Pain Characteristics Among Individuals with Duchenne Muscular Dystrophy According to Their Clinical Stage

Background: Assessment of pain is not routine, standardized, or well-understood in individuals with Duchenne muscular dystrophy (DMD), even though pain is a common problem reported by more than half of DMD patients. Previous studies in this area included multiple neuromuscular diseases with highly variable phenotypes. Therefore, our aim was to focus on DMD specifically and evaluate comprehensive pain characteristics according to the disease stages, from ambulatory to late non-ambulatory. Methods: This was a cross-sectional study conducted in an out-patient pediatric rehabilitation clinic. Participants were 148 males with confirmed DMD, 14.5±5.3 years of age. Face-to-face interviews were conducted using a structured questionnaire regarding pain frequency, duration, intensity, location, aggravating/relieving factors, pain interference (Brief Pain Inventory), pain quality (PainDETECT Questionnaire), and functional ability (DMD Functional Ability Self-Assessment Tool). Pain characteristics were analyzed according to the clinical stage: ambulatory (Amb), early non-ambulatory (ENA), and late non-ambulatory (LNA).Results: Of the 148 participants who completed the assessment, 66 (44.6%) reported pain during the previous 4 weeks. There were no differences in the pain duration or intensity among the three groups. Pain location (Amb: calf, ENA: knee, LNA: lumbosacral region), aggravating factor (Amb: ambulation, ENA: transfer, LNA: sitting), and relieving factor (Amb: rest and massage, ENA and LNA: positional change) differed according to the clinical stage. Individuals in the LNA stage reported an increase in the frequency of pain and number of pain sites. The effect of pain on mood was also found to be greater in the LNA group than in the other clinical stages. Conclusion: Pain characteristics including location, aggravating/relieving factors, pain frequency, and pain interference change as the disease progresses in patients with DMD. Clinicians could more efficiently and critically assess and manage the patients’ pain aspect, based on these findings.

The disability profile of primary health care users may vary depending on the type of care and musculoskeletal pain characteristics

Background: One of the biggest current challenges for Primary Health Care is dealing with the increased demand for chronic diseases that have resulted in greater disabilities in the population.Objective: To investigate the relationship between sociodemographic factors, musculoskeletal pain and its characteristics and the type of care in primary health care with self-reported disability.Methodology: This is a cross-sectional study, interviewing individuals selected from spontaneous demand for health care in two types of care, the health center and family health. Disability was investigated using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 and characteristics of intensity, frequency, duration, number of pain sites and regions. Measures of association between predictors and disability were performed with non-parametric statistical tests, and non-parametric regression models were presented for pain characteristics and for the general population.Results: 6.0% of the overall sample had severe level of disability, health center users had more self-reported disability than family health users (p<0.001). Fewer years of life (p=0.034) and lower per capita income quintile (p=0.014) were associated with greater disability. The most intense pain and in the greatest number of places increased the disability score by 1.8 (CI95%=1.0-2.6) and 6.3 (CI95%=0.1-12.2) points, respectively.Conclusion: Users who had more disabilities sought out spontaneous demand care units of the health center type, had lower per capita income, presented musculoskeletal pain of worse intensity and in a greater number of places.

The Differences of Pain Characteristics Among Post-Surgery Clients with General and Regional Anesthesia

Background: Surgery is one of the medical options for improving health. Surgery will break the main chain that causes health problems. Patients undergoing surgery will receive anesthetic management to relieve pain sensations. Pain sensations will be felt again after the period of anesthesia gradually disappears. Post-surgery clients will feel pain that varies widely. Purpose: This study aims to determine differences in the characteristics of postoperative client pain with general anesthesia and regional anesthesia. Methods: The method used was observational in postoperative clients with a cross-sectional design. Pain characteristics were observed after 4 hours postoperatively. Observation of pain used a pain characteristic observation sheet with observation items including pain intensity, pain onset, pain quality, and pain coping pattern. Observations were made on 30 postoperative clients with general anesthesia and 30 postoperative clients with regional anesthesia. The pain characteristics of the two groups after surgery were compared and the differences were seen. Result: The results of the study generally showed that the characteristcis of postoperative client pain with regional anesthesia (mean score = 18.1) were heavier than clients who received general anesthesia (mean score = 17.5). The results of the Mann Whitney test showed that the value of p = 0.000 (pain scale), p = 0.017 (pain time range), 0.000 (pain onset), p = 0.018 (pain intensity), p = 0.000 (pain depth), p = 0.000 (coping pattern). Conclusion: There are differences in pain characteristics between postoperative clients with general anesthesia and regional anesthesia on the aspects of pain scale, pain onset, the intensity of pain, depth of pain, and coping patterns of pain. The length of time of surgery and the level of depth of the surgical incision have a very significant effect on the characteristics of postoperative pain.

Facet Joint Injections for the Management of Low Back Pain: A Clinical Review

Introduction: Lumbar facet joints have been implicated in chronic low back pain (LBP) in up to 45% of patients with LBP. Facet joint pain (FJP) diagnosis and management are always challenging for pain physicians. FJP is not diagnosed by specific demographic features, pain characteristics, or physical findings, despite the electrodiagnostic studies and imaging modalities being available. Although comparative local anesthetics or placebo saline injections can be used, diagnostic blocks are the only reliable diagnostic measures according to the current literature. Methodology: A randomized, controlled clinical trial was conducted to evaluate the effectiveness of lumbar facet joint injections. A total of 229 participants were enrolled to receive facet injections with bupivacaine and steroid, medial branch blocks, or saline. Result: The results of this study showed that facet joint injections had little long-term therapeutic utility, but had a prognostic value compared to control injections before radiofrequency ablation. Thus, the results of this study emphasized the diagnostic value of facet joint injections. Conclusion: FJP is not diagnosed by demographic features, pain characteristics, physical findings, electrodiagnostic studies, or radiological evaluation as other types of LBP. Diagnostic blocks using comparative local anesthetic blocks or placebo injections are the only reliable diagnostic measures according to the current literature. Their validity, specificity, and sensitivity are considered reliable in the diagnosis of FJP. Facet joint-related anatomical, clinical, and technical knowledge is essential for successful pain management. Pain physicians should embrace all aspects of FJP management, from diagnosis to interventional management.

An Empirical Classification of Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach

Introduction: Youth with sickle cell disease (SCD) and chronic pain are a heterogeneous group with variability in their daily pain experience and physical and psychosocial functioning. We aimed to 1) empirically derive chronic pain subgroups based on sensory pain characteristics using cluster analysis within a sample of youth with chronic SCD pain, and 2) investigate derived subgroups for differences in sociodemographics, clinical characteristics, and psychosocial and functional outcomes. We hypothesized that chronic SCD pain subgroups with higher sensory pain experiences would be associated with poorer functional and psychosocial outcomes. Methods: Children and adolescents receiving care at comprehensive SCD clinics at three tertiary care locations within a southeast children's hospital were included if they were aged 10-18 years, any SCD genotype, reported chronic pain (i.e., pain on most days per month for a duration of at least 3 months), and had English fluency. Youth were excluded if they had comorbid medical conditions typically associated with pain but unrelated to SCD or had significant cognitive or developmental limitations that would interfere with study procedures. Patients completed a battery of patient-reported outcomes including pain characteristics (i.e., intensity, frequency, and the Adolescent Pediatric Pain Tool to assess number of pain locations and pain quality descriptors), PROMIS Pediatric Short Forms for pain interference, anxiety, and depressive symptoms, the Adolescent Sleep Wake Scale for sleep quality, and the Pain Catastrophizing Scale. Clinical characteristics and healthcare utilization outcomes were abstracted from electronic medical records including number of inpatient admissions for pain and emergency department visits for pain in the prior 12 months. Chronic SCD pain subgroups were based on sensory pain characteristics including pain intensity ratings, pain frequency, number of body sites affected by pain, and pain quality descriptors. Hierarchical cluster analysis informed the number of clusters at the patient level. K-means cluster analysis was used to assign patients to clusters once the number of clusters was established. Clusters were compared on sociodemographics, clinical characteristics, healthcare utilization, and child psychosocial and functional outcomes. Results: Youth (n=62) were on average (M) 13.9 years old (SD=2.5), 56% female, 95% Black or African American, and 85% Non-Hispanic/Latinx. Most (75%) had HbSS or HbSβ 0 and 67% were prescribed hydroxyurea. Hierarchical cluster analysis and k-means clustering supported a 2-cluster solution (see Figure 1). Cluster 1 (n=35; Frequent, Moderate Pain) was distinguished by significantly lower scores on worst pain intensity (M=6.4, SD=0.4), lower number of pain days per month (M=12.1, SD=2.8), fewer number of body sites affected by pain (M=8.9, SD=0.9), and lower pain quality ratings (M=15.9, SD=1.3). Cluster 2 (n=27; Almost Daily, High Pain) represented patients who reported high ratings of worst pain intensity (M=8.2, SD=0.3), daily to almost daily pain (M=20.3, SD=1.7), higher number of body sties affected by pain (M=12.5, SD=1.5), and higher ratings of pain quality (M=40.8, SD=1.9) (all p's &lt;.05). There were no differences between chronic SCD pain subgroups by sociodemographics (e.g., age, sex, family income), clinical characteristics (e.g., genotype, history of avascular necrosis, disease-modifying treatments, prescribed long-acting opioids, neuropathic medications, or antidepressants), or healthcare utilization. Patients in the Almost Daily High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing compared to patients in the Frequent, Moderate Pain subgroup (see Table 1). There were no differences between subgroups on anxiety or sleep quality. Conclusions: Two subgroups of chronic SCD pain were identified based on pain, psychosocial, and functional outcomes. Beyond sensory pain characteristics, pain interference, depressive symptoms, and pain catastrophizing were the only variables that best differentiated the chronic SCD pain subgroups. These empirically derived subgroups are comparable to other non-SCD chronic pain subgroups in pediatrics and adults. Identifying homogenous chronic SCD pain subtypes can inform tailored assessment and management of chronic pain. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.