New treatments and new assessment instruments for hidradenitis suppurativa

Research interest in Hidradenitis Suppurativa (HS) has grown exponentially over the past decades. Several groups have worked to develop novel scores that address the drawbacks of existing investigator assessed and patient reported outcome measures currently used in HS trials, clinical practice and research. In clinical trial settings, the drawbacks of the HiSCR have become apparent; mainly it's lack of a dynamic measurement of draining tunnels. The newly developed (dichotomous) IHS4 and HASI-R are backed up by adequate validation data and are good contenders to become the new primary outcome measure in HS clinical trials. Patient reported outcomes, as well as physician reported measures, are being developed by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). For example, the Hidradenitis Suppurativa Quality of Life (HiSQOL) score is a validated measure of HS-specific quality of life and is already being used in many HS trials. Magnitude of pain measurement via a 0-10 numerical rating scale is well-established, however consensus is still required to ensure consistent administration and interpretation of the instrument. A longitudinal measurement over multiple days rather than at one time point, such as for example the Pain Index could provide increased reliability and reduced recall bias. Ultimately, these newly developed scores and tools can be included in a standardized registry to be used in routine clinical practice.

Electroencephalogram-derived pain index for evaluating pain during labor

Background

The discriminative ability of a point-of-care electroencephalogram (EEG)-derived pain index (Pi) for objectively assessing pain has been validated in chronic pain patients. The current study aimed to determine its feasibility in assessing labor pain in an obstetric setting.

Methods

Parturients were enrolled from the delivery room at the department of obstetrics in a tertiary hospital between February and June of 2018. Pi values and relevant numerical rating scale (NRS) scores were collected at different stages of labor in the presence or absence of epidural analgesia. The correlation between Pi values and NRS scores was analyzed using the Pearson correlation analysis. The receiver operating characteristic (ROC) curve was plotted to estimate the discriminative capability of Pi to detect labor pain in parturients.

Results

Eighty paturients were eligible for inclusion. The Pearson correlation analysis exhibited a positive correlation between Pi values and NRS scores in parturients (r = 0.768, P < 0.001). The ROC analysis revealed a cut-off Pi value of 18.37 to discriminate between mild and moderate-to-severe labor pain in parturients. Further analysis indicated that Pi values had the best diagnostic accuracy reflected by the highest area under the curve (AUC) of 0.857, with a sensitivity and specificity of 0.767 and 0.833, respectively, and a Youden index of 0.6. Subgroup analyses further substantiated the correlations between Pi values and NRS scores, especially in parturients with higher pain intensity.

Conclusion

This study indicates that Pi values derived from EEGs significantly correlate with the NRS scores, and can serve as a way to quantitatively and objectively evaluate labor pain in parturients.

Stinging wasps (Hymenoptera: Aculeata), which species have the longest sting?

The stings of bees, wasps, and ants are something that catches the attention of anyone that experiences them. While many recent studies have focused on the pain inflicted by the stings of various stinging wasps, bees, or ants (Hymenoptera: Aculeata), little is known about how the length of the sting itself varies between species. Here, we investigate the sting length of a variety of aculeate wasps, and compare that to reported pain and toxicity values. We find that velvet ants (Hymenoptera: Mutillidae) have the longest sting compared to their body size out of any bee, wasp, or ant species. We also find that there is no link between relative sting length and pain; however, we did find an inverse relationship between relative sting length and toxicity with taxa having shorter relative stings being more toxic. While we found a significant relationship between host use and relative sting length, we suggest that the long sting length of the velvet ants is also related to their suite of defenses to avoid predation.

Honey bee sting pain index by body location

The Schmidt Sting Pain Index rates the painfulness of 78 Hymenoptera species, using the honey bee as a reference point. However, the question of how sting painfulness varies depending on body location remains unanswered. This study rated the painfulness of honey bee stings over 25 body locations in one subject (the author). Pain was rated on a 1–10 scale, relative to an internal standard, the forearm. In the single subject, pain ratings were consistent over three repetitions. Sting location was a significant predictor of the pain rating in a linear model (p < 0.0001, DF = 25, 94, F = 27.4). The three least painful locations were the skull, middle toe tip, and upper arm (all scoring a 2.3). The three most painful locations were the nostril, upper lip, and penis shaft (9.0, 8.7, and 7.3, respectively). This study provides an index of how the painfulness of a honey bee sting varies depending on body location.