Pain Perception in Contact Sport Athletes: A Scoping Review

Contact sports athletes are regularly facing acute physical pain in part of their practice. However, the literature investigating pain perception in these athletes remains scarce. This scoping review aimed to explore the literature surrounding pain perception in contact sport athletes and to compile and understand how it is studied. The search strategy consisted of using index terms and keywords in Medline, EMBASE, Sport-Discus, Web of Science, PsycINFO, CINAHL and ProQuest Dissertations & Theses Global search engines. Results revealed that a mix of team contact sports and combat sports are studied and included under the umbrella of contact sports. These athletes are being compared to non-athletes as well as athletes from non-contact sports. The cold pressor test and the pain pressure test are the two predominant methods used to investigate physical pain. This review highlights the need to clearly define sports based on contact levels expected in play to better define the types of pain athletes are facing in their practice. Athlete’s level of play as well as years of experience should also be more rigorously reported. While contact sport athletes seem to have a higher level of pain tolerance than both active controls and non-contact athletes, the methods of pain testing are not always justified and appropriate in relation to the pain induced during contact sports. Future experimental studies should use pain testing methods relevant to the pain experienced during contact sports and better justify the rationale for the choice of these methods.

Validation and Cross-Cultural Adaptation of the Spanish Version of the Pain Sensitivity Questionnaire (PSQ-S)

Experimental pain testing requires specific equipment and may be uncomfortable for patients. The Pain Sensitivity Questionnaire (PSQ) was developed to assess pain sensitivity, based on the pain intensity ratings (range: 0–10) of painful situations that occur in daily life. The main objective of this study was to carry out a cross-cultural adaptation and validation of the Spanish version of the PSQ (PSQ-S). A total of 354 subjects (296 healthy and 58 chronic pain patients) filled in the PSQ-S. A subgroup of 116 subjects performed experimental pain testing, including two modalities (cold and pressure), with different measures: pain intensity rating, pressure pain threshold, and tolerance. The validation results showed two factors: PSQ-S-moderate and PSQ-S-minor and, for the total scale and the two factors, an excellent internal consistency (Cronbach’s alpha coefficient > 0.9) and a substantial reliability (Intraclass Correlation Coefficient > 0.8). We obtained strong correlations with all the experimental pain rating parameters, catastrophizing, and depression variables, as well as moderate correlations with anxiety, central sensibilization, and impact on the quality of life. Chronic pain patients received elevated PSQ-S scores compared to healthy controls, and three cut-off values (PSQ-S-total = 7.00, PSQ-S-moderate = 7.57, and PSQ-S-minor = 6.29) based on ROC curve analyses were shown to be able to discriminate between healthy adults and adults with chronic pain. Therefore, PSQ-S may be a simple alternative to experimental pain procedures for clinical and experimental pain research.

A Holistic Systems Approach to Characterize the Impact of Pre- and Post-natal Oxycodone Exposure on Neurodevelopment and Behavior

Background: Increased risk of oxycodone (oxy) dependency during pregnancy has been associated with altered behaviors and cognitive deficits in exposed offspring. However, a significant knowledge gap remains regarding the effect of in utero and postnatal exposure on neurodevelopment and subsequent behavioral outcomes.Methods: Using a preclinical rodent model that mimics oxy exposure in utero (IUO) and postnatally (PNO), we employed an integrative holistic systems biology approach encompassing proton magnetic resonance spectroscopy (1H-MRS), electrophysiology, RNA-sequencing, and Von Frey pain testing to elucidate molecular and behavioral changes in the exposed offspring during early neurodevelopment as well as adulthood.Results:1H-MRS studies revealed significant changes in key brain metabolites in the exposed offspring that were corroborated with changes in synaptic currents. Transcriptomic analysis employing RNA-sequencing identified alterations in the expression of pivotal genes associated with synaptic transmission, neurodevelopment, mood disorders, and addiction in the treatment groups. Furthermore, Von Frey analysis revealed lower pain thresholds in both exposed groups.Conclusions: Given the increased use of opiates, understanding the persistent developmental effects of these drugs on children will delineate potential risks associated with opiate use beyond the direct effects in pregnant women.

Sucrase Breath Testing in Children Presenting With Chronic Abdominal Pain

Sucrase deficiency has been implicated in chronic abdominal pain. Testing for sucrase deficiency generally involves invasive procedures or lengthy clinical visits, but now noninvasive kits that allow home testing are available to test for sucrase deficiency. In order to assess feasibility and utility of at-home testing, we reviewed our experience in 75 consecutive patients. All patients seen in the abdominal pain clinic had histories obtained in a standardized fashion and all had sucrase breath tests completed at home utilizing a commercially available kit. Testing was completed by 46 patients (61.3%). Tests were abnormal indicating sucrase deficiency in 34.8% of those completing testing. No symptoms were predictive of a positive test although there were trends of an association of an abnormal test with diarrhea and bloating. Our findings suggest that sucrase deficiency occurs frequently enough that more widespread testing and/or an empiric trial of sucrose and starch restriction should be considered.

4095 Concurrent assessment of experimental pain and self-reported pain intensity with acute exercise intervention in fibromyalgia; clarifying or obscuring clinical outcomes?

OBJECTIVES/GOALS: Experimental pain testing is used to identify changes in nociceptive processing and outcomes with intervention. This study investigated exercise induced changes in experimental pain and self-reported pain intensity after an acute bout of exercise in participants with fibromyalgia. METHODS/STUDY POPULATION: Ten females with fibromyalgia (55±10yr) were familiarized to study procedures and underwent submaximal (20% maximal voluntary contraction) intermittent eccentric muscle contractions isolated to the right arm for 10-minutes. Self-reported pain intensity (0-10 numerical pain rating scale [NPRS]) of the exercising arm was measured before, during, and after exercise; whole-body pain intensity was measured before and after exercise. Experimental pain testing included measurement of pressure pain thresholds (kPa [PPTs]); temporal summation (TS) of pressure pain with a constant mechanical pressure; and TS of punctate pressure with repeated application of monofilaments before and after exercise. RESULTS/ANTICIPATED RESULTS: Participants reported minimal to moderate arm pain (3.1±2.1) during exercise. Following exercise, arm pain and whole-body pain significantly increased (3.1±2.2 and 1.6±0.5, respectively) [p<0.05]. No change occurred with PPTs at the bicep (138.9±49.5 to 142.8±55.3), PPTs at the quad (212.0±105.4 to 228.1±100.0), TS of mechanical pressure pain (7.6±2.1 to 7.9±1.5), TS of punctate pressure pain at the bicep (2.6±1.7 to 3.0±1.5), and TS of punctate pressure pain at the quad (3.6±1.5 to 3.7±1.4) before to after exercise respectively [p>0.05]. The change in self-reported arm and whole-body pain did not correlate with the change in experimental pain testing. DISCUSSION/SIGNIFICANCE OF IMPACT: In people with fibromyalgia, there is no relation between self-reported clinical pain and experimental pain following a single exercise session. Further research should identify the influence of exercise training on pain perception and if experimental pain testing translates to clinical insight.

0233 Pain, Fatigue, and Altered Reactivity to a Repeated Physiological Stressor in Insomnia Patients: An Explanatory-Driven Analysis

Introduction Fatigue and pain are prominent features of functional impairment in insomnia. This study aimed to better understand behavioral and physiological mechanisms of these complex relationships. Methods 22 participants with insomnia disorder (DSM-5 criteria, 18 female, age 18-49yrs) and 22 good-sleeper controls (19 female, age 18-47yrs) completed two-weeks sleep logs and actigraphy recordings prior to coming to the laboratory for overnight polysomnography and subsequent daytime testing that included questionnaires, three trials of cold pressor test (CPT), and pain testing with blood draws collected throughout. Insomnia diagnosis was determined by a board-certified sleep specialist, and exclusion criteria included psychiatric history within past 6 months, other sleep disorder, significant medical conditions, and any medications within past two weeks with significant effects on inflammation, autonomic function, or other psychotropic effects. For CPT, participants were instructed to immerse hand in ice cold water for at least one minute and rate pain intensity throughout the immersion and 3-minute recovery. Data were analyzed with linear mixed models. Results Per inclusion criteria, PSQI scores were differed between groups (insomnia: 10.2±2.7, range 7–16; control: 1.9±1.3, range 0–5; p&lt;.001). Insomnia consistently reported higher daily fatigue ratings compared to controls (p&lt;.001), as well as higher spontaneous pain globally and across several specific domains (p’s: .007-.03). In response to CPT, groups did not differ in their initial tolerance (i.e. immersion duration, p=.41) or intensity ratings during immersion (p=.88), however insomnia showed blunted recovery in intensity ratings (p&lt;.01). Control participants then showed an ability to habituate to repeated CPT by increasing immersion duration, whereas insomnia slightly decreased in tolerance across trials (Group effect: p&lt;.05). Conclusion These data indicate that habituation to and acute recovery from pain is deteriorated in chronic insomnia, which may be a key contributor to maintained pathophysiology over time and mechanism to target with comprehensive treatment. Support Merck Inc. MISP# 51971 (investigator-initiated), NIH/National Center for Research Resources UL1-RR02758 and M01-RR01032 to the Harvard Clinical and Translational Science Center.

The Role of Pets in Supporting Cognitive-Behavioral Chronic Pain Self-Management: Perspectives of Older Adults

Cognitive-behavioral self-management strategies are recommended for older adults with chronic pain. The goal of this study was to explore how pet ownership promotes use of these strategies in everyday life. We conducted four focus groups ( N = 25) with dog and cat owners aged ≥70 years with persistent pain. Participants described how their pets affect their daily routines and health, including pain and its management. We analyzed transcripts for salient themes, categorizing them according to their alignment with recommended pain self-management strategies: Mood Management (e.g., increases positive affect), Relaxation/Distraction (e.g., soothing presence), Physical Activity (e.g., dog-walking), Behavioral Activation (e.g., motivates activity even when pain present), Social Activation (e.g., facilitates socializing), and Sleep (e.g., encourages routine). Some participants described negative impacts of pet ownership. Having pets can facilitate behaviors and thoughts that may enhance coping with pain. Testing formal ways of leveraging pets’ role may expand nonpharmacological options for chronic pain management.