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To investigate whether biomarkers are modulated by prednisolone treatment in patients with hand osteoarthritis (OA) and whether they can predict response to prednisolone.
Learn More >Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC.
Learn More >Persistent post-mastectomy pain after breast surgery is variable in duration and severity across patients, due in part to interindividual variability in pain processing. The Rapid OPPERA Algorithm (ROPA) empirically identified three clusters of patients with different risk of chronic pain based on four key psychophysical and psychosocial characteristics. We aimed to test this type of group-based clustering within in a perioperative cohort undergoing breast surgery to investigate differences in postsurgical pain outcomes. Women (N=228) scheduled for breast cancer surgery were prospectively enrolled in a longitudinal observational study. Pressure pain threshold (PPT), anxiety, depression, and somatization were assessed preoperatively. At 2-weeks, 3, 6, and 12-months after surgery, patients reported surgical area pain severity, impact of pain on cognitive/emotional and physical functioning, and pain catastrophizing. The ROPA clustering, which used patients' preoperative anxiety, depression, somatization, and PPT scores, assigned patients to three groups: Adaptive (low psychosocial scores, high PPT), Pain Sensitive (moderate psychosocial scores, low PPT), and Global Symptoms (high psychosocial scores, moderate PPT). The Global Symptoms cluster, compared to other clusters, reported significantly worse persistent pain outcomes following surgery. Findings suggest that patient characteristic-based clustering algorithms, like ROPA, may generalize across diverse diagnoses and clinical settings, indicating the importance of "person type" in understanding pain variability. Perspective: This article presents the practical translation of a previously developed patient clustering solution, based within a chronic pain cohort, to a perioperative cohort of women undergoing breast cancer surgery. Such preoperative characterization could potentially help clinicians apply personalized interventions based on predictions concerning postsurgical pain.
Learn More >Symptomatic Chiari 1 malformation (CM1) is a common condition in Neurosurgery. Surgery involves hindbrain decompression and restoration of CSF flow through different surgical approaches. No Class 1 evidence exists to suggest the superiority of any of the surgical techniques. To investigate current surgical practice for symptomatic CM1 patients in the United Kingdom (UK) and determine the willingness to participate in a randomised controlled trial (RCT) comparing different surgical techniques. An electronic survey was sent to consultant members of the Society of British Neurological Surgeons and the British Chiari-Syringomyelia Group. The questions covered pre-operative and intra-operative management, presence of equipoise/uncertainty in optimal technique and willingness to participate in an RCT. 98 responses were received. 67% operate on adults. 30% on adult and paediatric patients. There is variation in routine pre-operative use of: ICP monitoring (18%), flexion/extension x-rays (16%), venography (20%) and ophthalmology assessment (26%). 18% of neurosurgeons would not offer foramen magnum decompression when the presenting symptom is only refractory cough/sneeze headache. 15% routinely perform bony decompression alone in adults vs 8% in children. In 68% of adult cases, durotomy is performed routinely (46% of them leave the dura open, 54% perform a type of duroplasty) and 16% routinely resect the cerebellar tonsils. Only 17% leave the dura open in children. The most common indicators for durotomy are syringomyelia and intra-operative ultrasound findings. 61% believe there is equipoise/uncertainty in the optimal strategy for decompression and would be willing to participate in an RCT. Comments also mention the heterogeneity of CM1 and that treatment should be tailored to each patient. There is wide variation in pre- and intra-operative management of CM1 patients in the UK and the majority of neurosurgeons would be willing to participate in an RCT comparing bony decompression alone vs dural opening with/without duroplasty.
Learn More >To characterize Urologic Chronic Pelvic Pain Syndrome (UCPPS) pain and urinary symptom trajectories with up to 9 years of follow-up and evaluate whether initial 1-year trajectories are associated with longer-term changes.
Learn More >Juvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major early complaint, and in 10-17% pain remains a major symptom. Very few data exist on sensory threshold changes at the knee in JIA, a location in which inflammation often manifests. We determined whether JIA is associated with sensory threshold changes at the knee by using Quantitative Sensory Testing (QST) and established reference values at the knee of children.
Learn More >To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN).
Learn More >A reciprocity between the stress and the pain system is recognized; however, the manner by which sex affects this reciprocity is unclear. Understanding the interactions of stress, pain, and sex may shed light on the apparent women's vulnerability to chronic pain, which often co-exists with increased distress, and to affective disorders, which often co-exist with chronic pain. The study's aim was to examine the effect of acute, validated, psychosocial stress on pain perception and modulation of women and men in a controlled manner. Participants were 82 women and 66 men. Heat-pain threshold, heat-pain tolerance and pain modulation by temporal summation of pain (TSP), and pain adaptation, were measured before and after exposure to the Montreal Imaging Stress Task (MIST) or to a sham task. The stress response was verified by perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. A significant stress response was obtained by the MIST among both sexes; however, women displayed a greater increase in perceived distress, and men displayed a greater increase in cortisol. Among women, TSP decreased and pain adaptation increased following the MIST, responses that were predicted by perceived distress levels. Among men, TSP increased following the MIST but was not predicted by the stress variables. In conclusion, acute stress manipulation seems to differentially affect both stress and pain responses of women and men: Women exhibited stress-induced antinociception, and men exhibited stress-induced pronociception. Higher perceived stress levels among women may trigger a temporary increase in pain inhibition mechanisms to serve evolutionary purposes.
Learn More >Despite a preponderance of pain-related attentional bias research, little is known about how these biases arise and change over time. We tested whether the degree of attentional bias malleability, that is, ability to acquire and relinquish patterns of selective attention towards pain information, predicts daily pain interference. Individuals with chronic pain (N = 66) completed a novel attentional bias malleability procedure based on a modified dot-probe paradigm. Participants received a contingency that encouraged an attentional preference toward and away from pain words across two counterbalanced blocks, and attentional bias was assessed before and after each contingency block. Participants then completed a daily diary for 7 days, including PROMIS-29 pain severity and interference. Multilevel modelling was conducted to predict daily pain interference from attentional bias malleability constructs, controlling for pain severity and demographic factors. Greater attentional bias (F1,391 = 3.97, p = .047), greater readiness to acquire an attentional bias (F1,389) = 4.92, p = .027), and less readiness to lose an acquired attentional bias toward pain (F1,354 = 5.18, p = .024) all predicted less pain interference. There was also an interaction between pain severity and overall attentional bias malleability (F1,62 = 5.48, p = .023), such that as pain severity increased, those who showed greater attentional bias malleability showed less corresponding increase in their pain interference, than those who showed less attentional bias malleability. This study adds new thinking to the dynamic nature of attentional bias, and how such biases might arise and influence pain outcomes.
Learn More >While prior research has identified racial disparities in prehospital analgesia for traumatic pain, little is known about non-traumatic pain. Using a national prehospital dataset, we sought to evaluate for racial and ethnic disparities in analgesia given by EMS for non-traumatic pain.
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