Pub Date : 2024-03-22DOI: 10.1101/2024.03.20.24304546
Julia Kumar, Dylan Atkinson, Adaora Chima, Laura McLaughlin, Rajvi Parikh, Peter Mende-Siedlecki, Monica Mitchell, Vidya Chidambaran
Background and Objectives: Although racial disparities in pediatric pain have been described, family-centered research is lacking. This mixed-methods study aimed to understand race-specific factors impacting acute pain experiences in Non-Hispanic White (NHW) and Black (NHB) children. Methods: NHW and NHB children (aged 8-17) (n=19 each) with a recent acute pain experience, and their caregivers were recruited. The following domains were assessed in children (deprivation, ethnic identity, pain, psychosocial, pain coping, resilience) and caregivers (education, income, Racial and Ethnic Microaggressions Scale (REMS), Adverse Childhood Events (ACEs), Adult Response to Childs Symptoms). Questionnaire measures were compared between groups using simple statistical tests. Fifteen dyads participated in focus groups. Thematic codes underlying pain experiences were identified. Results: NHB children had similar pain/psychosocial characteristics but differed in ethnic identity (2.7 (0.5) vs. 2.2 (0.5); P=.002), deprivation index (0.4 (IQR 0.3-0.5) vs. 0.3 (IQR 0.2, 0.3), P=.007) and pain coping efficacy (8.6 (0.4) vs. 9.8 (0.5), P=.045) from NHW children. NHB caregivers scored higher on REMS sub-scales, ACEs (0 (0,1) vs 0 (0,0); P=.02) and Protection (1.9 (0.6) vs. 1.6 (0.5); P=.03) behaviors in response to child pain. NHB and NHW participants endorsed satisfaction with pain experiences, opioid avoidance, and stoicism. Unlike NHW participants, NHB reported barriers related to trust, discrimination, and access. Conclusions: Racial differences in acute pain experiences suggest healthcare providers need to reinforce trust and consider underlying cultural and pain coping differences when treating pain in NHB children. Findings emphasize that family-centered and systems-based approaches are important for equity in pediatric pain.
背景和目标：虽然已经描述了儿科疼痛的种族差异，但缺乏以家庭为中心的研究。这项混合方法研究旨在了解影响非西班牙裔白人（NHW）和黑人（NHB）儿童急性疼痛经历的种族特定因素：研究招募了近期有过急性疼痛经历的非西班牙裔白人（NHW）和非西班牙裔黑人（NHB）儿童（8-17 岁）（各 19 人）及其照顾者。对儿童（贫困、种族认同、疼痛、社会心理、疼痛应对、复原力）和照顾者（教育、收入、种族和民族微小侵害量表（REMS）、童年不良事件（ACEs）、成人对儿童症状的反应）进行了以下方面的评估。通过简单的统计检验对各组之间的问卷测量结果进行比较。15 对夫妇参加了焦点小组。确定了疼痛体验的主题代码。结果NHB儿童的疼痛/心理社会特征相似，但在种族身份（2.7 (0.5) vs. 2.2 (0.5); P=0.002）、贫困指数（0.4 (IQR 0.3-0.5) vs. 0.3 (IQR 0.2, 0.3), P=0.007）和疼痛应对能力（8.6 (0.4) vs. 9.8 (0.5), P=0.045）方面与NHW儿童不同。在 REMS 分量表中，NHB 儿童的照顾者在应对儿童疼痛时的 ACE（0 (0,1) vs 0 (0,0)；P=.02）和保护（1.9 (0.6) vs 1.6 (0.5)；P=.03）行为上得分更高。NHB 和 NHW 参与者对疼痛体验、避免使用阿片类药物和委曲求全表示满意。与国家卫生福利部的参与者不同，国家卫生福利部的参与者报告了与信任、歧视和获取相关的障碍：急性疼痛体验的种族差异表明，医护人员在治疗非华裔儿童的疼痛时需要加强信任，并考虑潜在的文化和疼痛应对差异。研究结果强调，以家庭为中心和以系统为基础的方法对于儿科疼痛的公平治疗非常重要。
{"title":"Mixed Methods Family Centered Study of Pain Experience in Non-Hispanic White and Black Children","authors":"Julia Kumar, Dylan Atkinson, Adaora Chima, Laura McLaughlin, Rajvi Parikh, Peter Mende-Siedlecki, Monica Mitchell, Vidya Chidambaran","doi":"10.1101/2024.03.20.24304546","DOIUrl":"https://doi.org/10.1101/2024.03.20.24304546","url":null,"abstract":"Background and Objectives: Although racial disparities in pediatric pain have been described, family-centered research is lacking. This mixed-methods study aimed to understand race-specific factors impacting acute pain experiences in Non-Hispanic White (NHW) and Black (NHB) children.\u0000Methods: NHW and NHB children (aged 8-17) (n=19 each) with a recent acute pain experience, and their caregivers were recruited. The following domains were assessed in children (deprivation, ethnic identity, pain, psychosocial, pain coping, resilience) and caregivers (education, income, Racial and Ethnic Microaggressions Scale (REMS), Adverse Childhood Events (ACEs), Adult Response to Childs Symptoms). Questionnaire measures were compared between groups using simple statistical tests. Fifteen dyads participated in focus groups. Thematic codes underlying pain experiences were identified. Results: NHB children had similar pain/psychosocial characteristics but differed in ethnic identity (2.7 (0.5) vs. 2.2 (0.5); P=.002), deprivation index (0.4 (IQR 0.3-0.5) vs. 0.3 (IQR 0.2, 0.3), P=.007) and pain coping efficacy (8.6 (0.4) vs. 9.8 (0.5), P=.045) from NHW children. NHB caregivers scored higher on REMS sub-scales, ACEs (0 (0,1) vs 0 (0,0); P=.02) and Protection (1.9 (0.6) vs. 1.6 (0.5); P=.03) behaviors in response to child pain. NHB and NHW participants endorsed satisfaction with pain experiences, opioid avoidance, and stoicism. Unlike NHW participants, NHB reported barriers related to trust, discrimination, and access.\u0000Conclusions: Racial differences in acute pain experiences suggest healthcare providers need to reinforce trust and consider underlying cultural and pain coping differences when treating pain in NHB children. Findings emphasize that family-centered and systems-based approaches are important for equity in pediatric pain.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140205203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-16DOI: 10.1101/2024.03.15.24304340
Eva Beiner, Michelle Hermes, Julian Reichert, Kristian Kleinke, Stephanie Vock, Annette Loeffler, Leonie Ader, Andrei Sirazitdinov, Sebastian Keil, Tim Schmidt, Anita Schick, Martin Loeffler, Michael Hopp, Christian Ruckes, Juergen Hesser, Ulrich Reininghaus, Herta Flor, Wolfgang Eich, Hans-Christoph Friederich, Jonas Tesarz
Introduction: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue and tenderness and closely associated with high levels of stress. FMS is therefore often considered a stress-related disease. Methods: A comparative study was conducted with 99 individuals diagnosed with FMS and a control group of 50 pain-free individuals. Stress indicators were classified into three categories: perceived stress assessed using the Perceived Stress Scale, and daily average salivary cortisol and hair cortisol concentrations as indicators of acute and chronic stress levels related to the hypothalamic-pituitary-adrenal axis. Analysis of variance and covariance were used to identify group differences and the influence of covariates age, sex, and body mass index. Correlational analyses further elucidated the relationship between stress indicators and clinical symptoms. Results: Participants with FMS reported significantly higher perceived stress levels than controls (p < .001, ηp2 = .3), which were positively correlated with symptom burden (r = .64, p < .001). In contrast, there were no significant differences in the endocrinological stress indicators salivary and hair cortisol between the groups (p > .05), nor were these indicators associated with clinical symptoms. Conclusion: The study highlights the central role of perceived stress in FMS, whereas endocrinological indicators did not differentiate FMS from controls. This finding calls for a nuanced approach to clinical assessment and therapeutic interventions tailored to patients with FMS, emphasizing the management of perceived stressors.
{"title":"Perceived and endocrine acute and chronic stress indicators in fibromyalgia syndrome","authors":"Eva Beiner, Michelle Hermes, Julian Reichert, Kristian Kleinke, Stephanie Vock, Annette Loeffler, Leonie Ader, Andrei Sirazitdinov, Sebastian Keil, Tim Schmidt, Anita Schick, Martin Loeffler, Michael Hopp, Christian Ruckes, Juergen Hesser, Ulrich Reininghaus, Herta Flor, Wolfgang Eich, Hans-Christoph Friederich, Jonas Tesarz","doi":"10.1101/2024.03.15.24304340","DOIUrl":"https://doi.org/10.1101/2024.03.15.24304340","url":null,"abstract":"Introduction: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue and tenderness and closely associated with high levels of stress. FMS is therefore often considered a stress-related disease.\u0000Methods: A comparative study was conducted with 99 individuals diagnosed with FMS and a control group of 50 pain-free individuals. Stress indicators were classified into three categories: perceived stress assessed using the Perceived Stress Scale, and daily average salivary cortisol and hair cortisol concentrations as indicators of acute and chronic stress levels related to the hypothalamic-pituitary-adrenal axis. Analysis of variance and covariance were used to identify group differences and the influence of covariates age, sex, and body mass index. Correlational analyses further elucidated the relationship between stress indicators and clinical symptoms.\u0000Results: Participants with FMS reported significantly higher perceived stress levels than controls (p < .001, ηp2 = .3), which were positively correlated with symptom burden (r = .64, p < .001). In contrast, there were no significant differences in the endocrinological stress indicators salivary and hair cortisol between the groups (p > .05), nor were these indicators associated with clinical symptoms.\u0000Conclusion: The study highlights the central role of perceived stress in FMS, whereas endocrinological indicators did not differentiate FMS from controls. This finding calls for a nuanced approach to clinical assessment and therapeutic interventions tailored to patients with FMS, emphasizing the management of perceived stressors.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.09.24304024
Omar Khoja, Bárbara Silva-Passadouro, Elena Cristescu, Katie McEwan, Derek Doherty, Fiona OConnell, Frederique Ponchel, Matthew Mulvey, Sarah Astill, Ai Lyn Tan, Manoj Sivan
Purpose: New-onset chronic musculoskeletal (MSK) pain is one of the common persistent symptoms in Long COVID (LC). This study investigated its clinical characteristics, underlying mechanisms, and impact on function, psychological health, and quality of life. Patients and methods: 30 adults (19 female, 11 male) with LC and new-onset chronic MSK pain underwent clinical examination, Quantitative Sensory Testing (QST), and blood tests for inflammatory markers, and completed the following outcome measures: Timed Up and Go test (TUG), handgrip strength test, COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), Brief Pain Inventory (BPI), Pain Self-Efficacy Questionnaire (PSEQ), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire - short form (IPAQ-sf), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and EuroQol Five Dimensions health-related quality of life (EQ-5D-5L). Results: New-onset chronic MSK pain was widespread and continuous in nature, and worse in the joints. When compared to normative values reported in the literature: a) QST revealed mechanical hyperalgesia, heightened temporal summation of pain, and hypoesthesia to vibration stimuli, which is strongly suggestive of central sensitization; b) Plasma cytokine assays indicated distinct pro- inflammatory profiles; c) TUG time indicated reduced balance and mobility; d) handgrip strength revealed general weakness; e) physical activity was lower ; and f) there were moderate levels of depression and anxiety with lower self-efficacy scores and lower levels of pain catastrophizing. LC symptoms were of moderate severity (44.8/100), moderate functional disability (22.8/50) and severely compromised overall health (2.6/10) when compared to pre-COVID scores. Conclusion: New-onset chronic MSK pain in LC tends to be widespread, constant, and associated with weakness, reduced function, depression, anxiety, and reduced quality of life. There is associated central sensitization and proinflammatory state in the condition. Further research is essential to explore the longitudinal progression and natural evolution of the new-onset chronic MSK pain in LC.
{"title":"Clinical characterization of new-onset chronic musculoskeletal pain in Long COVID: a cross-sectional study","authors":"Omar Khoja, Bárbara Silva-Passadouro, Elena Cristescu, Katie McEwan, Derek Doherty, Fiona OConnell, Frederique Ponchel, Matthew Mulvey, Sarah Astill, Ai Lyn Tan, Manoj Sivan","doi":"10.1101/2024.03.09.24304024","DOIUrl":"https://doi.org/10.1101/2024.03.09.24304024","url":null,"abstract":"Purpose: New-onset chronic musculoskeletal (MSK) pain is one of the common persistent symptoms in Long COVID (LC). This study investigated its clinical characteristics, underlying mechanisms, and impact on function, psychological health, and quality of life.\u0000Patients and methods: 30 adults (19 female, 11 male) with LC and new-onset chronic MSK pain underwent clinical examination, Quantitative Sensory Testing (QST), and blood tests for inflammatory markers, and completed the following outcome measures: Timed Up and Go test (TUG), handgrip strength test, COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), Brief Pain Inventory (BPI), Pain Self-Efficacy Questionnaire (PSEQ), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire - short form (IPAQ-sf), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and EuroQol Five Dimensions health-related quality of life (EQ-5D-5L).\u0000Results: New-onset chronic MSK pain was widespread and continuous in nature, and worse in the joints. When compared to normative values reported in the literature: a) QST revealed mechanical hyperalgesia, heightened temporal summation of pain, and hypoesthesia to vibration stimuli, which is strongly suggestive of central sensitization; b) Plasma cytokine assays indicated distinct pro- inflammatory profiles; c) TUG time indicated reduced balance and mobility; d) handgrip strength revealed general weakness; e) physical activity was lower ; and f) there were moderate levels of depression and anxiety with lower self-efficacy scores and lower levels of pain catastrophizing. LC symptoms were of moderate severity (44.8/100), moderate functional disability (22.8/50) and severely compromised overall health (2.6/10) when compared to pre-COVID scores.\u0000Conclusion: New-onset chronic MSK pain in LC tends to be widespread, constant, and associated with weakness, reduced function, depression, anxiety, and reduced quality of life. There is associated central sensitization and proinflammatory state in the condition. Further research is essential to explore the longitudinal progression and natural evolution of the new-onset chronic MSK pain in LC.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-24DOI: 10.1101/2024.02.23.24302234
Mienke Rijsdijk, Hidde M Smits, Hazal R Azizoglu, Sylvia Brugman, Yoeri van de Burgt, Tessa C van Charldorp, Dewi J van Gelder, Janny C de Grauw, Eline A van Lange, Frank J Meye, Madelijn Strick, Hedi Walravens, Laura H.H. Winkens, Frank J.P.M. Huygen, Julia Drylewicz, Hanneke LDM Willemen
Background: Chronic pain is an ill-defined disease with complex biopsychosocial aspects, posing treatment challenges. We hypothesize that treatment failure results, at least partly, from limited understanding of diverse patient subgroups. We aim to identify subgroups through psychometric data, allowing for more tailored interventions. Methods: For this retrospective cohort study, we extracted patient-reported data from two Dutch tertiary multidisciplinary outpatient pain clinics (2018-2023) for unsupervised hierarchical clustering. Clusters were defined by anxiety, depression, pain catastrophizing, and kinesiophobia. Sociodemographics, pain characteristics, diagnosis, lifestyle, health-related quality of life (HRQoL) and treatment efficacy were compared among clusters. A prediction model was built utilizing a minimum set of questions to reliably assess cluster allocation. Results: Among 5,454 patients with chronic pain, three clusters emerged. Cluster 1 (n=750) was characterized by high psychological burden, low HRQoL, lower educational levels and employment rates, and more smoking. Cluster 2 (n=1,795) showed low psychological burden, intermediate HRQoL, higher educational levels and employment rates, and more alcohol consumption. Cluster 3 (n=2,909) showed intermediate features. Pain reduction following treatment was least in cluster 1 (28.6% after capsaicin patch, 18.2% after multidisciplinary treatment), compared to >50% in clusters 2 and 3. A model incorporating 15 psychometric questions reliably predicted cluster allocation. In conclusion, our study identifies distinct chronic pain patient clusters through 15 psychometric questions, revealing one cluster with notably poorer response to conventional treatment. Our prediction model may help clinicians improve treatment by allowing patient-subgroup targeted therapy according to cluster allocation.
{"title":"Divergent treatment responses in chronic pain: Identifying subgroups of patients through cluster analysis.","authors":"Mienke Rijsdijk, Hidde M Smits, Hazal R Azizoglu, Sylvia Brugman, Yoeri van de Burgt, Tessa C van Charldorp, Dewi J van Gelder, Janny C de Grauw, Eline A van Lange, Frank J Meye, Madelijn Strick, Hedi Walravens, Laura H.H. Winkens, Frank J.P.M. Huygen, Julia Drylewicz, Hanneke LDM Willemen","doi":"10.1101/2024.02.23.24302234","DOIUrl":"https://doi.org/10.1101/2024.02.23.24302234","url":null,"abstract":"Background: Chronic pain is an ill-defined disease with complex biopsychosocial aspects, posing treatment challenges. We hypothesize that treatment failure results, at least partly, from limited understanding of diverse patient subgroups. We aim to identify subgroups through psychometric data, allowing for more tailored interventions.\u0000Methods: For this retrospective cohort study, we extracted patient-reported data from two Dutch tertiary multidisciplinary outpatient pain clinics (2018-2023) for unsupervised hierarchical clustering. Clusters were defined by anxiety, depression, pain catastrophizing, and kinesiophobia. Sociodemographics, pain characteristics, diagnosis, lifestyle, health-related quality of life (HRQoL) and treatment efficacy were compared among clusters. A prediction model was built utilizing a minimum set of questions to reliably assess cluster allocation. Results: Among 5,454 patients with chronic pain, three clusters emerged. Cluster 1 (n=750) was characterized by high psychological burden, low HRQoL, lower educational levels and employment rates, and more smoking. Cluster 2 (n=1,795) showed low psychological burden, intermediate HRQoL, higher educational levels and employment rates, and more alcohol consumption. Cluster 3 (n=2,909) showed intermediate features. Pain reduction following treatment was least in cluster 1 (28.6% after capsaicin patch, 18.2% after multidisciplinary treatment), compared to >50% in clusters 2 and 3. A model incorporating 15 psychometric questions reliably predicted cluster allocation.\u0000In conclusion, our study identifies distinct chronic pain patient clusters through 15 psychometric questions, revealing one cluster with notably poorer response to conventional treatment. Our prediction model may help clinicians improve treatment by allowing patient-subgroup targeted therapy according to cluster allocation.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139953041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.1101/2024.02.07.24302408
Marwan N Baliki, Andrew D. Vigotsky, Gaelle Rached, Rami Jabakhanji, Lejian Huang, Paulo Branco, Olivia Cong, James Griffith, Ajay D. Wasan, Thomas J. Schnitzer, A. Vania Apkarian
Chronic pain is commonly treated with long-term opioids, but the neuropsychological outcomes associated with stable long-duration opioid use remain unclear. Here, we contrasted the psychological profiles, brain activity, and brain structure of 70 chronic back pain patients on opioids (CBP+O, average opioid exposure 6.2 years) with 70 patients managing their pain without opioids. CBP+O exhibited moderately worse psychological profiles and small differences in brain morphology. However, CBP+O had starkly different spontaneous brain activity, dominated by increased mesocorticolimbic and decreased dorsolateral-prefrontal activity, even after controlling for pain intensity and duration. These differences strongly reflected cortical opioid and serotonin receptor densities and mapped to two antagonistic resting-state circuits. The circuits’ dynamics were explained by mesocorticolimbic activity and reflected negative affect. We reassessed a sub-group of CBP+O after they briefly abstained from taking opioids. Network dynamics, but not spontaneous activity, reflected exacerbated signs of withdrawal. Our results have implications for the management and tapering of opioids in chronic pain.
{"title":"Neuropsychology of chronic back pain managed with long-term opioid use","authors":"Marwan N Baliki, Andrew D. Vigotsky, Gaelle Rached, Rami Jabakhanji, Lejian Huang, Paulo Branco, Olivia Cong, James Griffith, Ajay D. Wasan, Thomas J. Schnitzer, A. Vania Apkarian","doi":"10.1101/2024.02.07.24302408","DOIUrl":"https://doi.org/10.1101/2024.02.07.24302408","url":null,"abstract":"Chronic pain is commonly treated with long-term opioids, but the neuropsychological outcomes associated with stable long-duration opioid use remain unclear. Here, we contrasted the psychological profiles, brain activity, and brain structure of 70 chronic back pain patients on opioids (CBP+O, average opioid exposure 6.2 years) with 70 patients managing their pain without opioids. CBP+O exhibited moderately worse psychological profiles and small differences in brain morphology. However, CBP+O had starkly different spontaneous brain activity, dominated by increased mesocorticolimbic and decreased dorsolateral-prefrontal activity, even after controlling for pain intensity and duration. These differences strongly reflected cortical opioid and serotonin receptor densities and mapped to two antagonistic resting-state circuits. The circuits’ dynamics were explained by mesocorticolimbic activity and reflected negative affect. We reassessed a sub-group of CBP+O after they briefly abstained from taking opioids. Network dynamics, but not spontaneous activity, reflected exacerbated signs of withdrawal. Our results have implications for the management and tapering of opioids in chronic pain.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139764981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.1101/2024.01.29.24301629
Celina G Virgen, Robert Wright, Bryan Renslo, Tuleen Sawaf, Hanna Moradi, Maria Edelen, Jennifer Villwock
The Activity Based-Checks of Pain (ABCs) is a pain assessment tool incorporating activities of daily living and instrumental activities of daily living. Unlike widely used pain scales which are oftentimes unidimensional and highly subjective, the ABCs was designed to focus on function capabilities and limitations of patients due to pain. This study sought out to validate the factorial structure of the ABCs and assess its use in participants with chronic pain. Participants were recruited in two phases from Prolific; an online service designed to identify research participant recruitment based on study criteria. Phase one optimized the design of the ABCs, with 297 subjects selecting their preferred icon for each function and rating its understandability. The most preferred and understandable icons were then used in phase two, where 304 chronic pain participants completed the ABCs, PROMIS-29, additional PROMIS items that were analogous to the ABCs functions but not represented in the PROMIS-29, and the Brief Pain Inventory (BPI). Data was analyzed using exploratory factor analysis and confirmatory factor analysis demonstrating four factor loadings: multi-planal activities, sitting/hip flexor pain, walking/ambulation, and pain interference with lightweight unilateral activities. High internal consistency was demonstrated with all four factor loadings. Correlations between items in the ABCs, PROMIS, and BPI resulted in moderate to strong correlations demonstrating strong evidence for the validity of the ABCs as a functional pain assessment tool.
{"title":"Development and Validation of The Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale","authors":"Celina G Virgen, Robert Wright, Bryan Renslo, Tuleen Sawaf, Hanna Moradi, Maria Edelen, Jennifer Villwock","doi":"10.1101/2024.01.29.24301629","DOIUrl":"https://doi.org/10.1101/2024.01.29.24301629","url":null,"abstract":"The Activity Based-Checks of Pain (ABCs) is a pain assessment tool incorporating activities of daily living and instrumental activities of daily living. Unlike widely used pain scales which are oftentimes unidimensional and highly subjective, the ABCs was designed to focus on function capabilities and limitations of patients due to pain. This study sought out to validate the factorial structure of the ABCs and assess its use in participants with chronic pain. Participants were recruited in two phases from Prolific; an online service designed to identify research participant recruitment based on study criteria. Phase one optimized the design of the ABCs, with 297 subjects selecting their preferred icon for each function and rating its understandability. The most preferred and understandable icons were then used in phase two, where 304 chronic pain participants completed the ABCs, PROMIS-29, additional PROMIS items that were analogous to the ABCs functions but not represented in the PROMIS-29, and the Brief Pain Inventory (BPI). Data was analyzed using exploratory factor analysis and confirmatory factor analysis demonstrating four factor loadings: multi-planal activities, sitting/hip flexor pain, walking/ambulation, and pain interference with lightweight unilateral activities. High internal consistency was demonstrated with all four factor loadings. Correlations between items in the ABCs, PROMIS, and BPI resulted in moderate to strong correlations demonstrating strong evidence for the validity of the ABCs as a functional pain assessment tool.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139586314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-28DOI: 10.1101/2024.01.26.24301834
Katarina Jones, Megan Armstrong, John Luna, Rajan Thakkar, Fabia Renata, Jonathan Groner, Dana Noffsinger, Ai Ni, Bronwyn Griffin, Henry Xiang
Virtual reality (VR) effectively alleviates pain for pediatric patients during many medical care procedures, such as venipuncture and burn wound care. Whether VR pain alleviation therapeutics (VR-PAT) differ by a patients age or sex remains unresolved. This randomized clinical trial evaluated how age and sex affect VR pain alleviation during dressing care for pediatric burns. Ninety patients aged 6 to 17 years (inclusive) with burn injuries were recruited from an outpatient burn clinic of an American Burn Association verified pediatric burn center. Before randomization, expectations of VR helpfulness and need were assessed on a visual analog scale (VAS, 0 to 100). Participants were randomly assigned to active or passive VR for one burn dressing change. Immediately following the dressing change, participants self reported pain and the time spent thinking about pain and rated the VR features on the degrees of realism experienced, pleasure/fun, and perceived engagement level. Path analyses assessed how these VR features were interrelated and how they affected self-reported pain by age and sex. Patients aged 6 to 9 years reported higher mean expectations of VR helpfulness and need (mean=73.6 and 94.5, respectively) than 10 to 12 year olds (mean=55.7 and 84.2, respectively) and 13 to 17 year olds (mean=68.6 and 77.4, respectively). The path analysis indicated VR engagement and fun were significantly correlated (p value <0.05). VR engagement significantly negatively impacted overall pain scores during burn dressing (coefficient=-0.45, -0.41; p value <0.05) and significantly positively impacted time thinking of pain (coefficient=0.38, 0.32; p value <0.05). Younger patients had the highest expectations of VR pain alleviation helpfulness and need. VR game realism, fun, and engagement features were not statistically different between age groups and sexes. VR engagement and thinking of pain during burn dressing significantly positively affected self-reported pain (p value <0.05), suggesting an analgesic mechanism beyond distraction alone. Younger patients benefited more from VR pain alleviation therapeutics than older patients.
{"title":"Age and Sex Differences of Virtual Reality Pain Alleviation Therapeutic During Pediatric Burn Care: A Randomized Clinical Trial","authors":"Katarina Jones, Megan Armstrong, John Luna, Rajan Thakkar, Fabia Renata, Jonathan Groner, Dana Noffsinger, Ai Ni, Bronwyn Griffin, Henry Xiang","doi":"10.1101/2024.01.26.24301834","DOIUrl":"https://doi.org/10.1101/2024.01.26.24301834","url":null,"abstract":"Virtual reality (VR) effectively alleviates pain for pediatric patients during many medical care procedures, such as venipuncture and burn wound care. Whether VR pain alleviation therapeutics (VR-PAT) differ by a patients age or sex remains unresolved. This randomized clinical trial evaluated how age and sex affect VR pain alleviation during dressing care for pediatric burns. Ninety patients aged 6 to 17 years (inclusive) with burn injuries were recruited from an outpatient burn clinic of an American Burn Association verified pediatric burn center. Before randomization, expectations of VR helpfulness and need were assessed on a visual analog scale (VAS, 0 to 100). Participants were randomly assigned to active or passive VR for one burn dressing change. Immediately following the dressing change, participants self reported pain and the time spent thinking about pain and rated the VR features on the degrees of realism experienced, pleasure/fun, and perceived engagement level. Path analyses assessed how these VR features were interrelated and how they affected self-reported pain by age and sex. Patients aged 6 to 9 years reported higher mean expectations of VR helpfulness and need (mean=73.6 and 94.5, respectively) than 10 to 12 year olds (mean=55.7 and 84.2, respectively) and 13 to 17 year olds (mean=68.6 and 77.4, respectively). The path analysis indicated VR engagement and fun were significantly correlated (p value <0.05). VR engagement significantly negatively impacted overall pain scores during burn dressing (coefficient=-0.45, -0.41; p value <0.05) and significantly positively impacted time thinking of pain (coefficient=0.38, 0.32; p value <0.05). Younger patients had the highest expectations of VR pain alleviation helpfulness and need. VR game realism, fun, and engagement features were not statistically different between age groups and sexes. VR engagement and thinking of pain during burn dressing significantly positively affected self-reported pain (p value <0.05), suggesting an analgesic mechanism beyond distraction alone. Younger patients benefited more from VR pain alleviation therapeutics than older patients.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139586289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.1101/2024.01.22.24301597
Enrico De Martino, Adenauer Casali, Silvia Casarotto, Gabriel Hassan, Mario Rosanova, Bruno Andry Nascimento Couto, Thomas Graven-Nielsen, Daniel Ciampi de Andrade
Temporal dynamics of local cortical rhythms during acute pain remain largely unknown. The current study used a novel approach based on transcranial magnetic stimulation combined with electroencephalogram (TMS-EEG) to investigate evoked-oscillatory cortical activity during acute pain. Motor (M1) and dorsolateral prefrontal cortex (DLPFC) were probed by TMS, respectively, to record oscillatory power (event-related spectral perturbation and relative spectral power) and phase synchronization (inter-trial coherence) by 63 EEG channels during experimentally induced acute heat pain in 24 healthy participants. TMS-EEG was recorded before, during, and after noxious heat (Acute Pain condition) and non-noxious warm (Control condition), delivered in a randomized sequence. The main frequency bands (α, β1, and β2) of TMS-evoked potentials after M1 and DLPFC stimulation were recorded close to the TMS coil and remotely. Cold and heat pain thresholds were measured before TMS-EEG. Over M1, Acute pain decreased α-band oscillatory power locally and α-band phase synchronization remotely in parietal-occipital clusters compared with non-noxious warm (all P<0.05). The remote (parietal-occipital) decrease in α-band phase synchronization during Acute Pain correlated with the cold (P=0.001) and heat pain thresholds (P=0.023) and to local (M1) α-band oscillatory power decrease (P=0.024). Over DLPFC, Acute Pain only decreased β1-band power locally compared with non-noxious warm (P=0.015). Thus, evoked-oscillatory cortical activity to M1 stimulation is reduced by acute pain in central and parietal-occipital regions and correlated with pain sensitivity, in contrast to DLPFC, which had only local effects. This finding expands the significance of α and β band oscillations and may have relevance for pain therapies.
{"title":"Evoked oscillatory cortical activity during acute pain: Probing brain in pain by transcranial magnetic stimulation combined with electroencephalogram","authors":"Enrico De Martino, Adenauer Casali, Silvia Casarotto, Gabriel Hassan, Mario Rosanova, Bruno Andry Nascimento Couto, Thomas Graven-Nielsen, Daniel Ciampi de Andrade","doi":"10.1101/2024.01.22.24301597","DOIUrl":"https://doi.org/10.1101/2024.01.22.24301597","url":null,"abstract":"Temporal dynamics of local cortical rhythms during acute pain remain largely unknown. The current study used a novel approach based on transcranial magnetic stimulation combined with electroencephalogram (TMS-EEG) to investigate evoked-oscillatory cortical activity during acute pain. Motor (M1) and dorsolateral prefrontal cortex (DLPFC) were probed by TMS, respectively, to record oscillatory power (event-related spectral perturbation and relative spectral power) and phase synchronization (inter-trial coherence) by 63 EEG channels during experimentally induced acute heat pain in 24 healthy participants. TMS-EEG was recorded before, during, and after noxious heat (Acute Pain condition) and non-noxious warm (Control condition), delivered in a randomized sequence. The main frequency bands (α, β1, and β2) of TMS-evoked potentials after M1 and DLPFC stimulation were recorded close to the TMS coil and remotely. Cold and heat pain thresholds were measured before TMS-EEG. Over M1, Acute pain decreased α-band oscillatory power locally and α-band phase synchronization remotely in parietal-occipital clusters compared with non-noxious warm (all P<0.05). The remote (parietal-occipital) decrease in α-band phase synchronization during Acute Pain correlated with the cold (P=0.001) and heat pain thresholds (P=0.023) and to local (M1) α-band oscillatory power decrease (P=0.024). Over DLPFC, Acute Pain only decreased β1-band power locally compared with non-noxious warm (P=0.015). Thus, evoked-oscillatory cortical activity to M1 stimulation is reduced by acute pain in central and parietal-occipital regions and correlated with pain sensitivity, in contrast to DLPFC, which had only local effects. This finding expands the significance of α and β band oscillations and may have relevance for pain therapies.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"164 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139561876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-17DOI: 10.1101/2024.01.16.24301372
Andrew D. Vigotsky, Olivia Cong, Camila B Pinto, Joana Barroso, Jennifer Perez, Kristian Kjaer Petersen, Lars Arendt-Nielsen, Kevin Hardt, David Manning, A. Vania Apkarian, Paulo Branco
Total knee replacement (TKR) is the gold-standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6, and 12 months post-TKR. We assessed baseline and postoperative (3- and 6-months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM), and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia, and mechanical temporal summation to repeated pinprick stimulation. Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial OA-affected knee and cuff pressure on the ipsilateral calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with baseline KOA pain intensity. Moreover, baseline pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6- and 12-months, respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up, and vice-versa. Our findings suggest that preoperative pinprick hyperalgesia and PainDETECT neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.
{"title":"Mechanical hyperalgesia and neuropathic pain qualities impart risk for chronic postoperative pain after total knee replacement","authors":"Andrew D. Vigotsky, Olivia Cong, Camila B Pinto, Joana Barroso, Jennifer Perez, Kristian Kjaer Petersen, Lars Arendt-Nielsen, Kevin Hardt, David Manning, A. Vania Apkarian, Paulo Branco","doi":"10.1101/2024.01.16.24301372","DOIUrl":"https://doi.org/10.1101/2024.01.16.24301372","url":null,"abstract":"Total knee replacement (TKR) is the gold-standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6, and 12 months post-TKR. We assessed baseline and postoperative (3- and 6-months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM), and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia, and mechanical temporal summation to repeated pinprick stimulation. Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial OA-affected knee and cuff pressure on the ipsilateral calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with baseline KOA pain intensity. Moreover, baseline pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6- and 12-months, respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up, and vice-versa. Our findings suggest that preoperative pinprick hyperalgesia and PainDETECT neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139500530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1101/2023.12.18.23299896
Alessandra Venezia, Harriet Fawsitt-Jones, David Hohenschurz-Schmidt, Matteo Mancini, Matthew Howard, Elena Makovac
The autonomic nervous system (ANS) and pain exhibit a reciprocal relationship, whereupon acute pain triggers ANS responses, while resting ANS activity can influence pain perception. Nociceptive signalling can also be altered by "top-down" processes occurring in the brain, brainstem, and spinal cord, known as descending modulation. By employing the Conditioned Pain Modulation (CPM) paradigm, our previous study revealed a connection between reduced low-frequency heart rate variability (HRV) and CPM. Chronic pain patients often experience both ANS dysregulation and impaired CPM. Baroreceptors, which contribute to blood pressure and HRV regulation, may play a significant role in this relationship, but their involvement in pain perception and their functioning in chronic pain have not been sufficiently explored. In this study, we combined artificial baroreceptor stimulation in both pressure pain and CPM paradigms, seeking to explore the role of baroreceptors in pain perception and descending modulation. 22 patients with chronic low back pain (CLBP) and 29 healthy controls (HC) took part in this study. We identified a relationship between baroreflex functioning and perception of pressure pain, finding differential modulation of pressure pain between diagnostic groups. Specifically, HC participants perceived less pain in response to baroreflex activation, whereas CLBP patients exhibited increased pain sensitivity. CPM scores were associated with baseline measures of baroreflex efficiency in both patients and controls. Our data support the importance of the baroreflex in chronic pain and a possible mechanism of dysregulation involving the interaction between the autonomic nervous system and descending pain modulation.
{"title":"Investigating the Effects of Artificial Baroreflex Stimulation on Pain Perception: A Comparative Study in Healthy Participants and Individuals with Chronic Low Back Pain","authors":"Alessandra Venezia, Harriet Fawsitt-Jones, David Hohenschurz-Schmidt, Matteo Mancini, Matthew Howard, Elena Makovac","doi":"10.1101/2023.12.18.23299896","DOIUrl":"https://doi.org/10.1101/2023.12.18.23299896","url":null,"abstract":"The autonomic nervous system (ANS) and pain exhibit a reciprocal relationship, whereupon acute pain triggers ANS responses, while resting ANS activity can influence pain perception. Nociceptive signalling can also be altered by \"top-down\" processes occurring in the brain, brainstem, and spinal cord, known as descending modulation. By employing the Conditioned Pain Modulation (CPM) paradigm, our previous study revealed a connection between reduced low-frequency heart rate variability (HRV) and CPM. Chronic pain patients often experience both ANS dysregulation and impaired CPM. Baroreceptors, which contribute to blood pressure and HRV regulation, may play a significant role in this relationship, but their involvement in pain perception and their functioning in chronic pain have not been sufficiently explored. In this study, we combined artificial baroreceptor stimulation in both pressure pain and CPM paradigms, seeking to explore the role of baroreceptors in pain perception and descending modulation. 22 patients with chronic low back pain (CLBP) and 29 healthy controls (HC) took part in this study. We identified a relationship between baroreflex functioning and perception of pressure pain, finding differential modulation of pressure pain between diagnostic groups. Specifically, HC participants perceived less pain in response to baroreflex activation, whereas CLBP patients exhibited increased pain sensitivity. CPM scores were associated with baseline measures of baroreflex efficiency in both patients and controls. Our data support the importance of the baroreflex in chronic pain and a possible mechanism of dysregulation involving the interaction between the autonomic nervous system and descending pain modulation.","PeriodicalId":501393,"journal":{"name":"medRxiv - Pain Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：