantly influences patients' lives, causing functional, social, socioeconomic, and emotional changes that impact quality of life (QoL). The aim of this study was to evaluate which variables (e.g., psychological morbidity, illness representations, pain, and coping) contribute to QoL and to analyse the moderating role of illness- and wellness-focused coping in the relationship between pain interference and Qol, in chronic pain patients. A sociodemographic and clinical questionnaire, the Brief Illness Perception Questionnaire, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale, the Chronic Pain Coping Inventory, the Short Form Health Survey, and the Brief Pain Inventory were completed by 103 patients with chronic pain. Greater use of wellness-focused coping and being professionally active were associated with better physical QoL. Cognitive representations and illness-focused coping contributed to physical QoL, and psychological morbidity contributed to mental QoL. Illness-focused coping and wellness-focused coping moderated the relationship between pain interference and physical QoL, but not with mental QoL. Since pain interference was positively related to psychological morbidity, and the latter was negatively related to QoL, it is extremely important to evaluate and promote patients' coping strategies that are focused on well-being to improve QoL. Results from this study underline the relevance of a multidisciplinary approach to chronic pain and the need to account for psychological morbidity and coping strategies in intervention programs to promote QoL in chronic pain patients.

Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management

Chronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies.

Assessment of diagnostic criteria for the identification of central sensitization in patients with osteoarthritis pain: Results from a Delphi survey

To assess diagnostic criteria and currently used tools for the identification of central sensitization (CS) in patients with joint pain due to osteoarthritis (OA).Qualitative, cross-sectional and multicenter study based on a 2-round Delphi surveyPublic and private medical centers attending patients with joint pain.A total of 113 specialists in traumatology, physical medicine and rehabilitation, pain management, rheumatology, primary care physicians and geriatrics were enrolled in the study.Participants completed an ad-hoc 26-item questionnaire available from a microsite in Internet.The questionnaire was divided into 6 sections with general data on CS, impact of CS in patients with knee osteoarthritis (KOA), diagnostic criteria for CS, non-pharmacological and pharmacological treatment of CS and usefulness of the concept of CS in the integral management of patients with KOA. Consensus was defined as 75% agreement.Diagnostic criteria included pain of disproportionate intensity to the radiological joint lesion (agreement 86.7%), poor response to usual analgesics (85.8%), progression of pain outside the site of the lesion (76.1%) and concurrent anxiety and depression (76.1%). Based on the opinion of the specialists, about 61% of patients with KOA present moderate-to-severe pain, 50% of them show poor response to conventional analgesics, and 40% poor clinical-radiological correlation. Patients with KOA and CS showed higher functional disability and impairment of quality of life than those without CS (88.5%) and have a poor prognosis of medical, rehabilitation and surgical treatment (86.7%). Early diagnosis and treatment of CS may preserve function and quality of life during all steps of the disease (90.3%).The management of patients with osteoarthritis pain and CS requires the consideration of the intensity of pain related to the joint lesion, response to analgesics, progression of pain to other areas and concurrent anxiety and depression to establish an adequate therapeutic approach based on diagnostic criteria of CS.

The Effect of Heat Shock Protein 90 Inhibitor on Pain in Cancer Patients: A Systematic Review and Meta-Analysis

Background and objectives: Heat shock protein 90 (Hsp90) is a molecular chaperone that plays an essential role in tumor growth. Numerous Hsp90 inhibitors have been discovered and tested in preclinical and clinical trials. Recently, several preclinical studies have demonstrated that Hsp90 inhibitors could modulate pain sensitization. However, no studies have evaluated the impact of Hsp90 inhibitors on pain in the patients. This study aims to summarize the pain events reported in clinical trials assessing Hsp90 inhibitors and to determine the effect of Hsp90 inhibitors on pain in patients. Materials and Methods: We searched PubMed, EBSCOhost, and clinicaltrials.gov for Hsp90 inhibitor clinical trials. The pain-related adverse events were summarized. Meta-analysis was performed using the data reported in randomized controlled trials. Results: We identified 90 clinical trials that reported pain as an adverse effect, including 5 randomized controlled trials. The most common types of pain reported in all trials included headache, abdominal pain, and back pain. The meta-analysis showed that Hsp90 inhibitors increased the risk of abdominal pain significantly and appeared to increase the risk for back pain. Conclusions: In conclusion, Hsp90 inhibitor treatment could potentially increase the risk of pain. However, the meta-analysis demonstrated only moderate evidence for the connection between Hsp90 inhibitor and pain.

Unmet needs in the management of functional impairment in patients with chronic pain: a multinational survey

Background: A survey of European Pain Federation 2019 attendees was conducted to identify unmet needs in chronic pain patients. Materials & methods: Four questions were asked focusing on functional impairment in chronic pain, including who are at increased risk and ways to better identify and manage these patients. Results: In total 143 respondents indicated that key issues were lack of knowledge, lack of resources/time to assess and manage chronic pain and lack of sufficient tools to identify patients at risk for functional impairment. Education and training of primary care physicians, simplified guidelines and practical tools for assessment and use of multidisciplinary teams to treat chronic pain were recommended. Conclusion: There are many unmet needs in the management of functional impairment in chronic pain patients.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

Clinical relevance of chronic neuropathic pain phenotypes in mice: A comprehensive behavioral analysis

Despite a large number of preclinical studies performed each year, the safe and effective therapeutic interventions for chronic pain are scant. Therefore, it appears that pre-clinical modeling requires a systematically organized behavioral test paradigm to quantify the response of animals for a specific pain state. The present study, therefore, conceptualized a test battery to evaluate the behavioral changes in mice following neuropathic pain. We employed sciatic nerve chronic constriction injury (CCI) in C57BL/6 J mice to model chronic pain state. Mice were monitored for thermal hyperalgesia and grip strength for 30 days. Subsequently, mice underwent a behavioral test battery consisting of the nociceptive threshold, the affective and cognitive functions and motor coordination, and strength. Our results showed that CCI mice are insensitive to thermal stimuli. However, nerve-injured mice showed significant changes in neuromuscular coordination, basal anxiety, and hedonic state. Such impaired neuromuscular coordination is indicative of disability rather than the actual pain phenotype. While using the digital gait analysis, our study revealed rationales for the insensitivity of CCI mice to thermal stimuli. Our results suggest that the predictive validity of the CCI model necessitates a comprehensive behavioral test battery to select the clinically relevant and measurable phenotype to quantify chronic neuropathic pain.

The effect of pain neurophysiology education on healthcare students' knowledge, attitudes and behaviours towards pain: A mixed-methods randomised controlled trial

OBJECTIVE

1) To investigate the effects of a brief pain neuroscience education (PNE) lecture on multi-disciplinary healthcare students' knowledge, attitudes and behaviours towards people with pain post intervention and at 6-months follow-up, 2) To explore students' perceptions of PNE.

DESIGN

Mixed-methods randomized controlled trial.

SETTING

UK university.

PARTICIPANTS

Thirty-seven students (30♀, mean age 30 years) from six healthcare disciplines.

INTERVENTION

70-min PNE lecture (intervention group) or a 70-min control education.

MAIN OUTCOME MEASURES

1) Knowledge: The Revised Pain Neurophysiology Quiz (RPNQ); 2) Attitudes: Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS); 3) Behaviours: A case vignette to assess clinical recommendations; and 4) Thematic analysis of semi-structured interviews (n = 12).

RESULTS

The intervention group increased knowledge compared to the control, post-intervention [mean difference 3.7 (95% CI, 2.4, 5.0), P < 0.001] but not at 6-months (0.1 (-1.1, 1.3), P = 0.860). Greater improvements in attitudes for the intervention group were seen post-intervention [-10.4 (-16.3, -4.6), P < 0.001] and at 6-months [-5.8 (-11.5, -0.2), P < 0.044]. There was no difference in behaviours between groups. Thematic analysis identified increased patient empathy, partial and patchy reconceptualisation of pain and increased confidence in recommending an active management programme following PNE.

CONCLUSION

This study adds to existing knowledge by demonstrating that a 70-min PNE lecture can have a short-term effect on knowledge and positively shift attitudes towards people with pain in the short and medium-term. It also resulted in some students' reconceptualisation of pain, increased empathy, and confidence to recommend activity. The effect of PNE on clinical behaviours was unclear.

Quality of life and functional outcomes with tapentadol prolonged release in chronic musculoskeletal pain: post hoc analysis

Aims: To investigate quality of life (QOL) and functionality changes in chronic pain during tapentadol prolonged release (PR) treatment. Patients & methods: Post hoc analysis of data from three Phase III trials in patients with osteoarthritis knee pain or low back pain. QOL and functionality changes were assessed by SF-36 scores. Results: All SF-36 subdomain scores improved progressively to week 3 of tapentadol titration and were sustained during 12-week maintenance treatment. Improvements in SF-36 scores were similar between tapentadol dose groups (e.g., 200 to <300 mg vs ≥500 mg), with no greater effect from higher doses. QOL and functionality improvements were consistently greater with tapentadol PR than oxycodone controlled release. Conclusion: Tapentadol PR provides consistent, clinically relevant improvements in QOL and functionality in chronic pain.

Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection

BACKGROUND

Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions.

OBJECTIVES

To examine predictors of EOL discussions with significant others, family members, and friends.

METHODS

Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV.

RESULTS

Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM.

DISCUSSION

Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .

Characterizing Chronic Pain Episodes in Clinical Text at Two Health Care Systems: Comprehensive Annotation and Corpus Analysis

BACKGROUND

Chronic pain affects more than 20% of adults in the United States and is associated with substantial physical, mental, and social burden. Clinical text contains rich information about chronic pain, but no systematic appraisal has been performed to assess the electronic health record (EHR) narratives for these patients. A formal content analysis of the unstructured EHR data can inform clinical practice and research in chronic pain.

OBJECTIVE

We characterized individual episodes of chronic pain by annotating and analyzing EHR notes for a stratified cohort of adults with known chronic pain.

METHODS

We used the Rochester Epidemiology Project infrastructure to screen all residents of Olmsted County, Minnesota, for evidence of chronic pain, between January 1, 2005, and September 30, 2015. Diagnosis codes were used to assemble a cohort of 6586 chronic pain patients; people with cancer were excluded. The records of an age- and sex-stratified random sample of 62 patients from the cohort were annotated using an iteratively developed guideline. The annotated concepts included date, location, severity, causes, effects on quality of life, diagnostic procedures, medications, and other treatment modalities.

RESULTS

A total of 94 chronic pain episodes from 62 distinct patients were identified by reviewing 3272 clinical notes. Documentation was written by clinicians across a wide spectrum of specialties. Most patients (40/62, 65%) had 1 pain episode during the study period. Interannotator agreement ranged from 0.78 to 1.00 across the annotated concepts. Some pain-related concepts (eg, body location) had 100% (94/94) coverage among all the episodes, while others had moderate coverage (eg, effects on quality of life) (55/94, 59%). Back pain and leg pain were the most common types of chronic pain in the annotated cohort. Musculoskeletal issues like arthritis were annotated as the most common causes. Opioids were the most commonly captured medication, while physical and occupational therapies were the most common nonpharmacological treatments.

CONCLUSIONS

We systematically annotated chronic pain episodes in clinical text. The rich content analysis results revealed complexity of the chronic pain episodes and of their management, as well as the challenges in extracting pertinent information, even for humans. Despite the pilot study nature of the work, the annotation guideline and corpus should be able to serve as informative references for other institutions with shared interest in chronic pain research using EHRs.

Psychosocial characteristics of candidates for implantable pain devices: validation of an assessment model

Aim: To provide a detailed profile of Veteran and community patients with chronic pain who completed preprocedural psychological evaluations for implantable pain devices. Patients & methods: A total of 157 candidates completed a preimplantable pain device evaluation between June 2018 and October 2019 with a pain psychologist that included a structured interview, elicitation of patient-centered goals for the implantable device, and psychometric testing. Results: Candidates demonstrated moderate to high rates of sleep impairment (73%), depressive symptoms (62%), anxiety symptoms (61%), pain catastrophizing (37%), cognitive impairment screen (30%) and somatic symptoms (24%). Conclusion: Candidates for implantable pain devices report high rates of mood, sleep and cognitive impairment, reinforcing the value of preprocedural psychological evaluations.

Effectiveness of Intravenous Immunoglobulin for Management of Neuropathic Pain: A Narrative Review

Administrations of intravenous immunoglobulin (IVIG), an immune-modulating blood-derived product, may be beneficial for managing neuropathic pain. Here, we review previous studies to investigate the effectiveness of IVIG in managing neuropathic pain due to various neurological disorders. The electronic databases PubMed, Scopus, Embase, and the Cochrane Library were searched for studies published up to February 2020. Two reviewers independently assessed the studies using strict inclusion criteria. Ten studies were included and qualitatively analyzed. The review included patients with pain due to complex regional pain syndrome (CRPS), diabetic polyneuropathy, and others, such as postherpetic neuralgia and trigeminal neuralgia. We found that IVIG may be one of the beneficial options for managing neuropathic pain from various neurological disorders. In the four articles reviewed, no major adverse effects were reported, and the trend was toward a positive pain-reducing effect in eight articles. However, to confirm the benefits of IVIG on reducing neuropathic pain, more high-quality studies are required.

Feasibility Trial of a Mind-Body Activity Pain Management Program for Older Adults With Cognitive Decline

BACKGROUND AND OBJECTIVES

The relationship between chronic pain (CP) and cognitive decline (CD) is bidirectional among older adults. The CP-CD comorbidity can progressively worsen cognitive, physical, emotional, and social functioning with aging. We explored the feasibility and outcomes associated with two mind-body activity programs for CP and CD that focus on increasing walking using time goals (Active Brains) or step-count reinforced via Fitbit (Active Brains-Fitbit).

RESEARCH DESIGN AND METHODS

Older adults with CP and CD participated in a non-randomized open pilot of Active Brains (n = 6) and Active Brains-Fitbit (n = 6) followed by exit interviews. Quantitative analysis explored feasibility markers and signals of improvement on physical, cognitive, and emotional function, as well as additional program targets. Qualitative analyses were predominantly deductive and applied the Framework Method to enhance the programs and methodology.

RESULTS

Both programs met a-priori feasibility benchmarks. We found within-group improvements for pain intensity, pain-specific coping, physical function, and cognitive function in both programs. Exit interviews confirmed high satisfaction with both programs.

DISCUSSION AND IMPLICATIONS

Our mixed methods data provide preliminary evidence of feasibility, showed promise for improving outcomes, and yielded critical information to further enhance the programs. We discuss "lessons learned" and future directions.

A systematic review of internet-based interventions for women with chronic pain

Introduction

To evaluate the effects of internet-based interventions on physical and psychosocial outcomes in women with chronic pain through a systematic review.

Method

A search of the following electronic databases: PubMed/MEDLINE, ScienceDirect, and Web of Science. Two different authors separately tabulated the indices selected in identical predetermined forms. The methodological quality of all randomised trials was assessed using the Cochrane Collaboration’s tool for assessing the risk of bias.

Results

Seven articles were finally included. The main features of interventions included online cognitive-behavioural and/or psychoeducation therapy to improve health with an interactive component. The methodological quality showed a high risk of bias, mainly from a lack of blinding.

Conclusion

There are indicators that suggest that internet-based interventions may be useful for women with chronic pain. However, the validity of such a conclusion is limited as most trials included had a high risk of bias. More rigorous research is required before stating that such interventions can overcome the current limitations of traditional face-to-face care.

NIRS measures in pain and analgesia: Fundamentals, features, and function

Current pain assessment techniques based only on clinical evaluation and self-reports are not objective and may lead to inadequate treatment. Having a functional biomarker will add to the clinical fidelity, diagnosis, and perhaps improve treatment efficacy in patients. While many approaches have been deployed in pain biomarker discovery, functional near-infrared spectroscopy (fNIRS) is a technology that allows for non-invasive measurement of cortical hemodynamics. The utility of fNIRS is especially attractive given its ability to detect specific changes in the somatosensory and high-order cortices as well as its ability to measure (1) brain function similar to functional magnetic resonance imaging, (2) graded responses to noxious and innocuous stimuli, (3) analgesia, and (4) nociception under anesthesia. In this review, we evaluate the utility of fNIRS in nociception/pain with particular focus on its sensitivity and specificity, methodological advantages and limitations, and the current and potential applications in various pain conditions. Everything considered, fNIRS technology could enhance our ability to evaluate evoked and persistent pain across different age groups and clinical populations.

Inpatient postoperative undesirable side effects of analgesics management: a pediatric patients and parental perspective

Introduction

The use of analgesics for the treatment of post-operative pain is common, however, such medications are known to have potential side effects. These undesirable secondary effects can have an important impact on patients and impede their recovery.

Objectives

A review of the literature was conducted in order to gain a better understanding of the challenges confronted by pediatric patients in the acute post-operative period in terms of the side effects of analgesics.

Methods

An online search of keywords (pediatric, analgesic, pain medication, side effects, adverse effects, nausea and vomiting, post-operative, post-discharge, self-care, self-management, management, self-care strategies, patient expectations, patient concerns and education) using PubMed, Medline and Scopus databases, and using the snowballing method of reference tracking was conducted.

Results

A total of 10 studies (N = 10, 871 participants) published between 1990 and 2019 were reviewed. Common side effects experienced by patients were nausea, vomiting, and pruritus. Patients' parents reported having many concerns about analgesic use and reported a lack of knowledge on pain medications and side-effect management.

Conclusion

Areas of improvement in clinical practice include providing the patient and their parents with more information about the post-operative period, analgesic use, and side effects as well as prescribing appropriate treatments to alleviate side effects. This review reveals a lack of qualitative data on pain management and related undesired side effects in pediatric patients having undergone inpatient surgery in addition to the consequences on patients' daily living and on the self-care strategies they engage in to attenuate such effects.

A Meta-Analysis of Therapeutic Pain Neuroscience Education, Using Dosage and Treatment Format as Moderator Variables

OBJECTIVES

This meta-analysis aimed to assess the overall effect of therapeutic pain neuroscience education (TPNE) on chronic musculoskeletal pain and to further assess whether such an effect differs by TPNE dosage as well as other treatment format components. Dosage included the number of TPNE sessions provided as well as the amount of time per TPNE session. Structural components included TPNE provided alone as treatment or combined with other pain management modalities, as well as the inclusion of group-based treatment sessions.

METHODS

Electronic databases were utilized to search for randomized controlled trials that included TPNE. The overall effectiveness of TPNE was estimated on 4 pain outcome measures, including kinesiophobia, pain intensity, pain disability, and pain catastrophizing. The differential effectiveness of TPNE was examined using a mixed-methods moderator analysis on various study-level characteristics to identify potential moderators affecting the overall results.

RESULTS

Significant effects of TPNE were found on all the outcome measures. The only moderator that displayed a significant effect was group-based treatment on kinesiophobia (z = -2.23, P < 0.05, 95% confidence interval [CI] -2.70 to -0.20). Between-group analysis revealed that only interventions that included group sessions were found to be statistically significant (z = 2.20, P < 0.05) and displayed a large effect size (d = 0.80, 95% CI 0.09 to 1.50).

DISCUSSION

Therapeutic pain neuroscience education had a statistically significant impact on all the explored pain outcome measures. However, when investigating the treatment dosage and format moderator variables, they appeared to not have a statistically significant effect except for group-based interventions on kinesiophobia levels.

CONCLUSION

This meta-analysis examined the efficacy of TPNE for patients with chronic pain. It assessed various pain outcome measures following intervention. In addition, this research identified that various moderator variables do not have and do have an impact on the treatment modality of TPNE.

Prevalence, Characteristics, and Management of Chronic Noncancer Pain Among People Who Use Drugs: A Cross-Sectional Study

INTRODUCTION

Most studies on chronic noncancer pain (CNCP) in people who use drugs (PWUD) are restricted to people attending substance use disorder treatment programs. This study assessed the prevalence of CNCP in a community-based sample of PWUD, identified factors associated with pain, and documented strategies used for pain relief.

METHODS

This was a cross-sectional study nested in an ongoing cohort of PWUD in Montreal, Canada. Questionnaires were administered to PWUD seen between February 2017 and January 2018. CNCP was defined as pain lasting three or more months and not associated with cancer.

RESULTS

A total of 417 PWUD were included (mean age = 44.6 ± 10.6 years, 84% men). The prevalence of CNCP was 44.8%, and the median pain duration (interquartile range) was 12 (5-18) years. The presence of CNCP was associated with older age (>45 years old; odds ratio [OR] = 1.8, 95% CI = 1.2-2.7), male sex (OR = 2.3, 95% CI = 1.2-4.2), poor health condition (OR = 1.9, 95% CI = 1.3-3.0), moderate to severe psychological distress (OR = 2.9, 95% CI = 1.8-4.7), and less frequent cocaine use (OR = 0.5, 95% CI = 0.3-0.9). Among CNCP participants, 20.3% used pain medication from other people, whereas 22.5% used alcohol, cannabis, or illicit drugs to relieve pain. Among those who asked for pain medication (N = 24), 29.2% faced a refusal from the doctor.

CONCLUSIONS

CNCP was common among PWUD, and a good proportion of them used substances other than prescribed pain medication to relieve pain. Close collaboration of pain and addiction specialists as well as better pain assessment and access to nonpharmacological treatments could improve pain management in PWUD.

Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study

BACKGROUND

Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients' self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates.

METHODS

The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients' self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models.

RESULTS

Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient - 0.19 (95% CI, - 0.31 to - 0.06).

CONCLUSIONS

Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.

A neuroimaging marker for predicting longitudinal changes in pain intensity of subacute back pain based on large-scale brain network interactions

Identification of predictive neuroimaging markers of pain intensity changes is a crucial issue to better understand macroscopic neural mechanisms of pain. Although a single connection between the medial prefrontal cortex and nucleus accumbens has been suggested as a powerful marker, how the complex interactions on a large-scale brain network can serve as the markers is underexplored. Here, we aimed to identify a set of functional connections predictive of longitudinal changes in pain intensity using large-scale brain networks. We re-analyzed previously published resting-state functional magnetic resonance imaging data of 49 subacute back pain (SBP) patients. We built a network-level model that predicts changes in pain intensity over one year by combining independent component analysis and a penalized regression framework. Connections involving top-down pain modulation, multisensory integration, and mesocorticolimbic circuits were identified as predictive markers for pain intensity changes. Pearson’s correlations between actual and predicted pain scores were r = 0.33–0.72, and group classification results between SBP patients with persisting pain and recovering patients, in terms of area under the curve (AUC), were 0.89/0.75/0.75 for visits four/three/two, thus outperforming the previous work (AUC 0.83/0.73/0.67). This study identified functional connections important for longitudinal changes in pain intensity in SBP patients, providing provisional markers to predict future pain using large-scale brain networks.

Bruxism, Related Factors and Oral Health-Related Quality of Life Among Vietnamese Medical Students

Although bruxism is a common issue with a high prevalence, there has been a lack of epidemiological data about bruxism in Vietnam. This cross-sectional study aimed to determine the prevalence and associated factors of bruxism and its impact on oral health-related quality of life among Vietnamese medical students. Bruxism was assessed by the Bruxism Assessment Questionnaire. Temporomandibular disorders were clinically examined followed by the Diagnostic Criteria for Temporomandibular Disorders Axis I. Perceived stress, educational stress, and oral health-related quality of life were assessed using the Vietnamese version of Perceived Stress Scale 10, the Vietnamese version of the Educational Stress Scale for Adolescents, and the Vietnamese version of the 14-item Oral Health Impact Profile, respectively. The prevalence of bruxism, sleep bruxism, awake bruxism, and both conditions in Vietnamese medical students were 51.2%, 38.2%, 23.4%, and 10.4% respectively. Stress, temporomandibular joint pain, masticatory muscle pain, and tooth attrition were associated with the presence of bruxism. Vietnamese medical students were negatively affected by bruxism in terms of oral health-related quality of life.