Measuring Effects on Pain and Quality of Life after Abobotulinum Toxin A Injections in Children with Cerebral Palsy

Sixty-seven percent of children with cerebral palsy (CCP) experience pain. Pain is closely interrelated to diminished quality of life. Despite this, pain is an overlooked and undertreated clinical problem. The objective of this study was to examine the analgesic effect of a single lower extremity intramuscular injection of Abobotulinum toxin A/Dysport in CCP. Twenty-five CCP with at least moderate pain (r-FLACC ≥ 4) during passive range of motion were included. Localized pain and pain in everyday living were measured by r-FLACC and the Paediatric Pain Profile (PPP), respectively. Functional improvements were evaluated by the goal attainment scale (SMART GAS). Quality of life was evaluated by either the CPCHILD or the CP-QOL. The subjects were evaluated at baseline before injection, then after 4, 12, and 28 weeks. Twenty-two subjects had a significant mean and maximum localized pain reduction (p < 0.001) at four weeks post-treatment in 96% (21/22). The reduction was maintained at 12 (19/19) and 28 weeks (12/15). Daily pain evaluated by the PPP was significantly reduced and functional SMART GAS goals were significantly achieved from 4 to 28 weeks. Quality of life improved significantly at four weeks (CPCHILD). Significant functional gains and localized and daily pain reduction were seen from 4 to 28 weeks.

Associations between pain, self-efficacy, sleep duration, and symptoms of depression in adolescents: a cross-sectional survey

Background Although pain has been identified as an important public health problem among adolescents, few studies have investigated possible protective and risk factors for pain. The main aim of the present study was to investigate associations between prevalence of daily pain, self-efficacy, sleep duration, and symptoms of depression in a representative sample of Norwegian adolescents. Methods A comprehensive cross-sectional survey was completed by 12,867 junior high school students and high school students (response rate: 90%) aged 14–19 years. Logistic regression models were adjusted for age, gender, and parental educational level. Results We found a high prevalence of daily pain among adolescents, especially among girls (19%) compared with boys (7%). Short sleep duration was associated with increased odds ratios (ORs) of pain in the shoulders/neck (OR 1.3; 95% CI 1.3–2.0) and stomach (1.7; 1.2–2.4). Symptoms of depression were associated with increased ORs for all measured types of daily pain, including head (3.7; 3.0–4.6), shoulders/neck (3.9; 3.1–4.8), joints/muscles (4.3; 3.3–5.6), and stomach (5.5; 4.1–7.4). By contrast, self-efficacy was not associated with any form of daily pain. Conclusion Given the burden of pain, high incidence of pain problems, and strong association between pain and depression and, to some degree, short sleep duration, co-occurring symptoms may be an important area for research in the public health field. The results highlight the importance of early identification and prevention. Longitudinal studies are needed to understand better pain problems and their underlying mechanisms with the aim of developing targeted interventions.

Experience of Urinary Incontinence in Elderly Women in Urban Areas

Purpose: The purpose of the study was to understand and describe the experiences of urinary incontinence in older women in urban areas.Methods: Data were collected through individual in-depth interviews of 8 older women with urinary incontinence in urban areas from September 2020 to March 2021. The transcribed data were analyzed using Colaizzi's phenomenological six-step method.Results: Four theme clusters emerged: Urinary incontinence as an uninvited visitor in old age; The heavy daily pain urinary incontinence causes; Self-help efforts to cope with urinary incontinence; and A mind to hold on to the present condition so as not to deteriorate.Conclusion: This study provided an in-depth understanding of older women’s experiences with urinary incontinence in urban areas. Based on the results of this study, efforts should be made to develop and provide emotional and psychological support and prevention education programs that can adequately support older women with urinary incontinence in urban areas.

Pain Variability Predicts Subjective Function in Individuals with Patellofemoral Pain: A Short Report

Individuals with patellofemoral pain (PFP) experience pain during various functional activities. Long-term pain is a common consequence of PFP, yet little is known about daily pain variability. Twenty-five individuals with PFP completed the Anterior Knee Pain Scale (AKPS) and recorded daily pain over 10-days. Pain was evaluated by two measures of intensity (baseline pain, 10-day average pain) and two measures of variability (mean square of successive differences [MSSD], probability of acute change [PAC]). Associations between AKPS and the four pain measures were calculated with Pearson correlations. A linear regression was performed to examine the amount of variance in the AKPS explained by the four pain measures. Greater MSSD values were moderately associated with lesser AKPS scores (r =−.648, p&lt;.001). MSSD and 10-day averaged pain was the strongest predictor of AKPS (R2=.565, p&lt;.001). Pain variability provides a unique perspective in the pain experience and predicts patient-oriented function in individuals with PFP.

Brief Report: Characteristics and Needs of Persons Admitted to an Inpatient Psychiatric Hospital With Workers' Compensation Coverage

The rise of mental health issues in the workplace is widely known. Though mental health issues were not covered by the Workplace Safety Insurance Board (WSIB) in Ontario (Canada) until 2018, it was listed as responsible for payment of inpatient psychiatric hospital stays between 2006 and 2016. This population-level observational analytic study compares the clinical and service needs of 1,091 individuals admitted to inpatient psychiatry with WSIB coverage to all other admissions (n = 449,128). Secondary analysis was based on the interRAI Mental Health assessment. The WSIB group differed from all other admissions on almost all characteristics considered. Most notably, depression (65.08 vs. 57.02%), traumatic life events (25.48 vs. 15.58%), substance use (58.02 vs. 46.92%), daily pain (38.31 vs. 12.15%) and sleep disturbance (48.95 vs. 37.12%) were much higher in the WSIB group. Females with WSIB coverage had more depression (74.36 vs. 59.91%) and traumatic life events (30.00 vs. 22.97%), whereas males had more substance issues (63.62 vs. 47.95%). In addition, persons under the age of 55 had more substance issues (&lt;25 = 75.47%; 25–54 = 61.64%: 55 ± 40.54%) and traumatic life events (&lt;25 = 26.41%; 25–54 = 28.18%; 55 ± 15.31%), while those 25–54 years had more daily pain (41.67% vs. &lt;25 = 3.77% and 55 ± 34.23%) and sleep disturbance (50.74% vs. &lt;25 = 33.96% and 55 ± 45.94%). All variables differed significantly by sex and age within the comparison group, though not always following the patterns observed in the WSIB group. Future research examining mental health needs and outcomes among injured workers receiving inpatient psychiatric services is needed, and should take into account sex and age.

Medicare Usage Changes in Nursing Homes and Their Impacts on Long-Stay Resident Outcomes

Medicare provides skilled nursing facility (SNF) coverage for short-stay rehabilitation in nursing homes (NHs) at a better rate than Medicaid covers long-term NH care. National trends of increasing Medicare days culminated in 2010/2011 with a reduction to the SNF rates. Before the cuts, NHs that increased SNF days also improved outcomes for long-stay residents, including pain, pressure ulcer, and functional decline outcomes, suggesting spillover effects of SNF days. We replicated the prior study to determine how changes in SNF days and long-stay outcomes related following the rate cut. From 2011 to 2014, SNF days decreased and all three study outcomes improved. Spillover effects were not consistently observed. Decreasing SNF days was associated with increasing percentages of long-stay residents with daily pain and with decreasing percentages of long-stay residents getting pressure ulcers. Research on these associations in more recent years is needed to determine whether they persist and to inform practice.

Patient-Reported Pain and Opioid Use After Ambulatory Head and Neck Surgery

Objective The main objective of this study was to quantify daily pain and opioid use in patients after hemithyroidectomy and cervical lymph node biopsy (CLNB). The secondary objective was to identify factors associated with decreased pain and opioid use. Study Design Prospective cohort study from June 2017 to February 2019. Patients were given paper surveys to record daily postoperative opioid use and maximal pain on a visual analog scale. Setting Single institution (NewYork-Presbyterian/Weill Cornell Medical Center). Methods All adult patients undergoing hemithyroidectomy and CLNB by a single surgeon were consecutively selected for participation. Patients recorded daily pain and opioid analgesic use over a 2-week postoperative period. Results Of 33 patients enrolled, 29 (87.9%) returned a survey. Thirteen underwent CLNB, and 16 underwent hemithyroidectomy. Pain resolved after both procedures by the end of the 2-week period. CLNB patients used a median (interquartile range) of 15.0 (0-41.2) morphine milligram equivalents (MME), and 95% used 70 or fewer MME. Hemithyroidectomy patients used a median of 8.2 (4.5-13.9) MME, and 95% used 30 or fewer MME. Use of nonopioid analgesics was associated with a statistically significant decrease in pain (56.1 vs 171 visual analog scale, 95% confidence interval [CI] of Δ = [12.0 to 217.8]) and opioid use (12.2 vs 48.8 MME, 95% CI of Δ = [5.0 to 68.1 MME]) in CLNB but not in hemithyroidectomy. Conclusion Patients have low pain and opioid requirements after hemithyroidectomy and CLNB. Head and neck surgeons should evaluate their opioid-prescribing patterns for opportunities to safely decrease postoperative prescriptions.