Factorial validity of the short-form McGill pain questionnaire (SF-MPQ)

Pain beliefs and their relationship with pain, psychological distress and catastrophizing in individuals with Parkinson's disease

In Parkinson's disease (PD), a large number of individuals are confronted with pain. This issue has been receiving increasing attention in literature in recent years, as the complexity of pain in this disease makes its evaluation and treatment challenging. However, psychological variables related to the pain experience have received limited attention, especially when it comes to the exploration of beliefs regarding pain which, to our knowledge, remains unexplored in PD. Pain beliefs are defined as a subset of a patient's belief system which represents a personal understanding of the pain experience. Four dimensions of pain beliefs have been isolated in literature: mystery, pain permanence, pain constancy and self-blame. Thus, the goal of this study was first to describe pain beliefs in individuals with PD and second, to explore the relationships between pain beliefs and clinical and psychological variables. One hundred and sixty-nine international individuals with PD completed an online survey with socio-demographic and medical data. Participants completed self-report instruments to assess their pain (King's Parkinson's Disease Pain Questionnaire, McGill Pain Questionnaire and Brief Pain Inventory), psychological distress (Beck Depression Inventory, short-form and Parkinson Anxiety Scale), pain catastrophizing (Pain Catastrophizing Scale) and pain beliefs catastrophizing (Pain Beliefs and Perception Inventory). The study's findings revealed that most participants' beliefs are marked by the dimension of permanence, suggesting that individuals with PD perceive the pain experience as chronic and enduring. Meanwhile, pain is minimally perceived as constant, mysterious, or a source of guilt. Our finding concerning the permanence dimension deserves specific attention: even though this belief is prevalent in our population, it is not, or only weakly, associated with an impact on mood or pain catastrophizing. These results bring forth several hypotheses for understanding, highlighting the role of acceptance, and offer new perspectives toward improving clinical practices in terms of assessing and managing pain in PD.

Musculoskeletal symptoms in systemic lupus erythematosus patients and their impact on health-related quality of life

OBJECTIVES

To evaluate the musculoskeletal (MSK) symptoms experienced by SLE patients and determine how those symptoms relate to their health-related quality of life (HRQoL).

MATERIALS AND METHODS

This is a cross-sectional study that was carried out on 103 adult SLE patients. sociodemographic, clinical, and therapeutic data were recruited. They were asked to complete the following: Nordic Musculoskeletal, Short-Form McGill Pain, and Lupus QoL Questionnaires.

RESULTS

The mean age was 30.81 ± 9.44 years. There was a total of 86 females and 17 males (F: M:5:1). Almost all the patients reported MSK symptoms (96.1%). The maximum number of patients reported pain in the right and left wrist and hand (64.1%, 63.1%, respectively). One-fourth (25.2%) described at least five bodily sites of MSK symptoms, while 70.9% had more than five sites of MSK symptoms. Most of the patients described the pain as discomforting (40.8%). Patients with MSK symptoms scored significantly worse in all domains. In addition, the QoL scores of patients with more than 5 body sites of MSK symptoms were significantly lower than those of patients with fewer than 5 sites of MSK symptoms.

CONCLUSION

SLE patients have a high MSK burden, and MSK symptoms have a negative impact on HRQoL in these patients.

Towards a better Comprehension and Management of Pain and Psychological Distress in Parkinson's: The Role of Catastrophizing

OBJECTIVES

Pain is very prevalent in Parkinson's and challenging to manage. As many people with Parkinson's (PwP) with pain suffer from anxious and depressive symptoms, we examined the role of catastrophizing in mediating the relationship between pain and psychological distress for this population.

METHODS

169 international PwP completed an online survey with socio-demographic and medical data. Participants completed psychometric tests to assess their pain (King's Parkinson's Disease Pain Questionnaire, McGill Pain Questionnaire and Brief Pain Inventory), psychological distress (Beck Depression Inventory and Parkinson Anxiety Scale), pain coping strategies (Coping Strategies Questionnaire) and pain catastrophizing (Pain Catastrophizing Scale).

RESULTS

Depending on the tool used, 82.8% to 95.2% of participants reported pain. 23.5 % and 67.5% of participants showed respectively significant levels of depressive and anxiety symptoms. Psychological distress was significantly correlated with the quality of pain (both sensory and affective dimensions). Statistical models highlighted the mediating role of catastrophizing in the relationship between psychological distress and pain in Parkinson's.

CONCLUSION

These findings offer new perspectives toward understanding the underlying mechanisms of pain in Parkinson's and for effective therapeutic intervention goals to facilitate adaptation to pain symptoms in Parkinson's.

Effectiveness and Safety of Acupotomy on Lumbar Spinal Stenosis: A Pragmatic, Pilot, Randomized Controlled Trial

Purpose

In Korea, complex treatments such as acupotomy, acupuncture, and physical therapy are performed for lumbar spinal stenosis (LSS). Although there are reports of acupotomy as monotherapy or acupuncture treatment for LSS, pragmatic studies are lacking. Therefore, this study aimed to determine the effectiveness and safety of acupotomy for LSS to provide baseline evidence for a large-scale study.

Materials and Methods

This pragmatic randomized controlled pilot study enrolled 34 participants and randomly assigned them to two groups (n=17/group). The intervention was conducted for 8 weeks. Acupotomy plus and usual care groups received acupuncture (17 acupoints) and interferential current therapy (ICT) twice weekly; however, the acupotomy plus group received an additional acupotomy (7 acupoints) for treatment of the usual care group. The primary outcome was measured using visual analog scales (VAS), and secondary outcomes were assessed using the self-rated walking distance, short-form McGill Pain Questionnaire (SF-MPQ), and the Oswestry Disability Index (ODI). Outcome measurements were conducted at baseline and 4, 8, and 12 weeks after the commencement of the intervention. Adverse events were assessed at each visit. Hematological and biochemical examinations were performed at screening and week 8.

Results

Overall, 33 of the 34 participants completed the study, and one participant in the usual care group dropped out. In both groups, VAS scores at weeks 4, 8, and 12 significantly improved compared to baseline. Also, self-rated walking distance, SF-MPQ, and ODI scores were significantly improved at weeks 4, 8, and 12 than at baseline. However, there were no significant differences in the time-dependent and group-to-time interactions between the two groups. In addition, no severe adverse reactions were reported, and there were no significant differences in hematological and biochemical results.

Conclusion

This study provides baseline data for large-scale studies on the effectiveness and safety of acupotomy in LSS.

Clinical Trial Number

KCT0006234.

The Efficacy of a Preoperative Occupational Therapy Educational Session for Saudi Patients Undergoing a Lower Extremity Joint Replacement

Purpose

Prior to a lower extremity joint replacement, many surgical candidates participate in a preoperative occupational therapy educational program that is meant to increase patient awareness, promote positive health behaviors, and improve health outcomes after surgery. With the limited number of occupational therapists in Saudi Arabia, patients may only receive one preoperative educational session. The objective of the study was to explore the efficacy of one preoperative occupational therapy educational session for patients undergoing a lower extremity joint replacement.

Methods

A total of 19 participants were included in the study, 7 participants to the intervention and 12 participants to the control groups. Participants underwent either a total knee or total hip replacement. The intervention group received one preoperative educational session prior to the surgery and the control group received usual care. After the surgery, both groups were assessed on pain (SF-MPQ), Satisfaction (SPSQ), Quality of life (QOLS), functional performance (FIM). Mann-Whitney U-tests were used to compare between groups.

Results

The findings showed significant improvements in both pain (12.14 ± 7.22 vs 21.25 ± 8.60; p=0.02) and satisfaction (106.28 ± 25.17 vs 78.08 ± 31.49; p=0.03) when compared to usual care. Although both FIM and QOLS scores indicated improvements when compared to usual care, these results were not statistically significant. Effect sizes showed moderate and large effects for score differences on both the SF-MPQ and SPSQ (r= 0.47, r=0.52) respectively. Whereas effect sizes for score differences on both the FIM and QOLS were small.

Conclusion

An occupational therapy preoperative education session shows promise for patients undergoing lower extremity joint replacement; however, further research is needed to confirm these findings.

Effects of Tai Chi on the quality of life, mental wellbeing, and physical function of adults with chronic diseases: Protocol for a single-blind, two-armed, randomised controlled trial

INTRODUCTION

Quality of life (QoL), mental wellbeing, and physical function are often diminished among people with chronic disease. Tai Chi is a moderate form of exercise that may be effective in improving chronic disease management. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi program on chronic disease management.

METHODS AND ANALYSIS

This study will be a pilot, interventional, single-blind, two-armed, randomised, parallel, and controlled trial involving a 12-week Tai Chi program for Australian adults. Forty people aged 18 years and older, diagnosed with one or more chronic disease from general community will be recruited. All participants will be randomised to either a 12-week Tai Chi program or a waiting list control group. The Tai Chi program will involve 12 weeks of group Tai Chi sessions, with 45 minutes per session, twice a week. The primary outcome will be QoL as measured by mean scores on the 12-item Short Form Health Survey (SF-12v2) and the EuroQoL (EQ-5D). The secondary outcomes will include anxiety as measured by mean score on the generalised anxiety disorder 7 (GAD-7) survey; depression as measured by mean score on the patient health questionnaire (PHQ-9); work productivity and activity assessment (WPAI:SHP); pain (if any) as measured by mean scores on the visual analogue scale (VAS) and the McGill pain questionnaire (MPQ). These primary and secondary outcomes will be self-administered via two online assessments prior to (T0) and post-intervention (T1). Objective measures as additional secondary outcomes, will also be carried out by the research team including flexibility as measured by the finger to floor distance (FFD); obesity as measured by mean scores on body mass index (BMI); vital signs (blood pressure, heart rate, respiratory rate, temperate, and oxygen saturation) as measured by a blood pressure monitor, tympanic, and pulse oximetry device, and these outcomes will be measured at T0 and T1 in the ECU Holistic Health Research Clinic. People diagnosed with pre-diabetes or diabetes, their glycosylated haemoglobin (HbA1C) and fasting (before breakfast) blood glucose level (BGL) will also be measured via test kits at T0 and T1 in the clinic. Linear mixed modelling will be conducted to assess changes in outcomes. Statistical significance will be set at an alpha level of 0.05 with a medium effect size. All analyses will be conducted using R version 4.1. Qualitative data will be analysed using template thematic analysis.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Edith Cowan University (ECU) Human Research Ethics Committee (2021-03042-WANG). Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications. This study will provide an updated evidence on a safe, sustainable, and inexpensive non-pharmacological approach in the management of chronic disease, the number one burden of disease in Australia.

TRIAL REGISTRATION

Trial registration number: ACTRN12622000042741p.

Evaluating the performance of the Pain Interference Index and the Short Form McGill Pain Questionnaire among Chilean injured working adults

Background

Chronic pain can lead to economic instability, decreased job productivity, and poor mental health. Therefore, reliable identification and quantification of chronic pain is important for clinical diagnosis and treatment.

Objective

To determine the psychometric properties of the Spanish language versions of the Pain Interference Index (PII) and the Short Form McGill Pain Questionnaire (SF-MPG) among a population of working adults who experienced injury in Santiago, Chile.

Methods

A total of 1,975 participants with work-related injuries were interviewed to collect sociodemographic, occupational, and chronic pain characteristics. Construct validity and factorial structure of the PII and SF-MPG were assessed through exploratory factor analyses (EFA). Cronbach’s alpha was used to evaluate internal consistency.

Results

The PII mean score was 3.84 ± 1.43 among all participants. The SF-MPG median score was 11 [IQR: 6–16] in this study population. Cronbach’s alpha for the PII was 0.90 and 0.87 for the SF-MP. EFA resulted in a one factor solution for the PII. A two-factor solution was found for the SF-MPG. The two-factors for SF-MPG were sensory and affective subscales with Cronbach’s alpha of 0.82 and 0.714, respectively. When the two scales were combined, an EFA analysis confirmed the PII and SF-MPG measure different aspects of chronic pain.

Conclusions

The PII and SF-MPG had good construct validity and reliability for assessing different aspects of chronic pain among working Chilean adults.

Feasibility and therapeutic efficacy of a two-week low-level laser acupuncture therapy for shoulder and neck pain in office workers: Protocol for a pilot, single-blind, double-armed, randomised controlled trial

BACKGROUND

Shoulder and neck pain (SNP) is common in office workers and represents a serious public health problem given its detrimental impact on quality of life, physical functioning, personal finances, employers, and the health care system. Management with painkillers has adverse implications such as tolerance, addiction, and opioid abuse. Safe, sustainable, cost-effective, and evidence-based solutions are urgently needed. The non-invasive, painless, non-infectious, and safe modality of low-level laser acupuncture (LLLA) has shown promise for SNP management.

OBJECTIVE

The overarching aim of this study is to provide evidence of the feasibility and therapeutic efficacy of LLLA for office workers with SNP.

METHODS

This is a pilot, single-blind, double-armed, randomised controlled trial on the feasibility and therapeutic efficacy of a two-week LLLA therapy for office workers with SNP, aged 18 to 65 years. Each of the two study groups will contain 35 participants: the intervention group will receive LLLA from a licensed acupuncturist at the researchers' university clinic (10-20 min/session, 3 sessions/week) for two weeks; the control group will receive usual care without painkillers. Outcomes will be measured at baseline, throughout the two-week intervention, and at trial end. Surveys including open-ended questions will be completed. The primary outcome of this study is to evaluate the feasibility of a two-week LLLA therapy for office workers with SNP, as measured by recruitment and completion rates, patient safety, and treatment adherence and compliance. Participants' attitudes, motivation, and challenges to participation, intervention non-compliance, and experience of participating in the trial will be investigated via qualitative data. The secondary outcome is to evaluate the therapeutic efficacy of LLLA on SNP using the visual analogue scale (VAS) and the Short-Form McGill Pain Questionnaire (SF-MPQ); the work productivity and activity assessment (WPAI:SHP); 12-Item Short Form Survey (SF-12) for quality of life assessment; and the past 3-month out-of-pocket (OOP) cost for prescription and non-prescription SNP therapy, which is an indicative of the economic burden of SNP on patients and health care systems. This study was approved by Edith Cowan University's Human Research Ethics Committee (No. 2021-02225-WANG).

RESULTS

Data collection will commence in December 2021 with anticipated completion by December 2022.

CONCLUSIONS

Safe, sustainable, cost-effective, evidence-based interventions are needed to minimise the negative implications of SNP in office workers. LLLA is a promising modality in managing SNP. However, more consolidated evidence is required to provide insight regarding the effectiveness of LLLA. This study is expected to contribute to the challenging work of reducing the burden of SNP in office workers.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000426886p; https://www.anzctr.org.au/ACTRN12621000426886p.aspx.

Effects of a nurse-led Tai Chi programme on improving quality of life, mental wellbeing, and physical function of women with breast cancer: Protocol for a randomized controlled trial

Objectives:

Quality of life, mental wellbeing, and physical function deteriorate among women with breast cancer. Tai Chi is a moderate form of exercise that may be effective in improving the mental and physical wellbeing, therefore, the quality of life of women with breast cancer. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi programme on breast cancer management.

Methods:

The study will be an interventional, single-blind, double-armed, randomized, and controlled trial involving a 12-week Tai Chi programme for women with breast cancer. Forty participants aged 18 years and above who are diagnosed with breast cancer from the general community will be recruited. All participants will be randomized to either a Tai Chi programme or a waiting list control group. The Tai Chi programme will involve 12 weeks of group Tai Chi sessions, with 45 min per session, twice a week. The primary outcome will be potential improvements to the quality of life, and secondary outcomes will be potential improvements in mental wellbeing (anxiety and depression), and physical function (pain, flexibility, obesity, and vital signs). These outcomes will be assessed via self-administered online assessments and physical examinations pre-and post-intervention. Linear mixed modelling will be used to assess changes in outcomes.

Discussion and dissemination:

Tai Chi is a safe, easy to learn, inexpensive, and low-intensity exercise with increasing popularity worldwide. If the intervention improves the quality of life in women with breast cancer, this study will build research capacity and increase awareness of the potential for Tai Chi to empower patients and engage them in self-management of breast cancer symptoms. Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications.

Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

Background

In recent years, a growing number of researchers showed significant interest in psychological and social interventions to manage chronic musculoskeletal (MSK) pain. Cognitive and emotional empathy is an attractive and valuable sociopsychological factor that may provide protection and resilience against chronic MSK pain. However, its effect on outpatients remains underexplored.

Objective

To compare the empathy ability between chronic MSK pain outpatients and healthy controls and explore the relationship between cognitive/emotional empathy and chronic pain.

Methods

Patients with chronic MSK pain (n = 22) and healthy controls (n = 26) completed the pain assessment and empathy ability task, utilizing a multidimensional empathy assessment tool with satisfactory reliability and validity (i.e., the Chinese version of the Multifaceted Empathy Test (MET-C)).

Results

The data indicated that the chronic MSK pain outpatients had impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy: Student's t = −2.119, P = 0.040, and longer task completion time: Student's t = 3.382, P = 0.002) compared to healthy controls, and cognitive empathy was negatively correlated with pain intensity (r = −0.614, P = 0.002). Further, the impaired cognitive empathy was present in identifying positive, but not negative emotions.

Conclusion

These results indicate that chronic MSK pain is associated with impaired empathy ability. Our studies contribute to offering a potential direction for developing psychosocial interventions to treat chronic MSK pain.

Evaluating the efficacy of an attention modification program for patients with fibromyalgia: a randomized controlled trial

Persons with chronic musculoskeletal pain may be hypervigilant for pain-related cues which, paradoxically, may be maintaining their pain. Several randomized controlled trials have assessed whether a modified dot-probe protocol (ie, attention bias modification [ABM]) reduces chronic pain- and pain-related symptoms in persons with several diagnoses, including fibromyalgia. Scalability and economic efficiency potentiates the appeal of ABM protocols; however, research results have been mixed, with only some studies evidencing significant symptom gains from ABM and some evidencing gains for the control group. The current randomized controlled trial sought to replicate and extend previous ABM research using idiosyncratic word stimuli and a 1-month follow-up. Participants included treatment-seeking adult women (n = 117) with fibromyalgia who were randomly assigned to a standard (ie, control) or active (ie, ABM) condition. The protocol was delivered online and involved twice-weekly 15-minute sessions, for 4 weeks, with questionnaires completed at baseline, posttreatment, and 1-month follow-up. Symptom reports were analysed with mixed hierarchical modelling. There was no evidence of differences between the control and ABM groups. Both groups had small significant (Ps < 0.05) improvements in pain experiences at posttreatment, but not at follow-up (Ps > 0.05). There were no significant changes for either group on measures of anxiety sensitivity, illness/injury sensitivity, pain-related fear, pain-related anxiety, or attentional biases (Ps > 0.05). The current findings add to the emerging and mixed literature regarding ABM for pain by demonstrating that ABM produces no substantive improvements in pain or pain-related constructs in a large sample of patients with fibromyalgia.

The Relationship Between the Pain Experience and Emotion Regulation in Older Adults

OBJECTIVE

To investigate the relationship of emotion regulation strategies (i.e., emotional suppression and reappraisal) with pain catastrophizing, fear of pain, pain intensity, worry, and depression as function of age in samples of older and younger adults.

DESIGN

Cross-sectional design using validated questionnaires.

SETTING

Participants resided in the community. They completed validated measures using online questionnaires.

SUBJECTS

Two-hundred fifty-seven older adults and 254 younger adults with chronic pain participated.

METHODS

Participants completed validated questionnaires of emotion regulation strategies, pain-related functioning and mental health.

RESULTS

Emotion regulation varied as a function of age and gender. Among our chronic pain sample, older adult males reported lower use of reappraisal and suppression than younger adult males, while older adult females reported higher use of reappraisal than younger adult females. Emotional suppression was positively related to pain catastrophizing, pain intensity, worry, and depression. Reappraisal was negatively related to depression and worry. Interestingly, age showed a positive relationship with fear of pain, pain catastrophizing, worry, depression, and pain intensity, while gender was related to fear of pain and worry. Finally, emotional reappraisal partially mediated the relationship between the affective dimensions of pain intensity and pain catastrophizing among older adults.

CONCLUSIONS

Our results indicate that reappraisal strategies are important for older and younger adults with chronic pain, pointing to the necessity of considering these strategies when working clinically with such populations. However, given our findings as well as those in the literature, gender should also be considered.

Manipulation of the Duration of the Initial Self-Control Task Within the Sequential-Task Paradigm: Effect on Exercise Performance

Self-control exertion on an initial task has been associated with impaired performance on subsequent physical tasks also requiring self-control; an effect suggested to be mediated by changes in perceptions of pain and motivation. However, the effects of spending longer on the initial self-control task are unknown. This study, therefore, explored the potential for the duration of the initial self-control task to influence subsequent physical performance, perceptions of pain, and perceived motivation; particularly during the early stages of the physical task. In a within-subject design, 29 participants (11 male, 18 female) completed a wall-sit task until volitional exhaustion, on four separate occasions. Prior to each wall-sit, participants completed either a non-self-control task (congruent Stroop task) for 4 min, or a self-control task (incongruent Stroop task) for 4 (short duration), 8 (medium duration), or 16 (long duration) min. Participant's perceptions of pain and motivation were recorded every 30 s during the wall-sit. Wall-sit performance time was analyzed using one-way ANOVA and perceptions of pain and motivation analyzed using multi-level modeling. Wall-sit performance time was significantly longer on the non-self-control exertion trial compared to all other trials (all p < 0.01), as well as longer on both the short duration and medium duration self-control exertion trials compared to the long duration self-control exertion trial (both p < 0.001). Perceptions of initial (at 30 s) pain and motivation were different between the trials (main effect of trial: pain, p = 0.001; motivation, p < 0.001); whereby longer durations of self-control exertion increased perceptions of pain and decreased motivation. The decrease in motivation during the wall-sit task was greater on the long duration self-control exertion trial compared to all other trials (trial^∗time interactions, all p < 0.05). The present study provides novel evidence that spending longer on the initial self-control task led to greater detrimental effects on subsequent wall-sit performance time. Furthermore, longer duration self-control exertion tasks led to increased perceptions of pain and decreased motivation within the first 30 s of the wall-sit task, as well as a greater decrease in motivation across the wall-sit task. These attentional and motivational shifts may explain performance decrements following the exertion of self-control.

Breaking the cycle of smoking and pain: do pain-related anxiety and pain reduction expectancies sabotage attempts to quit smoking and can smoking cessation improve pain and pain-related disability outcomes?

Contemporary models of smoking and pain suggest a reciprocal and self-perpetuating cycle, wherein smoking reduces pain in the short term but indirectly exacerbates pain in the long term. In a sample of participants engaged in an active smoking-cessation attempt, this investigation assessed a) whether specific smoking risk factors (i.e., smoking expectancies for pain reduction, pain-related anxiety) acted as barriers to cessation, and b) whether breaking the smoking-pain cycle through successful smoking abstinence impacted pain and pain-related disability outcomes for participants with pain. Participants comprised 168 smokers (44.4% with pain) who engaged in an online smoking-cessation program. Pain-related anxiety, but not smoking expectancies, accounted for a significant proportion of variance of smoking dependence from pre- to post-intervention. Results suggest that pain-related anxiety is a risk factor for maintained smoking dependence for all smokers regardless of pain status. Participants with pain who successfully quit smoking experienced statistically and clinically meaningful decreases in pain and pain-related disability from pre- to post-intervention. Exploratory post hoc analyses indicated that individuals who signed-up for the smoking cessation program but failed to begin a quit-attempt had significantly higher pain disability, depression, and anxiety scores than participants who commenced a quit-attempt. Theoretical and practical implications are discussed.

A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design

BACKGROUND

Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP.

OBJECTIVE

This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities.

METHODS

We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up.

RESULTS

The 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions.

CONCLUSIONS

The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely.

Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days

Background

A large body of empirical evidence on Minorities' Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities.

Aim

The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days.

Methods

This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data.

Results

Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome.

Conclusion

In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Pain perception assessment using the short-form McGill pain questionnaire after cardiac surgery

Background:

Pain management remains an integral part of patient care after cardiac surgery, and it required proper pain assessment. The aim of the study was to assess pain perception using validated Arabic version of the short-form McGill Pain Questionnaire (SF-MPQ) and to identify analgesics prescribing patterns post cardiac surgery.

Methods:

This is a prospective study conducted in an adult cardiac critical care unit of a tertiary cardiac center from September 2018 to March 2019. The study enrolled 74 patients who underwent cardiac surgical procedures through a median sternotomy.

Results:

The mean age of our patients was 57 ± 11 years and 47 (63.5%) were males. Patients described post-cardiac surgery pain as heavy (n = 37; 50%) and tiring-exhausting (n = 49; 66%), mainly at the site of incision (n = 20; 27%). Pain intensity at day 1 according to pain rating index (PRI) and numerical rating scale (NRS) was 7 (25^th, 75^th percentiles: 2.8–15) and 6 (3–8), respectively. There was a significant change in pain intensity score between 2 days of assessment (PRI: 7 [2.8–15] vs 5 [2–11] P = 0.010; NRS: 6 (3–8) vs 5 (2–8), P = 0.021]). The most common analgesics prescribed were paracetamol (39%) and a combination of tramadol and paracetamol (33.8%).

Conclusion:

Pain decreased the second day after cardiac surgery compared to day 1. Paracetamol was the most prescribed analgesic; however, there was an underutilization which might be affected by insufficient pain reporting. Future improvement could focus on multimodal pain management and proper communication of pain experience.

Modification of the Neuropathic Pain Symptom Inventory for use in eye pain (NPSI-Eye)

Chronic eye pain, which has previously been assumed to be due to ocular surface abnormalities (ie, "dry eye [DE] disease"), has recently garnered attention as a potential indicator of neuropathic ocular pain in some patients. The purpose of this study was to evaluate the psychometric properties of a modified version of the Neuropathic Pain Symptom Inventory in individuals with eye pain (NPSI-Eye). Enrolled participants (n = 397) completed the NPSI-Eye, general pain severity questionnaires, DE symptom report, and psychological health indices. Participants also underwent mechanical pain sensitivity testing of the cornea, tear film assessment, and evaluation of the efficacy of anesthetic eye drops to relieve pain. Short-term test-retest reliability of the NPSI-Eye was excellent (intraclass correlation coefficient = 0.98, P < 0.001). Correlations between the NPSI-Eye and indicators of general eye pain were ≥0.65 (P < 0.001), whereas correlations between the NPSI-Eye and DE symptom severity and psychological health indices were lower (rho = 0.56, 0.32, 0.37; all P < 0.001). Individuals who reported little or no decrease in pain after anesthetic eye drops (hypothesized to indicate eye pain with at least partial central involvement) had significantly higher NPSI-Eye scores than participants whose eye pain was completely relieved by anesthetic (P < 0.05). Overall, our results support preliminary validation of the NPSI-Eye, yielding similar metrics to those reported in Bouhassira et al.'s original NPSI publication (2004). However, additional evaluation and refinement of some questions may be desirable, including the potential elimination of items that were not highly endorsed.

Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory Among Individuals With Chronic Low Back Pain

OBJECTIVES

The Illness Invalidation Inventory (3*I) was designed to assess individuals' perceived invalidation regarding chronic pain experiences. However, no study has yet investigated the psychometric properties of the 3*I among individuals with chronic low back pain (CLBP). Given the personal and societal impact of CLBP and the potential for invalidation associated with this condition, the current study sought to examine the psychometric properties of the 3*I among individuals with CLBP.

MATERIALS AND METHODS

Community-dwelling adults with CLBP living in the Southwestern United States (N=134) completed the 3*I. In line with previous literature, current analyses focused on the 3*I "family members" subscale. Exploratory and confirmatory factor analysis was performed on participant responses. Hierarchical linear regression analyses examined the relationship between the identified factors and participant self-reported pain severity, disability, and depression.

RESULTS

Exploratory factor analysis conducted on the 3*I "family members" subscale found 2 factors with high internal consistency (α>0.70) that cumulatively accounted for 49.04% of the variance in scores. Consistent with previous findings, factor loadings suggested that these factors correspond to "discounting" and "lack of understanding." Subsequent confirmatory factor analysis found that this 2-factor model demonstrated a good fit with the data. Greater perceived discounting by family members was associated with greater pain severity, disability, and depression.

DISCUSSION

The 2-factor model of the 3*I "family members" subscale identified in the current study reflects previous findings and extends the psychometric validity of the 3*I to a US multiethnic sample of individuals with CLBP.

Pregabalin Failed to Prevent Dry Eye Symptoms after Laser-Assisted in Situ Keratomileusis (LASIK) in a Randomized Pilot Study

PURPOSE

Perioperative pregabalin administration has been found to reduce the risk of persistent pain after a variety of surgical procedures. However, this approach has not been tested in relation to eye surgery. As such, the purpose of this study was to evaluate whether perioperative pregabalin can reduce the presence of dry eye (DE) symptoms, including eye pain, six months after laser-assisted in situ keratomileusis (LASIK).

METHODS

Prospective, masked, randomized single-center pilot study. Patients were treated with either pregabalin (oral solution of pregabalin 150 mg twice daily, first dose prior to surgery, continued for a total of 28 doses over 14 days) or placebo solution. The primary outcome was dry eye symptoms as measured by the Dry Eye Questionnaire 5 (DEQ-5). Secondary outcome measures included pain-related eye symptoms.

RESULTS

In total, 43 individuals were enrolled in the study and randomized to pregabalin (n = 21) or placebo (n = 22). Of those, 42 individuals completed the final visit after six months of follow-up. Some differences were noted between the two groups at baseline, including a higher frequency of females in the pregabalin group. At 6-months, there were no significant differences in the percentage of patients with DE symptoms (DEQ5 ≥ 6, 57% vs. 33%, p = 0.14), DE symptom severity (DEQ5, 6.6 ± 5.0 vs. 4.5 ± 4.2, p = 0.14), ocular pain intensity (numerical rating scale, 1.10 ± 1.48 vs. 0.38 ± 0.97, p = 0.08), or neuropathic pain complaints (Neuropathic Pain Symptom Inventory-Eye, 2.81 ± 4.07 vs. 3.14 ± 5.85, p = 0.83) between the pregabalin and control groups. Ocular signs were likewise similar between the groups, and of note, did not correlate with DE symptoms. The strongest predictor of DE symptoms six months post-surgery was the presence of DE symptoms prior to surgery.

CONCLUSIONS

Perioperative pregabalin did not reduce the frequency or severity of DE symptoms at a six month follow-up after LASIK in this small pilot study.

Efficacy of submucosal bupivacaine injection for pain relief after endoscopic submucosal dissection: A multicenter, prospective, randomized controlled, and double-blind trial

BACKGROUND AND AIM

Although abdominal pain is a common adverse event related to endoscopic submucosal dissection (ESD), it can be sometimes underestimated by endoscopists. There are some endoscopic interventions available for the prevention of post-ESD pain, but their efficacy has not been established. We investigated whether a submucosal injection of bupivacaine (BP) can reduce procedure-related abdominal pain compared with the standard method.

METHODS

We performed a multicenter, double-blinded, randomized controlled trial of 86 adult patients referred for ESD as treatment for gastric neoplasms. Patients were randomly assigned to either the BP submucosal or conventional solution group. Questionnaires were collected when the study began (baseline) and immediately after ESD, as well as at 6, 12, and 24 hours post-operatively. The primary outcome was indicated by the visual analog scale (VAS) evaluated at 6 hours after procedure.

RESULTS

There were no significant differences in primary outcomes between groups and among all time points (immediately, 12, and 24 hours after ESD). The VAS and short-form McGill pain (SF-MP) scores were higher immediately after ESD than at 6, 12, or 24 hours post-operatively. The incidence of abdominal pain immediately after ESD was 94.0% (78/83) for all patients of both groups, and there was no significant difference between the 2 groups in the rate of abdominal pain immediately after ESD (BP group 37/40 [92.5%] versus non-BP group 41/43 [95.3%], P = .934). In univariable and multivariable analyses, BP did not have protective effect on post-ESD abdominal pain.

CONCLUSIONS

Submucosal BP injection does not promote pain relief or mitigate the effects of post-ESD abdominal pain.

When more is not merrier: shared stressful experiences amplify

Sharing experiences with others, even without communication, can amplify those experiences. We investigated whether shared stressful experiences amplify. Participants completed the Cold Pressor Task at the same time as a confederate, or while the confederate completed another task. Importantly, participants in the shared (vs. unshared) condition experienced more sensory pain characteristics and reported more stress over time in relation to the task. Importantly, they reported thinking more about the confederate's thoughts and feelings. This mentalizing sometimes mediated effects, suggesting the task amplified when participants constructed mental representations of others' CPT experience (e.g. that it hurts) and incorporated it into their own responses.

Reliability and validity of the Brief Pain Inventory in individuals with chronic obstructive pulmonary disease

BACKGROUND

Pain is prevalent in chronic obstructive pulmonary disease (COPD) and the Brief Pain Inventory (BPI) appears to be a feasible questionnaire to assess this symptom. However, the reliability and validity of the BPI have not been determined in individuals with COPD. This study aimed to determine the internal consistency, test-retest reliability and validity (construct, convergent, divergent and discriminant) of the BPI in individuals with COPD.

METHODS

In order to examine the test-retest reliability, individuals with COPD were recruited from pulmonary rehabilitation programmes to complete the BPI twice 1 week apart. In order to investigate validity, de-identified data was retrieved from two previous studies, including forced expiratory volume in 1-s, age, sex and data from four questionnaires: the BPI, short-form McGill Pain Questionnaire (SF-MPQ), 36-Item Short Form Survey (SF-36) and Community Health Activities Model Program for Seniors (CHAMPS) questionnaire.

RESULTS

In total, 123 participants were included in the analyses (eligible data were retrieved from 86 participants and additional 37 participants were recruited). The BPI demonstrated excellent internal consistency and test-retest reliability. It also showed convergent validity with the SF-MPQ and divergent validity with the SF-36. The factor analysis yielded two factors of the BPI, which demonstrated that the two domains of the BPI measure the intended constructs. The BPI can also discriminate pain levels among COPD patients with varied levels of quality of life (SF-36) and physical activity (CHAMPS).

CONCLUSION

The BPI is a reliable and valid pain questionnaire that can be used to evaluate pain in COPD.

SIGNIFICANCE

This study formally established the reliability and validity of the BPI in individuals with COPD, which have not been determined in this patient group. The results of this study provide strong evidence that assessment results from this pain questionnaire are reliable and valid.

Trauma, Pain, and Psychological Distress

Abstract. Posttraumatic stress disorder (PTSD) and chronic musculoskeletal pain (CMP) are highly prevalent ( Breslau, 2002 ) and comorbid disorders ( Otis, Keane, & Kerns, 2003 ). The shared vulnerability model explains this overlap in part through a common attentional bias toward threat ( Asmundson, Coons, Taylor, & Katz, 2002 ). The current study made use of the acoustic startle to assess cognitive bias to threat in participants (n = 106; 64% women) who reported experiencing a motor vehicle accident (MVA). Participants were divided into five groups based on their diagnoses: PTSD, CMP, both PTSD and CMP, any general (i.e., non-PTSD) anxiety disorder with no CMP, and a no-disorder Control group. Self-report measures were used to assess psychological symptoms, trauma response, and pain-related factors. Word stimuli (i.e., trauma, sensory pain, health, pleasant, neutral) were presented visually prior to onset of the acoustic startle probe to assess for diagnosis-congruent attentional biases (e.g., persons with PTSD respond differently to trauma words). Relative to the general anxiety and control group, persons with PTSD or chronic pain demonstrated delayed startle peak and greater startle intensity across all word stimuli types; the results suggest there may be psychophysiologically measurable differences associated with PTSD and pain. The startle probe paradigm remains relatively nascent for such research, but has potential utility for assessment and treatment monitoring. Comprehensive results, discussion, and implications are analyzed.

Past Pain Experience and Experimentally induced Pain Perception

Many intercurrent factors may be involved in the modulation of the pain message and its expression, such as the previous experience of pain built along the life. In this study, we aimed to determine whether susceptibility to experimentally induced pain is differentially influenced by the individual previous painful experience in subjects with schizophrenia (SC) major depression (MD), and controls (C).

METHODS

The SC (30), MD (32) and C (30) groups participated in experimental pain tests (application of pressure and induction of ischemia) after a semi-structured interview to make an inventory of the previous painful experiences, and the evaluation of anxiety either with autonomic (heart rate, blood pressure) or psychological (Hospital Anxiety Depression scale HAD) measures, and catastrophism.

RESULTS

The reported pain intensities, severities, duration, of the previous pain events, and the number of previous painful events were equivalent in the three groups, except for the number of painful events experimented before the last six months which was lower in the MD group. Experimental pain sensitivity was influenced by the diagnosis, the HAD scores or the number and intensities of previous lived painful events.

CONCLUSION

The lack of a past experience of pain was comparable for the different groups, suggesting that psychiatric disorders do not affect the experience of pain associated with daily life or past events. For each subject, the reported previous experience of pain influences the present feeling of pain.

Bodily Sensory Inputs and Anomalous Bodily Experiences in Complex Regional Pain Syndrome: Evaluation of the Potential Effects of Sound Feedback

Neuroscientific studies have shown that human's mental body representations are not fixed but are constantly updated through sensory feedback, including sound feedback. This suggests potential new therapeutic sensory approaches for patients experiencing body-perception disturbances (BPD). BPD can occur in association with chronic pain, for example in Complex Regional Pain Syndrome (CRPS). BPD often impacts on emotional, social, and motor functioning. Here we present the results from a proof-of-principle pilot study investigating the potential value of using sound feedback for altering BPD and its related emotional state and motor behavior in those with CRPS. We build on previous findings that real-time alteration of the sounds produced by walking can alter healthy people's perception of their own body size, while also resulting in more active gait patterns and a more positive emotional state. In the present study we quantified the emotional state, BPD, pain levels and gait of twelve people with CRPS Type 1, who were exposed to real-time alteration of their walking sounds. Results confirm previous reports of the complexity of the BPD linked to CRPS, as participants could be classified into four BPD subgroups according to how they mentally visualize their body. Further, results suggest that sound feedback may affect the perceived size of the CRPS affected limb and the pain experienced, but that the effects may differ according to the type of BPD. Sound feedback affected CRPS descriptors and other bodily feelings and emotions including feelings of emotional dominance, limb detachment, position awareness, attention and negative feelings toward the limb. Gait also varied with sound feedback, affecting the foot contact time with the ground in a way consistent with experienced changes in body weight. Although, findings from this small pilot study should be interpreted with caution, they suggest potential applications for regenerating BDP and its related bodily feelings in a clinical setting for patients with chronic pain and BPD.

Vulvodynia is not created equally: empirical classification of women with vulvodynia

Background

Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity.

Objective

The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry. We hypothesized that women with vulvodynia can be clustered into subgroups based on distress and pain sensitivity.

Design

A cross-sectional study.

Methods

We conducted an exploratory hierarchical agglomerative cluster analysis using Ward’s cluster method and squared Euclidean distances to identify unique subgroups based on baseline psychological distress and pain sensitivity. The variables included the catastrophizing subscale of the Coping Strategies Questionnaire, the Beck Depression Inventory, the State Trait Anxiety Index-Trait scale, McGill Pain Questionnaire-Affective subscale, and vulvar and pelvic muscle pressure pain sensitivity.

Subjects

Eight sites enrolled women who presented with vaginal or vulval pain of at least 3-month duration.

Results

Two distinct subgroups, high pain sensitivity with high distress (n=27) and low pain sensitivity with low distress (n=100), emerged from the cluster analysis. Validation indicated that subgroups differed in terms of clinical pain intensity, sensory aspects of pain, and intercourse pain.

Conclusion

Empirical classification indicates that unique subgroups exist in women with vulvodynia. Providers should be aware of the heterogeneity of this condition with respect to pain-related distress and pain sensitivity.

Effects of systemic lidocaine versus magnesium administration on postoperative functional recovery and chronic pain in patients undergoing breast cancer surgery: A prospective, randomized, double-blind, comparative clinical trial

Introduction

We aimed to compare the effects of intraoperative lidocaine and magnesium on postoperative functional recovery and chronic pain after mastectomy due to breast cancer. Systemic lidocaine and magnesium reduce pain hypersensitivity to surgical stimuli; however, their effects after mastectomy have not been evaluated clearly.

Methods

In this prospective, double-blind, clinical trial, 126 female patients undergoing mastectomy were randomly assigned to lidocaine (L), magnesium (M), and control (C) groups. Lidocaine and magnesium were administered at 2 mg/kg and 20 mg/kg for 15 minutes immediately after induction, followed by infusions of 2 mg/kg/h and 20 mg/kg/h, respectively. The control group received the same volume of saline. Patient characteristics, perioperative parameters, and postoperative recovery profiles, including the Quality of Recovery 40 (QoR-40) survey, pain scales, length of hospital stay, and the short-form McGill pain questionnaire (SF-MPQ) at postoperative 1 month and 3 months were evaluated.

Results

The global QoR-40 scores on postoperative day 1 were significantly higher in group L than in group C (P = 0.003). Moreover, in sub-scores of the QoR-40 dimensions, emotional state and pain scores were significantly higher in group L than those in groups M and C (P = 0.027 and 0.023, respectively). At postoperative 3 months, SF-MPQ and SF-MPQ-sensitive scores were significantly lower in group L than in group C (P = 0.046 and 0.036, respectively).

Conclusions

Intraoperative infusion of lidocaine improved the quality of recovery and attenuated the intensity of chronic pain in patients undergoing breast cancer surgery.

Effects on Spasticity and Neuropathic Pain of an Oral Formulation of Δ9-tetrahydrocannabinol in Patients WithProgressive Multiple Sclerosis

PURPOSE

The aim of the present study was to evaluate the efficacy of an oral formulation of Δ9-tetrahydrocannabinol (ECP002A) in patients with progressive multiple sclerosis (MS).

METHODS

This accelerated proof-of-concept study consisted of 2 phases: a crossover challenge (dose-finding) phase and a 4-week, parallel, randomized, placebo-controlled treatment phase. Twenty-four patients with progressive MS and moderate spasticity were enrolled. During the treatment phase, biomarkers for efficacy and secondary pharmacodynamic effects were measured at baseline and after 2 and 4 weeks of treatment. Serum samples were collected to determine pharmacokinetic properties and perform population modeling. Safety and tolerability profiles were assessed based on adverse events and safety measurements.

FINDINGS

Pain was significantly reduced when measured directly after administration of ECP002A in the clinic but not when measured in a daily diary. A similar pattern was observed in subjective muscle spasticity. Other clinical outcomes were not significantly different between active treatment and placebo. Cognitive testing indicated that there was no decline in cognition after 2 or 4 weeks of treatment attributable to ECP002A compared with placebo. Implications This study specifically underlines the added value of thorough investigation of pharmacokinetic and pharmacodynamic associations in the target population. Despite the complex interplay of psychoactive effects and analgesia, the current oral formulation of Δ9-tetrahydrocannabinol may play a role in the treatment of spasticity and pain associated with MS because it was well tolerated and had a stable pharmacokinetic profile.

Rating Scales for Pain in Parkinson's Disease: Critique and Recommendations

BACKGROUND

We aimed at critically appraising the clinimetric properties of existing pain scales or questionnaires and to give recommendations for their use in Parkinson's disease (PD).

METHODS

Clinimetric properties of pain scales used in PD were systematically evaluated. A scale was classified as 'recommended' if was used in PD, showed adequate clinimetric properties, and had been used by investigators other than the original developers; as 'suggested' if it was used in PD and fulfilled only one other criterion; and as 'listed' if it was used in PD but did not meet the other criteria. Only scales rating pain intensity or for syndromic classification were assessed.

RESULTS

Eleven of the 34 scales initially considered fulfilled inclusion criteria. Among the scales rating pain intensity, the "Brief Pain Inventory short form," "McGill Pain Questionnaire short and long forms," "Neuropathic Pain Symptoms Inventory," "11-point Numeric Rating Scale," "10-cm Visual Analog Scale," and "Pain-O-Meter" were "recommended with caution" because of lack of clinimetric data in PD, whereas the "King's PD Pain Scale" was "recommended." Among scales for pain syndromic classification, the "DN4" was "recommended with caution" because of lack of clinimetric data in PD; the "Leeds Assessment of Neuropathic Symptoms and Signs," "Pain-DETECT," and the "King's PD Pain Scale" were "suggested."

CONCLUSIONS

King's PD pain scale can be recommended for the assessment of pain intensity in PD. Syndromic classification of pain in PD may be achieved by the DN4, but clinimetric data in PD are needed for this scale.

Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial

Nipple pain and damage are commonly experienced by breastfeeding women and are associated with negative breastfeeding outcomes. Health care providers often recommend the application of lanolin to treat painful/damaged nipples, yet no randomized controlled trial has evaluated the effectiveness of lanolin on nipple pain and breastfeeding outcomes. The purpose of this study was to evaluate the effect of lanolin on nipple pain among breastfeeding women with damaged nipples. A randomized, single-blind, controlled trial was conducted at a tertiary care hospital in Hamilton, Ontario, Canada. Breastfeeding women (N = 186) identified as having nipple pain/damage were randomized to apply lanolin (intervention group; n = 93) or to receive usual postpartum care (control group; n = 93). The primary outcome was nipple pain at 4 days post-randomization measured by the Numeric Rating Scale. Additional outcomes included nipple pain measured by the Short Form McGill Pain Questionnaire, breastfeeding duration/exclusivity, breastfeeding self-efficacy, and maternal satisfaction with lanolin treatment versus usual care. The results revealed no significant group differences in mean pain scores at 4 days post-randomization. Women in both groups experienced clinically relevant decreases in nipple pain by 7 days post-randomization. Significantly, more women in the lanolin group reported that they were satisfied with treatment compared with those receiving usual care. No significant group differences were found for other secondary outcomes. While more women were satisfied using lanolin, its application to sore/damaged nipples was ineffective for reducing nipple pain or improving breastfeeding outcomes.

Assessing multiple dimensions of urgency sensation: The University of South Australia Urinary Sensation Assessment (USA2 )

AIMS

To develop and assess structure, test-retest reliability, and discriminative validity of a self-report questionnaire (University of South Australia Urinary Sensation Assessment: USA² ) to assess multiple dimensions of urgency sensation.

METHODS

The USA² was designed and tested over two prospective, observational studies (2013-2014). Participants were English speaking Australians aged 50 or more with and without overactive bladder (OAB; determined by OAB awareness tool), recruited via health and recreation centers. In Study 1, exploratory factor analysis determined USA² structure and subscales. In Study 2, confirmatory factor analysis reassessed structure; Mann-Whitney U-tests determined discriminative validity (OAB vs. non-OAB for subscale and total scores) with Cohen's d effect sizes. Thirty-three individuals completed the USA² twice; intraclass correlation coefficients (ICCs) and Wilcoxon signed rank tests assessed test-retest reliability.

RESULTS

Questionnaires were returned by 189 eligible participants in Study 1 and 211 in Study 2. Exploratory factor analysis revealed three subscales: "urgency," "affective," "fullness." Confirmatory factor analysis supported these subscales. Subscale and total scores were significantly different between groups with and without OAB (P < 0.001). Cohen's d effect sizes (95%CI) were total score 1.8 (0.5-3.1), "urgency" subscale 1.8 (1.3-2.3), "affective" 1.7 (0.95-2.4), and "fullness" 0.75 (0.42-1.09). Total and subscales scores demonstrated test-retest reliability; ICCs (95%CIs) of 0.95 (0.9-0.98), 0.96 (0.92-0.98), 0.94 (0.88-0.97), and 0.78 (0.56-0.89).

CONCLUSIONS

The USA² assesses multiple dimensions of urgency sensation, is reliable over a 2-week period, and discriminates between older adults with and without OAB. Further validation is required in conditions other than overactive bladder. Neurourol. Urodynam. 36:667-672, 2017. © 2016 Wiley Periodicals, Inc.

A prospective time-series quality improvement trial of a standardized analgesia protocol to reduce postoperative pain among neurosurgery patients

OBJECTIVE The inclusion of the pain management domain in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey now ties patients' perceptions of pain and analgesia to financial reimbursement for inpatient stays. Therefore, the authors wanted to determine if a quality improvement initiative centered on a standardized analgesia protocol could significantly reduce postoperative pain among neurosurgery patients. METHODS The authors implemented a 10-month, prospective, interrupted time-series trial of a quality improvement initiative. The intervention consisted of a multimodal, interdepartmental, standardized analgesia protocol with process improvements from preadmission to discharge. All neurosurgical-floor patients participated in the quality improvement intervention, with data collected on a systematically randomly sampled subset of 96 patients for detailed analysis. Patient-reported numeric rating scale pain on the first postoperative day (POD) served as the primary outcome. RESULTS Implementation of the analgesia protocol resulted in improved preoperative and postoperative documentation of pain (p < 0.001) and improved use of multimodal analgesia, including use of NSAIDs (p < 0.009) and gabapentin (p < 0.027). This intervention also correlated with a 32% reduction in reported pain on the 1st POD for all neurosurgical patients (mean pain scale scores 4.31 vs 2.94; p = 0.000) and a 43% reduction among spinal surgery patients (mean pain scale scores 5.45 vs 3.10; p = 0.036). After controlling for covariates, implementation of the protocol was a significant predictor of lowered postoperative pain (p = 0.05) on the 1st POD. This reduction in pain correlated with protocol compliance (p = 0.028), and a significant decrease in the monthly number of naloxone doses suggests improved safety (mean dose ± SD 1.5 ± 1.0 vs 0.33 ± 0.5; p = 0.04). Furthermore, a significant and persistent reduction in the pain management component of the HCAHPS scores suggests a durability of results extending beyond the life of the study (72.1% vs 82.0%; p = 0.033). CONCLUSIONS The implementation of a standardized analgesia protocol can significantly reduce postoperative pain among neurosurgical patients while increasing safety. Given the current climate of patient-centered outcomes, this study has broad implications for the continuum of care model proposed in the Affordable Care Act. Clinical trial registration no.: NCT01693588 ( clincaltrials.gov ).

High-Definition and Non-invasive Brain Modulation of Pain and Motor Dysfunction in Chronic TMD

BACKGROUND

Temporomandibular disorders (TMD) have a high prevalence and in many patients pain and masticatory dysfunction persist despite a range of treatments. Non-invasive brain neuromodulatory methods, namely transcranial direct current stimulation (tDCS), can provide relatively long-lasting pain relief in chronic pain patients.

OBJECTIVE

To define the neuromodulatory effect of five daily 2x2 motor cortex high-definition tDCS (HD-tDCS) sessions on clinical pain and motor measures in chronic TMD patients. It is predicted that M1 HD-tDCS will selectively modulate clinical measures, by showing greater analgesic after-effects compared to placebo, and active treatment will increase pain free jaw movement more than placebo.

METHODS

Twenty-four females with chronic myofascial TMD pain underwent five daily, 20-min sessions of active or sham 2 milliamps (mA) HD-tDCS. Measurable outcomes included pain-free mouth opening, visual analog scale (VAS), sectional sensory-discriminative pain measures tracked by a mobile application, short form of the McGill Pain Questionnaire, and the Positive and Negative Affect Schedule. Follow-up occurred at one-week and four-weeks post-treatment.

RESULTS

There were significant improvements for clinical pain and motor measurements in the active HD-tDCS group compared to the placebo group for: responders with pain relief above 50% in the VAS at four-week follow-up (P = 0.04); pain-free mouth opening at one-week follow-up (P < 0.01); and sectional pain area, intensity and their sum measures contralateral to putative M1 stimulation during the treatment week (P < 0.01). No changes in emotional values were shown between groups.

CONCLUSION

Putative M1 stimulation by HD-tDCS selectively improved meaningful clinical sensory-discriminative pain and motor measures during stimulation, and up to four-weeks post-treatment in chronic myofascial TMD pain patients.

Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain

Introduction

Evidence suggests that painful intercourse, pain-related psychosocial factors, and altered pain processing magnify the pain experience, but it is not clear how these factors are related to each other.

Aim

The aims were to (i) characterize differences between women with pelvic pain and pain-free women using a battery of pain-related psychosocial measures, clinical pain ratings, and evoked local and remote pain sensitivity; and (ii) examine the relationship between intercourse pain, clinical pain, and local and remote evoked pain sensitivity.

Methods

Women with pelvic pain lasting at least 3 months and pain-free women completed questionnaires and underwent pain sensitivity testing. Self-report measures included clinical pain intensity, pain catastrophizing, pain-related fear, pain anxiety, depression, sexual function, and self-efficacy. Pain sensitivity measures included threshold and tolerance and temporal summation of pain. Separate analyses of variance (anova) were used to test group differences in self-report and pain sensitivity measures. Correlations were calculated among dyspareunia, psychosocial factors, and evoked pain.

Main Outcome Measures

Self-reported pain and pain sensitivity measures.

Results

Twenty-eight pain-free women and 14 women with pelvic pain participated in this study. Women with pelvic pain reported greater pain intensity and greater psychosocial involvement compared with pain-free women. No differences existed between groups for thermal or pressure measures, but women with pelvic pain rated their pain with pain testing significantly higher than pain-free women. Intercourse pain was significantly associated with affective and sensory pain and pressure pain ratings at the puborectalis, vulvar vestibule, adductor longus tendons, and tibialis anterior muscle.

Conclusions

Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23.

Confirmatory factor analysis of the Korean version of the short-form McGill pain questionnaire with chronic pain patients: a comparison of alternative models

Background

The Short Form of the McGill Pain Questionnaire (SF-MPQ) is the most widely used assessment of the quality and intensity of pain. In previous validation studies, the factor structure of the SF-MPQ varied widely from various two-factor structures to a five-factor structure, although research on the SF-MPQ quite consistently supports its two-factor structure (i.e., sensory and affective) across different countries and languages. In Korea, the results of exploratory factor analysis of a Korea version of SF-MPQ (KSF-MPQ) showed 2-factor structure consisting of ‘sensory’ and ‘affective’ excluding two items such as splitting and heavy. As an attempt to further validate the KSF-MPQ, the purpose of this study was to confirm whether the KSF-MPQ model is an appropriate model for chronic pain patients in Korea by comparing several alternative models of the SF-MPQ.

Findings

A total of 150 chronic pain patients seeking treatment in Seoul, Korea, participated and completed the KSF-MPQ. Confirmatory factor analysis was conducted to evaluate the adequacy of the KSF-MPQ model and several alternative models. The results indicated that the adjusted KSF-MPQ model showed the best fit to the data among the models in chronic pain patients in Korea.

Conclusions

The results showed the KSF-MPQ is cross-culturally equivalent to the original questionnaire. Thus, the KSF-MPQ is valid measurement for assessing the quality and intensity of pain to chronic pain patients and may be helpful in clinical and research settings in Korea.

In-home telerehabilitation for proximal humerus fractures: a pilot study

The objective of this study was to investigate the feasibility of an in-home telerehabilitation program for proximal humerus fractures. Seventeen patients with proximal humerus fractures were recruited by an orthopedic specialist during emergency room visits. Telerehabilitation treatments were given at the patient’s home over an 8-week period using a videoconferencing system. Pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), disabilities including shoulder range of motion (flexion, extension, internal rotation, external rotation, abduction), and upper limb function (Disability of the Arm, Shoulder and Hand questionnaire [DASH]) were measured in face-to-face evaluations before (T1) and immediately after (T2) the program. Participant satisfaction with the health care received was also evaluated at T2 with the Health care satisfaction questionnaire. All the clinical outcomes improved post-intervention (p < 0.05). Also, patient satisfaction was high (overall score of 82 ± 7%). Therefore, in-home teletreatment seems to be a promising way to dispense rehabilitation services for this population.

Associations between serum biomarkers and pain and pain-related function in older adults with low back pain: a pilot study

OBJECTIVES

To examine the relationship between serum biomarkers and self-reported pain intensity and pain-related function, in addition to the contribution of magnetic resonance imaging (MRI) findings of lumbar spine degenerative changes, in older adults with chronic low back pain.

DESIGN

Single-center cross-sectional cohort study.

SETTING

Academic medical center.

PARTICIPANTS

Individuals aged 60 and older with axial low back pain without radiculopathy or previously diagnosed osteoarthritis of the knee or hip or pain outside the low back that is more severe than the back pain (n = 43).

MEASUREMENTS

To examine pain-related impairment, pain was measured on a pain thermometer and the McGill Pain Questionnaire Short Form was administered. To examine pain-related function or activity limitation, the Roland Morris Disability Questionnaire, Short Physical Performance Battery (SPPB), and repetitive trunk rotation were used. Single plasma samples were obtained before and after physical performance tests and analyzed for inflammatory markers (E-selectin and regulated on activation, normal T cell expressed and secreted (RANTES)), inhibitors of catabolic enzymes (tissue inhibitor of metalloproteinases-1 (TIMP-1)), markers of matrix turnover (C- telopeptide of type II collagen (CTX-II) and aggrecan chondroitin sulfate 846 (CS846)), and stress biomarkers (neuropeptide Y (NPY)). Conventional nongadolinium lumbar MRI was performed and analyzed quantitatively and clinically.

RESULTS

Composite MRI measurements did not show significant correlation with pain or pain-related function. Basal levels and changes in serum biomarkers in response to activity, particularly NPY and RANTES, demonstrated associations with pain and pain-related function in addition to the explanatory power of MRI-based results.

CONCLUSION

Serum biomarkers may be a metric for assessment of active disease in older adults, in whom imaging changes are ubiquitous. In addition, changing levels of biomarkers in response to activity suggests that they may be useful as metrics to measure treatment responses in future studies and may reflect potential targets for use in designing personalized treatment for older adults with low back pain.

Fearful thinking predicts hypervigilance towards pain-related stimuli in patients with chronic pain

Cognitive impairment plays a role in the development and maintenance of chronic pain. Patients with painful disorders are reported to show attentional biases toward pain-related information. However, these findings are controversial, and rarely has any study examined whether chronic pain patients have attentional biases to pain-related conditioned stimuli (CS). In this study, twenty-one patients diagnosed with trigeminal neuralgia (TN) were recruited from the neurosurgical department of a large urban general hospital. Sixteen family members and twenty-one pain-free volunteers were included as two separate control groups. Pain ratings, pain-related anxiety, general anxiety, and depression were measured in all subjects using questionnaires. Two dot probe tests were performed, one that used pictures of painful versus neutral faces as cues, and another that presented three types of CS as cues that predicted certain, uncertain, or no pain. Our results demonstrate that the TN patients showed attentional biases towards painful faces and the CSs that signaled uncertain pain. Moreover, the ratings of negative emotion about their pain conditions correlated significantly with the presence of attentional biases. The patients' close family members, however, displayed biases towards uncertain-pain CS. This study demonstrates that patients with chronic pain have increased attention towards pain-related information, and the fearful thinking about pain was positively correlated with this phenomenon.