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Objectives Musculoskeletal pain is common among children and adolescents. Despite the lack of evidence regarding harms and benefits, musculoskeletal pain is often managed with pain medication. The aim of this systematic review is to assess the prevalence of pain medication use for musculoskeletal pain among children and adolescents and the factors and side effects associated with use. Content Three databases (EMBASE, CINAHL and PsychINFO) were systematically searched to identify studies designed to examine the prevalence, frequency or factors associated with the use of pain medication for musculoskeletal pain in children and adolescents (aged 6–19 years). The included studies were assessed for study quality and data were extracted. Summary The search initially provided 20,135 studies. After screening titles, abstracts and full-texts, 20 studies were included. In school settings, 8–42% of children used pain medication for musculoskeletal pain, and 67–75% of children in sports clubs and from pain clinics used pain medication. The most consistent factors associated with the use of pain medications were pain characteristics and psychological factors (e.g. being bullied, low-self-esteem), while mixed evidence was found for increasing age and female gender. Only two studies reported on the duration of use and only one study on adverse effects related to the use of pain medication. Outlook We found that 8–42% of adolescents from school-based samples use pain medication for MSK pain, while the prevalence among adolescents from sports clubs and pain clinics is higher (67–75%). Pain characteristics (pain duration, severity, intensity, disability levels and the presence of ≥2 pain conditions or multisite pain) and psychological factors were associated with a higher use of pain medication, while for higher age and female gender the evidence of association was mixed. Future studies should systematically collect information on the type, duration of use of pain medication and side effects to confirm the findings of this review.

Tepe, Nermin (Balikesir Author), Background /aim: In this study, we aimed to compare the efficacy of greater occipital nerve (GON) block alone and GON combined with supraorbital nerve (SON) block in the treatment of medication overuse headache (MOH). Material and methods: 82 patients were divided into two groups: 41 patients were administered bilateral GON block while the other 41 patients GON + SON block. Nerve blocks were administered every 10 days for a total of 5 sessions. After each administration and 20 days after the last injection, information on pre and post treatment numerical rating scale (NRS) score, number of painful days, analgesic intake, duration of pain were collected. Results: The decrease in headache evaluation parameters was similar in both groups after the block. The NRS scores in the GON and GON + SON groups before the treatment was (8.2 +/- 0.7, 8.5 +/- 0.7), the number of painful days in a month was (21.4 +/- 6.9, 21.2 +/- 4.6 days), the number of analgesics taken monthly was (45 +/- 25.6, 47.5 +/- 29.9), the duration of pain was (44.9 +/- 24.6, 41.7 +/- 22.8 h), respectively. On the 60th day of treatment, the NRS scores in the GON and GON + SON groups were found to be (6.8 +/- 2.5, 4.8 +/- 2.3), the number of painful days in a month was (4.2 +/- 3.3, 2.2 +/- 1.5), respectively. The number of monthly analgesic consumption was (4.4 +/- 3.8, 0.9 +/- 1.2), and the duration of pain was (28.4 +/- 19.3, 19.4 +/- 16.1 h). Conclusion: This study showed significant reductions in headache parameters in both groups. However, NRS score, analgesic intake, number of painful days, and pain duration significantly better improved in the GON block added SON block group.

Latar Belakang: Low back pain (LBP) merupakan keadaan nyeri punggung bawah. Nyeri yang timbul pada low back pain bukan merupakan suatu penyakit ataupun diagnosis, melainkan istilah untuk nyeri yang dirasakan di area anatomi yang terkena dengan berbagai variasi lamanya terjadi nyeri. Pada beberapa kejadian nyeri awal dapat berlanjut selama periode 3 bulan dan akhirnya berkembang menjadi chronic low back pain (CLBP). Tujuan: Studi ini adalah untuk mengetahui pengaruh penurunan nyeri setelah diberikan core stabilization exercise (CSE) terhadap chronic low back pain berdasarkan literature yang ada dan mengetahui jenis latihan core stabilization exercise pada chronic low back pain berdasarkan literature yang ada. Metode: Penelitian ini adalah menggunakan studi critical review. Hasil: Dari hasil studi ini ditemukan 8 dari 148 artikel yang sesuai dengan kriteria inklusi. Pada studi ini 8 artikel yang digunakan sebagai landasan studi yang dilanjutkan untuk tahap appraisal. Hasil dari appraisal terdapat 6 artikel memiliki nilai Quartile 1 (Q1) dan 2 artikel yang memiliki nilai Quartile 2 (Q2). Lalu penilaian PEDro scale didaptkan 7 artikel yang memiliki bias rendah > 5 dan 1 artikel memiliki bias yang tinggi ?5. Kesimpulan: Berdasarkan hasil studi yang telah dilakukan pada pengaruh core stabilization exercise terhadap penurunan nyeri pada chronic low back pain berdasarkan studi pada literature yang ada dapat disimpulkan bahwa core stabilization exercise berpengaruh dalam penurunan nyeri pada chronic low back pain.

AIM: Prior research has primarily focused on static pain assessment, largely ignoring the dynamic nature of pain over time. We used a novel assessment tool for characterizing pain duration, frequency, and amplitude in women with dysmenorrhea and evaluated how these metrics were affected by naproxen treatment. METHODS: Dysmenorrheic women (n=25) rated their menstrual pain by squeezing a pressure bulb proportional to the magnitude of their pain. To evaluate whether bulb squeezing was affected by naproxen, we compared parameters before and after naproxen. We also analyzed the correlation between pain relief on a numerical rating scale to changes in bulb squeezing parameters. Random bulb-squeezing activity in pain-free participants (n=14) was used as a control for nonspecific effects or bias. RESULTS: In dysmenorrheic women, naproxen reduced the duration of the squeezing during a painful bout, the number of painful bouts and bout intensity. Before naproxen, the correlation between these bulb squeeze parameters and self-reported pain on numeric rating scale was not significant (R(2) = 0.12, p = 0.304); however, there was a significant correlation between changes in bulb squeeze activity and self-reported pain relief after naproxen (R(2) = 0.55, p < 0.001). CONCLUSIONS: Our study demonstrates a convenient technique for continuous pain assessment, capturing three different dimensions: duration, frequency, and magnitude. Naproxen may act by reducing the duration and frequency of episodic pain in addition to reducing the severity. After further validation, these methods could be used for other pain conditions for deeper phenotyping and assessing novel treatments.

The purpose of this study was to examine associations between the degree of central sensitization (CS) and remote muscle performance in people with chronic low back pain (CLBP).The 2011 fibromyalgia (FM) criteria and severity scales (2011 FM survey) were used as a surrogate measure of CS to divide the participants into 2 groups: FM-positive CLBP and FM-negative CLBP. Measures related to central sensitization included the 2011 FM survey and pressure pain threshold of the thumbnail. Measures related to muscle performance included neck flexor muscle strength and endurance and plantar flexor muscle strength. Between-groups and correlation analyses were performed.Sixty people with CLBP were enrolled (30 FM-positive, 30 FM-negative). There was no significant difference between the subgroups in age, sex, or pain duration (P.05). The FM-positive CLBP group showed poorer neck flexor muscle endurance (P = .01) and plantar flexor muscle strength (P = .002) than the FM-negative CLBP group, whereas neck flexor muscle strength was not different between the groups (P = .175). Scores for FM and values for pressure pain thresholds of the thumbnail were associated with neck flexor muscle strength (respectively, r = -0.320, P = .013, and r = 0.467, P.001), endurance (r = -0.242, P.001, and r = 0.335, P = .009), and plantar flexor muscle strength (r = -0.469, P.001, and r = 0.500, P.001).We found associations between the degree of CS and remote muscle strength and endurance, suggesting that poor remote muscle performance is possibly a clinical sign of CS in people with CLBP.

Objectives It is important to validate self-reported musculoskeletal pain used in epidemiological studies for evaluation of pain outcome measures. The main objective of this paper was to assess the association between self-reported neck/shoulder/upper limb pain and clinical signs of disorders in the region, especially by comparing a measure that only used pain intensity with a measure that combined pain intensity and pain duration. Methods Four hundred and twenty technical school students of both genders were included with a median age of 17 years (16–28). The students stated the pain in four intensity grades and the pain duration in four period lengths within the preceding four weeks period. A pain severity index was calculated by multiplying the pain intensity (0–3) and the duration (1–4). A clinical examination was performed within a week after completing the form. The associations were evaluated by agreement, correlation and symmetric strength of association (contingency). Results The study found low correlation and low positive agreement for neck/shoulder and upper limb pain related to clinical signs of disorders in the region. However, the relationship showed high negative agreement and high contingency. The negative agreement increased for the neck/shoulder region with higher cut-off points for dichotomization, but not for the upper limb region. The index combining reports of pain intensity with pain duration, do not improve agreement, correlation or contingency with clinical signs compared to use of pain intensity alone. Conclusions This study showed an association between self-reported neck/shoulder/upper limb pain intensity and clinical signs of musculoskeletal disorders of the region. An index combining pain intensity and duration (Pain Severity Index) did not increase this association. From the results we suggest using pain intensity reports alone and if dichotomizing is wanted, choosing a cut-off point at high pain levels, especially for neck and shoulder pain.

Our aim was, to examine the effect of supportive care provided based on the philosophy of HypnoBirthing during labor fear, pain, duration, satisfaction, and cost. Study was single-blind, randomized controlled trial using a pre-post and control group design. It was conducted with 60 nulliparous women during childbirth. This study showed that the levels of labor fear, pain duration and cost were lower and the levels of satisfaction the labor experience were higher in the intervention group. This care also plays an effective role in reducing the cost of labor. It is recommended that this program should be used during labor. © 2020 Taylor & Francis Group, LLC.

AIMS To examine the associations of self-reported presence of tinnitus with subtypes of temporomandibular disorders (TMD) as assessed by Axis I of the Diagnostic Criteria for TMD (DC/TMD) and with psychologic characteristics as assessed by Axis II. METHODS This retrospective controlled study included 108 consecutive TMD patients referred to the Tel Aviv University Orofacial Pain Clinic. Each patient received full Axis I and Axis II diagnoses according to the DC/TMD. The patients were asked about currently experiencing tinnitus. Pearson chi-square test and Fisher exact test were used to test the associations between categorical variables. Mann-Whitney test was used to assess differences in continuous variables between categories. A P value < .05 was considered statistically significant. RESULTS Thirty-three (30.6%) TMD patients reported experiencing tinnitus. There was a significantly higher prevalence of myofascial pain with referral (P = .008) and nonspecific physical symptoms (P = .014) among the TMD patients who reported tinnitus. In addition, those patients reported significantly longer pain duration compared to TMD patients without tinnitus (P = .039). CONCLUSION This study emphasizes the necessity of assessing both Axes I and II according to the DC/TMD in future studies and supports creating a standardized tinnitus screener tailored to TMD patients for future studies on tinnitus in TMD patients.

Introduction. This study was conducted to evaluate the effects of oral aloe vera gel pills supplementation on the intensity of menstrual pain. A randomized, single-blind clinical experimental plan was conducted amongst 150 single students aged 20 to 26 years who suffered from menstrual pain, at the Islamic Azad University of Medical Sciences from December 24, 2015 to October 22, 2016. The extent of pain was evaluated using the Cox Menstrual Symptom Scale (CMSC). Material and method. Each participant was randomly assigned to aloe vera gel pill or the anti-PG drug Ibuprofen, ending with 60 participants in each group equally. The first trial group received 10 mg of aloe vera gel orally four times daily until the pain grade reached one or less. The control group received Ibuprofen and three tablets orally three times a day. The participants were permitted to take another drug that they usually took for their pain relief, in addition to the allocated treatment in case of continued pain. At the end of the trial, these participants were excluded in data analysis. Results and discussions. Changes in the grade and the duration of the pain of participants were compared at the first and second months in both groups. Sample size was computed using alpha = 5 and absolute error equal to 0.24 for correlation between medication and pain with acceptable absolute precision formula (AAPF). Result of this study showed that the mean age was 22.1 +/- 1.4and 20.4 +/- 1.2 years in aloe vera gel pills and Ibuprofen groups, respectively. No significant difference was observed for the matched characteristics studied between the treated groups. the mean pain grade amongst aloe vera group was decreased from 2.81 +/- 0.65 to 2.02 +/- 0.34, while in Ibuprofen group from 2.48 +/- 0.4 to 1.32 +/- 0.15, respectively, using the described given dose. As result obtained that there was no statistically significant decrease in pain duration for the women who received Ibuprofen compared to those who used aloe vera. Also there was no significant difference in pain grade between the groups at the second month of intervention (p=0.61). Pain duration at the second month of trial was similar between the both groups (p=0.76). Conclusions. In conclusion we could suggest that aloe vera gel pill as a novel herbal pain killer represents an effective treatment for the menstrual pain with no important side effects, although further clinical trials are recommended to look at the possible side effects in an extended spectrum of subjects.

Das Mainzer Stadienmodell der Schmerzchronifizierung (Mainz Pain Staging System [MPSS]) wurde uberwiegend bei Menschen in mittlerem Alter und mit chronischen Ruckenschmerzen validiert und soll zur Prognoseeinschatzung und zur Steuerung des Ressourceneinsatzes bei Therapiebeginn dienen. Bei multimorbiden und funktionell beeintrachtigten Menschen (geriatrische Patienten) mit multipler Schmerzursache ist unklar, ob dieses Instrument uberhaupt umgesetzt werden kann und Aussagen zur Chronifizierungsschwere von Schmerzen zulasst. Deshalb wurden 173 konsekutive Patienten mit Schmerzen in der zweiten Woche einer stationaren geriatrischen Behandlung nach dem MPSS eingestuft. Zur Validierung wurden die Fragen aus dem Schmerzinterview fur geriatrische Patienten (SgP) herangezogen. Zudem wurde das MPSS mit der eigenanamnestischen Angabe zur Dauer des Hauptschmerzes verglichen. Bis auf die Fragen zur Medikamenteneinnahme konnte das MPSS uberwiegend eigenanamnestisch erhoben werden. Selbst wenn man die aktuelle analgetische Therapie heranzieht, wies das MPSS signifikante Zusammenhange mit dem sensorischen, affektiven und emotionalen Schmerzerleben aus dem SgP auf. Die Angaben zur Dauer korrelierten nur mit einer Kategorie des MPSS (Schmerzbild). Das MPSS ist bei multimorbiden und funktionell beeintrachtigten alteren Patienten in stationarer Behandlung umsetzbar. Chronifizierungsmerkmale sind in hoheren Stadien ausgepragter als in niedrigeren. Nur eine Kategorie des MPSS kann eigenanamnestisch nicht valide erhoben werden. Die Moglichkeiten der Prognoseabschatzung und der Ressourcensteuerung mithilfe des MPSS sollten fur dieses Kollektiv weiter untersucht werden.

PURPOSE This study characterized ocular pain symptoms in individuals with and without a history of refractive surgery (RS) using a cross-sectional survey of individuals with ocular pain. METHODS A link to an anonymous survey was posted on a corneal neuralgia Facebook group that included individuals with ocular pain from any etiology and sent to individuals seen in our clinic with ocular pain. The survey asked about medical history, ocular pain symptoms (using standardized questionnaires), and treatment responses. Respondents were split into 2 groups based on a history of RS. RESULTS One hundred one individuals responded to the survey. The mean age for all respondents was 41.6 ± 15.6 years, and 50% reported a history of RS. A total of 46% of individuals with a history of RS reported that their ocular pain started within 1 month of surgery, with median pain duration of 36 (interquartile range 22-84) months. The median Dry Eye Questionnaire-5 (range 0-22) scores were 16 and 15 for the RS and no-RS groups, respectively. Most individuals in both groups characterized their pain as burning (score ≥1: RS, 86%; no-RS, 80%) and reported evoked pain to wind, light, or temperature (score ≥1: RS, 97%; no-RS, 85%). Fifty-nine of 101 individuals responded to treatment questions. Individuals in both groups reported >30% improvement in pain symptoms with some topical and systemic approaches. CONCLUSIONS Individuals with a history of RS developed ocular pain soon after surgery, which persisted for years. Symptom profiles were similar between those with and without RS. Topical and systemic approaches can treat pain in both groups.

Background Chronic inflammatory joint diseases (CIJD) have been linked to increased cardiovascular morbidity and mortality. A decisive reason could be a dysregulation of the autonomic nervous system, which is responsible for the control of cardiovascular function. So far, the cause of changes in autonomic nervous system functions remains elusive. In this study, we investigate the role of chronic pain and the insular cortex in autonomic control of cardiac functioning in patients with CIJD. Methods We studied the autonomic nervous system through the assessment of heart rate and heart rate variability (HRV) at rest and under cognitive stimulation. Furthermore, we investigated insular cortex volume by performing surface-based brain morphometry with FreeSurfer. For this study, 47 participants were recruited, 22 individual age- and sex-matched pairs for the magnetic resonance imaging analyses and 14 for the HRV analyses. All available patients’ data were used for analysis. Results Pain duration was negatively correlated with the resting heart rate in patients with chronic inflammatory joint diseases (n = 20). In a multiple linear regression model including only CIJD patients with heart rate at rest as a dependent variable, we found a significant positive relationship between heart rate at rest and the volume of the left insular cortex and a significant negative relationship between heart rate at rest and the volume of the right insular cortex. However, we found no significant differences in HRV parameters or insular cortex volumes between both groups. Conclusions In this study we provide evidence to suggest insular cortex involvement in the process of ANS changes due to chronic pain in CIJD patients. The study was preregistered with the German Clinical Trials Register ( https://www.drks.de ; DRKS00012791; date of registration: 28 July 2017).

Purpose Inconsistent and inadequate pain assessment practices in cerebral palsy (CP) have resulted from a lack of standardisation of pain assessment, limited use of appropriate tools and failure to integrate disability and biopsychosocial models. To assist with improving consistency, this study aimed to establish consensus from key stakeholders regarding domains considered essential for measuring chronic pain in children and young people with CP. Method A modified electronic Delphi study was conducted on 83 stakeholders, including clinicians, researchers, people with CP and parents of children with CP. Participants rated 18 domains sourced from existing literature as either "core", "recommended", "exploratory" or "not required". Results After two rounds of surveys, 12 domains were considered core: pain location, pain frequency, pain intensity, changeable factors, impact on emotional wellbeing, impact on participation, pain communication, influence on quality of life, physical impacts, sleep, pain duration and pain expression. Conclusion These domains reflect the complexity of pain in a heterogeneous population where medical comorbidities are common and communication and intellectual limitations impact significantly on the ability of many to self-report. The domains will be utilised to build a framework of pain assessment specific to children and young people with CP guided by the biopsychosocial model.Implications for rehabilitationChronic pain is under-identified and poorly assessed in the cerebral palsy (CP) population.The perspectives of clinicians, researchers and consumers are vital for developing a framework for chronic pain assessment in CP.Consensus of key stakeholders found 12 domains considered essential to incorporate into a chronic pain assessment model in CP.

Poor sleep quality (SQ) negatively affects pain associated with musculoskeletal disorders (MSD). As the level of economic development of a country determines its sanitary conditions, these can influence the sleep–pain relationship, therefore, it is relevant to generate evidence in the population with MSD in developing countries. This cross-sectional study sought to determine the effect of poor SQ on pain in Chilean individuals with MSD, controlling for sex and duration of pain (in months). Method: A total of 228 individuals were included. SQ was measured with the Pittsburg Sleep Quality Index (PSQI), pain (intensity, interference and distress relative to pain) was measured with visual analog scales. Structural equation modeling (SEM) was performed to analyze the effect of SQ on pain. Results: A high frequency of poor SQ was present in the studied group, and was more prevalent in women. The SEM model evidenced that poor SQ predicts greater pain. Sex influences sleep quality and pain, but not pain duration. Conclusions: These findings indicate that poor SQ predicts higher pain in MSD and that women exhibit worse SQ and more significant pain than men. Our findings support that SQ should be considered in the comprehensive approach to pain in individuals with MSD.

While vertebroplasty enjoys continued use in some settings, there is now high-moderate quality evidence based on systematic review that includes five placebo-controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. Serious harms including cord compression, ventricular perforation, pulmonary embolism, infection and death have been reported. This unfavourable risk-benefit ratio should be convincing doctors and patients to stop the use of vertebroplasty. At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence-informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from 'awareness raising' campaigns.

Background and purpose Long-term pain is common and entails large costs to society. One physiotherapy treatment with documented positive effects for patients with long-term pain is Basic Body Awareness therapy (BBAT). However, studies are lacking about patients' experience of BBAT's influence on their pain. Therefore, the aim of this study was to investigate how patients experience BBAT's influence on their long-term pain. Methods For this qualitative interview study, participants were selected from two supervised BBAT groups. To qualify for the study, participants had to meet two inclusion criteria: having pain for at least 6 months, and attending BBAT for at least 6 months. Six females between the ages of 25 and 61 years were included. Pain duration ranged from 9 to 20 years, and duration of practicing BBAT ranged from 8 to 120 months. Semi-structured interviews were conducted and qualitative content analysis was performed. Results The analysis revealed four main categories of BBAT experience: increases motivation, requires processing, increases control over pain and changes attitude to oneself, body and pain. Discussion Patients with long-term pain experienced BBAT as being helpful in processing their pain because they were forced to face the pain instead of trying to ignore it. Participants experienced a decrease in pain through development of an increased sense of control as well as a changed attitude to themselves, their bodies and their pain. It is important for physiotherapists to understand that pain can increase during BBAT and to support the patients in this process during the therapy.

BACKGROUND Central sensitization (CS) is found in patients with musculoskeletal disorders and is related to clinical symptoms, including pain-related disability. The Central Sensitization Inventory (CSI) has been developed for patients who are at risk of symptoms related to CS, and CSI severity levels are suggested for clinical interpretation of the CSI score. However, the longitudinal relationship between CSI severity and pain-related disability is unclear in primary care. In this study, we investigated the association between CSI severity levels and the profiles of patients with musculoskeletal disorders as well as the longitudinal relationship between CSI severity levels and pain-related disability in primary care settings. METHODS A total of 553 patients were assessed using CSI, EuroQol-5 dimension (EQ5D), and Brief Pain Inventory (BPI). Of the 553 patients, 150 patients were reassessed at the 3-month follow-up. Patients were grouped into three severity levels according to baseline CSI score: subclinical, mild, and moderate to higher level. RESULTS As the CSI severity levels increased, the clinical symptoms tended to worsen on cross-sectional analysis (p

The goal of the study is to assess the effectiveness and safety of testosterone replacement therapy in males with androgenic deficiency and nephrolithiasis who require surgical treatment. Patients and methods. All in all 565 patients were involved in the study. In 226 of them (40%) surgical treatment was used. In a majority of these cases (90%) contact uretherolithotripsy was used. In half of the patients uretheroscopy had revealed large and long-lasting concrements. In order to assess the effectiveness of nephrolithiasis surgical treatment on the background of testosterone replacement treatment the assessment of hormonal status during pre- and postoperative periods was accomplished, duration and intensity of pain during the early post-operative period was evaluated as well as narcotic analgetics application frequency and the duration of antibacterial therapy and the stay in the hospital. Results of the study. Replacement testosterone therapy during the early postoperative period in male patients with nephrolithiasis and androgen deficit has been demonstrated to reduce the leukocyteuria duration and the need for antibacterial therapy thus decreasing the stay at the hospital. Replacement testosterone therapy in male patients with nephrolithiasis and androgen deficit who had dealt with surgical treatment has been shown to decrease the pain duration and intensity thus decreasing the need for narcotic analgetics. The use of replacement testosterone therapy in the complex treatment of nephrolithiasis in patients after surgery contributes to faster liquidation of hyperglycemia and normalization of carbohydrate metabolism. Replacement testosterone therapy in male patients with androgen deficit and nephrolithiasis who need surgical treatment contributes to reduction of kidney stone disease relapse rate. Conclusion. Replacement testosterone therapy in male patients with nephrolithiasis and androgen deficit who need surgical treatment considerably improve the postoperative period quality.

Introdução: Políticas de saúde e qualidade de vida no trabalho devem ser desenvolvidas a partir de cada realidade. Objetivo: Caracterizar o perfil sociodemográfico, ocupacional e de saúde de profissionais com sintomas osteomusculares da unidade ambulatorial de um Hospital Universitário. Material e Métodos: Estudo transversal, descritivo, quantitativo, com profissionais de um hospital universitário com sintomas osteomusculares. Utilizou-se questionários de caracterização sociodemográfica e ocupacional, questionário internacional de atividade física, Nórdico, escala numérica, tempo de duração dos sintomas, questionário de avaliação de incapacidade causada pela dor, tratamento para a dor relatada e escala de estresse percebido. Resultados: População constituída, majoritariamente, por mulheres (66,4%), na metade da vida economicamente ativa (média de 39,02 anos±11,00), com formação superior (60,8%), apenas um emprego (84%), celetistas no local (68%), jornada de trabalho conforme estipulado pela legislação trabalhista (média de 42,30 horas±9,36), atuantes em setores assistenciais (59,2%) e que praticavam atividades físicas (58,4%). A maioria relatou tempo de duração da dor de até 6 semanas (50,4%), mas parcela considerável referiu dor persistente por mais de 12 semanas (40%), sendo a parte inferior das costas a região de maior ocorrência (38,4%). A maioria não consultou profissionais de saúde (62,4%) e não realizou tratamento (72,8%). Dentre as pessoas que realizaram, a maior parte informou utilizar medicação prescrita (7,2%), pilates (5,6%) e automedicação (4,8%). A intensidade da dor foi semelhante à de outros estudos (média de 6,05±2,77). A maioria informou não ter impedimentos para realizar atividades (76%) e a incapacidade causada pela dor caracterizou-se como moderada (média de 29,46±18,87). A média de estresse percebido condiz com resultados de estudos nacionais (19,06±4,73). Conclusão: O conhecimento dessa realidade pode subsidiar o planejamento de políticas e implementação de estratégias que contribuam com a promoção da saúde dos trabalhadores e qualidade de vida no trabalho.

Background: The typical sign or main symptom in acute coronary syndrome (ACS) patients is chest pain, which is an initial benchmark or early sign for diagnosis. Certain factors, such as gender differences, the presence of diabetes mellitus or other clinical conditions, may make the patient not realize they have ACS. Therefore, this study aims to identify the characteristics of chest pain symptoms in male and female patients with ACS. Design and Methods: This is a non-experimental quantitative study, namely analytical observation using a cross-sectional approach within 4 months (January-April 2019). Furthermore, the samples were 53 ACS patients (28 male and 25 female). Results: The chest pain characteristics that have a significant relationship with gender differences in ACS patients are shown based on the aspects of location, pain duration and quality. Male patients are more likely to feel pain at the left or middle chest, the duration is between 20 min with moderate pain quality, which tends to become severe, while females are more likely to feel pain at the chest which radiates to the neck and chin, the duration is usually >20 min, with mild to moderate pain quality. Conclusions: The result showed a significant difference in chest pain characteristics in male and female patients with ACS. Regarding location, duration and quality of chest pain, male ACS patients mostly have more typical symptoms, while females’ symptoms are atypical. Significance for public health There are various characteristics of chest pain differences between male and female patients with Acute Coronary Syndrome. The findings of this study showed that it is important to provide optimal nursing care and also educate patients and families about the signs, or symptoms that often occur, especially atypical symptoms. This will reduce the tendency to delay in seeking treatment, which will affect prehospital delay time.

OBJECTIVES Increased evidence indicates that pain location affects central sensitization (CS)-related symptoms. In addition, pain location and pain duration may be intricately related to CS-related symptoms. However, these factors have been investigated separately. This study aimed to investigate the association between CS-related symptoms and pain location and/or pain duration in patients with musculoskeletal disorders. METHODS Six hundred thirty-five participants with musculoskeletal disorders were included in this cross-sectional study. All participants were assessed for pain location, pain duration, central sensitization inventory (CSI), EuroQol-5 dimension, and brief pain inventory. The participants were categorized into 3 groups based on pain location (spinal, limb, and both spinal and limb pain) and into 2 groups based on pain duration (acute and chronic pain). RESULTS The interaction between pain location and pain duration were not significant on CSI score (P > 0.05). The odds ratio for higher CSI score (≥ 40) in patients with both spinal and limb pain vs. those with spinal or limb pain was 2.64 (P

BackgroundThere is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain.MethodsWe will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology.DiscussionThis network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain.Systematic review registrationPROSPERO CRD42019145257

The influence of pre-radiotherapy pain duration on post-treatment outcomes was assessed. Patients that received palliative radiotherapy were analyzed in a prospective observational study investigating curative and palliative radiotherapy. Brief Pain Inventory data were acquired at baseline and 1, 2, and 3 months after commencing irradiation. The pain response in terms of the index pain (i.e., pain caused by the irradiated tumors) was assessed using the International Consensus Endpoint. Patients were diagnosed with predominance of other pain (POP) if non-index pain of malignant or unknown origin was present and showed a higher pain score than the index pain. Competing risk analyses were performed in which deaths without the pain endpoints were considered as competing events. Of 229 patients analyzed, 123 (54%) experienced a pain response and 43 (19%) experienced POP. Multivariable analyses using the Fine-Gray model revealed that patients with shorter pain duration (

Introduction Little is known about the development of specific acromioclavicular joint osteoarthritis. Its histologic alterations are controversial, and radiologic alterations are seen in asymptomatic people. The objective of this study was to evaluate histologically the distal clavicle subchondral bone and to analyze magnetic resonance images in patients with painful and nonpainful acromioclavicular joint osteoarthritis. Methods An observational, analytical, and cross-sectional study with a control group was conducted. Between August 2018 and June 2019, we analyzed a total of 41 patients. Group 1 consisted of patients with pain in the acromioclavicular joint (symptomatic osteoarthritis), and group 2 consisted of patients without pain in the acromioclavicular joint (asymptomatic osteoarthritis). Results Twelve of the 15 patients with acromioclavicular joint pain (group 1) were female, 13 presented distal clavicle edema on magnetic resonance imaging, and 9 had subchondral bone edema on histologic examination. Patients with acromioclavicular joint pain had longer shoulder pain duration than patients without pain. Women were more likely to have acromioclavicular joint pain compared with men. Patients with edema on magnetic resonance imaging showed a greater chance of presenting pain in the acromioclavicular joint in comparison with patients without edema. Conclusion Women had a higher chance of presenting with acromioclavicular joint pain than men. Patients with edema on magnetic resonance imaging were more likely to present with pain than patients without edema. Patients with acromioclavicular joint pain had longer shoulder pain duration than patients without pain, and subchondral bone edema on histologic examination was more frequent in patients with pain.

Pain is a distressing symptom for children and adolescents with cancer and is experienced by individuals differently. This study sought to determine subgroups according to their pain experiences, and how demographic, clinical, and quality of life (QOL)-related characteristics might differ across subgroups.This cross-sectional study recruited 187 pediatric patients with cancer aged 8 to 17 years old and asked them to complete measures of pain intensity, pain duration, pain interference and pain control using the Chinese translation of the validated questionnaire from the Pain Squad app, as well as 7 PROMIS measures assessing QOL-related outcomes. Latent profile analysis (LPA) was used to identify latent subgroups.Three subgroups of children were identified: low-pain/low-duration (69.5%), moderate-pain/high-duration (19.8%), and high-pain/moderate-duration (10.7%). Hospitalized children were more likely to be in the moderate-pain/high-duration subgroup. Children in the high-pain/moderate-duration subgroup were more likely to be cared for by unemployed caregivers. Scores on depressive symptoms (p = 0.002), anger (p 0.001), anxiety (p = 0.045), fatigue (p = 0.044), and mobility (p = 0.008) questionnaire were significantly worse in the high-pain/moderate-duration subgroup than the other two subgroup.This study provides a scientific foundation for further studies exploring predictive factors related to pain experiences. More targeted treatment strategies targeting the specific characteristics of each subgroup will help improve patients' QOL and use of medical resources.The 3 identified pain subgroups demonstrate the heterogeneity in pain experiences among pediatric patients with cancer. Knowledge of these subgroups can assist clinicians in better identifying and targeting pain treatment for children with cancer.

Background The study was aiming to optimize excessive gum chewing as an experimental model to induce jaw muscle pain and fatigue similar to those in painful TMDs with durations that would allow immediate investigations of jaw-motor function. Further, if any sex differences would be detected in the expression of pain. Methods This randomized, double blinded study included 31 healthy participants of both sexes. A standardized chewing protocol of either 40- or 60-min of chewing was used with a wash-out period of 1 week. Subjective fatigue, pain characteristics and functional measures were assessed. For statistical analyses, Wilcoxon Signed Rank test, Mann–Whitney Rank Sum test and Friedman’s ANOVA with Tukey post-hoc test were used. Results High subjective fatigue scores that lasted up to 20 min after the end of the trial were significantly induced both in the 40- and 60-min chewing trials (P . Significant but mild pain was induced only in the 60-min trial (P = 0.004*) and only in men (P = 0.04*). Also, the induced pain area was significantly bigger in the 60-min trial (P = 0.009*). However, this increase in pain and pain area did not last to the first 10-min follow-up. There were no significant differences neither between the 40- and 60-min chewing trials, except regarding the pain area (P = 0.008*), nor between the sexes. Conclusion Taken together, excessive chewing in its current form does not seem to be a proper pain experimental model. The model needs further adjustments in order to mimic TMD-pain especially in women and to prolong the pain duration.

Herpes zoster or shingles causes a severe painful rash that spreads along dermatomes in the face or chest wall, which leads to a condition known as postherpetic neuralgia (PHN). There is no cure for PHN, but there are many treatments to reduce pain duration and severity. In this case report, we describe a patient treated for PHN using pregabalin (Lyrica) after failure with gabapentin. Despite being listed as a controlled substance by the Food and Drug Administration, pregabalin may be an effective first-line therapy for PHN and other forms of neuropathic and chronic pain.

This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coefficients were used to investigate the rate of change in the activity patterns. Age, sex, pain intensity, and pain duration were controlled. The results show that excessive persistence was the only self-reported activity pattern to show a linear change over the 15-day period. There was a decrease in excessive persistence, and this decrease was slower with higher levels of activity avoidance. However, no significant association was found between sex, age, pain intensity, and pain duration and excessive persistence at baseline or change over time. At baseline, a positive association was found between excessive persistence and pain avoidance, pain-related persistence, and pacing to reduce pain, and a negative association was found between excessive persistence and pacing to save energy for valued activities. This result suggests a profile characterized by alternate periods of high and low activity that, in this study, were unrelated to longitudinal changes in pain intensity.

Purpose The aim of this study was to compare the efficacy of the tunnel technique for root coverage using a new xenogeneic acellular dermal matrix vs. connective tissue grafting (CTG) for the treatment of multiple maxillary adjacent recessions (recession type 1) at 12 months postoperatively. Methods This study enrolled 12 patients with at least 3 contiguous, bilateral, symmetrical maxillary gingival recessions (i.e., at least 6 recessions per patient). In total, 74 recessions were treated using the modified coronally advanced tunnel (MCAT) technique combined with a novel porcine-derived acellular dermal matrix (PADM) at 37 test sites or CTG at 37 control sites. The following clinical parameters were measured: recession height, clinical attachment level, width of keratinized tissue, probing depth, recession width, gingival thickness, mean root coverage (MRC), and complete root coverage (CRC). Comparisons between test and control groups were made for pain visual analog scale scores at 14 days. Results At 12 months, the MCAT with PADM (test) yielded a statistically significant improvement in all clinical parameters studied. MRC was significantly higher on the control sides (80.6%±23.7%) than on the test sides (68.8%±23.4%). Similarly, CRC was 48.7%±6.8% on the control sides (CTG), in contrast to 24.3%±8.2% on the test sides (PADM). Statistically significant differences were observed in favor of the control sides for all clinical parameters studied. Nevertheless, the MCAT in adjunction with PADM was clearly superior at reducing mean and maximum patient-reported postoperative pain intensity and pain duration in the first week after surgery. Conclusions The use of PADM to treat multiple recessions improved clinical parameters at 12 months, but these outcomes were nevertheless poorer than those observed for CTG. However, PADM reduced morbidity, particularly the pain experienced by patients. Trial Registration ClinicalTrials.gov Identifier: NCT03162016, Graphical Abstract

Background: One of the most important surgical issues in the treatment of pilonidal sinus disease is recurrence. Aim of the work: The aim of this study is to compare two surgical techniques (rhomboid flap and semiclosure method) for treatment of recurrent pilonidal sinus. Patients & Methods: This randomized clinical trial was conducted in Zagazig University Hospitals between the period of Aug 2018 to Feb 2019 on 12 patients with recurrent pilonidal sinus, divided randomly into 2 groups: Group A 6 patients managed by semiclosure method and Group B 6 patients operated with rhomboid flap method. Results: There was a significant difference regarding pain duration, time of comfort sit, total time of healing and time of return to work between the two groups for the favor of group B which was markedly short in patients of group B. according to post-operative complication regarding delayed wound healing and wound infection had no significant difference between group A and group B. Regarding post-operative recurrence, follow up of both groups done during postoperative care and at time of 2nd, 3rd, 4th and 6th post-operative months. Only one case of group B had recurrence with no recurrent cases reported during the 6 post-operative months in group A .Conclusions: Patient of group A shows decreased pain duration, time need for comfortable sit and early return to work. There no significant difference between the 2 groups in post-operative complications. Rhomboid flap repair is an advantageous and effective modality than semiclosure method in treatment of sacrococcygeal disease

Objective: to study dynamics of pain intensity in patients undergone anterior subaxial cervical fusion depending on the type of fixing construction. Materials and Methods . Thirty-five patients were operated for traumatic cervical spine injury: resection of the damaged vertebral body and fusion with vertical cylindrical implant types Mesh combined with ventral plate (29 patients) or telescopic vertebral body replacement implant (24 patients). The pain intensity was evaluated during observation period: before surgery, after 5–7 days, 3 months, 6 months and 12–18 months after operation using a numeral rating scale. Results. The data obtained demonstrate the benefit of using telescopic vertebral body replacement implant that is evident as a lower level of pain intensity in patients in the postoperative period. The studied index difference is statistically significant in observation terms of 5–7 days and 3 months. The gradual leveling of differences between the groups is observed with 12–18 months after surgery. Conclusion. The type of fusion system when used during surgery has a great influence on the pain duration in the postoperative period. Optimal selection of implant design can improve the quality of life in patients after anterior subaxial cervical fusion.

The cingulate cortex (CC) is a brain region that plays a key role in pain processing, but CC abnormalities are not unclear in patients with trigeminal neuralgia (TN). The purpose of this study was to determine the central causal mechanisms of TN and the surrounding brain structure in healthy controls and patients with TN using 7 Tesla (T) magnetic resonance imaging (MRI). Whole-brain parcellation in gray matter volume and thickness was assessed in 15 patients with TN and 16 healthy controls matched for sex, age, and regional variability using T1-weighted imaging. Regions of interest (ROIs) were measured in rostral anterior CC (rACC), caudal anterior CC (cACC) and posterior CC (PCC). We also investigated associations between gray matter volume or thickness and clinical symptoms, such as pain duration, Barrow Neurologic Institute (BNI) scores, offender vessel, and medications, in patients with TN. The cACC and PCC exhibited gray matter atrophy and reduced thickness between the TN and control groups. However, the rACC did not. Cortical volumes were negatively correlated with pain duration in transverse and inferior temporal areas, and thickness was also negatively correlated with pain duration in superior frontal and parietal areas. The cACC and PCC gray matter atrophy occurred in the patients with TN, and pain duration was associated with frontal, parietal, and temporal cortical regions. These results suggest that the cACC, PCC but not the rACC are associated with central pain mechanisms in TN.

Disbudding is a routine practice in many dairy herds due to the effort to decrease the risk of injuries. Although the disbudding practice is regulated, it can vary among farms. The variation may be caused by many factors, such as herd size or type of breed, but also by farmers' perception of pain caused by disbudding. Hence, the aim of this study was to specify the disbudding practice on dairy farms in the Czech Republic and to assess these practices, including the use of pain mitigation medication, by breed, herd size, and sex of the disbudded calves. We analyzed data from 106 Czech dairy farms, which were collected by a trained interviewer at dairy meetings in 2014–2015. The farmers answered questions regarding the farm's basic characteristics, disbudding practice, and his/her attitude to the pain caused by disbudding. To test the influence of breed, herd size, and sex of disbudded calves on different variables, logistic regression models were used. Disbudding was performed in 92.5% of the surveyed farms; 63.3% of dairy calves were disbudded before 4 wk of age, and Czech Fleckvieh calves were 2.8 times more likely to be disbudded before 4 wk of age than Holstein calves. The hot-iron method was the most used method (69.4%). Calves were 4.5 times more likely to be disbudded by hot iron in herds where both heifers and bulls were disbudded than in herds where only heifers were disbudded. Most (>90%) surveyed farms did not use any pre- or post-procedure medication to mitigate the pain caused by disbudding. The disbudding procedure was performed mainly by farm personnel (94.9%), who were trained by a veterinarian or veterinary technician (46.9%) or by other farm personnel (37.8%) or were not trained (15.3%). Two-thirds of farmers observed behavioral changes in calves after disbudding. Most farmers estimated the pain caused by disbudding to be mild or moderate (20.4 or 45.9%, respectively) and 15.3% of farmers estimated it to be severe. Almost a quarter of interviewed farmers were unable to assess the duration of pain, 39.8% farmers estimated that the pain lasts only several minutes, and 20.4% estimated that the pain lasts up to 6 h. We detected a tendency that farmers of larger herds estimated pain duration to be shorter (odds ratio=1.2). To improve calves' welfare, training is needed in disbudding practice, focusing on the advantage of pain mitigation.

Background The aim of this study was to assess correlation between pain and degenerative bony changes on cone-beam computed tomography (CBCT) images of temporomandibular joints (TMJs). Methods Two hundred eighty-three temporomandibular joints with degenerative bony changes were evaluated. Pain intensity (numeric rating scale, NRS) and pain duration in patients with degenerative joint disease (DJD) were also analyzed. We classified condylar bony changes on CBCT into five types: osteophyte (Osp), erosion (Ero), flattening (Fla), subchondral sclerosis (Scl), and pseudocyst (Pse). Results Degenerative bony changes were the most frequent in the age groups of 10~19, 20–29, and 50~59 years. The most frequent pain intensity was “none” (NRS 0, 34.6%) followed by “annoying” (NRS 3–5, 29.7%). The most frequent condylar bony change was Fla (219 joints, 77.4%) followed by Ero (169 joints, 59.7%). “Ero + Fla” was the most common combination of the bony changes (12.7%). The frequency of erosion was directly proportional to NRS, but the frequency of osteophyte was inversely proportional. The prevalence of Ero increased from onset until 2 years and gradually decreased thereafter. The prevalence of Osp, Ero, and Pse increased with age. Conclusions Osp and Ero can be pain-related variables in degenerative joint disease (DJD) patients. “Six months to 2 years” may be a meaningful time point from the active, unstable phase to the stabilized late phase of DJD.

Objective To investigate gamma knife radiosurgery (GKS) for benign tumor-associated secondary trigeminal neuralgia (TN). Methods Between 2006 and 2015, 21 patients with secondary TN due to meningioma were treated using GKS. Their mean age was 56.5 ± 12.2 years. The 50% isodose was 12.5 ± 1.1 Gy for the first GKS for the meningioma. Retrogasserian targeting of the trigeminal nerve at 90 Gy with a 4-mm collimator was used for the second GKS. Results The pain duration until GKS was 1.9 ± 1.9 years. The meningiomas were located in the cisternal space in 13 patients (56.5%) and involved the skull base in 8 patients (43.5%). The mean duration of follow-up was 3.7 ± 2.7 years. The pain control outcome was a Marseilles Pain Scale (MPS) score of I to IV in 15 patients (71%) and a score of V in 6 patients (29%). For these latter patients, we performed a second GKS targeting the trigeminal nerve and resulting in MPS scores of I to IV. The tumor size did not increase in any patient and decreased by >10% in 12 (80%) of the 15 patients who were followed for at least 1 year. Trigeminal nerve visibility may improve after tumor shrinkage. Retrogasserian trigeminal nerve targets may be used even with invisible trigeminal nerves using Meckel's cave as an anatomic marker. Conclusions Here we show the reproducible feasibility of a 2-session GKS procedure using higher radiation doses, the first dose to treat the tumor and the second to treat the trigeminal nerves using retrogasserian targeting.

Weakness of the trapezius and serratus anterior (SA) muscle may be a risk factor for unilateral neck pain.This study examined the trapezius (upper, middle, and lower) and SA muscle strength ipsilateral and contralateral to the painful side in violinists with unilateral neck pain.Twenty-six female violinists with unilateral neck pain participated in this study. Participants reported the pain intensity and duration and completed the Neck Disability Index (NDI). The strengths of the upper (UT), middle (MT), and lower (LT) trapezius and SA muscles were measured using a handheld dynamometer. Paired t-test was used to compare the strength of the muscles between ipsilateral and contralateral to the painful side within subjects. The relationship between pain intensity, pain duration, and neck disability and strength deficit of the muscle was demonstrated by Pearson's correlation and Spearman's rank correlation.The strengths of the UT, MT, LT, and SA muscles were significantly decreased on the painful side compared with the contralateral side (P0.05). Except for correlations between pain intensity and percent strength deficit of the UT and between pain duration and percent strength deficit of the MT (P0.05), there were no significant associations between pain intensity, pain duration, or NDI and the percent strength deficit of the UT, MT, LT and SA muscles (P0.05).These results suggest that decreased UT, MT, LT, and SA muscle strength on the side of the pain should be considered in the rehabilitation of violinists with unilateral neck pain.

Accumulating evidence from neuroimaging studies has supported that chronic pain could induce changes in brain function. However, few studies have focused on the dynamic regional homogeneity (dReHo) of trigeminal neuralgia (TN). In this study, twenty-eight TN patients and 28 healthy controls (HC) were included. Based on the resting-state fMRI (rsfMRI), we detected abnormalities in dReHo in the TN patients. Patients with TN had decreased dReHo in the left middle temporal gyrus, superior parietal lobule, and precentral gyrus, and increased dReHo in the thalamus. Furthermore, the increase in dReHo in the thalamus was positively correlated with duration of TN (r = 0.485, p = 0.012). These results provide compelling evidence for abnormal resting-state brain activity in TN and suggest that the duration of TN may play a critical role in brain function.

Background The Pain Sensitivity Questionnaire (PSQ) is a self‐rating instrument developed as a time‐ and cost‐saving alternative to quantitative sensory testing (QST). The aims of the study were to assess (a) the associations between PSQ scores and QST in women with persistent pelvic pain and in pain‐free controls and (b) to what extent demographic variables and psychological distress influenced PSQ scores. Methods Fifty‐five healthy women and 37 women with persistent pelvic pain participated. All filled in the PSQ and Hospital Anxiety and Depression Scale and had QST (heat, cold and pressure pain thresholds) performed on six locations on the body. Information on age, body mass index, smoking habits and pain duration were collected. Principal component analysis and orthogonal partial least square regressions were used. Results The patients scored significantly higher on PSQ than the controls. Significant multivariate correlations between pain thresholds and PSQ scores were found only in the patient group. In the patient group, the heat and cold pain thresholds correlated more strongly with PSQ scores than the pressure pain threshold. Conclusions The PSQ score was significantly higher in pelvic pain patients, and correlations between QSTs and the PSQ were only found for patients. Significance The PSQ reflects pain sensitivity in women with PPP and can be used as a non‐invasive and painless way to assess this condition in clinical practice. Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Research Council; County council of Ostergotland; Linkoping University; IMI Paincare

Testicular torsion (TT) remains an important cause of testicular loss. Subtle presentations, such as abdominal pain, may be responsible for late diagnosis and increased testicular loss. This study assesses the influence of pain onset location over testicular outcome.Data of children 17 years and younger submitted to surgical treatment for TT by our department from January 2017 to December 2018 were collected. Demographics, clinical presentation and outcome were reviewed.73 patients (median age of 15.3 years old) were included in the study. 22% (16/73) patients presented with abdominal pain. When compared to patients with initial testicular pain, patients with abdominal pain showed a significant delay in TT diagnosis/treatment (median pain duration of 36 h vs 5 h) and a significantly higher rate of testicular loss [81% (13/16) vs 4% (2/57), p 0.001]. The majority of testicular losses (68%, 13/19) occurred in patients with abdominal pain. In patients with abdominal pain, TT was initially overlooked in 69% (11/16) of cases, resulting in 81% (9/11) gonadal loss; none of these 11 patients were initially evaluated by a surgeon. All patients with testicular pain were evaluated in order to exclude TT.Abdominal pain is a frequent presentation of TT, being an important cause of delayed diagnosis/treatment and associated higher testicular loss rate.Treatment study.Level III.

Background: Acute myocardial infarction (AMI) has been considered the leading cause of death and disability all over the globe where Bangladesh is not an exception. Early medical attention seeking behavior is decisive for saving valuable lives and reducing further complications. Objectives: Current research aimed to identify the factors related to delay in seeking medical care among AMI sufferers. Methods: This descriptive cross-sectional study was carried out by face-to-face interview from January 2017 to June 2018. A total of 120 patients were conveniently recruited from Ibrahim Cardiac Hospital and Research Institute, which is a tertiary level hospital in Dhaka. Delay in medical care seeking time was investigated using a pretested semi-structured questionnaire. Data were evaluated by Statistical Package for the Social Science version 20 and the relationship was assessed by using t-test. Results: Respondents who lived in the rural area (P = 0.01), whose pain duration less than 6 hours (P = 0.01) and radiation of pain (P = 0.02), took self-treatment (P = 0.04), misinterpretation of symptoms (P = 0.04), living long distance (P = 0.01), lack of suitable transport (P = 0.04), and faced traffic jam (P = 0.00) showed significantly higher delay in seeking medical care. Conclusions: It is necessary to develop a strategy for reducing delay in medical care seeking in patients with AMI to reduce cardiovascular mortality and morbidity. Proper education regarding major cardiovascular events could be an effective option.

Aim: The central sensitization inventory (CSI) is a validated, patient-reported questionnaire that quantifies symptoms of hypersensitivity disorders such as chronic pain, for which central sensitization (CS) may be the etiology. Objective: To investigate the analgesic effectiveness of ActiPatch and analyze the relationship between baseline CSI scores and demographics of chronic pain sufferers. Methods: Upon completing a 7-day ActiPatch trial, baseline CSI scores along with other assessment measures were obtained via e-mail from 174 chronic pain sufferers. Conclusion: CSI scores were positively correlated with gender (higher for women), baseline visual analog scale scores and pain duration. ActiPatch was found to be effective in reducing baseline pain for all subjects by an average of 4.3 visual analog scale points.

BACKGROUND: Musculoskeletal pain in youth is common but little is known about the influence of the number of pain sites on pain characteristics. The objective of this study was to compare pain characteristics, quality of life, sleep, sport participation between adolescents without pain, those with single site pain, and those with multi-site pain and investigate the relationship between pain duration and number of pain sites.METHODS: An online survey was sent via email to 7177 possible middle- and high-school students. The students completed a survey containing questions about their pain (including location, duration, intensity, frequency), health-related quality of life, sleep quantity and quality, and sports participation. Quantitative variables were analysed with one-way ANOVAs or t-tests and qualitative variables were analysed with Pearson Chi-squared tests. Relationships were investigated with a Pearson Correlation.RESULTS: Of the respondents (n = 1021), 52.9% reported no pain, 17.2% reported pain in a single-site, and 29.9% reported pain in multiple sites. Those with multi-site pain reported significantly lower quality of life than both pain-free youth (p 0.10). Those with multi-site pain reported greater intensity (p = 0.005) and duration (p CONCLUSIONS: A large percentage of youth experience regular pain that affects their self-reported quality of life and sleep, with greater effects in those with multi-site pain.

The aim of this study was to evaluate the frequency of neuropathic pain (NP) in patients with low back pain (LBP) and the relationship of NP with demographic characteristics and pain duration. Four hundred and forty patients were evaluated with respect to NP. Demographic data were collected and Douleur Neuropathique 4 Questions (DN4) questionnaire was used to identify NP. Any difference in demographic characteristics or duration of pain was investigated between the patients with and without NP. Sociodemographic factors which are independently associated with NP were analyzed. According to DN4, 43.9% of the patients had NP. Mean age of the patients was 44.8 years (± 13.7). 343 (77.9%) of the patients had chronic LBP (more than 3 months). The patients with NP were older (p

BACKGROUND AND OBJECTIVES: Because of its expressive prevalence and difficult clinical management, chronic pelvic pain is an important cause of morbidity, disability, and reduction of quality of life in women. Psychological factors influence the perception of pain and can interfere in the medical approach, justifying the application of projective tools, such as the pain portrait, previously not applied in women with chronic pelvic pain. The objective of this study was to obtain a greater clarification about the psychological component in the assessment of the chronic pelvic pain by applying the pain portrait in women with chronic pelvic pain. METHODS: This is an exploratory cross-sectional study conducted with 80 women with chronic pelvic pain. It was applied a pre-structured interview to collect sociodemographic, behavioral and clinical data. The pain portrait was applied to investigate the perceptions and beliefs about pain. The drawings were classified by content analysis and consensus among the authors. RESULTS: The average age of the participants was 39.40±9.21 years, average pain intensity of 7.03±2.58 and average pain duration of 8.84±7.65 years. The main portraits referred to negative feelings (37.50%), harmful instruments (33.75%) and geometric forms (25%), with a predominance of cold colors (63.70%). More than 60% of the participants put hope only in medical procedures, while 25% believed that there was no solution to their pain. CONCLUSION: Women represented their chronic pelvic pain in an affective way, with the use of few and cold colors. They considered themselves having a passive role in their treatment and related their pain to family losses.

Objective. To assess the durability of treatment over various chronic pain conditions of an emerging, nonprescription electromagnetic neuromodulation device that uses pulsed shortwave therapy. Methods. A 6-month prospective study, involving 240 chronic pain sufferers, 94% of whom reported using pain pills and 98% reported using pain therapies prior to entering the study. Their average baseline pain was 8.2 VAS points before treatment; they had a pain duration of 6.5 years, and they were positive responders to pulsed shortwave therapy in an initial 7-day trial. Prospective assessments were obtained at intervals of 3, 4, and 6 months following a retrospective 7-day assessment. Longitudinal analyses were conducted to determine pain relief trends after the initial 7-day device use. Results. Seven days after initial treatment, the average pain was reduced to 2.9, a 65% pain reduction for the study subjects. At the 6-month measurement, the average pain was 3.3, a 60% pain reduction from baseline. Only 17% of the subjects saw their pain level increase although this new level was still lower than baseline pain. Pain relief translated into improved quality of life and reduced medication use for the majority of the subjects. There were no significant adverse side effects reported over the 6 months of use. Conclusion. Ninety-seven percent of the recruited subjects, all of whom had previously reported clinically significant pain relief using the 7-day PSWT device, sustained this relief for 6 months by using the device on an as-needed basis.

We test the QALY concept to evaluate the utility of therapies. The QALY is the sum of the duration of each health state a patient faces weighted by the utility the patient obtains from this state. The QALY implies linear utility functions over duration. Corresponding analyses for health-related decisions are problematic as inducing health levels is difficult. In this study, we evaluate both utilities over pain duration for a fixed pain level and over pain intensity for a fixed duration, with real health consequences, using the cold pressor test. We find that, for human decision-makers, utility over pain duration does not increase linearly over time when making health-related decisions. This suggests that the QALY might not capture preferences as intended.

Mastalgia is a distressing symptom and may be severe enough to interfere with usual daily activities. Breast pain is either cyclical or noncyclical. Currently; multiple options are available for the treatment of mastalgia including hormonal and nonhormonal agents. This study was conducted to evaluate the role of centchroman as a nonhormonal first-line treatment for moderate to severe mastalgia. To accomplish this; a prospective open-label, single-arm study was done using the Pretest-Posttest Design. A total of 100 women suffering from mastalgia were grouped according to the characteristic pattern of breast pain (cyclic and noncyclic) and received centchroman 30 mg/day for 12 weeks followed by observation for 12 weeks. The efficacy analysis of centchroman was done by comparing median Visual Analog Scale score, median pain duration and side effects over time among the two groups. Centchroman significantly alleviates mastalgia with minimal side effects. The median pain score was significantly reduced over successive visits (1, 4, 12, and 24 weeks). The median pain duration decreased remarkably over time in comparison to the baseline (p = 0.001). Overall the response rate was 88% at the end of 12 weeks and 85% at the end of 24 weeks. The drug was found more effective with a quicker response in cyclic pattern of matalgia. Complete response was observed in 66% of cyclic mastalgia and 40% of noncyclic mastalgia patients at 1 week of therapy. The response was improved over time in both groups and at completion of treatment (12 weeks) 92% patients in cyclic group and 80% patients in noncyclic group were pain free. The effect of the drug persisted till the completion (24 weeks) of the study (p = 0.001). These results imply that centchroman is very effective in treating breast pain and can be prescribed as drug of first choice for mastalgia.

Introduction: Neck–shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. The mechanism of the neck–shoulder pain musculoskeletal disorder is complicated, multifactorial, and sometimes unclear. Cases: Seven patients presented at an outpatient pain clinic, each with a chief complaint of chronic neck–shoulder pain that these patients had had for various time periods. Intervention: The patients were treated with 45-minute sessions of Chinese Balance Acupuncture per the protocol of Richard Teh-Fu Tan, OMD, LAc. Main Outcome Measures: Pain intensity, pain duration, and quality of life (QoL) were measured during the treatment period, and the QoL was measured during the 3-month follow-up after three acupuncture sessions. Results: After the third session (1.5 weeks after the beginning of treatment), the patients reported complete dissipation of pain or significant reductions in pain intensity. There was also substantial improvement in QoL during the treatment period and dur...

Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature.Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman’s rho correlation (r=0.462,p<0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied.Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis.