Fifty years on the Visual Analogue Scale (VAS) for pain-intensity is still good for acute pain. But multidimensional assessment is needed for chronic pain

Comparing clinical outcomes of patients with severe lower limb trauma undergoing orthoplastic and orthopedic surgeries: A long-term study protocol

This long-term study protocol aims to compare the clinical outcomes of patients with severe lower limb trauma undergoing orthoplastic and orthopedic surgeries, focusing on their physical and psychological status. Patients with lower limb injuries and open fractures have been recruited since October 2019 and will be followed up until October 2024. The patients will be divided into two groups: (1) Orthoplastic group, where single-stage debridement, fixation, and soft tissue repair will be performed, and (2) Orthopedic group, where soft tissue repair will be done in a delayed-stage. The follow-up period will be one year, during which clinical data, limb function recovery, psychological scores, and health-related quality of life (HRQOL) will be evaluated to assess postoperative recovery and clinical outcomes. Additional clinical data, such as socio-demographic information, baseline features, Enneking score, Visual Analogue Scale (VAS) score, two-point discrimination score, and blood test parameters will also be collected. The 36-Item Short Form Health Survey (SF-36) will be used to evaluate HRQOL, while the Post-traumatic Stress Disorder Checklist (PCL) will assess the severity of self-reported post-traumatic stress disorder. The results of this study will provide valuable insights into prognostically relevant targets and contribute to improving the management and outcomes of patients with lower limb injuries and open fractures, who often face challenges related to limb disability and potential amputation postoperatively, significantly impacting their psychological and physical well-being.

Development and efficacy evaluation of a personalised self-care programme for reducing work-related musculoskeletal disorders among rubber farmers in Thailand

Introduction

Work-related musculoskeletal disorders (WMSDs), the most common causes of work-related pain, suffering, absenteeism, and disability, are a major health concern for rubber farmers. WMSDs are persistent and frequently recur, resulting in increased health burdens for workers. Fortunately, appropriate intervention may relieve discomfort. Specified interventions have been recommended to reduce incidences of WMSD.

Objective

This study aimed to develop and evaluate the efficacy of a personalised self-care programme (PSCP) for relieving pain caused by WMSDs among rubber farmers.

Methods

Demographic data and details concerning the prevalence of pain regions were collected using a questionnaire adapted from the Nordic Musculoskeletal Questionnaire (IOC 1.00). The evidence gained from modified questionnaires and special tests was used to develop the PSCP. The PSCP was verified by three experts (IOC 1.00). Based on the questionnaires, only participants with a pain score of 3 or higher were recruited for the study. The PSCP's efficacy was evaluated by comparing the results before application and after 28 days. A numerical rating scale was employed to estimate the degree of pain. The pathogeneses of WMSDs were confirmed with a special test performed by a physical therapist. Additionally, the levels of interleukin (IL)-6 and IL-10 were measured to determine the PSCP's effect on inflammatory molecules. The efficacy of the PSCP was analysed using a paired t-test.

Results

The results showed that farmers experienced the greatest discomfort in the lower back, followed by the shoulders, legs, and neck. Therefore, this PSCP was designed to alleviate work-related musculoskeletal pain in these body regions. A reduction in pain by two degrees was observed after 28 days of the PSCP (x ‾ before = 5.26, SD = 1.96, x ‾ after = 2.40, SD = 1.64, p < 0.001). Special tests confirmed that the number of pain regions were also decreased (x ‾ before = 0.089, SD = 0.067, x ‾ after = 0.016, SD = 0.030, p < 0.001). In addition, IL-10 levels increased (p ≤ 0.001) following the PSCP, whereas IL-6 levels remained unaltered.

Conclusions

After 28 days of use, the PSCP was effective at reducing pain levels, decreasing pain regions, and promoting the production of anti-inflammatory molecules. This finding demonstrates that the PSCP could help alleviate work-related musculoskeletal pain among rubber farmers. The PSCP may be an appropriate intervention for alleviating pain.

Outcomes of Apert Syndrome Hand Reconstruction With Tilapia Skin: A Prospective Study

BACKGROUND

Tilapia skin has already been used in various medical scenarios, but there are no studies showing the use of tilapia skin for hand reconstruction in Apert syndrome. The objective of this study is to determine whether the use of tilapia skin during graft bed preparation for children with Apert syndrome can shorten wound reepithelialization intervals, reduce the number of dressing changes, and decrease patient discomfort.

METHODS

This is a prospective study on consecutive patients with Apert syndrome who underwent hand reconstruction at our Hospital. Patients were divided into 2 groups: (1) a control group consisting of patients who underwent conventional digit separation hand reconstruction surgery (2) an experimental group consisting of patients who underwent similar digit separation hand reconstruction surgery that commenced with the placement of a thin layer of tilapia skin at the raw commissures during a first operation, which was subsequently replaced by an autologous skin graft during a second operation staged 10 days postoperatively. Pain assessment was performed using the Visual Analog Scale. The number of dressing changes was also assessed. A T test compared the total number of dressings changes and pain data.

RESULTS

Experimental group patients (n = 8) required an average of 9.4 days of daily dressing changes, and control group patients (n = 5) required an average of 20.8 days of daily dressing changes ( P < 0.05) and tended to experience significantly less pain when compared with patients in the control group ( P = 0.079).

CONCLUSION

Tilapia skin can shorten wound reepithelialization intervals by reducing the total number of dressing changes.

Assessing independence in mobility activities in trauma care: Validity and reliability of the Activity Independence Measure-Trauma (AIM-T) in humanitarian settings

The importance of measuring outcomes after injury beyond mortality and morbidity is increasingly recognized, though underreported in humanitarian settings. To address shortcomings of existing outcome measures in humanitarian settings, the Activity Independence Measure-Trauma (AIM-T) was developed, and is structured in three subscales (i.e., core, lower limb, and upper limb). This study aimed to assess the AIM-T construct validity (structural validity and hypothesis testing) and reliability (internal consistency, inter-rater reliability and measurement error) in four humanitarian settings (Burundi, Iraq, Cameroon and Central African Republic). Patients with acute injury (n = 195) were assessed using the AIM-T, the Barthel Index (BI), and two pain scores. Structural validity was assessed through confirmatory factor analysis. Hypotheses were tested regarding correlations with BI and pain scores using Pearson correlation coefficient (PCC) and differences in AIM-T scores between patients' subgroups, using standardized effect size Cohen's d (d). Internal consistency was assessed with Cronbach's alpha (α). AIM-T was reassessed by a second rater in 77 participants to test inter-rater reliability using intraclass correlation coefficient (ICC). The results showed that the AIM-T structure in three subscales had an acceptable fit. The AIM-T showed an inverse weak to moderate correlation with both pain scores (PCC<0.7, p≤0.05), positive strong correlation with BI (PCC≥0.7, p≤0.05), and differed between all subgroups (d≥0.5, p≤0.05). The inter-rater reliability in the (sub)scales was good to excellent (ICC 0.86-0.91) and the three subscales' internal consistency was adequate (α≥0.7). In conclusion, this study supports the AIM-T validity in measuring independence in mobility activities and its reliability in humanitarian settings, as well as it informs on its interpretability. Thus, the AIM-T could be a valuable measure to assess outcomes after injury in humanitarian settings.

Screening tool development for hand surgery referrals in systemic sclerosis

BACKGROUND

Systemic Sclerosis (SSc) patients may need hand surgery.

OBJECTIVE

To develop a screening tool for rheumatologists to identify potential candidates with systemic sclerosis for hand surgery, optimizing referrals.

METHODS

A pilot cross-sectional study from January 2015 to December 2016.

SAMPLE SIZE

51 participants.

INCLUSION CRITERIA

≥ 18 years old, meeting the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc and hand impairment.

DATA COLLECTED

age, sex, race, disease duration, SSc subtypes, vasodilator use, skin thickness, finger stiffness, presence of Digital Ulcers (DU) and/or calcinosis, presence of Raynaud's Phenomenon (RP) attacks, health status and disability, disease status, pain intensity and functional status of the hands. Data were analyzed by a multivariate logistic regression model.

RESULTS

Fulfillment of surgical criteria: 68.8%. The surgical group had higher scores on the HAQ-DI (1.39 vs. 0.96, p = 0.032) and CHFS (25.0 vs. 12.0, p = 0.005) questionnaires, and a higher frequency of DU (91.43% vs. 18.75%, p < 0.0010), calcinosis (60.0% vs. 0.0%, p < 0.001), use of vasodilators (100.0% vs. 75.0%, p = 0.007) and digital stiffness (28.57% vs. 0.0%, p = 0.017). The presence of DU increased the chance of surgical indication by 46.2 times (ORIC 95% = 8.23 to 259.49). The statistical model showed good accuracy (86.3%, p < 0.001), sensitivity (91.4%), and specificity (81.2%).

CONCLUSION

The presence of DU in SSc could be used as a screening feature for early identification and referral of potential candidates for hand surgery.

Pain assessment tools for use with children in acute pain in the emergency department

There is a lack of timely administration of an appropriate analgesic for children in acute pain in emergency departments in the UK and elsewhere. Unrelieved acute pain may result in deterioration in a child's physical and psychological condition therefore assessment is essential to enable triage nurses to offer an appropriate analgesic. This should be achieved by using a validated pain assessment tool which, where appropriate, enables the child to self-report their pain. This article describes various validated pain assessment tools for use with children with acute pain and considers how triage nurses can determine which is the most appropriate to use. Regardless of which tool is selected, it is important to offer the child an analgesic and to reassess their pain at appropriate intervals.

A Critical Appraisal of the Chronic Pain Rate After Inguinal Hernia Repair

Purpose: To critically appraise highly cited studies reporting on the rate of chronic pain after inguinal hernia repair. Methods: Google Scholar was searched on 23 May 2022. We only included publications with more than 10 citations per year since publication and more than 100 citations in total. Both reports of original data and systematic reviews were included. Risk of bias and quality of the included studies were assessed with either the Joanna Briggs Institute Checklist for Prevalence Studies or the AMSTAR 2 depending on study design. Results: Twenty studies were included and evaluated. The rate of chronic postoperative inguinal pain of any degree ranged from 10%-63%, and the rate of moderate-to-severe pain ranged from 1%-18%. All studies reported the rate of pain of any degree, and most studies reported the rate of moderate-to-severe pain influencing daily activities. Studies used different temporal definitions of chronic pain, but most studies defined it as pain persisting either three or six months postoperatively. Ten studies used unvalidated questionnaires or significantly modified versions of validated questionnaires. Eleven studies primarily included patients receiving open repair. Included studies had median 21 citations per year (range 10-39) and median 387 citations in total (range 127-788). Conclusion: The rates of chronic postoperative inguinal pain reported in the included highly cited studies are possibly inaccurate, excessive, and outdated. New prospective studies based on uniform definitions and standards of measurement are warranted to better assess a contemporary chronic pain rate after inguinal hernia repair.

ASAD: A Novel Audification Console for Assessment and Communication of Pain and Discomfort

Pain and discomfort are subjective perceptions that are difficult to quantify. Various methods and scales have been developed to find an optimal manner to describe them; however, these are difficult to use with some categories of patients. Audification of pain has been utilized as feedback in rehabilitation settings to enhance motor perception and motor control, but not in assessment and communication settings. We present a novel tool, the Audification-console for Self-Assessment of Discomfort (ASAD), for assessing and communicating pain and discomfort through sound. The console is a sequence of increasing pitch and frequencies triggered at the press of buttons and displayed as a matrix that can be associated with the subjective perception of pain and discomfort. The ASAD has been evaluated in its ability to capture and communicate discomfort, following a fatigue test in the lower limbs with thirty healthy volunteers, and compared to the most common self-reported methods used in the NHS. (The National Health Service (NHS) is the publicly funded healthcare system in England and one of the four National Health Service systems in the United Kingdom.) This was a qualitative, within subjects and across groups experiment study. The console provides a more accurate assessment than other scales and clearly recognizable patterns of sounds, indicating increased discomfort, significantly localized in specific frequency ranges, thus easily recognizable across subjects and in different instances of the same subject. The results suggest a possible use of the ASAD for a more precise and automatic assessment of pain and discomfort in health settings. Future studies might assess if this is easier to use for patients with communication or interpretation difficulties with the traditional tools.

Association of Pre-procedural Anxiety with Procedure-related Pain During Outpatient Pediatric Burn Care: A Pilot Study

The relationship between preprocedural anxiety and pain is not clear but has the potential to change the way pediatric patients need to be cared for prior to burn procedures. Using results from our recent randomized clinical trial among outpatient burn patients (n=90) age 6-17 years, the objective of this subsequent analysis was to assess whether preprocedural anxiety was associated with self-reported and researcher observed pain scores. Anxiety before the dressing change was assessed using an abbreviated State-Trait Anxiety Inventory for Children (range 6-21) and reported with 95% confidence intervals (CI). Self-reported pain was reported using a Visual Analog Scale (range 0-100) and observed pain was assessed using the Face, Legs, Activity, Cry, and Consolability-revised scale. Over half of patients (58.9%) reported mild anxiety (score <12) and about 5% of patients reported severe anxiety (score >16). Younger children (6-8 years) reported higher anxiety scores than older children (15-17 years), but the difference did not achieve statistical significance (mean=12.7, 95% CI: 11.5-13.9, p=0.09). Nonparametric spearman correlation indicated that anxiety score was significantly correlated with observed pain (p=0.01) and self-reported overall pain neared statistical significance (p=0.06). In the final logistic regression of reporting moderate-to-severe pain (pain score >30), the association between anxiety scores and self-reported overall moderate-to-severe pain was statistically significant (p=0.03) when adjusting for race, healing degree, and pain medication use within 6 hours prior to burn dressing care. This pilot study provides preliminary data showing that anxiety before outpatient pediatric burn dressing changes is significantly associated with self-reported overall moderate-to-severe pain.

Impact of oral motor task training on corticomotor pathways and diadochokinetic rates in young healthy participants

Background

Studies addressing the training‐induced neuroplasticity and interrelationships of the lip, masseter, and tongue motor representations in the human motor cortex using single syllable repetition are lacking.

Objective

This study investigated the impact of a repeated training in a novel PaTaKa diadochokinetic (DDK) orofacial motor task (OMT) on corticomotor control of the lips, masseter, and tongue muscles in young healthy participants.

Methods

A total of 22 young healthy volunteers performed 3 consecutive days of training in an OMT. Transcranial magnetic stimulation was applied to elicit motor evoked potentials (MEPs) from the lip, masseter, tongue, and first dorsal interosseous (FDI, internal control) muscles. MEPs were assessed by stimulus–response curves and corticomotor mapping at baseline and after OMT. The DDK rate from PaTaKa single syllable repetition and numeric rating scale (NRS) scores were also obtained at baseline and immediately after each OMT. Repeated‐measures analysis of variance was used to detect differences at a significance level of 5%.

Results

There was a significant effect of OMT and stimulus intensity on the lips, masseter, and tongue MEPs compared to baseline (p < .001), but not FDI MEPs (p > .05). OMT increased corticomotor topographic maps area (p < .001), and DDK rates (p < .01).

Conclusion

Our findings suggest that 3 consecutive days of a repeated PaTaKa training in an OMT can induce neuroplastic changes in the corticomotor pathways of orofacial muscles, and it may be related to mechanisms underlying the improvement of orofacial fine motor skills due to short‐term training. The clinical utility should now be investigated.

The Effect and Safety of Thunder-Fire Moxibustion for Low Back Pain: A Meta-Analysis of Randomized Controlled Trials

Background

Low back pain (LBP) is considered the leading cause of people living with years of disability worldwide. Notably, thunder-fire moxibustion (TFM) is a new type of moxibustion, which has been widely applied to treat pain syndromes for thousands of years. This study aims to provide evidence to evaluate the effect and safety of TFM in treating LBP.

Methods

A systematic search of PubMed, Web of Science, the Cochrane Library, Embase, EBSCO, CNKI, Wanfang Data, CBM, and VIP (until April 2021) was used to identify studies reporting pain intensity, disability, Japanese Orthopedic Association (JOA) score, and quality of life in patients with LBP. Randomized controlled trials (RCTs), which compared TFM and other therapies in LBP, were included. Meanwhile, methodological quality was evaluated using the Cochrane criteria for risk of bias, and the level of evidence was rated utilizing the GRADE approach.

Results

Twenty-one RCTs, including 2198 patients, satisfied the inclusion criteria. Compared with other therapies, the effect of TFM was statistically significant, pain intensity decreased (SMD = 0.94; 95% CI (0.74, 1.14); p < 0.00001), disability improved (SMD = 1.39; 95% CI (0.19, 2.59); p=0.02), and the JOA score increased (SMD = -1.34; 95% CI (-1.88, -0.80); p < 0.00001). It was also reported that the patient's quality of life improved after treatment for a period of 4 weeks (SMD = -0.29; 95% CI (-0.42, -0.16); p < 0.0001) and after a follow-up of 1 month (SMD = -0.20; 95% CI (-0.34, -0.07); p=0.003). The evidence level of the results was determined to be very low to low.

Conclusions

Based on the existing evidence, it can be concluded that TFM may have a better effect than other treatments on LBP. However, it is not yet possible to assess the safety level of TFM therapy. Due to the universal low quality of the eligible trials and low evidence level, rigorously designed large-scale RCTs must be conducted in order to further confirm the results in this review.

The effect of olive cream on pain and healing of caesarean section wounds: a randomised controlled clinical trial

OBJECTIVE

This study was performed to determine the effect of olive cream on the severity of pain and healing of caesarean section wounds.

METHOD

This study is a parallel randomised clinical trial that was conducted on women who had caesarean sections at Ayatollah Taleghani Hospital in Arak, Iran. Women were assigned to intervention, placebo and control groups by a block randomisation method. Women in the intervention and placebo groups were asked to use olive cream and placebo cream, respectively, twice a day from the second day after surgery to the tenth day. The wound healing score and pain intensity score were assessed using the REEDA and VAS scales, respectively, before and at the end of the intervention.

RESULTS

The intervention group consisted of 34 women, the placebo group of 34 women and the control group of 35 women. We found a statistically significant difference between the intervention and placebo groups, intervention and control groups, and placebo and control groups in terms of the pain intensity (p<0.05 in all three cases). Also, we found a statistically significant difference between the intervention and placebo groups, and intervention and control groups in terms of the scores of wound healing on the tenth day after surgery (p<0.05 in both cases).

CONCLUSION

Olive cream can be effective in relieving pain and enhancing caesarean section wound healing, and since no specific side effects were reported, the use of olive cream is recommended.

Cluster-then-classify methodology for the identification of pain episodes in chronic diseases

Chronic diseases benefit of the advances on personalize medicine coming out of the integrative convergence of significant developments in systems biology, the Internet of Things and Artificial Intelligence. 70% to 80% of all healthcare costs in the EU and US are currently spent on chronic diseases, leading to estimated costs of 700 billion and $3.5 trillion respectively. The management of symptomatic pain crises in chronic diseases is based on general clinical guidelines that do not take into account the singularities of the crises, such as their intensity or duration, so that the pain of those particular crises may cause the medication to be ineffective and lead the patient to overmedication. Knowing in detail the characteristics of the pain would help the physician to objectively prescribe personalized treatments for each patient and crisis. In this manuscript, we make a step further on the prediction of symptomatic crisis from ambulatory collected data in chronic diseases. We propose a categorization of pain types according to subjective symptoms of real patients. Our approach has been evaluated in the migraine disease. The migraine is one of the most disabling neurological diseases that affects over 12% of the population worldwide and leads to high economic costs for private and public health systems. This study aims to classify pain episodes by the characterization of pain curves reported by patients in real time. Pain curves have been described as a set of morphological features. With these features the pain episodes are clustered then classified by unsupervised and supervised machine learning models. It is shown that the evolution of different pain episodes in chronic diseases can be modeled and clustered. Over a population of 51 migraine patients, it has been found that there are 4 clusters of pain types that can be classified using 4 morphological features with an accuracy of 99.0% using a Logistic Model Tree algorithm.

Pain Action Unit Detection in Critically Ill Patients

Existing pain assessment methods in the intensive care unit rely on patient self-report or visual observation by nurses. Patient self-report is subjective and can suffer from poor recall. In the case of non-verbal patients, behavioral pain assessment methods provide limited granularity, are subjective, and put additional burden on already overworked staff. Previous studies have shown the feasibility of autonomous pain expression assessment by detecting Facial Action Units (AUs). However, previous approaches for detecting facial pain AUs are historically limited to controlled environments. In this study, for the first time, we collected and annotated a pain-related AU dataset, Pain-ICU, containing 55,085 images from critically ill adult patients. We evaluated the performance of OpenFace, an open-source facial behavior analysis tool, and the trained AU R-CNN model on our Pain-ICU dataset. Variables such as assisted breathing devices, environmental lighting, and patient orientation with respect to the camera make AU detection harder than with controlled settings. Although OpenFace has shown state-of-the-art results in general purpose AU detection tasks, it could not accurately detect AUs in our Pain-ICU dataset (F1-score 0.42). To address this problem, we trained the AU R-CNN model on our Pain-ICU dataset, resulting in a satisfactory average F1-score 0.77. In this study, we show the feasibility of detecting facial pain AUs in uncontrolled ICU settings.

Optimizing the Treatment of CRPS With Ketamine

OBJECTIVE

This study aimed to develop a method that objectively measures the clinical benefits of ketamine infusions to treat complex regional pain syndrome (CRPS), thus making it possible, for the first time, to determine the optimal dosing of ketamine and duration of treatment to treat CRPS.

MATERIALS AND METHODS

All patients were diagnosed with hyperalgesia associated with CRPS. Patients underwent an outpatient, 4-day, escalating dose ketamine infusion. Hyperalgesia was measured using pain thresholds. Clinical outcome was determined without knowledge of the patient's pain thresholds throughout treatment.

RESULTS

We found a correlation between pain thresholds and the intensity of pain reported by the patient at various sites of the body. We found that clinical outcomes correlated with improvement in pain thresholds. There was a plateau in pain thresholds between days 3 and 4 for the lower extremities. There was no plateau in pain thresholds observed for the upper extremities.

DISCUSSION

Our findings suggest that 4 days of treatment are sufficient for the treatment of CRPS of the lower extremities. For the upper extremities, >4 days may be required. Our study is the first to utilize quantitative sensory testing to direct the treatment of a chronic pain disorder.

Can Residential Greenspace Exposure Improve Pain Experience? A Comparison between Physical Visit and Image Viewing

Reducing the burden of pain via greenspace exposure is a rising research topic. However, insufficient evidence has been found in relation to the environmental effect itself. Residential greenspace, as a convenient but limited natural environment for urban dwellers, has benefits and services yet to be discovered. Therefore, the current study recruited 24 young adults to evaluate the effects of physical visit to, or image viewing of, residential greenspace on pain perception and related psychophysiological outcomes, via simulated pain. Pain threshold and tolerance were recorded via the level of pain stimuli, and pain intensity was evaluated using the Visual Analog Scale (VAS). The state scale of the State-Trait Anxiety Inventory (STAI-S) and two adjective pairs were employed to measure the state anxiety and subjective stress, respectively. Meanwhile, heart rate (HR), heart rate variability (HRV), and blood pressure (BP) were measured to investigate physiological responses. Besides, Scenic Beauty Estimation (SBE) was also employed to assess participants' preference regarding the experimental environments. The results revealed that visiting the greenspace significantly increased the pain threshold and tolerance, while no significant effect was observed for image viewing. On the other hand, no significant difference was observed in pain-related psychophysiological indices between the experimental settings, but significantly negative associations were found between the scores of SBE and subjective stress and state anxiety. In conclusion, the current study brings experimental evidence of improving pain experience via residential greenspace exposure, while the related psychophysiological benefits require further investigation.

Effect of guided imagery on anxiety, muscle pain, and vital signs in patients with COVID-19: A randomized controlled trial

Background

COVID-19 can lead to anxiety due to its high mortality rate. Patients with COVID-19 may suffer from muscle pain. This study aimed to determine the effect of guided imagery on anxiety, muscle pain, and vital signs in patients with COVID-19.

Methods

110 patients with COVID-19 were recruited and randomly assigned to two control and intervention groups. Data were collected using the Spielberger Anxiety Inventory, the McGill Pain Questionnaire, and the Visual Analogue Scale. The intervention group received ten training sessions of guided imagery.

Results

The results indicated a significant difference in the mean scores of state (t = -3.829, p < .001), trait anxiety (t = -2.946, p = .004), pain quality (t = -4.223, p < .001), pain intensity (t = -3.068, p = .003), and heart rate, systolic blood pressure, and oxygen saturation (p < .001) between the two groups after the intervention.

Conclusions

Guided imagery as a cost-effective method of complementary medicine is recommended to manage anxiety and pain in patients with COVID-19.

Evaluation of the Arabic version of the Chronic Pain Grade scale: Psychometric properties

To increase our understanding of chronic pain in clinical and research contexts, an assessment of its dimensions using reliable and valid self-reported pain measures is imperative. However, well-validated Arabic chronic pain assessment scales are lacking. The Chronic Pain Grade (CPG) scale has been used worldwide, yet an Arabic version of the CPG scale has not yet been validated. Thus, we conducted this study to demonstrate the psychometric properties, including reliability, convergent validity, and construct validity of the Arabic CPG scale. A cross-sectional study was conducted in two hospitals in Saudi Arabia. Data were collected from a convenience sample of 233 chronic pain patients. The confirmatory factor analysis showed an excellent fit with the factor structure of the CPG scale and, thus, supported construct validity. The two identified subscales were pain intensity and pain disability. Convergent validity was supported by having significant correlations between the short-form McGill Pain Questionnaire and CPG subscales. Internal consistency reliability was demonstrated, as Cronbach's α was 0.916 for pain intensity and 0.815 for pain disability. This study provides evidence that the Arabic CPG scale is a reliable and valid measure of chronic pain dimensions, including pain intensity, and pain-related disability. This Arabic version of the CPG scale has the potential to expand research and clinical assessment in the Arab world. Future studies are required for further validation.

TCM nonpharmacological interventions for ankylosing spondylitis: A protocol for systematic review and network meta-analysis

BACKGROUND

Ankylosing spondylitis (AS) is a common infammatory rheumatic disease that affects the axial skeleton. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for AS. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis.

METHODS

According to the strategy, the authors will retrieve a total of 7 electronic databases by December 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for AS. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument.

RESULTS

This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of AS.

CONCLUSION

This study will generate evidence for different TCM nonpharmacological therapies for AS and provide a decision-making reference for clinical research.

ETHICS AND DISSEMINATION

This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/FHD2U.

Correlation of patient- and clinician-assessment of pain: comparing physiotherapy and general practice

The clinical work of GPs and physiotherapists frequently involves the assessment of patient pain. In this study, we aimed to determine the correlation of patient- and clinician-assessment of severity of pain through quantitative analysis of patient- and clinician-assessed pain scores collected at metropolitan general practice and physiotherapy clinics. Prior to a consultation, 30 patients were asked to complete a short general health survey within which they answered questions regarding current pain and, if in pain, the severity of that pain on the visual analogue scale. Following the consultation, their clinicians were asked questions on their observation of the patients, including whether they observed that their patients were in pain and, if so, how severe on the visual analogue scale. Statistical analysis of these data showed that although there was a correlation between the physiotherapist- and patient-assessed pain scores, there was no correlation between the GP- and patient-assessed pain scores. Accurately establishing the severity of patient pain can be difficult. These results suggest that GPs routinely underestimate the severity of patient pain. If the severity of patient pain is clinically relevant, GPs could improve the accuracy of assessment by asking patients directly about that aspect of pain.

Design and Implementation of an Intelligent Analgesic Bracelet Based on Wrist-ankle Acupuncture

A flexible, multifunctional, and intelligent analgesic bracelet was proposed in this article to alleviate symptoms of pain. Based on the theory of wrist-ankle acupuncture in traditional Chinese medicine, transcutaneous electrical nerve stimulation is the technical basis of the method. A set of targeted circuit system capable of generating adjustable electrical stimulation signals to simulate filamentary acupuncture was designed. The system architecture includes a wireless communication module, a signal control module, a stimulus signal generation module, and a wearable, flexible bracelet. In addition, a pain assessment interface with a visual analog scale was designed to assess pain levels. Two comparative experiments were designed, involving a custom pain assessment scale and hand-held dolorimeter that were performed before and after wearing the bracelet to verify the analgesic effect of the bracelet. The results showed that the wrist-worn analgesic bracelet is significantly effective in alleviating pain in various parts of the human body.

TCM nonpharmacological interventions for chronic low-back pain: A protocol for systematic review and network meta-analysis

BACKGROUND

chronic low back pain (CLBP) are common symptoms bothering people in daily life. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for CLBP. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis.

METHODS

According to the strategy, The authors will retrieve a total of 7 electronic databases by September 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for CLBP. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument.

RESULTS

This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of CLBP.

CONCLUSION

This study will generate evidence for different TCM nonpharmacological therapies for CLBP and provide a decision-making reference for clinical research.

ETHICS AND DISSEMINATION

This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/4H3Y9.

A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea

This retrospective study aimed to explore the benefits and safety of probiotics (live combined Bacillus subtilis and Enterococcus faecium granules with multivitamines) for the treatment of children with antibiotic-associated diarrhea (AAD).A total of 72 children with AAD were analyzed in this study. Of these, 36 children received routine treatment plus probiotics, and were assigned to a treatment group. The other 36 children underwent routine treatment alone, and were assigned to a control group. Patients in both groups were treated for a total of 7 days. The efficacy and safety were evaluated by duration of diarrhea (days), number of dressings needed daily, abdominal pain intensity, stool consistency (as assessed by Bristol Stool Scale (BSS)), and any adverse events.After treatment, probiotics showed encouraging benefits in decreasing duration of diarrhea (days) (P < .01), number of dressings needed every day (P < .01), abdominal pain intensity (P < .01), and stool consistency (BSS (3-5), P < .01; BSS (6-7), P < .01). In addition, no adverse events were documented in this study.The findings of this study demonstrated that probiotics may provide promising benefit for children with AAD. Further studies are still needed to warrant theses findings.

Efficacy and safety of moxibustion for chronic low back pain: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

To systematically review and meta-analyze the efficacy of moxibustion in treating patients with chronic low back pain (CLBP).

METHODS

A systematic search of the Cochrane Library, Web of Science, PubMed, Embase, EBSCO, CBM, Wanfang, CNKI and VIP (until November, 2019) was used to identify studies reporting pain intensity (VAS or NRS), disability (ODI or RMDQ), JOA score, and quality of life (SF-36) in patients with CLBP. Study selection, data extraction was performed critically and independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) was applied to test the quality of evidence from the quantitative analysis.

RESULTS

Ten RCTs, including 987 patients, met the inclusion criteria. Moxibustion had a superior effect on VAS score when compared with western medicine [RR = -1.69, 95%CI(-2.40, -0.98), p < 0.00001] and acupuncture [RR = -0.47, 95%CI(-0.92, -0.02), p=0.04], but it failed to do so when compared with core stability training [RR = -0.41, 95%CI(-0.87, 0.05), p=0.08]. The result showed that moxibustion plus other active treatments (including western medicine, massage, acupuncture and core stability training) had better effects on low back pain relief compared with active treatments alone. Moxibustion showed favourable effects on disability [SMD = -3.80, 95%CI (-5.49, -2.11), p < 0.0001], JOA score [MD = 4.10, 95%CI(2.30, 5.90), p < 0.00001], and SF-36 score [MD = 13.41, 95%CI(9.68, 17.14), p < 0.00001]. The evidence level of the results from the ten studies was determined to be very low to low.

CONCLUSIONS

It is difficult to draw firm conclusions that moxibustion is an effective intervention for treating CLBP due to the small sample size of eligible trails and the high risk of bias among the available articles. Rigorously designed large-scale RCTs are required to further confirm the results in this review.

Self-management and adherence in childhood-onset systemic lupus erythematosus: what are we missing?

OBJECTIVES

The aims of this study are (1) to characterize factors influencing self-management behaviors and quality of life in adolescent and young adult (AYA) patients with childhood-onset systemic lupus erythematosus (cSLE) and (2) to identify barriers and facilitators of treatment adherence via focus groups.

METHODS

AYAs with cSLE ages 12-24 years and primary caregivers of the adolescents participated in this study. Recruitment occurred during pediatric rheumatology clinic visits at a Midwestern children's hospital or the hospital's cSLE active clinic registry. Information about disease severity was obtained from patient health records. Pain and fatigue questionnaires were administered. Descriptive statistics were used to analyze data.

RESULTS

Thirty-one AYA patients and caregivers participated in six focus groups. Ten major themes emerged from sessions; four were expressed both by the AYA and caregiver groups: knowledge deficits about cSLE, symptoms limiting daily function, specifically mood and cognition/learning, barriers and facilitators of adherence, and worry about the future. Themes unique to AYA participants included symptoms limiting daily functioning-pain/fatigue, self-care and management, impact on personal relationships, and health care provider communication/relationship. For caregiver groups unique themes included need for school advocacy, disruption of family schedule, and sense of normalcy for their adolescent.

CONCLUSION

AYAs with cSLE face a lifelong disease characterized by pervasive pain, fatigue, organ damage, isolation-social and/or physical-and psycho-socioeducational challenges. This study confirmed that continued psychosocial support, health information education, adherence interventions, and personalized treatment plans are necessary to increase self-management and autonomy in AYAs with cSLE.

Machine learning methods for automatic pain assessment using facial expression information: Protocol for a systematic review and meta-analysis

INTRODUCTION

Prediction of pain using machine learning algorithms is an emerging field in both computer science and clinical medicine. Several machine algorithms were developed and validated in recent years. However, the majority of studies in this topic was published on bioinformatics or computer science journals instead of medical journals. This tendency and preference led to a gap of knowledge and acknowledgment between computer scientists who invent the algorithm and medical researchers who may use the algorithms in practice. As a consequence, some of these prediction papers did not discuss the clinical utility aspects and were causally reported without following related professional guidelines (e.g., TRIPOD statement). The aim of this protocol is to systematically summarize the current evidences about performance and utility of different machine learning methods used for automatic pain assessments based on human facial expression. In addition, this study is aimed to demonstrate and fill the knowledge gap to promote interdisciplinary collaboration.

METHODS AND ANALYSIS

We will search all English language literature in the following electronic databases: PubMed, Web of Science and IEEE Xplore. A systematic review and meta-analysis summarizing the accuracy, interpretability, generalizability, and computational efficiency of machine learning methods will be conducted. Subgroup analyses by machine learning method types will be conducted.

TIMELINE

The formal meta-analysis will start on Jan 15, 2019 and expected to finish by April 15, 2019.

ETHICS AND DISSEMINATION

Ethical approval will be exempted or will not be required because the data collected and analyzed in this meta-analysis will not be on an individual level. The results will be disseminated in the form of an official publication in a peer-reviewed journal and/or presentation at relevant conferences.

REGISTRATION

PROSPERO CRD42018103059.

Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: A randomized controlled trial

OBJECTIVE

This study aims to evaluate the effect of high intensity laser therapy (HILT) in patients with lumbar disc protrusion (LDP).

METHODS

This study included 63 patients suffering from protrusion of lumbar intervertebral disc; they were divided into Groups 1 (n= 32) and 2 (n= 31). Group 1 was treated with HILT and spinal decompression system (SDS). Patients in Group 2 received SDS alone. Evaluations were conducted on oswestry disability index (ODI), lumbosacral portion pain, and lower limb radiation pain with visual analogue scale (VAS) of two patient groups before treatment, two weeks after treatment, and 1 month after follow-up visit. Lumbar flexion range and angle of straight leg raising before treatment and 2 weeks after treatment.

RESULTS

After two weeks of treatment of two patient groups, ODI, VAS, lumbar flexion range and angle of straight leg raising significantly improved compared with their conditions before treatment (P< 0.01). A significant difference was noted in ODI, lumbar flexion range, and angle of straight leg raising between groups after two weeks of treatment (P< 0.05). Non-statistical significant difference was observed in lumbosacral portion pain and lower limb radiation pain with VAS (P> 0.05). However, difference in was VAS smaller in Group 1. All groups showed significantly different results in terms of ODI, lumbosacral portion pain, and lower limb radiation pain with VAS.

CONCLUSION

As one of available treatments for LDP, HILT can speed up improvement in lumbar segment motion, angle of straight leg raising, and overall function and allow early return of patients to their family and society. Treatment effect is long-lasting and can be widely promoted and applied clinically.

Pain is prevalent among adolescents and equally related to stress across genders

Background

Young people seem increasingly disabled due to pain and stress. Pain and stress are health risks with adverse long-term health effects. Traditionally, these health risks have been most prevalent and strongest associated in females, also regarding children and adolescents. Main objectives in this study were to investigate current gender differences in musculoskeletal pain and perceived stress in adolescents aged 15 and 16 years with respect to prevalence and group differences for various aspects of stress and pain, and to explore the relationship between stress and pain, specified for gender.

Methods

A cross-sectional study was conducted with 17 participating public schools. The survey was administrated by the schools in accordance with given procedures, emphasizing the volunteer and anonymous participation of the pupils. Primary study measurements were pain and stress. The pain measurements addressed different aspects of musculoskeletal pain including pain sites, pain duration and pain intensity (measured by a Visual analogue scale; VAS). The stress instrument used was the Perceived stress questionnaire (PSQ) comprising different factors of stress, i.e. worries, tension, joy and demands. The secondary study measurement was body mass index (BMI).

Results

The study sample comprised 422 adolescents aged 15 and 16 years; 218 females and 204 males. The pain reporting was high in both genders, 57.3 per cent of the females and 44.6 per cent of the males. In general, the female adolescents reported more pain and stress, although several pain measures corresponded between genders. The pain prevalence was similar across genders with respect to lower extremity pain, back pain and arm pain. Lower extremity pain was the most frequent reported pain in both genders. More females reported head pain (Pearson Chi-Square 7.11, p = .008), severe pain (VAS ≥ 7, Pearson Chi-Square 13.12, p = .004) and moderate to severe stress (PSQ ≥ 0.45, Pearson Chi-Square 29.11, p < .001). Comparison analyses of the continuous pain and stress variables revealed significant mean (95% confidence interval [CI]) differences between genders for all stress variables with the highest mean scores in females. In both genders there were significant (p < .01) correlations between all the continuous pain and stress variables. In 9 out of 15 correlations, the stress-pain associations were strongest in males (Pearson product-moment correlation (r) between 0.34 and 0.38). Only in females, the body mass index (BMI) appeared associated (weakly) to pain and stress, in terms of pain intensity (VAS, r = 0.19) and lack of joy (as a factor of stress, r = 0.16).

Conclusion

Pain and stress were prevalent in the adolescent sample, with generally higher reporting among females. Several pain measures corresponded between genders, but stress differed significantly between genders for all variables. Scrutinizing the relationship between pain and stress revealed significant stress-pain associations regarding all variables across genders, i.e. the pain complaints among the adolescents seemed equally related to stress in males and females in the sample.