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Chronic pain prevention and treatment constitute a challenge for occupational health. The aim of this study was to provide data on workers in a variety of jobs and multiple contexts to determine the prevalence and characteristics of different chronic pain disorders, in view to highlighting possible new targets for preventive actions. 1,008 participants working in 14 French IKEA stores were analyzed in this observational study on the basis of their responses to surveys on their sociodemographic characteristics, psychosocial factors, lifestyle and pain disorders. The prevalences of chronic pain, moderate-to-severe chronic pain and high-impact chronic pain were 49%, 30% and 11%, respectively. Chronic pain was predominantly located in the neck and back, and identified mostly as nociceptive, with, for some participants, a neuropathic component (mixed pain). The majority of chronic pain was reported as being due to professional activity, and causing at least one work stoppage during the past year in half of the participants. Jobs that were the most common sources of chronic pain were those with a higher proportion of repetitive gestures, no consecutive days of rest, stress at work, such as cash-register/catering jobs. Overall, this study highlighted profiles at risk of developing or suffering from chronic pain, and several associated factors: ≥40 years old, female sex, overweight/obesity, repetitive gestures, no consecutive days of rest, stress, catastrophism, workplace environment, poor quality of life and mental state. In conclusion, these data give interesting information on the characteristics of workers with chronic pain and highlight profiles of participants. REGISTRATION NUMBER: NCT03931694 PERSPECTIVE: This study provides important information about the features of chronic pain in a model of a working population of Western countries. This information can be used to propose preventive actions.
Learn More >In this randomized, double-blind, placebo-controlled trial, we evaluated the role of transcutaneous electrical nerve stimulation (TENS) in the multimodal treatment (non-opioid analgesics and kinesiotherapy) of postoperative pain following open inguinal hernia repair. In total, 80 males participants with elective primary unilateral hernia Lichtenstein repair were randomly allocated to receive TENS or a placebo-TENS procedure. The TENS group received local and segmental conventional TENS on the first and second postoperative days. In the placebo-TENS group, intensity was set at 0-0.5mA. Change of pain level at rest, when walking, when standing up from bed, pressure algometry parameters and additional analgesic use were the main outcomes. Reduction of VAS pain score and absolute and relative pain relief were observed in the TENS group following the procedures compared to the placebo-TENS group (p<0.001). The pressure pain threshold and maximal tolerable pressure in the hernia side were equal before the TENS procedure in both groups (p=0.84), but after the procedure, these were higher in TENS group (p<0.001). Additional non-opioid analgesics requirements were lower in the TENS group on the first and second postoperative days (p<0.001). TENS is a safe procedure that can reduce postoperative pain and analgesic use after open inguinal hernia repair. The study was registered in the database of clinicaltrials.gov (register number NCT03739060) Perspective This article presents TENS as a safe and effective non-pharmacologic intervention to reduce post-operative pain after open inguinal hernia repair. TENS could be used in daily practice as part of a multimodal postoperative pain treatment, especially for patients suffering from hyperalgesia.
Learn More >Phonophobia in migraineurs may be due to lower hearing threshold (HT) and higher brainstem neuronal excitability. We report correlation of phonophobia in migraineurs with HT, brain stem auditory evoked potential (BAEP) findings and auditory triggers. Sixty-one migraineurs and 101 controls were included for HT, of whom 59 migraineurs and 31 controls had BAEP studies. Clinical details, migraine triggers and headache frequency were noted. Hearing threshold was measured, and amplitudes of waves I to V of BAEP studies were measured. Migraineurs had lower HT compared with controls (41.61 ± 5.25 vs. 45.39 ± 6.26 dB; p < 0.001) especially in chronic migraine (40.24 ± 4.81; P < 0.001). Hearing threshold correlated with headache frequency (P < 0.05) and auditory, visual and tactile (P < 0.05) triggers. Hearing threshold was lower during headache (P < 0.001). Wave II, III and IV amplitudes of BAEP were higher in migraineurs than the controls. Wave II (P < 0.05) and III (P < 0.05) amplitudes correlated with HT. Migraineurs have lower HT, especially in those having chronic migraine, ictal HT recording and multiple sensory triggers. Higher amplitudes of BAEP waves in migraineurs and its relationship with frequency of headache and HT suggest sensitization of brainstem auditory neurons.
Learn More >To investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use.
Learn More >Several neuromodulation methods exists for migraine treatment. The aim of the present study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) focusing on migraine treatment using neurostimulation methods.
Learn More >To identify factors associated with work productivity in adults with migraine, and accommodations or interventions to improve productivity or the workplace environment for them.
Learn More >Emerging data points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84-4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46-7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44-5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.
Learn More >Most studies examining the components of the fear-avoidance model have examined processes at the group level. The current study used ecological momentary assessments to: (a) investigate the group and intraindividual relationships between pain fear, avoidance, and pain severity, (b) identify any heterogeneity between these relationships, and (c) explore the role of moderators to explain such heterogeneity.
Learn More >The co-occurrence of headache and epilepsy is well-documented in the adult population. The aim of the prospective study was to analyse in the paediatric population the correlations between the types of peri-ictal headaches and types of seizures. Furthermore, an attempt was made to find trends in characteristic features of peri-ictal headaches. A total of 57 children with peri-ictal headache were enrolled in the study. The participants' guardians were asked to keep a diary of the seizure and peri-ictal headache episodes during a 180-day period. During follow-up visits, systematic history regarding peri-ictal headaches was taken.
Learn More >Being born preterm is related to adverse health effects later in life. We studied whether preterm birth predicts the risk of migraine.
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