The Relationship Between Knee Pain and Heart Failure in Older Black and Latino Women

Background Knee pain is the second-most prevalent and disabling common pain condition globally, having deleterious effects on daily function including mobility and exercise capacity; chronic knee pain is especially prevalent in older adults. There is substantial evidence to indicate that physically inactive individuals have higher rates of cardiovascular disease. Nonetheless, studies investigating cardiovascular risks with osteoarthritis have had mixed results. Objective This study explores the relationship between knee pain and heart failure especially examining the factors of age, gender, race in U.S. older adults. Methods Retrospective secondary analysis of Medicare claims data for 1.478 million adults over age 65. The standard analytical file for 2017 was segmented according to the presence of any of several ICD-10 codes for heart failure (HF). Medicare beneficiaries with and without HF diagnoses were evaluated for knee pain and other common pain-associated conditions; pain condition data was stratified by age, gender and race codes. Results Knee pain was markedly increased in women with HF in the 65-70- and 70–75-year-old age-cohorts and relatively less increased in older age-cohorts and males. Knee pain in women was especially elevated in those with Medicare race codes indicating Black and Hispanic status. Conclusion in a large cohort of Medicare beneficiaries, knee pain was noted to be markedly increased in younger cohorts of older women with HF, and more prevalent in Black and Hispanic women. Further studies should evaluate lifestyle, biomechanics, and inflammatory factors that may be contributing to this relationship.

Comparison of chronic widespread pain prevalence with different criteria in two cohorts of rheumatoid arthritis

Objective This study aims to investigate chronic widespread pain with the 1990 (CWP1990) and 2019 (CWP2019) definitions 6 years after the onset of rheumatoid arthritis (RA), in one patient cohort with tight controls and one conventional cohort, and factors associated with reporting CWP1990 and CWP2019, respectively. Methods A cohort of 80 RA patients with monthly visits to the physician the first 6 months was compared to a cohort of 101 patients from the same clinic with conventional follow-up. Both cohorts had early RA (< 13 months). The prevalence of CWP1990 and the more stringent CWP2019 were in a 6-year follow-up investigated with a questionnaire, including a pain mannequin and a fear-avoidance beliefs questionnaire. Results In the tight control cohort, 10% reported CWP2019 after 6 years compared to 23% in the conventional cohort (p = 0.026). There was no difference when using the CWP1990 definition (27% vs 31%, p = 0.546). When adjusted for important baseline data, the odds ratio for having CWP2019 was 2.57 (95% CI 1.02–6.50), in the conventional group compared to the tight control group (p = 0.046). A high level of fear-avoidance behaviour towards physical activity was associated with CWP2019, OR 10.66 (95% CI 1.01–112.14), but not with CWP1990 in the tight control cohort. Conclusion A more stringent definition of CWP identifies patients with a more serious pain condition, which potentially could be prevented by an initial tight control management. Besides tight control, caregivers should pay attention to fear-avoidance behaviour and tailor treatment. Key Points • CWP2019 is a more stringent definition of chronic widespread pain and identifies patients with a more serious pain condition. • Patients with a serious pain condition could be helped by frequent follow-ups. • This study suggests that a special attention of fear-avoidance behaviour towards physical activity in patients with RA is needed.

A COMPARATIVE STUDY REGARDING PAIN PERCEPTION AMONG MALES AND FEMALES OF UNIVERSITY STUDENTS IN PUNJAB, SINDH & BALOCHISTAN

Objective: To compare gender differences on pain perception in Pakistani culture. Study Design: Cross-sectional study. Place and Duration of Study: Public and private universities of Rawalpindi, Islamabad, Gujrat, Karachi, and Quetta, from Mar to May 2019. Methodology: A scale of religious identity was developed (n=300). Additionally, participants (n=240) were assigned to pain condition and no pain condition (control condition). Pain condition made them aware of headaches, while the control condition made them aware of death. Participants in both conditions were informed to jot down their emotions. They were also pro-vided Positive and Negative Affect Schedule (PANAS), a distractor task in the form of a story followed by a religious identity scale to compare the difference in percentages of males and females in pain and no pain perception on religious identity. Results: The alpha reliability of the religious identity scale was 0.60 depicting a moderately internally consistent scale. Furthermore, the findings of the present study showed significant gender differences on pain perception. Mean values indicated high score for females (226.39 ± 28.43) than males (216.39 ± 31.73) in pain condition and similar was the case of no pain condition for females (130.81 ± 23.27) and males (133.35 ± 20.06). Whereas, males 33 (63.04%) were high on religious identity as compared to females 35 (56.06%) in pain condition whereas females 34 (50.84%) were high in no pain condition on religious identity as compared to males 22 (37.31%). Conclusion: Findings suggested that significant differences exist between males and females in perceiving pain.

Anterior Insular-Nucleus Accumbens Pathway Controls Refeeding-Induced Analgesia Under Chronic Inflammatory Pain Condition

Feeding behaviors are closely associated with chronic pain in adult rodents. Our recent study revealed that 2 hr refeeding after 24hr fasting (i.e. refeeding) attenuates pain behavior under chronic inflammatory pain conditions. However, while brain circuits mediating fasting-induced analgesia have been identified, the underlying mechanism of refeeding-induced analgesia is still elusive. Herein, we demonstrate that the neural activities in the nucleus accumbens shell (NAcS) and anterior insular cortex (aIC) were increased in a modified Complete Freund’s Adjuvant (CFA)-induced chronic inflammatory pain condition, which was reversed by refeeding. We also found that refeeding reduced the enhanced excitability of aICCamKII–NAcSD2R projecting neurons in this CFA model. Besides, chemogenetic inhibition of aICCamKII–NAcSD2R neural circuit suppressed chronic pain behavior while activation of this circuit reversed refeeding-induced analgesia. Thus, the present study suggests that aICCamKII – NacSD2R neural circuit mediates refeeding-induced analgesia, thereby serving as a potential therapeutic target to manage chronic pain.

Photobiomodulation for Complex Regional Pain Syndrome: A Case Report and Literature Summary

Complex Regional Pain Syndrome (CRPS) is a highly debilitating chronic pain condition characterized by continuous regional pain disproportionate to duration and intensity of the initial damaging stimulus. In CRPS, abnormal perception, transmission, and modulation of pain by nerve cells and the autonomic nervous system induces extreme increases in perceived pain that may be accompanied by swelling, temperature sensitivity, color fluctuations, and/or skin changes. CRPS most commonly affects the extremities but may spread to other limbs or bodily locations. Since there is currently no cure for the underlying processes that play a role in causing this debilitating condition, therapeutic options seek to mitigate some of the symptoms of CRPS to improve quality of life. A recent systematic review found low-quality evidence of efficacy for all currently available CRPS treatments as well as a lack of consensus about first-line treatments. The pathophysiological complexity of CRPS, in addition to the lack of non-invasive, efficacious therapies for this extremely burdensome pain condition, highlights the vital need to explore novel therapeutic options in both research and clinical practice. Photobiomodulation through the repeated application of high-intensity laser therapy in a clinical setting has been shown to modulate nociception, minimize inflammation, and reduce different types of chronic and acute pain. The present case report describes a clinical protocol using laser therapy for CRPS, presents longitudinal pain scores, and summarizes mechanisms of action supporting the subsequent reduction of CRPS symptoms. After a series of laser treatments, the patient showed marked improvement in range of movement, hypersensitivity, pain, and function. Photobiomodulation through high-intensity laser therapy may represent a promising therapy for individuals affected by CRPS, although further randomized, controlled trials are recommended to evaluate efficacy on different disease-affected areas, assess dose-response relationships, and refine optimal treatment frequency.

Altered Hippocampal Functional Connectivity Is Closely Related to Pain and Catastrophic Thinking Habits in Patients With Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a chronic pain condition after a cure of herpes zoster. Patients with PHN often suffer from physical pain and psychological distress. We investigated the relationship between functional alternations in the brains of patients with PHN and their clinical manifestations using resting-state fMRI. We acquired resting-state fMRI data from 17 patients with PHN and matched healthy controls. We performed seed-based functional connectivity (FC) analysis and statistical comparisons in FC. We also performed correlation analysis between FC strengths and clinical scores about pain intensity, anxiety, depression and pain catastrophizing. In FC analysis, brain regions in the salience, default mode, sensorimotor and reward network were set as seeds. FC between the medial prefrontal cortex (mPFC) and hippocampus increased in PHN group. In contrast, FC between the hippocampus and primary somatosensory cortex (SI) decreased in PHN group. Furthermore, the SI-hippocampus FC was negatively correlated with pain intensity and the mPFC-hippocampus FC was positively correlated with pain catastrophizing tendency. Our findings indicate that the hippocampus is related to pain perception and catastrophic thinking habits in patients with PHN. Functional alteration of the hippocampus may have a major role in the development and maintenance of chronic pain condition in patients with PHN.

Do Histories of Painful Life Experiences Affect the Expression of Empathy Among Young Adults? An Electroencephalography Study

Previous research suggests that prior experience of pain affects the expression of empathy. However, most of these studies attended to physical pain despite evidence indicating that other forms of pain may also affect brain activity and emotional states in similar ways. To address this limitation, we compared empathic responses of 33 participants, some of whom had experienced a personal loss, across three conditions: observing strangers in physical pain, psychological pain, and a non-painful condition. We also examined the effect of presence of prior painful experience on empathic reactions. In addition, we examined the stimulation type, prior experience, and ERPs in the early Late Positive Potential (300–550 ms), late Late Positive Potential (550–800 ms), and very late Late Positive Potential (VLLPP; 800–1,050 ms) time windows. Behavioral data indicated that participants who had personally experienced a loss scored significantly higher on perspective taking in the psychological-pain condition. ERP results also indicated significantly lower intensity in Fp2, an electrode in the prefrontal region, within VLLPP time window for participants experiencing a loss in the psychological-pain condition. The results of both behavioral and ERP analysis indicated that prior experience of psychological pain is related to cognitive empathy, but not affective empathy. The implication of these findings for research on empathy, for the study of psychological pain, and the moderating influence of prior painful experiences are discussed.