Scandinavian Journal of Pain最新文献

Objectives: The cold pressor test, in which subjects immerse part of an extremity in cold water for a specified amount of time, evokes both pain and unpleasantness. As it is low cost and readily available, it is widely used in pain research. However, data on the impact of race, area of exposure, and the effects of instructions are lacking.

Methods: Cold pressure test data were recorded in a mixed Asian and European healthy population. Trial 1 was a randomised crossover trial varying the extent of hand submersion (two fingers, four fingers, and whole hand) (n = 54). Trial 2 was a randomised cross-sectional design, investigating instructed and non-instructed pain expectations, n = 40.

Results: European subjects tolerated the cold pressor test longer than Asian subjects (116 ± 14 versus 93 ± 36 s, p < 0.001), and fewer subjects withdrew their hand in less than two minutes (9% vs 43%, p = 0.007). Stimulation area influenced pain tolerance, with more subjects able to maintain two-finger immersion in cold water for 2 min compared to whole-hand immersion (p < 0.001). The instruction or no instruction did not affect the numeric rating scale when comparing instruction levels (p = 0.88). Additionally, pain tolerance was not affected either (p = 1).

Conclusion: The cold pressor test is a robust tool across genders, race, and instruction levels. Significant differences were found in pain perception and tolerance across different locations and stimulation intensities. However, instructions in expected pain did not affect the outcomes, reflecting the robustness of the test.

Introduction: Trigeminal neuralgia (TN) caused by a dolichoectatic vertebral artery is a rare and atypical form of TN, where an enlarged and tortuous vertebral artery compresses the trigeminal nerve at its root entry zone. The term dolichoectatic is of Greek origin and means elongated, torturous or dilated. The vascular anomaly may lead to the characteristic severe, stabbing facial pain. This type of TN is often identified through advanced imaging techniques such as magnetic resonance imaging or angiography, which reveal the vascular anomaly impinging on the nerve. Treatment options for the type of TN secondary to dolichoectatic vertebrobasilar artery include primarily microvascular decompression or Gamma knife treatment to alleviate nerve compression and reduce symptoms.

Case reports: The authors present two illustrative cases of elderly patients: an 82-year-old with the right-sided and a 68-year-old patient with the left-sided facial pain, respectively. Both patients presented with lancinating and irritating facial pain. Magnetic resonance imaging in both patients confirmed compression of the trigeminal nerve secondary to a vertebrobasilar dolichoectatic artery. The authors performed microvascular decompression in both patients, which resulted in instant pain relief.

Conclusion: Early diagnosis and surgical intervention are crucial for effective pain management and improved patient outcomes.

Objectives: Most patients with chronic pain are identified and managed in primary care (PC). Chronic pain management is challenging, which is manifested by increased healthcare utilization (HCU) in this patient group. The interdisciplinary pain rehabilitation program (IPRP) is the gold standard treatment for patients with chronic pain but is scarcely used in PC. The aim of this study was to evaluate the HCU of patients with chronic pain in PC 1 year before and 1 year after an IPRP by examining the distribution of costs and resources.

Methods: This retrospective cohort study combined data from a national pain registry and HCU data from regional administrative registries, including 146 patients who participated in an IPRP in PC. The outcome measure was the number of outpatient healthcare contacts. Costs and the distribution of resources were compared across the two measurement intervals using paired t-tests. HCU costs were described from a healthcare provider perspective.

Results: HCU decreased by 16% in the year following IPRP compared to the year before. Costs for outpatient visits dropped by 12% or €434 per participant. Visits to physiotherapists and general practitioners decreased the most, by 31% (p = 0.048) and 23% (p < 0.001) respectively. Visits to nurses, occupational therapists, and psychologists/social workers in turn increased marginally (6%, 5% vs 10%).

Conclusions: IPRP in PC may lead to reduced HCU, freed resources, and streamlined chronic pain management. The study offers valuable insights into expected changes in HCU for chronic pain patients after an IPRP and how these changes may impact daily activities at the PC center.

Objectives: Chronic pain represents a major public health challenge, substantially affecting daily functioning and overall well-being. While self-management strategies can be effective, they are often introduced only after pharmacological or surgical treatments have proven insufficient, highlighting the need for more personalized, accessible, and early interventions in primary care. However, the feasibility and practical implementation of such approaches remain insufficiently explored. Considering these challenges, the aims of this study were to co-create and to evaluate the feasibility of a personalized, multidisciplinary, and coordinated intervention for chronic pain management within municipal healthcare services.

Methods: The intervention included a generic pain management course (part one) and a personalized second part offering various group-based courses. Participants (n = 70) were recruited through an orthopedic outpatient clinic and general practitioners. Individual consultations with course leaders were conducted before, during, and after the intervention. Questionnaires assessing health-related quality of life, alcohol consumption, medication use, and sleep were administered at baseline, midway, and post-intervention, along with a self-reported evaluation of the intervention after completion.

Results: Among the total participants (n = 70), 81% completed Part 1 of the intervention, while 61% completed the entire intervention. At baseline, participants had a mean EQ-5D-5L score of 0.65 and an EQ-VAS score of 48.8. Regarding alcohol use, 47% were drinking once a month or less, and no participants were drinking alcohol four or more times a week. Insomnia was reported by 84%. Paracetamol was the most used daily medication (41%), followed by non-steroidal anti-inflammatory drugs and weak opioids (26% each). In Part 2 of the intervention, stress management courses were the most frequently selected (26%), followed closely by physical activity and body-mind activity at 23%. Most participants reported benefit, with 63% (Part 1) and 56% (Part 2) indicating good or very good benefit, and 98% would recommend it to others.

Conclusion: This feasibility study demonstrates the potential for addressing the complex needs of individuals with chronic pain through a personalized and multidisciplinary intervention in primary care. The high completion rates indicate feasibility and acceptability. The findings support further evaluation of resource use, implementation, and effectiveness in future controlled trials.

Objectives: Pain assessment is challenging given its subjective nature, and existing assessment tools have limitations, especially for patients having problems with verbal communication. A prior study evaluated the Grasp, a handheld device for assessing pain intensity through squeezing, showing a moderate association with the numeric rating scale (NRS). This study examined an improved version of the Grasp with instant visual feedback through color-coded categories and compared it to NRS.

Methods: Healthy adults underwent two consecutive cold pressor tests (CPTs), reporting pain intensity via NRS or Grasp with colour-coded feedback. Two additional CPTs assessed the association of repeated measurements with both instruments. The Grasp was calibrated to individual strength before CPTs.

Results: Forty-six subjects completed all tests. Pain intensity association between Grasp and NRS was moderate with a mean Kendall's τ-b coefficient (τ-b) of 0.45, 95% confidence interval (CI) 0.35-0.56. Repeated Grasp measurements showed a moderate association (τ-b = 0.37, 95% CI 0.27-0.48), while repeated NRS measurements had a stronger association (τ-b = 0.71, 95% CI 0.64-0.78). After adjusting Grasp to individual squeeze strength (resulting in a 0.0-1.0 scale), a simple equation relating NRS value and mean Grasp value was identified: Grasp = 0.091 × NRS. Grouping reports into mild, moderate, and severe pain resulted in agreement proportions across two CPTs of 69% for Grasp and 79% for NRS.

Conclusions: The moderately high agreement proportions for pain intensity categories suggest that the Grasp method with colour-coded feedback may be useful for categorical pain intensity assessment, especially in settings where conventional tools (i.e., NRS) are inconvenient or not feasible.

Objectives: The purpose of the study was to assess the prevalence of both non-chronic and chronic pain among women of childbearing age and describe the impact that pain has on their health-related quality of life (HRQoL).

Methods: This is a cross-sectional cohort study, and the data were collected as part of the ICEPAIN nationwide study. Participants were recruited from a randomised sample, stratified by age and residence to secure a proportional sample, by email invitation. Women between 18 and 45 years of age participated, and data were collected through a web-based platform with questionnaires that measured sociodemographic characteristics, lifestyle factors, sleep quality, pain severity, characteristics of pain, pain interference (Brief Pain Inventory), and HRQoL (SF-12-v2). Spearman correlation was used when assessing relationships between demographic and lifestyle factors, and HRQoL and pain. Chi-square, Mann-Whitney U, ANOVA, and multivariate general linear model were used to assess group differences.

Results: In total, 969 women of childbearing age (18-45 years) participated in the study, and the response rate was 34.8%. The average age was 36.1 ± 6.3 years, and the majority (82.5%) were married, cohabiting, or in a steady relationship. Altogether, 45.9% of the sample reported having pain during the past week (n = 445); the vast majority, 80.4% (n = 366), had chronic pain. The majority of the participants, 57.3%, had moderate or severe pain. Chronic pain was significantly correlated with higher age, higher BMI, experiencing pain during the period, and poorer sleep quality. In contrast, no significant correlation was found between chronic pain and parity, residence, education, physical exercise, smoking, or alcohol drinking. Both non-chronic and chronic pain interfered with mood, sleep, general activities, and other aspects of daily life, and the effect of pain was significantly greater among women with chronic pain. Among these, pain severity was strongly correlated with the level of pain interference (0.79). A negative correlation between pain interference and HRQoL (physical component score, -0.64, and mental component score, -0.34) was observed among women with chronic pain.

Conclusions: Both non-chronic and chronic pain are common among women of childbearing age in Iceland. It interferes with daily life and affects their HRQoL.

Objectives: Pressure algometry is a validated method for objectively quantifying pain sensitivity in musculoskeletal disorders, particularly useful for diagnosis and monitoring of treatment responses. However, its application to abdominal pain sensitivity remains insufficiently standardized, especially regarding the influence of physiological factors such as respiration. This study investigated the impact of respiratory phase (inhalation vs exhalation) on abdominal pressure pain thresholds (PT) to support the development of standardized assessment protocols.

Methods: Thirty-one healthy medical students were recruited for the study. Each participant underwent three assessments of the abdominal PT with varying respiration phases. Furthermore, intraclass correlation coefficients (ICCs) were estimated to quantify the reliability of PT measurements.

Results: The respiration phase has a significant impact on the PT, which was found to be significantly lower during exhalation than during inhalation (431 ± 177 vs 492 ± 186 kPa, p = 0.0003). The pressure application rate (PAR) for the expiratory measurements was significantly lower compared to the inspiratory PAR (112 ± 56 vs 130 ± 63 kPa/s, p = 0.0007). Both ICCs had similar magnitudes (close to 0.9). No significant difference in PT was found between sexes.

Conclusions: Our study underscores the impact of respiration on pain perception, revealing increased abdominal PT during inhalation. A standardized approach is needed for abdominal PT assessment to guarantee its success in diagnostic and therapeutic evaluations.