The value of interdisciplinary treatment for sickness absence in chronic pain: a nationwide register‐based cohort study

ABSTRACT

Background

Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence.

Methods

With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a five-year period between patients either allocated to an IDT program or to treatment-as-usual (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration.

Results

IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the five-year period. Intriguingly, sick leave was higher in IDT patients [563 (552, 573) vs. 478 (466, 490) days], whereas disability pension was higher in controls [152 (144, 160) vs. 169 (161, 178) days].

Conclusion

In line with much of the currently available research, we found no support for IDT decreasing sickness absence in chronic pain patients.

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The value of interdisciplinary treatment for sickness absence in chronic pain: a nationwide register‐based cohort study

ABSTRACT

Background

Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence.

Methods

With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a five-year period between patients either allocated to an IDT program or to treatment-as-usual (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration.

Results

IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the five-year period. Intriguingly, sick leave was higher in IDT patients [563 (552, 573) vs. 478 (466, 490) days], whereas disability pension was higher in controls [152 (144, 160) vs. 169 (161, 178) days].

Conclusion

In line with much of the currently available research, we found no support for IDT decreasing sickness absence in chronic pain patients.

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Covid-19: “Life on hold” for NHS patients needing musculoskeletal care

“I’ve been in debilitating pain for far too long,” says Sara Schroter, aged 49, who is from London and works at The BMJ. She developed symptoms of severe sciatica in November 2020. Completely...

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The value of interdisciplinary treatment for sickness absence in chronic pain: a nationwide register‐based cohort study

ABSTRACT

Background

Interdisciplinary treatment (IDT) is an internationally recommended intervention for chronic pain, despite inconclusive evidence of its effects on sickness absence.

Methods

With data from 25,613 patients in Swedish specialist healthcare, we compared sickness absence, in the form of both sick leave and disability pensions, over a five-year period between patients either allocated to an IDT program or to treatment-as-usual (controls). To obtain population-average estimates, a Markov multistate model with theory-based inverse probability weights was used to compute both the proportion of patients on sickness absence and the total sickness absence duration.

Results

IDT patients were more likely than controls to receive sickness absence benefits at any given time (baseline: 49% vs. 46%; 5-year follow-up: 36% vs. 35%), and thereby also had a higher total duration, with a mean (95% CI) of 67 (87, 48) more days than controls over the five-year period. Intriguingly, sick leave was higher in IDT patients [563 (552, 573) vs. 478 (466, 490) days], whereas disability pension was higher in controls [152 (144, 160) vs. 169 (161, 178) days].

Conclusion

In line with much of the currently available research, we found no support for IDT decreasing sickness absence in chronic pain patients.

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The Imperative for Racial Equality in Pain Science: A Way Forward

In the United states, 2020 was an extraordinarily polarizing year characterized by the COVID-19 pandemic, social epidemics (i.e., racial violence, opioid crisis), and natural disasters. The public execution of a Black American man, George Floyd, at the hands of law enforcement, revealed anew the insidious, dehumanizing, and unacceptable impact of physical trauma, structural violence, systemic racism and social injustice, long overdue for acknowledgement and change. Many of us who conduct research on health disparities have found it increasingly difficult to reconcile this senseless act (and so many others) with the direction of our own programs of disparities and equity research.

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Cannabidiol Product Dosing and Decision-Making in a National Survey of Individuals with Fibromyalgia

Fibromyalgia (FM) is a common condition affecting 2-4% of the population that is characterized by widespread pain and a cluster of co-occurring symptoms, including fatigue, sleep disturbances, and cognitive dysfunction.2, 18 Managing FM is challenging due to modest effects of approved fibromyalgia medications17, 30 and limited access to non-pharmacological therapies.4 As medical cannabis has become more available in the US,7 many individuals with FM have reported using cannabis-based medicines for symptom management.

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The disruptive effects of pain on the early allocation of attentional resources: An attentional blink study.

Abstract

Recent evidence suggests that pain dampens attentional processes. However, much of this work has been based on higher-order attentional tasks that involve only spatial attention. Other aspects of the process through which pain engages and holds attention are relatively understudied, in particular, temporal attention. The present set of studies explored how naturally occurring pain (i.e., acute headache) and pain-valenced stimuli affect ability to recall the second of two targets presented in rapid succession. Across both experiments participants were required to indicate the presence of a predefined probe (T2) and, in the dual task, identify a target (T1). The probe (T2) was placed in three different temporal proximities (ranging from 70ms to 1000ms) following presentation of the target (T1). In experiment 1, thirty-six participants completed a task that comprised a rapid stream of letters. Experiment 2 manipulated the threat value, and the complexity, of the stimuli by replacing letters with words. In the dual task condition, T1 was a word from one of four affect categories (neutral, positive, negative, pain). Being in acute pain reduced the accuracy of identification. This reduction in performance occurred regardless of the temporal positioning of the probe consistent with previous work that suggests pain has an overall dampening effect. Further, when the affect category of the word was pain-related, T2 accuracy performance was negatively affected. These findings add to the previous evidence that pain has a general dampening effect on attention and that pain-related stimuli are difficult to disengage from.

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The disruptive effects of pain on the early allocation of attentional resources: An attentional blink study.

Abstract

Recent evidence suggests that pain dampens attentional processes. However, much of this work has been based on higher-order attentional tasks that involve only spatial attention. Other aspects of the process through which pain engages and holds attention are relatively understudied, in particular, temporal attention. The present set of studies explored how naturally occurring pain (i.e., acute headache) and pain-valenced stimuli affect ability to recall the second of two targets presented in rapid succession. Across both experiments participants were required to indicate the presence of a predefined probe (T2) and, in the dual task, identify a target (T1). The probe (T2) was placed in three different temporal proximities (ranging from 70ms to 1000ms) following presentation of the target (T1). In experiment 1, thirty-six participants completed a task that comprised a rapid stream of letters. Experiment 2 manipulated the threat value, and the complexity, of the stimuli by replacing letters with words. In the dual task condition, T1 was a word from one of four affect categories (neutral, positive, negative, pain). Being in acute pain reduced the accuracy of identification. This reduction in performance occurred regardless of the temporal positioning of the probe consistent with previous work that suggests pain has an overall dampening effect. Further, when the affect category of the word was pain-related, T2 accuracy performance was negatively affected. These findings add to the previous evidence that pain has a general dampening effect on attention and that pain-related stimuli are difficult to disengage from.

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Lumbar spinal stenosis

What you need to knowSuspect lumbar spinal stenosis in people over 50 who describe leg pain or paraesthesia on walking or prolonged standing, and who are walking reduced distances as a resultImaging...

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Association between Pain Intensity and Discontinuing Opioid Therapy or Transitioning to Intermittent Opioid Therapy after Initial Long-Term Opioid Therapy: A Retrospective Cohort Study

With greater awareness of opioid harms and emerging evidence that long-term opioid therapy (LTOT) may not be more effective than other treatments for chronic, non-cancer pain (CNCP),4,19 prescribers are frequently confronted with decisions about discontinuing or tapering patients’ opioid regimens. To inform these decisions, prescribers and patients need information about effects of opioid reduction on patients’ pain.

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Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My‐LIFE European Delphi survey

Abstract

Background

Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice.

Methods

Overall, 148 healthcare practitioners from 5 European countries completed a 2-wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of 5 factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception, and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach.

Results

Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR=18.3, 95% CI 13.4-25.05).

Conclusions

This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients.

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The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Abstract

Background and Objective

Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties.

Databases and Data Treatment

MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed.

Results

Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms.

Significance

This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.

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Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My‐LIFE European Delphi survey

Abstract

Background

Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice.

Methods

Overall, 148 healthcare practitioners from 5 European countries completed a 2-wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of 5 factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception, and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach.

Results

Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR=18.3, 95% CI 13.4-25.05).

Conclusions

This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients.

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The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Abstract

Background and Objective

Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties.

Databases and Data Treatment

MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed.

Results

Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms.

Significance

This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.

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Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My‐LIFE European Delphi survey

Abstract

Background

Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice.

Methods

Overall, 148 healthcare practitioners from 5 European countries completed a 2-wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of 5 factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception, and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach.

Results

Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR=18.3, 95% CI 13.4-25.05).

Conclusions

This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3gTSDce
via IFTTT

The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Abstract

Background and Objective

Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties.

Databases and Data Treatment

MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed.

Results

Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms.

Significance

This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.

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Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My‐LIFE European Delphi survey

Abstract

Background

Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice.

Methods

Overall, 148 healthcare practitioners from 5 European countries completed a 2-wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of 5 factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception, and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach.

Results

Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR=18.3, 95% CI 13.4-25.05).

Conclusions

This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3gTSDce
via IFTTT

The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review

Abstract

Background and Objective

Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties.

Databases and Data Treatment

MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed.

Results

Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms.

Significance

This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.

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Slowing in peak-alpha frequency recorded after experimentally-induced muscle pain is not significantly different between high and low pain-sensitive subjects

Acute muscle pain serves an important protective function in preventing or limiting muscle damage. However, often in chronic musculoskeletal pain conditions, muscle pain no longer serves protective functions but may be associated with abnormal brain responses24,55. Functional and structural brain imaging studies have recently demonstrated that increased perception of chronic musculoskeletal pain is associated with altered activity of neural networks3,4 and grey matter thickness of several cortical regions1,52.

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How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3vW16Qv
via IFTTT

How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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The Role of Skin Mast Cells in Acupuncture Induced Analgesia in Animals: A Preclinical Systematic Review and Meta-analysis

Pain is defined as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.62 Pain sensation is considered indispensable to survival, leading to the protective behavior necessary to enable injured tissues to heal.1 It is a major symptom of many medical conditions and can interfere with a person's quality of life and general functioning.2, 6 The mechanism and regulation of pain includes the operation of noxious stimulus to pain receptors and their process and conduction to the central nervous system.

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Increased GABA+ in people with migraine, headache and pain conditions- a potential marker of pain

Chronic pain is the leading cause of disability worldwide, when considering both migraine and musculoskeletal pain conditions such as low back pain82. Randomised controlled trials in musculoskeletal pain40,81 and headache conditions13, 71, 78, have investigated numerous approaches to reduce the burden of chronic pain. However, results remain modest with some patients failing to respond to interventions17, 34, 68, 74. It is not fully understood why some people fail to recover from an initial onset of pain.

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How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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How many steps per day during the early postoperative period is associated with patient-reported outcomes of disability, pain, and opioid use after lumbar spine surgery?

Publication date: Available online 25 June 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Hiral Master, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, Lee H. Riley, Brian J. Neuman, Joseph S. Cheng, Oran S. Aaronson, Clinton J. Devin, Stephen T. Wegener, Kristin R. Archer

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[Correspondence] India's pain: beyond COVID-19 case numbers and mortality rates

The premature relaxation of safety measures, the mass gatherings, the insufficient vaccine roll-outs, and the spread of highly virulent COVID-19 variants have brought India's health system to its knees. This issue has attracted much scrutiny and international criticism over the failures of the administration. However, the Editors1 do not look beyond the numbers or shed sufficient light on the plight of the Indian public.

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Comment on the paper: Evidence‐based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines

Abstract

Corp et al. conducted an important study to synthesize the evidence from European guidelines on neck and lower back pain to identify appropriate recommendations (Corp et al., 2021). The Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) was used to critically appraise these guidelines (Corp et al., 2021). Although AGREE II is a concise and widely used tool in the appraisal of the methodological quality of guidelines, it has some major limitations, which should be considered by the abovementioned authors and health providers (Liu et al., 2021).

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Authors’ reply to the comment by Zhang et al

Abstract

We thank Zhang et al. (2021) for their interest in our work (Corp et al 2021). As the authors point out these are new versions of the AGREE reporting tools and inevitably there will be some delay in their implementation.

Overall, we concur that in the future teams conducting reviews of guidelines should take the points raised in this letter into consideration.

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Economic long‐term effects of intensive interdisciplinary pain treatment in pediatric patients with severe chronic pain: Analysis of claims data

Abstract

Objective

Chronic pain in children and adolescents gives rise to high health care costs. Successful treatment is supposed to reduce the economic burden. The objective of this study was to determine the changes in health care utilization and expenditures from one year before (Pre) intensive interdisciplinary pain treatment (IIPT) to the first (Post 1) and second (Post 2) years after discharge in a sample of pediatric chronic pain patients.

Methods

Claims data from one statutory health insurance company were analyzed for 119 children and adolescents (mean age = 15.3, 68.9% female) who sought IIPT at the German Pediatric Pain Centre. Costs incurred for inpatient treatment, outpatient treatment, medication, remedies and aids were compared before treatment and two years after discharge. Health care utilization was compared using Wilcoxon signed-rank test, and expenditures using trimmed means and the Yuen’s t-test.

Results

Overall costs were significantly lower in the two years after IIPT compared to before IIPT (Pre: 3543€, Post 1: 2681€, Post 2: 1937€ (trimmed means)). Health care utilization changed significantly; hospitalizations decreased in the years after discharge, while psychotherapies stayed stable in the year after discharge but lessened in the second year.

Conclusion

The results of this study support prior findings on the high economic burden of pediatric chronic pain. IIPT may contribute to a transition in health care utilization from somatic-focused treatments to more psychological treatments. Overall costs were reduced as soon as the first year after discharge and decreased even further in the second year.

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The Effect of a Pain Educational Video Intervention upon Child Pain‐Related Outcomes: a Randomized Controlled Study

ABSTRACT

Background

Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce.

Methods

The current study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e., experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children’s demographic (i.e., sex and age) and psychological (i.e., baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (M_age=11.85, SD= 1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e., experimental group) or to a control condition whereby they did not watch any video.

Results

Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison to the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only.

Conclusions

Further investigation is needed to optimize pain educational video-interventions and to determine whether more beneficial outcomes can be found in clinical (i.e., non-experimental) situations and in children with persistent or recurring pain problems.

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Online multidisciplinary interventions for paediatric chronic pain: a content analysis

Abstract

Background

Many online interventions for paediatric chronic pain have been developed and evaluated. In accordance with the biopsychosocial model, the recommended treatment approach for chronic pain is multidisciplinary. Despite this, multidisciplinary components within existing online interventions have not been examined. The objective of the present review was to summarise and evaluate the content of existing online interventions for paediatric chronic pain by mapping intervention content to evidence-based guidelines for chronic pain management.

Methods

Interventions were identified using an updated systematic review. Nine chronic pain management strategies that reflect evidence-based guidance for multidisciplinary chronic pain management were defined by the authors, examples of which include ‘pain education’, ‘activity pacing’ and ‘physiotherapy’. Identified interventions were then coded against the target strategies. These codes were compiled descriptively to provide an overview of how well each chronic pain management strategy was represented across the dataset, and which interventions represented the most strategies.

Results

Thirty-five articles, relating to 13 unique interventions for paediatric chronic pain management were identified; few encompassed a complete multidisciplinary approach. Many CBT-based interventions included multidisciplinary elements. Across interventions, physiotherapy and non-pharmacological physical therapies were the least represented chronic pain management strategies.

Conclusions

The content analysis revealed a lack of online interventions encompassing complete multidisciplinary pain management. It is important that new interventions for paediatric chronic pain management are evidence-based and reflect current best practice guidelines. Established intervention development approaches should be utilised and include a process evaluation to help identify which intervention components are effective in which contexts.

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Persistent moderate to severe pain and long‐term cognitive decline

Abstract

Background

The longitudinal association between persistent moderate to severe pain and subsequent long-term cognitive decline remains inconclusive.

Methods

Study population came from the English Longitudinal Study of Ageing, an ongoing prospective and nationally representative cohort of community-dwelling adults aged ≥50 years in England. At waves 1 (2002/2003) and 2 (2004/2005) of the study, pain severity was measured based on pain intensity scores ranged from 0 to 10. We defined moderate to severe pain as pain intensity scores ≥5 points. Persistent moderate to severe pain was defined as participants reported moderate to severe pain at both waves 1 and 2. Standardized global cognitive Z scores derived from verbal memory, temporal orientation, and semantic fluency were used as the primary outcome.

Results

6869 individuals (3896 women; mean age: 63.9±9.5 years) who have accepted twice measurements of pain at waves 1 and 2 (baseline), and at least 1 reassessment of cognitive function at waves 3 (2006/2007) to 8 (2016/2017), were included in this study. Each 5-points increase in the sum of pain intensity scores was associated with a faster rate of –0.009 (95% CI: –0.013 to –0.006, P<0.001) in global cognitive Z scores. Compared with no pain group, persistent moderate to severe pain group was associated with a significantly faster decline rate of –0.031 SD/year (95% CI: –0.043 to –0.018), in global cognitive Z scores. The relationships of persistent moderate to severe pain with verbal memory, temporal orientation, and semantic fluency were similar.

Conclusion

Cognitive function should be monitored in individuals with persistent moderate to severe pain.

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Revealing the time course of laser evoked potential habituation by high temporal resolution analysis

Abstract

Background and Objectives

Reduced laser evoked potential (LEP) habituation indicates abnormal central pain processing. But the paradigm (4 stimulation blocks a 25 stimuli) is time-consuming and potentially omits important information on the exact habituation time course. This study examined whether a high temporal resolution (HTR) analysis (dividing the 4 stimulation blocks into 12 analysis blocks) can answer the following questions: 1)After how many stimuli does LEP-habituation occur? 2)Is there a difference in LEP-habituation in younger versus older subjects? 3)Is HTR applicable on radiculopathy patients?

Methods

EEG data of 129 subjects were included. 34 young healthy and 28 advanced-aged healthy subjects were tested with LEPs on the hand dorsum. 37 radiculopathy patients and 30 controls were tested with LEPs on the L3 dermatome. The EEG data of the hand dorsa have been analysed conventionally and with HTR analysis. The applicability of HTR has been tested on radiculopathy patients and respective controls.

Results

HTR was well-feasible in young healthy subjects and revealed a strong habituation effect during the first 25 stimuli (i.e. within the first 5 minutes). After approximately 48 stimuli, no further significant habituation was detectable. LEP-amplitudes were higher in young subjects. HTR was unsuitable for elderly subjects and middle-aged radiculopathy patients.

Conclusions

In young healthy subjects, HTR allows a shortening of the test protocol while providing a detailed information on the time course of LEP habituation. A shorter protocol might be useful for the applicability of the LEP paradigm for clinical and experimental settings as well as pharmacological studies.

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Comment on the paper: Evidence‐based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines

Abstract

Corp et al. conducted an important study to synthesize the evidence from European guidelines on neck and lower back pain to identify appropriate recommendations (Corp et al., 2021). The Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) was used to critically appraise these guidelines (Corp et al., 2021). Although AGREE II is a concise and widely used tool in the appraisal of the methodological quality of guidelines, it has some major limitations, which should be considered by the abovementioned authors and health providers (Liu et al., 2021).

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Authors’ reply to the comment by Zhang et al

Abstract

We thank Zhang et al. (2021) for their interest in our work (Corp et al 2021). As the authors point out these are new versions of the AGREE reporting tools and inevitably there will be some delay in their implementation.

Overall, we concur that in the future teams conducting reviews of guidelines should take the points raised in this letter into consideration.

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Economic long‐term effects of intensive interdisciplinary pain treatment in pediatric patients with severe chronic pain: Analysis of claims data

Abstract

Objective

Chronic pain in children and adolescents gives rise to high health care costs. Successful treatment is supposed to reduce the economic burden. The objective of this study was to determine the changes in health care utilization and expenditures from one year before (Pre) intensive interdisciplinary pain treatment (IIPT) to the first (Post 1) and second (Post 2) years after discharge in a sample of pediatric chronic pain patients.

Methods

Claims data from one statutory health insurance company were analyzed for 119 children and adolescents (mean age = 15.3, 68.9% female) who sought IIPT at the German Pediatric Pain Centre. Costs incurred for inpatient treatment, outpatient treatment, medication, remedies and aids were compared before treatment and two years after discharge. Health care utilization was compared using Wilcoxon signed-rank test, and expenditures using trimmed means and the Yuen’s t-test.

Results

Overall costs were significantly lower in the two years after IIPT compared to before IIPT (Pre: 3543€, Post 1: 2681€, Post 2: 1937€ (trimmed means)). Health care utilization changed significantly; hospitalizations decreased in the years after discharge, while psychotherapies stayed stable in the year after discharge but lessened in the second year.

Conclusion

The results of this study support prior findings on the high economic burden of pediatric chronic pain. IIPT may contribute to a transition in health care utilization from somatic-focused treatments to more psychological treatments. Overall costs were reduced as soon as the first year after discharge and decreased even further in the second year.

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The Effect of a Pain Educational Video Intervention upon Child Pain‐Related Outcomes: a Randomized Controlled Study

ABSTRACT

Background

Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce.

Methods

The current study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e., experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children’s demographic (i.e., sex and age) and psychological (i.e., baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (M_age=11.85, SD= 1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e., experimental group) or to a control condition whereby they did not watch any video.

Results

Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison to the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only.

Conclusions

Further investigation is needed to optimize pain educational video-interventions and to determine whether more beneficial outcomes can be found in clinical (i.e., non-experimental) situations and in children with persistent or recurring pain problems.

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Online multidisciplinary interventions for paediatric chronic pain: a content analysis

Abstract

Background

Many online interventions for paediatric chronic pain have been developed and evaluated. In accordance with the biopsychosocial model, the recommended treatment approach for chronic pain is multidisciplinary. Despite this, multidisciplinary components within existing online interventions have not been examined. The objective of the present review was to summarise and evaluate the content of existing online interventions for paediatric chronic pain by mapping intervention content to evidence-based guidelines for chronic pain management.

Methods

Interventions were identified using an updated systematic review. Nine chronic pain management strategies that reflect evidence-based guidance for multidisciplinary chronic pain management were defined by the authors, examples of which include ‘pain education’, ‘activity pacing’ and ‘physiotherapy’. Identified interventions were then coded against the target strategies. These codes were compiled descriptively to provide an overview of how well each chronic pain management strategy was represented across the dataset, and which interventions represented the most strategies.

Results

Thirty-five articles, relating to 13 unique interventions for paediatric chronic pain management were identified; few encompassed a complete multidisciplinary approach. Many CBT-based interventions included multidisciplinary elements. Across interventions, physiotherapy and non-pharmacological physical therapies were the least represented chronic pain management strategies.

Conclusions

The content analysis revealed a lack of online interventions encompassing complete multidisciplinary pain management. It is important that new interventions for paediatric chronic pain management are evidence-based and reflect current best practice guidelines. Established intervention development approaches should be utilised and include a process evaluation to help identify which intervention components are effective in which contexts.

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Persistent moderate to severe pain and long‐term cognitive decline

Abstract

Background

The longitudinal association between persistent moderate to severe pain and subsequent long-term cognitive decline remains inconclusive.

Methods

Study population came from the English Longitudinal Study of Ageing, an ongoing prospective and nationally representative cohort of community-dwelling adults aged ≥50 years in England. At waves 1 (2002/2003) and 2 (2004/2005) of the study, pain severity was measured based on pain intensity scores ranged from 0 to 10. We defined moderate to severe pain as pain intensity scores ≥5 points. Persistent moderate to severe pain was defined as participants reported moderate to severe pain at both waves 1 and 2. Standardized global cognitive Z scores derived from verbal memory, temporal orientation, and semantic fluency were used as the primary outcome.

Results

6869 individuals (3896 women; mean age: 63.9±9.5 years) who have accepted twice measurements of pain at waves 1 and 2 (baseline), and at least 1 reassessment of cognitive function at waves 3 (2006/2007) to 8 (2016/2017), were included in this study. Each 5-points increase in the sum of pain intensity scores was associated with a faster rate of –0.009 (95% CI: –0.013 to –0.006, P<0.001) in global cognitive Z scores. Compared with no pain group, persistent moderate to severe pain group was associated with a significantly faster decline rate of –0.031 SD/year (95% CI: –0.043 to –0.018), in global cognitive Z scores. The relationships of persistent moderate to severe pain with verbal memory, temporal orientation, and semantic fluency were similar.

Conclusion

Cognitive function should be monitored in individuals with persistent moderate to severe pain.

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Revealing the time course of laser evoked potential habituation by high temporal resolution analysis

Abstract

Background and Objectives

Reduced laser evoked potential (LEP) habituation indicates abnormal central pain processing. But the paradigm (4 stimulation blocks a 25 stimuli) is time-consuming and potentially omits important information on the exact habituation time course. This study examined whether a high temporal resolution (HTR) analysis (dividing the 4 stimulation blocks into 12 analysis blocks) can answer the following questions: 1)After how many stimuli does LEP-habituation occur? 2)Is there a difference in LEP-habituation in younger versus older subjects? 3)Is HTR applicable on radiculopathy patients?

Methods

EEG data of 129 subjects were included. 34 young healthy and 28 advanced-aged healthy subjects were tested with LEPs on the hand dorsum. 37 radiculopathy patients and 30 controls were tested with LEPs on the L3 dermatome. The EEG data of the hand dorsa have been analysed conventionally and with HTR analysis. The applicability of HTR has been tested on radiculopathy patients and respective controls.

Results

HTR was well-feasible in young healthy subjects and revealed a strong habituation effect during the first 25 stimuli (i.e. within the first 5 minutes). After approximately 48 stimuli, no further significant habituation was detectable. LEP-amplitudes were higher in young subjects. HTR was unsuitable for elderly subjects and middle-aged radiculopathy patients.

Conclusions

In young healthy subjects, HTR allows a shortening of the test protocol while providing a detailed information on the time course of LEP habituation. A shorter protocol might be useful for the applicability of the LEP paradigm for clinical and experimental settings as well as pharmacological studies.

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Characteristics and Network Influence of Providers Involved in the Treatment of Patients with Chronic Back, Neck or Joint Pain in Arkansas

Four out of five US adults are diagnosed with back pain at some point in their lifetime,27 making back pain among the top five conditions for seeking primary care.15 It is estimated that most of the cases involving non-specific back pain improve within a month, suggesting the lack of need for intensive treatment such as imaging, specialist visits, or initiating opioid treatment.14 Moreover, guidelines and studies have emphasized the role of alternative pharmacotherapies and non-pharmacological treatments for the treatment of back and joint pain.

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Moderate to severe chronic pain in later life: risk and resilience factors for recovery

Chronic pain, generally defined as pain persisting beyond a normal healing time, is associated with higher mortality, lower quality of life, and substantial health burden.15, 47, 56 Overall, chronic pain increases with age,16 with risk factors among older adults including advanced age, female gender, lower socioeconomic status (SES), poor health, and previous pain history.10, 13, 50 However, rather than a lifelong condition, chronic pain can come and go. Despite research on the risk factors of chronic pain development in later life, there has been little focus on the process of recovery.

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Attentional Biases Towards Body Expressions of Pain in Men and Women

Psychosocial approaches often focus on cognitive and emotional factors to help understand the variation in men and women's pain19,20. For example, anxiety has been found to be more strongly related to pain in men, whereas depression has a stronger relationship with pain in women17,36,44. In experimental studies, focusing attention on pain sensations has also been shown to increase the pain thresholds of men more than women 34, 35, whereas women report more negative pain thoughts, greater negative appraisals of body signals, and higher cognitive intrusion from pain33,49.

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The role of the observers’ perception of a model's self-confidence in observationally induced placebo analgesia

Observational learning has been shown to be involved in both pain induction and modulation 11,12,17, which has important consequences for the development, prevention and management of various pain syndromes 17. Growing evidence shows that observational learning is also effective in producing placebo effects. In previous studies, placebo analgesia 10,13,19,29,32 and nocebo hyperalgesia 31,34,35 were powerfully induced by observing another person experiencing analgesia or hyperalgesia, respectively.

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Unexpected injectate spread into the space of Okada during attempted epidural injection: Yet another case

European Journal of Pain, Volume 25, Issue 6, Page 1381-1383, July 2021.

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Issue Information

European Journal of Pain, Volume 25, Issue 6, Page 1175-1176, July 2021.

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Is opioid therapy for chronic non‐cancer pain associated with a greater risk of all‐cause mortality compared to non‐opioid analgesics? A systematic review of propensity score matched observational studies

Abstract

Background

The many risks associated with opioid therapy for chronic non-cancer pain (CNCP) have led to questions about use. This is particularly relevant for risk of increased mortality. However, underlying medical conditions of those using opioids may influence mortality findings due to confounding by indication. Similarly, non-opioid analgesics are also associated with an increased risk of mortality, too.

Methods

We have conducted a systematic review of propensity score matched observational studies comparing mortality associated with opioid use compared to non-opioid analgesics. Clinicaltrials.gov, Google Scholar, MEDLINE and Scopus were searched from inception to July 2020. Propensity score matched observational studies comparing opioids to non-opioid analgesics in real-world settings were analysed. Primary outcome was pooled adjusted hazard ratio (aHR) of all-cause death. Effects were summarized by a random effects model.

Results

Four studies with seven study arms and 120,186 patients were analysed. Pooled aHR for all-cause death was 1.69 (95% confidence interval [CI] 1.47, 1.95). When mortality risk was confined to out-of-hospital deaths, the pooled aHR was 2.12 (95% CI 1.46, 3.09). The most frequent cause of death was cardiovascular death. Before matching, patients with opioids were older and had more somatic diseases than patients with non-opioids. Despite extensive propensity score matchings and sensitivity analyses, all studies could not fully exclude confounding by indication.

Conclusions

Possibly, opioids are associated with an increased all-cause mortality risk compared to non-opioid analgesics. When considering treatment options for patients with CNCP, the possible risk of increased all-cause mortality with opioids should be discussed.

Significance

An increased all-cause mortality associated with opioid use compared to non-opioid analgesics for CNCP was identified by a systematic review of four propensity score matched cohort studies in real-world settings. The number needed to harm for an additional excess death per 10,000 person-years was 116. Despite extensive propensity score matchings and sensitivity analyses, all studies could not fully exclude confounding by indication. The potential risk of increased all-cause mortality with opioids should be discussed with patients when considering opioid treatment.

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The effect of experimental pain on the excitability of the corticospinal tract in humans: A systematic review and meta‐analysis

Abstract

Background and objective

Pain influences motor control. Previous reviews observed that pain reduces the excitability of corticospinal projections to muscles tested with transcranial magnetic stimulation. However, the independent effect of the type of pain models (tonic, phasic), pain location and tissues targeted (e.g. muscle, skin) remains unexplored. The objective of this review was to determine the influence of experimental pain and of different methodological factors on the corticospinal excitability.

Databases and data treatment

Three electronic databases were searched: Embase, Pubmed and Web of Science. Meta-analyses were conducted in three consecutive steps to reduce methodological variability: (a) all studies; (b) same pain location; (c) same tissues, pain location and muscle state. Strength of evidence was assessed for each analysis performed.

Results

Forty studies were included in the review and 26 in the meta-analysis as it focused only on studies using tonic pain. Overall, there was conflicting/moderate evidence of a diminution of corticospinal excitability during and after tonic pain. When considering only pain location, tonic hand and face pain induced a reduction in corticospinal excitability (limited evidence). Both muscle and cutaneous hand pain reduced corticospinal excitability (limited/conflicting evidence). Similar results were observed for phasic pain (limited evidence).

Conclusions

Our results confirm the inhibitory effect of pain on corticospinal excitability for both tonic and phasic pain. This reduction was specific to hand and face pain. Also, both cutaneous and muscle hand pain reduced excitability. The strength of evidence remains limited/conflicting. More high-quality studies are needed to confirm our conclusions.

Significance

This study adds evidence on the effect of specific factors on the modulation of corticospinal excitability during/after experimental pain. The reduction in corticospinal excitability was driven by hand and face pain. We confirmed previous results that muscle pain reduces corticospinal excitability and provided evidence of a similar effect for cutaneous pain. Both models may inform on the influence of different types of pain on motor control. Future studies are needed to determine the origin of the effect of pain.

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Long‐term outcomes of children with severe chronic pain: Comparison of former patients with a community sample

Abstract

Background

Findings on the short- and long-term effectiveness of intensive interdisciplinary pain treatment (IIPT) for children with severe chronic functional pain are promising. However, a definitive appraisal of long-term effectiveness cannot be made due to a lack of comparison groups. The aim of the present study was to compare the health status of former patients with the health status of an age- and sex-matched comparison group from the community.

Methods

Data from two samples, a clinical sample of former patients (n = 162; aged 14 to 26) and an age- and sex-matched community sample (n = 162), were analysed. Former patients provided data 7 years after IIPT. Pain characteristics, physical and mental health status, autonomy, coping and health care utilisation were compared between the two samples.

Results

Seven years after treatment, the majority (58%) of the clinical sample were completely pain-free. Compared to the community sample, the clinical sample demonstrated worse physical and mental health and continued to seek more frequent health care, irrespective of whether or not they experienced ongoing chronic pain. However, the clinical sample reported better coping strategies and a comparable level of autonomy.

Conclusion

Patients experiencing severe chronic pain in childhood who engage in IIPT are likely to have recovered from their pain in early adulthood. Long-term treatment effects may manifest in better coping strategies. However, reduced mental and physical health status may indicate a negative long-term effect of early chronic pain experiences or a general vulnerability in people developing a chronic pain condition in childhood.

Significance

The majority of severely impaired paediatric chronic pain patients no longer suffer from chronic pain seven years after intensive interdisciplinary pain treatment. However, former patients have worse physical and mental health status than a community sample, and continue to seek out more frequent health care utilisation, irrespective of whether or not they continue to experience chronic pain. Therefore, potential negative long-term effects of childhood chronic pain experiences need specific attention early on.

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Effects of multifocal transcranial direct current stimulation targeting the motor network during prolonged experimental pain

Abstract

Background

Antinociceptive effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) have been extensively studied in the past years. However, M1 does not work in isolation, but it rather interacts within a network, the so-called resting-state motor network.

Objective

To explore the anti-nociceptive effects of a new multifocal tDCS approach administered to regions linked to the resting state motor network (network-tDCS) compared to sham tDCS.

Methods

Healthy individuals were included in this randomized, parallel and double-blinded study comprising two consecutive interventions with 24-hr interval of either active (n = 19) or sham (n = 19) network-tDCS. Prolonged pain was induced by application of topical capsaicin on the dorsum of the hand during a 24-hr period. Assessments of corticomotor excitability (transcranial magnetic stimulation), pain ratings (numerical rating scale, NRS), skin pain sensitivity on the arm (heat and mechanical), temporal summation of pain (TSP) and conditioned pain modulation (CPM) were performed at baseline (Day1-baseline), after 25 min of capsaicin application and before the first tDCS session (Day1-post-cap), and after the second tDCS session (Day2).

Results

Comparing Day2 to Day1-baseline measures, there was reduced corticomotor excitability (p < .05) and impaired CPM-effect (p < .05) after sham but not after active network-tDCS. Pain NRS ratings increased at Day2 compared to Day1-post-cap (p < .01) in both groups whereas no significant changes were found in pain sensitivity and TSP.

Conclusions

Present findings demonstrate that tDCS applied over regions linked to the resting state motor network reverts the inhibition of corticomotor excitability and CPM impairment both provoked by prolonged experimental pain for 24 hr.

Significance

These findings highlight that the stimulation of the resting state motor network with multifocal tDCS may represent a potential cortical target to treat chronic pain, particularly in patients exhibiting maladaptive corticomotor excitability and impaired conditioned pain modulation effects.

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Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

Abstract

The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid-related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US-driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non-existent access to opioids for pain relief. Over 25 million people are at the end-of-life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US-based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage.

Significance

The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.

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MiRNA‐107 contributes to inflammatory pain by down‐regulating GLT‐1 expression in rat spinal dorsal horn

Abstract

Background

Inflammatory pain is a severe clinical problem that affects the quality of life in patients. However, the currently available treatments for inflammatory pain have limited effect and even causes severe side effects. The aim of this study was to investigate the roles of miRNA-107 and glutamate transporter 1 (GLT-1) in the inflammatory pain of rats induced by complete Freund's adjuvant (CFA).

Methods

Paw withdrawal threshold (PWT) of rats was measured by von Frey Filaments. The expressions of miRNA-107 and GLT-1 in the lumbar spinal dorsal horn (L4-L6) were measured with real-time quantitative PCR and western blotting analysis. Fluorescent in situ hybridization and fluorescent-immunohistochemistry were employed to detect the expression of miRNA-107, GLT-1 and co-location of miRNA-107 with GLT-1.

Results

Injection of CFA significantly reduced PWT of rats. The miRNA-107 expression level was obviously up-regulated while the GLT-1 expression level was decreased in the spinal dorsal horn of CFA rats. miRNA-107 and GLT-1 were co-expressed in the same cells of the spinal dorsal horn in CFA rats. Ceftriaxone, a selective activator of GLT-1, obviously increased the PWT of CFA rats. Furthermore, antagomir of miRNA-107 reversed the down-regulation of GLT-1 and alleviated CFA-induced mechanical allodynia of CFA rats.

Conclusions

These results suggest that an increase of miR-107 contributes to inflammatory pain through downregulating GLT-1 expression, implying a promising strategy for pain therapy.

Significance

The currently available treatments for inflammatory pain has limited effect even causes severe side effects. MiRNAs may have important diagnostic and therapeutic potential in inflammatory pain. In present study, we show a potential spinal mechanism of allodynia in rat inflammatory pain model induced by CFA. Increased miR-107 contribute to inflammatory pain by targeting and downregulating GLT-1 expression, implying a promising strategy for inflammatory pain.

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Inhibition of ferroptosis‐like cell death attenuates neuropathic pain reactions induced by peripheral nerve injury in rats

Abstract

Background

Relationships between iron-dependent ferroptosis and nerve system diseases have been recently revealed. However, the role of ferroptosis in neuropathic pain (NeP) remains to be elucidated. Thus, we aimed to investigate whether ferroptosis in spinal cord contributes to NeP induced by a chronic constriction injury (CCI) of the sciatic nerve.

Methods

Forty Sprague-Dawley rats received CCI or sham surgery, and were randomly assigned to the following four groups: sham group; CCI + LIP group; CCI + Veh group; and CCI group. Liproxstatin-1 or corn oil were separately injected intraperitoneally for three consecutive days after surgery in the CCI + LIP or CCI + Veh group. The mechanical and thermal hypersensitivities were tested after surgery. Biochemical and morphological changes related to ferroptosis in the spinal cord were also assessed. These included iron content, glutathione peroxidase 4 (GPX4) and anti-acyl-CoA synthetase long-chain family member 4 (ACSL4) expression, lipid peroxidation assays, as well as mitochondrial morphology.

Results

CCI-induced NeP was followed by iron accumulation, increased lipid peroxidation and dysregulation of ACSL4 and GPX4. Moreover transmission electron microscopy confirmed the presence of aberrant morphological changes on mitochondrial, such as mitochondria shrinkage and membrane rupture. Furthermore, the administration of liproxstatin-1 on CCI rats attenuated hypersensitivities, lowered the iron level, decreased spinal lipid peroxidation, restored the dysregulations in GPX4 and ACSL4 levels, and protected against CCI induced morphological changes in mitochondria.

Conclusions

Our findings indicated the involvement of ferroptosis in CCI induced NeP, and point to ferroptosis inhibitors such as liproxstatin-1 as potential therapies for hypersensitivity induced by peripheral nerve injury.

Significance

The spinal ferroptosis-like cell death was involved in the development of neuropathic pain resulted from peripheral nerve injury, and inhibition of ferroptosis by liproxstatin-1 could alleviate mechanical and thermal hypersensitivities. This knowledge suggested that ferroptosis could represent a potential therapeutic target for neuropathic pain.

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Efficacy of transforaminal epidural magnesium administration when combined with a local anaesthetic and steroid in the management of lower limb radicular pain

Abstract

Background

Lower limb radicular pain resulting from a herniated intervertebral disc is a cause of functional disability and could lead to increased consumption of opioids. We evaluated the efficacy of epidural magnesium combined with a local anaesthetic and steroid in the management of this pain.

Methods

This was a prospective, case-control, randomized, double-blind study. Fifty patients each received 2 ml bupivacaine, 1 ml (40 mg) methylprednisolone and 1 ml saline (0.9%) (group C) or magnesium (200 mg) instead of saline (group M). The primary outcome measure was the improvement in the pain score (assessed using a visual analogue scale (VAS)), and the secondary outcome was the improvement in the functional ability (assessed using the Modified Oswestry Disability Questionnaire (MODQ)). The VAS and MODQ scores were assessed before and at 1 day, 1 week, 1 month and 3 months post-intervention.

Results

The VAS and MODQ scores were significantly better in group M compared to those in group C at all times post-injection (p-value < 0.001). Comparisons within the same group showed that the VAS and MODQ scores were significantly better at all post-injection time points compared to the pre-injection scores in both group C and group M (p-values < 0.0001).

Conclusions

Adding magnesium to a local anaesthetic and steroid to be injected in the transforaminal epidural space could improve the pain and the quality of life in patients suffering from lower limb radicular pain due to lumbo-sacral disc herniation, and this improvement could last for up to 3 months.

Significance

Magnesium is efficient when added to local anaesthetics and steroids for management of lower limb radicular pain.

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The association between exposure to domestic abuse in women and the development of syndromes indicating central nervous system sensitization: A retrospective cohort study using UK primary care records

Abstract

Background

Domestic abuse is a global public health issue. The association between the development of central sensitivity syndromes (CSS) and previous exposure to domestic abuse has been poorly understood particularly within European populations.

Methods

A retrospective cohort study using the ‘The Health Improvement Network,’ (UK primary care medical records) between 1st January 1995–31st December 2018. 22,604 adult women exposed to domestic abuse were age matched to 44,671 unexposed women. The average age at cohort entry was 36 years and the median follow-up was 2.5 years. The outcomes of interest were the development of a variety of syndromes which demonstrate central nervous system sensitization. Fibromyalgia, chronic fatigue syndrome and temporomandibular joint disorder outcomes have been reported previously. Outcomes were adjusted for the presence of mental ill health.

Results

During the study period, women exposed to domestic abuse experienced an increased risk of developing chronic lower back pain (adjusted incidence rate ratio [aIRR] 2.28; 95% CI 1.85–2.80), chronic headaches (aIRR 3.15; 95% CI 1.07–9.23), irritable bowel syndrome (aIRR 1.41; 95% CI 1.25–1.60) and restless legs syndrome (aIRR 1.89; 95% CI 1.44–2.48). However, no positive association was seen with the development of interstitial cystitis (aIRR 0.52; 95% CI 0.14–1.93), vulvodynia (aIRR 0.42; 95% CI 0.14–1.25) and myofascial pain syndrome (aIRR 1.01; 95% CI 0.28–3.61).

Conclusion

This study demonstrates the need to consider a past history of domestic abuse in patients presenting with CSS; and also consider preventative approaches in mitigating the risk of developing CSS following exposure to domestic abuse.

Significance

Domestic abuse is a global public health issue, with a poorly understood relationship with the development of complex pain syndromes. Using a large UK primary care database, we were able to conduct the first global cohort study to explore this further. We found a strong pain morbidity burden associated with domestic abuse, suggesting the need for urgent public health intervention to not only prevent domestic abuse but also the associated negative pain consequences.

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Development and validation of the Brief Assessment of Distress about Pain

Abstract

Background

The experience of pain is a complex interaction of somatic, behavioural, affective and cognitive components. Negative psychological states (e.g., anxiety, fear and depression) are intertwined with pain and contribute to poorer outcomes for individuals suffering from chronic and acute pain by exacerbating the overall experience of pain and leading to increased dysfunction, disability, and distress. A need exists for efficient assessment of aversive emotional states that are associated with pain.

Methods

A multistage developmental process included expert judges, two undergraduate samples, and a chronic pain patient sample. The 4-item Brief Assessment of Distress about Pain (BADP) scale was developed to assess anxiety, fear, and depression related to pain, as well as an overall evaluation of distress about pain.

Results

Principal components analyses indicated that the BADP consisted of one factor. Inter-scale correlation coefficients revealed that the BADP was highly related to other measures that assess similar constructs, suggesting evidence for convergent validity. Intra-scale correlation coefficients indicated that the items of the BADP were only moderately associated with each other. Findings also supported evidence for discriminative validity, test–retest reliability, and internal consistency of the BADP.

Conclusions

The BADP has good psychometric properties as a measure of negative affectivity related to pain. The scale's single negative affectivity item may be useful for screening. The BADP helps address a gap in the literature with regard to a brief measure assessing fear, anxiety, depression, and negative affect in relation to pain. Demonstrated utility in a patient sample indicates the measure is suitable for further clinical study.

Significance

The BADP provides an efficient, psychometrically-supported means to assess affective distress (i.e., anxiety, fear, depression, and negative affect) associated with pain.

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‘External timing’ of placebo analgesia in an experimental model of sustained pain

Abstract

Background

Research on placebo analgesia commonly focuses on the impact of information about direction (i.e., increase or decrease of pain) and magnitude of the expected analgesic effect, whereas temporal aspects of expectations have received little attention so far. In a recent study, using short-lasting, low-intensity stimuli, we demonstrated that placebo analgesia onset is influenced by temporal information. Here, we investigate whether the same effect of temporal suggestions can be found in longer lasting, high-intensity pain in a Cold Pressor Test (CPT).

Methods

Fifty-three healthy volunteers were allocated to one of three groups. Participants were informed that the application of an (inert-)cream would reduce pain after 5 min (P5) or 30 min (P30). The third group was informed that the cream only had hydrating properties (NE). All participants completed the CPT at baseline and 10 (Test 10) and 35 min (Test 35) following cream application. Percentage change in exposure time (pain tolerance) from baseline to Test 10 (Δ10) and to Test 35 (Δ35) and changes in heart rate (HR) during CPT were compared between the three groups.

Results

Δ10 was greater in P5 than in NE and P30, indicating that analgesia was only present in the group that was expecting an early onset of analgesia. Δ35 was greater in P5 and P30 compared to NE, reflecting a delayed onset of analgesia in P30 and maintained analgesia in P5. HR differences between groups were not significant.

Conclusions

Our data suggest that ‘externally timing’ of placebo analgesia may be possible for prolonged types of pain.

Significance

Research on placebo effects mainly focuses on the influence of information about direction (i.e., increase or decrease of pain) and magnitude (i.e., strong or weak) of the expected effect but ignores temporal aspects of expectations. In our study in healthy volunteers, the reported onset of placebo analgesia followed the temporal information provided. Such ‘external timing’ effects could not only aid the clinical use of placebo treatment (e.g., in open-label placebos) but also support the efficacy of active drugs.

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Role of the endocannabinoid system in a mouse model of Fragile X undergoing neuropathic pain

Abstract

Background

Neuropathic pain is a complex condition characterized by sensory, cognitive and affective symptoms that magnify the perception of pain. The underlying pathogenic mechanisms are largely unknown and there is an urgent need for the development of novel medications. The endocannabinoid system modulates pain perception and drugs targeting the cannabinoid receptor type 2 (CB2) devoid of psychoactive side effects could emerge as novel analgesics. An interesting model to evaluate the mechanisms underlying resistance to pain is the fragile X mental retardation protein knockout mouse (Fmr1KO), a model of fragile X syndrome that exhibits nociceptive deficits and fails to develop neuropathic pain.

Methods

A partial sciatic nerve ligation was performed to wild-type (WT) and Fmr1KO mice having (HzCB2 and Fmr1KO-HzCB2, respectively) or not (WT and Fmr1KO mice) a partial deletion of CB2 to investigate the participation of the endocannabinoid system on the pain-resistant phenotype of Fmr1KO mice.

Results

Nerve injury induced canonical hypersensitivity in WT and HzCB2 mice, whereas this increased pain sensitivity was absent in Fmr1KO mice. Interestingly, Fmr1KO mice partially lacking CB2 lost this protection against neuropathic pain. Similarly, pain-induced depressive-like behaviour was observed in WT, HzCB2 and Fmr1KO-HzCB2 mice, but not in Fmr1KO littermates. Nerve injury evoked different alterations in WT and Fmr1KO mice at spinal and supra-spinal levels that correlated with these nociceptive and emotional alterations.

Conclusions

This work shows that CB2 is necessary for the protection against neuropathic pain observed in Fmr1KO mice, raising the interest in targeting this receptor for the treatment of neuropathic pain.

Significance

Neuropathic pain is a complex chronic pain condition and current treatments are limited by the lack of efficacy and the incidence of important side effects. Our findings show that the pain-resistant phenotype of Fmr1KO mice against nociceptive and emotional manifestations triggered by persistent nerve damage requires the participation of the cannabinoid receptor CB2, raising the interest in targeting this receptor for neuropathic pain treatment. Additional multidisciplinary studies more closely related to human pain experience should be conducted to explore the potential use of cannabinoids as adequate analgesic tools.

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Prevalence and characteristics of new‐onset pain in COVID‐19 survivours, a controlled study

Abstract

Background

We assessed whether COVID-19 is associated with de novo pain and de novo chronic pain (CP).

Methods

This controlled cross-sectional study was based on phone interviews of patients discharged from hospital after COVID-19 compared to the control group composed of individuals hospitalized during the same period due to non-COVID-19 causes. Patients were classified as having previous CP based on the ICD-11/IASP criteria, de novo pain (i.e. any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID-19. We assessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty-six COVID-19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history.

Results

Length of in-hospital-stay and ICU admission rates were significantly higher amongst COVID-19 survivours, while mechanical ventilation requirement was similar between groups. Pre-hospitalisation pain was lower in COVID-19 compared to control group (10.9% vs. 42.5%; p = 0.001). However, the COVID-19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, p = 0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p = 0.001). New-onset CP was 19.6% in COVID-19 patients and 1.4% (p = 0.002) in controls. These differences remained significant (p = 0.001) even after analysing exclusively (COVID: n = 40; controls: n = 34) patients who did not report previous pain before the hospital stay. No statistically significant differences were found for mean new-onset pain intensity and interference with daily activities between both groups. COVID-19 pain was more frequently located in the head/neck and lower limbs (p < 0.05). New-onset fatigue was more common in COVID-19 survivours necessitating inpatient hospital care (66.8%) compared to controls (2.5%, p = 0.001). COVID-19 patients who reported anosmia had more new-onset pain (83.3%) compared to those who did not (48.0%, p = 0.024).

Conclusion

COVID-19 was associated with a significantly higher prevalence of de novo CP, chronic daily headache, and new-onset pain in general, which was associated with persistent anosmia.

Significance

There exists de novo pain in a substantial number of COVID-19 survivours, and some develop chronic pain. New-onset pain after the infection was more common in patients who reported anosmia after hospital discharge.

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