Persistent Non-pharmacological Pain Management and Brain-Predicted Age Differences in Middle-Aged and Older Adults With Chronic Knee Pain

Chronic pain has been associated with changes in pain-related brain structure and function, including advanced brain aging. Non-pharmacological pain management is central to effective pain management. However, it is currently unknown how use of non-pharmacological pain management is associated with pain-related brain changes. The objective of the current study was to examine the association between brain-predicted age difference and use of non-pharmacological pain management (NPM) in a sample of middle-aged and older adults with and without chronic knee pain across two time points. One-hundred and 12 adults (mean age = 57.9 ± 8.2 years) completed sociodemographic measures, clinical pain measures, structural T1-weighted brain magnetic resonance imaging, and self-reported non-pharmacological pain management. Using a validated approach, we estimated a brain-predicted age difference (brain-PAD) biomarker, calculated as brain-predicted age minus chronological age, and the change in brain-PAD across 2 years. Repeated measures analysis of covariance was conducted to determine associations of non-pharmacological pain management and brain-PAD, adjusting for age, sex, study site, and clinical pain. There was a significant time*pain/NPM interaction effect in brain-PAD (p < 0.05). Tests of simple main effects indicated that those persistently using NPM had a “younger” brain-PAD over time, suggesting a potential protective factor in persistent NPM use. Future studies are warranted to determine the influence of NPM in brain aging and pain-related neurological changes

Prevalence of Oral Pain and Barriers to use of Emergency Oral Care Facilities Among Adult Tanzanians.

Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations.\ud Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%); self medication (17.6%); respondents thinking that pain would disappear with time (15.7%); and lack of money to pay for transport to the dental clinic (15.0%). Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07-1.57, P < 0.001). Respondents from rural areas were more likely report dental clinics far from home (OR = 5.31, CI = 2.09-13.54, P < 0.001); self medication at home (OR = 3.65, CI = 2.25-5.94, P < 0.001); and being treated by traditional healer (OR = 5.31, CI = 2.25-12.49, P < 0.001) as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended

Cross validation of bi-modal health-related stress assessment

This study explores the feasibility of objective and ubiquitous stress assessment. 25 post-traumatic stress disorder patients participated in a controlled storytelling (ST) study and an ecologically valid reliving (RL) study. The two studies were meant to represent an early and a late therapy session, and each consisted of a "happy" and a "stress triggering" part. Two instruments were chosen to assess the stress level of the patients at various point in time during therapy: (i) speech, used as an objective and ubiquitous stress indicator and (ii) the subjective unit of distress (SUD), a clinically validated Likert scale. In total, 13 statistical parameters were derived from each of five speech features: amplitude, zero-crossings, power, high-frequency power, and pitch. To model the emotional state of the patients, 28 parameters were selected from this set by means of a linear regression model and, subsequently, compressed into 11 principal components. The SUD and speech model were cross-validated, using 3 machine learning algorithms. Between 90% (2 SUD levels) and 39% (10 SUD levels) correct classification was achieved. The two sessions could be discriminated in 89% (for ST) and 77% (for RL) of the cases. This report fills a gap between laboratory and clinical studies, and its results emphasize the usefulness of Computer Aided Diagnostics (CAD) for mental health care

The epidemiology of chronic pain in Libya: a cross-sectional telephone survey.

BACKGROUND: Chronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya. METHODS: A cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %). RESULTS: The prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled. CONCLUSIONS: The prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management

The placebo effect and its determinants in fibromyalgia: meta-analysis of randomized controlled trials

The aims of this study were to determine whether placebo treatment in randomised controlled trials (RCTs) is effective for fibromyalgia and to identify possible determinants of the magnitude of any such placebo effect. A systematic literature search was undertaken for RCTs in people with fibromyalgia that included a placebo and/or a no-treatment (observation only or waiting list) control group. Placebo effect size (ES) for pain and other outcomes was measured as the improvement of each outcome from baseline divided by the standard deviation of the change from baseline. This effect was compared with changes in the no-treatment control groups. Meta-analysis was undertaken to combine data from different studies. Subgroup analysis was conducted to identify possible determinants of the placebo ES. A total of 3912 studies were identified from the literature search. After scrutiny, 229 trials met the inclusion criteria. Participants who received placebo in the RCTs experienced significantly better improvements in pain, fatigue, sleep quality, physical function, and other main outcomes than those receiving no treatment. The ES of placebo for pain relief was clinically moderate (0.53, 95%CI 0.48 to 0.57). The ES increased with increasing strength of the active treatment, increasing participant age and higher baseline pain severity, but decreased in RCTS with more women and with longer duration of fibromyalgia. In addition, placebo treatment in RCTs is effective in fibromyalgia. A number of factors (expected strength of treatment, age, gender, disease duration) appear to influence the magnitude of the placebo effect in this condition

Gender differences in coerced patients with schizophrenia

European Commission (Quality of life and Management of Living Resources Programme, contract number QLG4-CT- 2002-01036), Czech Ministry of Education research grant MSM002160849, and research grants PRVOUK–P26/LF1/4 and PRVOUK–P03/LF1/

Impact of Propranolol and Psychologically Informed Intervention on Pain Sensitivity: Secondary Analysis from the Biopsychosocial Influence on Shoulder Pain Preclinical Randomized Trial

Mark D Bishop,1– 3 Corey B Simon,4,5 Yanan Huo,6 Margaret R Wallace,7 Paul A Borsa,8 Roger B Fillingim,2,9 Roland Staud,10 Samuel S Wu,11 Steven Z George4,5,12 1Department of Physical Therapy, University of Florida, Gainesville, FL, USA; 2Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA; 3Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA; 4Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC, USA; 5Duke Clinical Research Institute, Duke University, Durham, NC, USA; 6Gilead Sciences, Inc., Foster City, CA, USA; 7Department of Molecular Genetics and Microbiology, UF Genetics Institute, University of Florida, Gainesville, FL, USA; 8Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; 9Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA; 10Department of Medicine, University of Florida, Gainesville, FL, USA; 11Department of Biostatistics, University of Florida, Gainesville, FL, USA; 12Departments of Orthopaedic Surgery and Population Health Sciences, Duke University, Durham, NC, USACorrespondence: Mark D Bishop, Department of Physical Therapy, University of Florida, 1225 Center Drive, HPNP &num;1139, Gainesville, FL, 32610, USA, Tel +1+352+2736112, Email [email protected]: Measures of pain sensitivity have potential relevance for patient care. We previously identified a subgroup of people at risk for ongoing pain characterized by genetic AND psychological factors. Here, we report planned secondary analyses examining the effect of personalized interventions on pain sensitivity outcomes.Patients and Methods: Two hundred and sixty-one healthy individuals with the COMT SNP rs6269 AA genotype and Pain Catastrophizing Scale scores of 5 or higher received exercise-induced muscle injury, followed by a randomly assigned treatment: (1) general education and placebo; (2) personalized psychological intervention and placebo; (3) general education and propranolol; or (4) personalized psychological intervention and propranolol. Pain sensitivity outcomes (pressure pain thresholds (PPT), suprathreshold heat rating, temporal summation, and conditioned pain modulation efficiency) were compared using a mixed effect model to examine difference among groups, adjusted for age, sex and race.Results: No main effects for group assignment were noted (p > 0.05 for all), when considered as 4 groups or 2 collapsed groups (ie propranolol vs placebo or personalized psychologic vs general education). Interaction terms were then entered into our models in an exploratory fashion. For PPT outcomes interactions were noted for, sex and time, and race and time (p< 0.015). For temporal summation outcomes, interactions were noted for sex and group and race and group (p < 0.015).Conclusion: Results indicated no statistically reliable changes in pain sensitivity when considering matched vs unmatched treatment groups. Caution is needed in this interpretation given that the trial was not powered to specifically identify these differences. Exploratory analysis of interactions among ethnic/racial and gender identities by treatment, however, showed the potential for differential effects for specific pain sensitivity measures. Significant interactions across modalities suggest analysis of higher order interactions/intersectionality could be of great interest for testing efficacy of personalized interventions in future trials.Plain Language Summary: Purpose: In previous work, we identified a set of genetic and cognitive traits that were associated with persistent pain after exercise induced muscle pain. Participants and methods: In this current study, we tested whether a combination of information focused on how you think about pain and a medication tailored to a genetic risk factor would help people without clinical pain conditions recovery faster from exercise-induced muscle pain than using general information and placebo medication. Results: The study did not strongly support that interventions matched to higher risk of persistent pain made changes for all the people. What we did find is that individuals’ ethnic, racial and gender identities might be influencing sensitivity to specific measures of pain sensitivity. Conclusions: Interactions among individuals’ identities might impact pain sensitivity. These findings could be used to generate hypotheses for and/or inform future studies of individualized medicine approaches for pain.Keywords: muscle, exercise, shoulder, genetic