Pain Research and Treatment The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. iACT-CEL: A Feasibility Trial of a Face-to-Face and Internet-Based Acceptance and Commitment Therapy Intervention for Chronic Pain in Singapore Thu, 23 Feb 2017 08:27:30 +0000 Psychological interventions are increasingly utilising online or mobile phone based platforms to deliver treatment, including that for people with chronic pain. The aims of this study were to develop an adapted form of Acceptance and Commitment Therapy (ACT) for chronic pain in Singapore and to test the feasibility of elements of this treatment delivered via the internet and email. Methods. Thirty-three participants recruited from a tertiary pain management clinic and via the clinic website participated in this program over a period of five weeks with a 3-month follow-up. Treatment outcomes were assessed at three assessment time points. Results. 90.9% of participants completed the program, with 81.8% reporting high treatment satisfaction. Significant changes in depression, , (baseline to posttreatment), , (baseline to follow-up), and pain intensity, , (baseline to follow-up) were found. Mainly small effect sizes with a moderate effect size () for depression were found at posttreatment. Clinically meaningful improvement in at least one outcome was demonstrated in 75.8% of participants. Conclusions. An adaptation of ACT for people with chronic pain in Singapore appears promising. Optimal treatment design and more effective ways to target outcomes and processes measured here are required. Su-Yin Yang, Rona Moss-Morris, and Lance M. McCracken Copyright © 2017 Su-Yin Yang et al. All rights reserved. Quantitative Thermal Testing Profiles as a Predictor of Treatment Response to Topical Capsaicin in Patients with Localized Neuropathic Pain Tue, 21 Feb 2017 00:00:00 +0000 There are no reliable predictors of response to treatment with capsaicin. Given that capsaicin application causes heat sensation, differences in quantitative thermal testing (QTT) profiles may predict treatment response. The aim of this study was to determine whether different QTT profiles could predict treatment outcomes in patients with localized peripheral neuropathic pain (PeLNP). We obtained from medical records QTT results and treatment outcomes of 55 patients treated between 2010 and 2013. Warm sensation threshold (WST) and heat pain threshold (HPT) values were assessed at baseline at the treatment site and in the asymptomatic, contralateral area. Responders were defined as those who achieved a > 30% decrease in pain lasting > 30 days. Two distinct groups were identified based on differences in QTT profiles. Most patients (27/31; 87.1%) with a homogenous profile were nonresponders. By contrast, more than half of the patients (13/24, 54.2%) with a nonhomogenous profile were responders (). A nonhomogenous QTT profile appears to be predictive of response to capsaicin. We hypothesize patients with a partial loss of cutaneous nerve fibers or receptors are more likely to respond. By contrast, when severe nerve damage or normal cutaneous sensations are present, the pain is likely due to central sensitization and thus not responsive to capsaicin. Prospective studies with larger patient samples are needed to confirm this hypothesis. A. Serrano, D. Torres, M. Veciana, C. Caro, J. Montero, and V. Mayoral Copyright © 2017 A. Serrano et al. All rights reserved. Evaluating the Measurement Properties of the Self-Assessment of Treatment Version II, Follow-Up Version, in Patients with Painful Diabetic Peripheral Neuropathy Mon, 16 Jan 2017 08:43:55 +0000 Background. The Self-Assessment of Treatment version II (SAT II) measures treatment-related improvements in pain and impacts and impressions of treatment in neuropathic pain patients. The measure has baseline and follow-up versions. This study assesses the measurement properties of the SAT II. Methods. Data from 369 painful diabetic peripheral neuropathy (PDPN) patients from a phase III trial assessing capsaicin 8% patch (Qutenza®) efficacy and safety were used in these analyses. Reliability, convergent validity, known-groups validity, and responsiveness (using the Brief Pain Inventory-Diabetic Neuropathy [BPI-DN] and Patient Global Impression of Change [PGIC]) analyses were conducted, and minimally important differences (MID) were estimated. Results. Exploratory factor analysis supported a one-factor solution for the six impact items. The SAT II has good internal consistency (Cronbach’s alpha: 0.96) and test-retest reliability (intraclass correlation coefficients: 0.62–0.88). Assessment of convergent validity showed moderate to strong correlations with change in other study endpoints. Scores varied significantly by level of pain intensity and sleep interference () defined by the BPI-DN. Responsiveness was shown based on the PGIC. MID estimates ranged from 1.2 to 2.4 (pain improvement) and 1.0 to 2.0 (impact scores). Conclusions. The SAT II is a reliable and valid measure for assessing treatment improvement in PDPN patients. Floortje van Nooten, Dylan Trundell, Dorota Staniewska, Jun Chen, Evan W. Davies, and Dennis A. Revicki Copyright © 2017 Floortje van Nooten et al. All rights reserved. The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis Wed, 14 Dec 2016 08:03:31 +0000 Background. Aromatherapy refers to the medicinal or therapeutic use of essential oils absorbed through the skin or olfactory system. Recent literature has examined the effectiveness of aromatherapy in treating pain. Methods. 12 studies examining the use of aromatherapy for pain management were identified through an electronic database search. A meta-analysis was performed to determine the effects of aromatherapy on pain. Results. There is a significant positive effect of aromatherapy (compared to placebo or treatments as usual controls) in reducing pain reported on a visual analog scale (SMD = −1.18, 95% CI: −1.33, −1.03; ). Secondary analyses found that aromatherapy is more consistent for treating nociceptive (SMD = −1.57, 95% CI: −1.76, −1.39, ) and acute pain (SMD = −1.58, 95% CI: −1.75, −1.40, ) than inflammatory (SMD = −0.53, 95% CI: −0.77, −0.29, ) and chronic pain (SMD = −0.22, 95% CI: −0.49, 0.05, ), respectively. Based on the available research, aromatherapy is most effective in treating postoperative pain (SMD = −1.79, 95% CI: −2.08, −1.51, ) and obstetrical and gynecological pain (SMD = −1.14, 95% CI: −2.10, −0.19, ). Conclusion. The findings of this study indicate that aromatherapy can successfully treat pain when combined with conventional treatments. Shaheen E. Lakhan, Heather Sheafer, and Deborah Tepper Copyright © 2016 Shaheen E. Lakhan et al. All rights reserved. Response to: Comment on “Cost-Saving Early Diagnosis of Functional Pain in Nonmalignant Pain: A Noninferiority Study of Diagnostic Accuracy” Tue, 29 Nov 2016 08:58:38 +0000 N. Egloff, R. J. Cámara, C. Merz, B. Wegmann, S. Stauber, and R. von Känel Copyright © 2016 N. Egloff et al. All rights reserved. A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain Sun, 06 Nov 2016 11:23:18 +0000 Psychosocial pain management interventions are efficacious for cancer pain but are underutilized. Recent advances in mobile health (mHealth) technologies provide new opportunities to decrease barriers to access psychosocial pain management interventions. The objective of this study was to gain information about the accessibility and efficacy of mobile pain coping skills training (mPCST) intervention delivered to cancer patients with pain compared to traditional in-person pain coping skills training intervention. This study randomly assigned participants () to receive either mobile health pain coping skills training intervention delivered via Skype or traditional pain coping skills training delivered face-to-face (PCST-trad). This pilot trial suggests that mPCST is feasible, presents low burden to patients, may lead to high patient engagement, and appears to be acceptable to patients. Cancer patients with pain in the mPCST group reported decreases in pain severity and physical symptoms as well as increases in self-efficacy for pain management that were comparable to changes in the PCST-trad group (’s < 0.05). These findings suggest that mPCST, which is a highly accessible intervention, may provide benefits similar to an in-person intervention and shows promise for being feasible, acceptable, and engaging to cancer patients with pain. Tamara J. Somers, Sarah A. Kelleher, Kelly W. Westbrook, Gretchen G. Kimmick, Rebecca A. Shelby, Amy P. Abernethy, and Francis J. Keefe Copyright © 2016 Tamara J. Somers et al. All rights reserved. Effective Concentration of Lidocaine Plus Fentanyl for Caudal Block in Patients Undergoing Transrectal Ultrasound Guided Prostate Biopsy Sun, 30 Oct 2016 09:19:24 +0000 Objective. This study determined the effective concentration (EC) of lidocaine plus 75 μg fentanyl for caudal block in patients undergoing transrectal ultrasound (TRUS) guided prostate biopsy. Methods. Consecutive male patients scheduled for TRUS guided prostate biopsy were enrolled. The mixed solution for caudal block contained lidocaine and 75 μg fentanyl, in total 20 mL. The concentration of lidocaine was determined using the up-and-down method, starting at 0.8% (a step size of 0.1%). A successful caudal block was defined by no pain perception during biopsy. The EC50 of lidocaine for successful caudal block was calculated and side effects were evaluated. Results. A total of 23 patients were recruited. The EC50 of lidocaine for successful caudal block was 0.53%. Conclusions. Lidocaine of 0.53% combined with 75 μg fentanyl resulted in excellent caudal block in 50% of male patients undergoing transrectal ultrasound guided prostate biopsy. Jinguo Wang, Honglan Zhou, Wei An, Na Wang, and Yang Gao Copyright © 2016 Jinguo Wang et al. All rights reserved. Comment on “Cost-Saving Early Diagnosis of Functional Pain in Nonmalignant Pain: A Noninferiority Study of Diagnostic Accuracy” Wed, 14 Sep 2016 13:13:35 +0000 Katsuhiro Toda Copyright © 2016 Katsuhiro Toda. All rights reserved. Risk Factors Linked to Psychological Distress, Productivity Losses, and Sick Leave in Low-Back-Pain Employees: A Three-Year Longitudinal Cohort Study Thu, 18 Aug 2016 08:14:28 +0000 Background. Low back pain (LBP) is one of the most common health problems worldwide. Purpose. To investigate the link between baseline demographic and occupational, medical, and lifestyle data with following psychological and occupational outcomes in a large sample of employees with LBP over a 3-year period. Study Design. Three-year prospective cohort study. Methods. Italian-speaking employees () with a diagnosis of LBP were included. Screening at Time 1 was done in order to collect information about severity and classification of LBP, demographic, lifestyle, and occupational status data. Psychological distress (PGWBI) and occupational burden were assessed after 3 years. Results. After 3 years, employees with LBP not due to organic causes had an increased risk of psychological distress. Gender appears to be an important variable for following occupational burden. Indeed, being a white-collar man with a LBP without organic causes seems to be a protective factor for following work outcomes, while being a white-collar woman with a LBP not due to organic causes appears to be a risk factor for subsequent sick leave. Moreover, LBP severity affects psychological and occupational outcomes. Conclusion. Our findings have several implications that could be considered in preventive and supportive programs for LBP employees. Angelo Compare, Paolo Marchettini, and Cristina Zarbo Copyright © 2016 Angelo Compare et al. All rights reserved. Triptans Use for Migraine Headache among Nonelderly Adults with Cardiovascular Risk Wed, 17 Aug 2016 12:51:30 +0000 Objective. To examine the association between the cardiovascular (CV) risk factors and triptans use among adults with migraine. Methods. A retrospective cross-sectional study design was used. Data were derived from 2009–2013 Medical Expenditure Panel Survey (MEPS). The study sample consisted of adults (age > 21 years) with migraine headache (N = 1,652). Multivariable logistic regression was used to examine the relationship between CV risk factors and triptans use. Results. Overall, 21% adults with migraine headache used triptans. Nearly two-thirds (61%) of adults with migraine had at least one CV risk factor. A significantly lower percentage of adults with CV risk (18.1%) used triptans compared to those without CV risk factors (25.5%). After controlling for demographic, socioeconomic status, access to care, and health status, adults with no CV risk factors were more likely to use triptans as compared to those with one CV risk factor (AOR = 1.83, 95% CI = 1.17–2.87). There were no statistically significant differences in triptans use between those with two or more CV risk factors and those with one CV risk factor. Conclusion. An overwhelming majority of adults with migraine had a contraindication to triptans based on their CV risk factors. The use of triptans among adults with migraine and multiple CV risk factors warrants further investigation. Monira Alwhaibi, Arijita Deb, and Usha Sambamoorthi Copyright © 2016 Monira Alwhaibi et al. All rights reserved. Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience Thu, 11 Aug 2016 07:25:06 +0000 A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients. Markus A. Bendel, Susan M. Moeschler, Wenchun Qu, Eugerie Hanley, Stephanie A. Neuman, Jason S. Eldrige, and Bryan C. Hoelzer Copyright © 2016 Markus A. Bendel et al. All rights reserved. Load Handling and Repetitive Movements Are Associated with Chronic Low Back Pain among Jute Mill Workers in India Tue, 02 Aug 2016 13:23:23 +0000 Introduction. WHO recognizes low back pain as one of the most important ergonomic stressors. Therefore, the present study was designed to find out the magnitude of the problem among jute mill workers in India and identify possible associations. Methodology. This cross-sectional workplace based study was conducted among eight (8) selected jute mills of India. Subjects with self-reported back pain for at least last 12 weeks were included and male jute mill workers actively engaged in work entered the study and completed all assessments. Results. Among all participants 55% () had current chronic low back pain. Age was an important association with subjects in the age group of 40–59 years more likely to have pain (, OR 1.44). Regarding ergonomic risk factors lifting of load of more than 20 kg (, OR 1.42) and repetitive movements of limbs (, OR 0.67) were significant associations of chronic low back pain. Conclusion. This study identified a significant prevalence of current chronic low back pain among jute mill workers. Regarding ergonomic risk factors the present study has identified two significant associations: lifting of load above 20 kg and repetitive movements of limbs. Therefore, this study has identified need for workplace interventions in this occupational group employing approximately 3,50,000 workers in India. S. Goswami, S. Dasgupta, A. Samanta, G. Talukdar, A. Chanda, P. Ray Karmakar, A. Majumdar, D. Bhattacharya, and A. Chakrabarti Copyright © 2016 S. Goswami et al. All rights reserved. Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients Tue, 19 Jul 2016 08:42:55 +0000 Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1–10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, , and health status (VAS) from 40.6 to 61.9, . Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement. Juan Antonio García García, Patricia Hernández-Puiggròs, Javier Tesedo Nieto, María Pilar Acín Lázaro, Alfredo Carrera González, Miguel José Arranz Soler, and Sergio Maldonado Vega Copyright © 2016 Juan Antonio García García et al. All rights reserved. A Clinical Experimental Model to Evaluate Analgesic Effect of Remote Ischemic Preconditioning in Acute Postoperative Pain Thu, 30 Jun 2016 12:37:23 +0000 This study aims to evaluate the viability of a clinical model of remote ischemic preconditioning (RIPC) and its analgesic effects. It is a prospective study with twenty (20) patients randomly divided into two groups: control group and RIPC group. The opioid analgesics consumption in the postoperative period, the presence of secondary mechanical hyperalgesia, the scores of postoperative pain by visual analog scale, and the plasma levels interleukins (IL-6) were evaluated. The tourniquet applying after spinal anesthetic block was safe, producing no pain for all patients in the tourniquet group. The total dose of morphine consumption in 24 hours was significantly lower in RIPC group than in the control group (). The intensity analysis of rest pain, pain during coughing and pain in deep breathing, showed that visual analogue scale (VAS) scores were significantly lower in RIPC group compared to the control group: , 0.0119, and 0.0015, respectively. There were no differences between groups in the analysis of presence or absence of mechanical hyperalgesia () and in the serum levels of IL-6 dosage over time (). This clinical model of remote ischemic preconditioning promoted satisfactory analgesia in patients undergoing conventional cholecystectomy, without changing serum levels of IL-6. Francisco Elano Carvalho Pereira, Irene Lopes Mello, Fernando Heladio de Oliveira Medeiros Pimenta, Debora Maia Costa, Deysi Viviana Tenazoa Wong, Claudia Regina Fernandes, Roberto César Lima Junior, and Josenília M. Alves Gomes Copyright © 2016 Francisco Elano Carvalho Pereira et al. All rights reserved. Increased Risk of Postthoracotomy Pain Syndrome in Patients with Prolonged Hospitalization and Increased Postoperative Opioid Use Thu, 02 Jun 2016 07:40:06 +0000 Background. Postthoracotomy pain syndrome (PTPS) is unfortunately very common following thoracotomy and results in decreased quality of life. The purpose of this retrospective study was to determine perioperative patient, surgical, and analgesic characteristics associated with the development of PTPS. Methods. Sixty-six patients who presented to the Mayo Clinic Rochester Pain Clinic were diagnosed with PTPS 2 months or more after thoracotomy with postoperative epidural analgesia. These patients were matched with sixty-six control patients who underwent thoracotomy with postoperative epidural analgesia and were never diagnosed with PTPS. Results. Median (IQR) hospital stay was significantly different between control patients (5 days (4, 6)) compared with PTPS patients (6 days (5, 8)), . The total opioid equivalent utilized in oral morphine equivalents in milligrams for the first three days postoperatively was significantly different between control patients and PTPS patients. The median (IQR) total opioid equivalent utilized was 237 (73, 508) for controls and 366 (116, 874) for PTPS patients (). Conclusion. Patients with a prolonged hospital stay after thoracotomy were at an increased risk of developing PTPS, and this is a novel finding. Patients who utilize higher oral morphine equivalents for the first 3 days were also at increased risk for PTPS. Michelle A. O. Kinney, Adam K. Jacob, Melissa A. Passe, and Carlos B. Mantilla Copyright © 2016 Michelle A. O. Kinney et al. All rights reserved. The Efficacy of Interdisciplinary Rehabilitation for Improving Function in People with Chronic Pain Sun, 08 May 2016 11:16:28 +0000 Objective. To examine the efficacy of interdisciplinary rehabilitation for improving function in people with chronic pain. Design. Retrospective Chart Review. Setting. The Pain Rehabilitation Center (PRC) at a medical center. Participants. Individuals admitted to the PRC. Interventions. The PRC operates a 3-week outpatient program that utilizes an interdisciplinary approach to treat people with chronic pain. The main treatment elements include physical therapy, occupational therapy, cognitive behavioral therapy (CBT), and medication management. Physical therapy groups focus on moderate exercise despite symptoms. Occupational therapists teach moderation, time management, and activity modification. CBT groups, led by a pain psychologist, address the psychosocial comorbidities of chronic pain. Medical staff oversee the tapering of opiate analgesics and other symptom targeted treatments. This integrated approach is indicated when conventional treatments have been ineffective. Outcome Measures. The objective outcome was the 6-minute walk test (6 mWT) distance. The subjective outcomes were performance (COPM-PER) and satisfaction (COPM-SAT) as measured by the Canadian Occupational Performance Measure (COPM). Results. Average 6 mWT distances improved by 39% from 375 m to 523 m. Average COPM-PER scores increased from 3.4 to 7.5. Average COPM-SAT scores increased from 2.4 to 7.5. Conclusions. Comprehensive interdisciplinary outpatient rehabilitation can significantly improve function in people with chronic pain. Svetlana Kurklinsky, Rachel B. Perez, Elke R. Lacayo, and Christopher D. Sletten Copyright © 2016 Svetlana Kurklinsky et al. All rights reserved. Experiences of Iranian Nurses on the Facilitators of Pain Management in Children: A Qualitative Study Wed, 30 Mar 2016 11:26:49 +0000 Background. Despite decades of research and the availability of effective analgesic approaches, many children continue to experience moderate-to-severe pain after hospitalization. Greater research efforts are needed to identify the factors that facilitate effective pain management. The aim of this study was to explore the perceptions of Iranian nurses on facilitators of pain management in children. Materials and Methods. This qualitative study collected the data profoundly through unstructured interviews with 19 nurses in Amirkola Children’s Hospital in Babol and Children’s Medical Center in Tehran, during 2013-2014. Purposeful sampling and analysis of the data were conducted using conventional qualitative content analysis. Results. Four themes were extracted through data analysis: mother and child participation in diagnosis and pain relief, the timely presence of medical staff and parents, proper communication, and training and supportive role of nurses. Conclusion. Mother and child participation in the report and diagnosis of pain and nonpharmacological interventions for pain by the mother, the timely presence of medical team at the patient’s bedside, and proper interaction along with the training and supportive role of a nurse enhanced the optimal pain management in hospitalized children. Parvin Aziznejadroshan, Fatemeh Alhani, and Eesa Mohammadi Copyright © 2016 Parvin Aziznejadroshan et al. All rights reserved. Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion Tue, 29 Mar 2016 13:54:41 +0000 Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS. Daniel Muñoz-García, Alfonso Gil-Martínez, Almudena López-López, Ibai Lopez-de-Uralde-Villanueva, Roy La Touche, and Josué Fernández-Carnero Copyright © 2016 Daniel Muñoz-García et al. All rights reserved. Pain Predicts Function One Year Later: A Comparison across Pain Measures in a Rheumatoid Arthritis Sample Mon, 28 Mar 2016 09:10:44 +0000 Background. Guidance is limited on best measures and time periods to reference when measuring pain in order to predict future function. Objective. To examine how different measures of pain predict functional limitations a year later in a sample of rheumatoid arthritis patients. Methods. Logistic regression analyses were conducted using baseline and one-year data (). Pain intensity in the last 24 hours was measured on a 0–10 numerical rating scale and in the last month using an item from the Arthritis Impact Measurement Scale 2 (AIMS2). AIMS2 also provided frequency of severe pain, pain composite scores, and patient-reported limitations. Physician-rated function was also examined. Results. Composite AIMS2 pain scale performed best, predicting every functional outcome with the greatest magnitude, a one-point increase in pain score predicting 21% increased odds of limitations (combined patient and physician report). However, its constituent item—frequency of severe pain in the last month—performed nearly as well (19% increased odds). Pain intensity measures in last month and last 24 hours yielded inconsistent findings. Conclusion. Although all measures of pain predicted some functional limitations, predictive consistency varied by measure. Frequency of severe pain in the last month provided a good balance of brevity and predictive power. Vivian Santiago, Karen Raphael, and Betty Chewning Copyright © 2016 Vivian Santiago et al. All rights reserved. Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry Tue, 22 Mar 2016 12:23:39 +0000 Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient’s perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean ≥ 5 in both groups). Pain interference with mobilization was reported by 87–93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given. Renée Allvin, Narinder Rawal, Eva Johanzon, and Ragnar Bäckström Copyright © 2016 Renée Allvin et al. All rights reserved. Cost-Saving Early Diagnosis of Functional Pain in Nonmalignant Pain: A Noninferiority Study of Diagnostic Accuracy Mon, 21 Mar 2016 07:21:48 +0000 Objectives. We compared two index screening tests for early diagnosis of functional pain: pressure pain measurement by electronic diagnostic equipment, which is accurate but too specialized for primary health care, versus peg testing, which is cost-saving and more easily manageable but of unknown sensitivity and specificity. Early distinction of functional (altered pain perception; nervous sensitization) from neuropathic or nociceptive pain improves pain management. Methods. Clinicians blinded for the index screening tests assessed the reference standard of this noninferiority diagnostic accuracy study, namely, comprehensive medical history taking with all previous findings and treatment outcomes. All consenting patients referred to a university hospital for nonmalignant musculoskeletal pain participated. The main analysis compared the receiver operating characteristic (ROC) curves of both index screening tests. Results. The area under the ROC curve for peg testing was not inferior to that of electronic equipment: it was at least 95% as large for finger measures (two-sided ) and at least equally as large for ear measures (two-sided ). Conclusions. Routine diagnostic testing by peg, which is accessible for general practitioners, is at least as accurate as specialized equipment. This may shorten time-to-treatment in general practices, thereby improving the prognosis and quality of life. Rafael J. A. Cámara, Christian Merz, Barbara Wegmann, Stefanie Stauber, Roland von Känel, and Niklaus Egloff Copyright © 2016 Rafael J. A. Cámara et al. All rights reserved. Morphine Suppository versus Indomethacin Suppository in the Management of Renal Colic: Randomized Clinical Trial Thu, 17 Mar 2016 12:32:33 +0000 Background. Renal colic is a medical emergency due to the rapid onset and devastating nature of its pain. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are both used as first-line choices in its management. Aim. This study aimed to compare the efficacy and safety of opioids and NSAIDs in the management of acute renal colic. Methods. One hundred and fifty-eight patients were divided into two groups () and received either 10 mg morphine or 100 mg indomethacin suppositories. The severity of pain was measured using verbal numeric rating scale at baseline and 20, 40, 60, and 90 minutes after the administration of analgesics. Drug side effects as well as patients’ vital signs were also recorded. Results. The mean decrease in the pain score during the first 20 minutes was significantly higher among those who received morphine suppository. However, no significant difference was observed between the two groups regarding the mean decrease in pain score during the first 40, 60, and 90 minutes after the admission. Prevalence of drug side effects or changes in the vital signs was not significantly different between the two groups. Conclusions. Morphine suppositories seem to be more efficient in achieving rapid pain relief comparing to indomethacin. Forough Zamanian, Mohammad Jalili, Maziar Moradi-Lakeh, Maryam Kia, Rokhsareh Aghili, and Seyed Mojtaba Aghili Copyright © 2016 Forough Zamanian et al. All rights reserved. Impact of Opioid and Nonopioid Drugs on Postsurgical Pain Management in the Rat Wed, 16 Mar 2016 12:38:30 +0000 Aim. Nonsteroidal anti-inflammatory drugs or opioids are commonly used to control surgical pain following veterinary and clinical procedures. This study evaluated the efficacy of postoperative ketorolac or buprenorphine following abdominal surgery. Main Methods. Mean arterial pressure (MAP), heart rate, animal activity, corticosterone levels, and a nociceptive sensitivity assay were used to evaluate 18 adult male Sprague-Dawley rats which underwent aortic artery occlusion for implantation of a radiotelemetry device. The animals were treated postoperatively with intraperitoneal injections of vehicle, ketorolac (10 mg/kg), or buprenorphine (0.06 mg/kg) every 8 hours for 3 days. Key Findings. There were no consistent significant changes in any of the telemetry parameters after treatment with ketorolac compared with no saline treatment with the exception of increased MAP in the buprenorphine group during the first 48 hours when compared with other treatment groups. There was a sustained increase in fecal corticosterone levels from baseline on days 2–7 with buprenorphine compared with vehicle- or ketorolac-treated animals. All treatment conditions displayed reduced paw withdrawal thresholds (PWTs) from day 1 to day 21 following surgery. Compared with the vehicle treatment group, buprenorphine-treated animals exhibited significantly lower PWT levels from day 4 to 14 days. Significance. Given the prolonged increase in fecal corticosterone levels and pronounced changes in tactile hyperalgesia behavior in rodents subjected to buprenorphine treatment, these data suggest that ketorolac may be superior to buprenorphine for the treatment of postprocedure pain behavior in rodents. Natalie M. Wilson, Matthew S. Ripsch, and Fletcher A. White Copyright © 2016 Natalie M. Wilson et al. All rights reserved. Coadministration of Resveratrol and Rice Oil Mitigates Nociception and Oxidative State in a Mouse Fibromyalgia-Like Model Wed, 16 Mar 2016 09:36:21 +0000 The mechanism underlying pain symptoms in fibromyalgia (FM) is not fully understood. Oxidative stress has emerged as pathophysiological event occurring during the development of the disease. The present study aimed at investigating the efficacy of resveratrol associated with rice bran oil on fibromyalgia-like mice model. Subcutaneous injection of reserpine (0.25 mg/Kg) during 3 days produced fibromyalgia-like symptoms. Resveratrol and/or rice oil or pregabalin were administered through oral route in therapeutic (single dose) and preventive (four doses) schemes. In both schemes, treatment with resveratrol associated with rice bran oil and pregabalin significantly reduced mechanical allodynia and thermal hyperalgesia in animals. The preventive scheme displayed antidepressant effect which was demonstrated by the forced swimming test as well as reduced reactive species in the cerebrospinal fluid of reserpinized animals. Taken together, our data provide evidences that the intake of resveratrol associated with rice bran oil plays antinociceptive and antidepressant actions probably through reducing reactive species and suggests the involvement of oxidative stress in this model of FM as possible underlying mechanism of pathogenesis of the disease. Caroline Peres Klein, Marcos Rodrigues Cintra, Nancy Binda, Danuza Montijo Diniz, Marcus Vinicius Gomez, Andre Arigony Souto, and Alessandra Hubner de Souza Copyright © 2016 Caroline Peres Klein et al. All rights reserved. School Absenteeism due to Toothache among Secondary School Students Aged 16–18 Years in the Ha’il Region of Saudi Arabia Thu, 18 Feb 2016 11:34:00 +0000 Objective. This study assessed the impact of toothache on school attendance among secondary school students in the Ha’il Region, Saudi Arabia. Methods. A cross-sectional, paper based survey was conducted among 16–18-year-old students of public sector secondary schools in the Ha’il Region, Saudi Arabia. Results. Of the 510 students selected from the participating schools, 480 were analyzed (94.1%). Of the sample, 50.4% were boys. Among the participants in the study, 86 students reported school absence due to toothache in the six months prior to the survey. Consequently, the prevalence of absenteeism due to toothache in this study was of 18%. Conclusion. The prevalence of school absenteeism due to toothache among students in the Ha’il Region was low. Yet, still, missed school days due to toothache may have implications for students also in the Ha’il Region, Saudi Arabia, as school absenteeism leads to missed opportunities for learning and academic advancement. Sameer Shaikh, Ammar Ahmed Siddiqui, and Mohammad Aljanakh Copyright © 2016 Sameer Shaikh et al. All rights reserved. Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia Tue, 09 Feb 2016 06:52:59 +0000 Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects. Jinguo Wang, Hongqin Li, Haichun Ma, and Na Wang Copyright © 2016 Jinguo Wang et al. All rights reserved. Prevalence of Low Back Pain among Undergraduate Physiotherapy Students in Nigeria Wed, 03 Feb 2016 12:11:29 +0000 Background. Low back pain (LBP) is a major cause of disability and the most common work-related musculoskeletal disorder among physiotherapists. This study examined the prevalence of low back pain among students undergoing training to become physiotherapists. Methods. Participants were 207 undergraduate clinical physiotherapy students at three universities in Nigeria. A modified version of a questionnaire used in a previous study was utilized to obtain demographic, educational activities, and LBP data. Prevalence of LBP was examined with descriptive statistics while factors associated with prevalence were explored using chi-square statistics. Results. More male students (53.1%) and those in the penultimate year of study (53.1%) participated in the study. Lifetime, 12-month, 1-month, and 7-day prevalence of LBP were 45.5%, 32.5%, 17.7%, and 11.5%, respectively. Prevalence of LBP was not significantly associated with any of the demographic variables. Educational activities, namely, “having techniques practiced on self for ≤10 hours” and “treating patients for ≥30 hours,” a month prior to the study were significantly () associated with higher 1-month and 7-day LBP prevalence, respectively. Conclusions. Although the prevalence of LBP was comparatively low, its association with educational activities emphasizes the need to incorporate effective LBP preventive strategies in the training of physiotherapy students. Grace O. Vincent-Onabajo, Ejiofor Nweze, Fatima Kachalla Gujba, Mamman Ali Masta, Mohammad Usman Ali, Ali Alhaji Modu, and Chuka Umeonwuka Copyright © 2016 Grace O. Vincent-Onabajo et al. All rights reserved. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic Thu, 14 Jan 2016 14:28:30 +0000 This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery () as well as the reported number of daily hours in moderate/severe pain (). Women reported more pain than men (). Pain trajectories did not differ by education, employment, cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0–3 postoperatively (). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (), and similar results were observed for ratings of pain with activity (). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. Nikolai Kornilov, Maren Falch Lindberg, Caryl Gay, Alexander Saraev, Taras Kuliaba, Leiv Arne Rosseland, Konstantin Muniz, and Anners Lerdal Copyright © 2016 Nikolai Kornilov et al. All rights reserved. Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery Thu, 31 Dec 2015 06:53:46 +0000 Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29–4.32) increased odds of preoperative opioid use (). The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70) increased odds of illicit preoperative opioid use (). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27) increased odds of legitimate preoperative opioid use (). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain. Jennifer M. Hah, Yasamin Sharifzadeh, Bing M. Wang, Matthew J. Gillespie, Stuart B. Goodman, Sean C. Mackey, and Ian R. Carroll Copyright © 2015 Jennifer M. Hah et al. All rights reserved. Effect of Pregabalin on Cardiovascular Responses to Exercise and Postexercise Pain and Fatigue in Fibromyalgia: A Randomized, Double-Blind, Crossover Pilot Study Tue, 29 Dec 2015 12:35:03 +0000 Pregabalin, an approved treatment for fibromyalgia (FM), has been shown to decrease sympathetic nervous system (SNS) activity and inhibit sympathetically maintained pain, but its effects on exercise responses have not been reported. Methods. Using a randomized double-blind crossover design, we assessed the effect of 5 weeks of pregabalin (versus placebo) on acute cardiovascular and subjective responses to moderate exercise in 19 FM patients. Blood pressure (BP), heart rate (HR), and ratings of perceived exertion (RPE) during exercise and ratings of pain, physical fatigue, and mental fatigue before, during, and for 48 hours after exercise were compared in patients on pregabalin versus placebo and also versus 18 healthy controls. Results. On placebo, exercise RPE and BP were significantly higher in FM patients than controls (). Pregabalin responders (, defined by patient satisfaction and symptom changes) had significantly lower exercise BP, HR, and RPE on pregabalin versus placebo () and no longer differed from controls (). Cardiovascular responses of nonresponders () were not altered by pregabalin. In responders, pregabalin improved ratings of fatigue and pain (), but negative effects on pain and fatigue were seen in nonresponders. Conclusions. These preliminary findings suggest that pregabalin may normalize cardiovascular and subjective responses to exercise in many FM patients. Andrea T. White, Kathleen C. Light, Lucinda Bateman, Ronald W. Hughen, Timothy A. Vanhaitsma, and Alan R. Light Copyright © 2015 Andrea T. White et al. All rights reserved.