Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees

Introduction. There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP. Objective. To characterise PLP and, secondarily, to determine predictors for its diagnosis. Methodology. This is a cross-sectional study involving patients with unilateral traumatic lower-limb amputation aged over 18 years. Those with clinical decompensation or evidence of disease, trauma, or surgery in the central or peripheral nervous system were excluded. Sociodemographic and rehabilitative data were collected; PLP was characterised using the visual analogue scale (VAS), pain descriptors, and weekly frequency. Results. A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50–79.3) mm characterised by 13 (6–20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5–4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS ( p < 0.05 ). Conclusion. PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.

Managing Advanced Cancer Pain Together (MACPT) conversation tool: an evaluation of use in clinical practice

Aim: To investigate use of the ‘Managing Advanced Cancer Pain Together’ conversation tool between individuals with advanced cancer and healthcare professionals (HCPs) during routine consultations. Methods: Twenty-one patients and six HCPs completed questionnaires before and after use of the tool (at their routine consultation 1 and consecutive consultation 2, respectively). Results: Patients and HCPs were satisfied with communication during both consultations. When using the tool, patients most frequently selected physical pain descriptors (95.2%), followed by emotional (81.0%), social (28.6%) and spiritual (28.6%) descriptors. Patients found the tool useful, stating that it helped them describe their pain. HCPs considered the tool difficult to incorporate into consultations. Conclusion: The study highlighted the need to consider the various aspects of cancer pain.

Prevalence of Pain within Limb Girdle Muscular Dystrophy R9 and Implications for Other Degenerative Diseases

Our primary aim was to establish the prevalence of pain within limb girdle muscular dystrophy R9 (LGMDR9). As part of the Global FKRP Registry, patients are asked to complete the Short Form McGill Pain Questionnaire (SF-MPQ) annually. We used the results of this questionnaire to determine individuals’ maximum pain score and total pain score and examined overall pain intensity and associations between pain intensity and LGMDR9 genotypes, age, and ambulatory status. We also considered the pain descriptors used and pain progression over time. Of the 502 patients, 87% reported current pain and 25% reported severe current pain. We found no associations in pain severity between the different genotypes of LGMDR9. However, we did find statistically significant associations between pain severity and ambulatory status and between our paediatric and adult populations. We found pain descriptors to be more common words that one may associate with non-neural pain, and we found that a significant number of individuals (69%) reported a fluctuating pain pattern over time. We concluded that pain should be considered a significant issue among individuals with LGMDR9 requiring management. Implications regarding assessment of pain for other degenerative diseases are discussed.

Contemporary English Pain Descriptors as Detected on Social Media Using Artificial Intelligence and Emotion Analytics Algorithms: Cross-sectional Study

Background Pain description is fundamental to health care. The McGill Pain Questionnaire (MPQ) has been validated as a tool for the multidimensional measurement of pain; however, its use relies heavily on language proficiency. Although the MPQ has remained unchanged since its inception, the English language has evolved significantly since then. The advent of the internet and social media has allowed for the generation of a staggering amount of publicly available data, allowing linguistic analysis at a scale never seen before. Objective The aim of this study is to use social media data to examine the relevance of pain descriptors from the existing MPQ, identify novel contemporary English descriptors for pain among users of social media, and suggest a modification for a new MPQ for future validation and testing. Methods All posts from social media platforms from January 1, 2019, to December 31, 2019, were extracted. Artificial intelligence and emotion analytics algorithms (Crystalace and CrystalFeel) were used to measure the emotional properties of the text, including sarcasm, anger, fear, sadness, joy, and valence. Word2Vec was used to identify new pain descriptors associated with the original descriptors from the MPQ. Analysis of count and pain intensity formed the basis for proposing new pain descriptors and determining the order of pain descriptors within each subclass. Results A total of 118 new associated words were found via Word2Vec. Of these 118 words, 49 (41.5%) words had a count of at least 110, which corresponded to the count of the bottom 10% (8/78) of the original MPQ pain descriptors. The count and intensity of pain descriptors were used to formulate the inclusion criteria for a new pain questionnaire. For the suggested new pain questionnaire, 11 existing pain descriptors were removed, 13 new descriptors were added to existing subclasses, and a new Psychological subclass comprising 9 descriptors was added. Conclusions This study presents a novel methodology using social media data to identify new pain descriptors and can be repeated at regular intervals to ensure the relevance of pain questionnaires. The original MPQ contains several potentially outdated pain descriptors and is inadequate for reporting the psychological aspects of pain. Further research is needed to examine the reliability and validity of the revised MPQ.

Neuropathic Pain Syndromes

The International Association for the Study of Pain defines neuropathic pain as pain that is initiated or caused by a lesion or disease affecting the somatosensory system in either the peripheral nervous system or the central nervous system. Several well-recognized descriptors for neuropathic pain suggest a neuropathic rather than nociceptive pathophysiology (hot, burning, painful cold, freezing, prickling or tingling, pins and needles, electrical, shooting, stabbing, lancinating, and itching). However, whether the pain descriptors are used alone or incorporated into questionnaires to identify neuropathic pain, their sensitivity and specificity are limited (generally 70%-85%); therefore, verbal pain descriptors are insufficient for making the diagnosis of neuropathic pain.

A Multi-Center Cohort Study on Characteristics of Pain, Its Impact and Pharmacotherapeutic Management in Patients with ALS

Background: Although pain is common in amyotrophic lateral sclerosis (ALS) and an effectively treatable symptom, it is widely under-recognized and undertreated. This study investigates epidemiological and clinical characteristics of pain, its impact and pharmacological treatment in ALS patients. In addition, opportunities for further optimization of pain therapy need to be identified. Methods: Patients from three German ALS outpatient clinics were asked to complete the Brief Pain Inventory and the ALS Functional Rating Scale—Extension and to participate in semi-structured telephone interviews. Results: Of the 150 study participants, 84 patients reported pain. Pain occurred across all disease stages, predominantly in the neck, back and lower extremities. It was described with a broad spectrum of pain descriptors and mostly interfered with activity-related functions. Of the 84 pain patients, 53.8% reported an average pain intensity ≥4 on the numerical rating scale (NRS), indicating pain of at least moderate intensity, and 64.3% used pain medication. Irrespective of the medication type, 20.4% of them had no sufficient pain relief. Thirteen out of 30 patients without pain medication reported an average NRS value ≥4. Eleven of them—mainly in the context of high pain interference with daily functions—were supposed to benefit from adequate pain therapy. However, many patients had relevant concerns and misconceptions about pain therapy. Conclusion: Given the frequency, extent and multi-faceted impact of pain, it is necessary to systematically assess pain throughout the disease course. Potentials to optimize pain therapy were seen in the subset of patients with insufficient pain relief despite medication and in those patients without pain medication but high pain interference. However, there is a need to respond to patients’ barriers to pain therapy.

Disentangling ‘sciatica’ to understand and characterise somatosensory profiles and potential pain mechanisms

Objectives The study aimed to investigate if patients with lumbar radicular pain only and those with combined lumbar radicular pain + radiculopathy differ in their somatosensory profiles and pain experiences. Methods Quantitative sensory testing (QST) was performed in 26 patients (mean age 47 ± 10 years, 10 females) with unilateral leg pain in the L5 or S1 distribution in their main pain area (MPA) and contralateral mirror side, in the relevant foot dermatome on the symptomatic side and in the hand dorsum. Pain experience was captured on the painDETECT. Results Eight patients presented with lumbar radicular pain only and 18 patients with combined radicular pain + radiculopathy. Patients with radicular pain only demonstrated widespread loss of function (mechanical detection) bilaterally in the MPA (p<0.003) and hand (p=0.002), increased heat sensitivity in both legs (p<0.019) and cold/heat sensitivity in the hand (p<0.024). QST measurements in the dermatome did not differ compared to HCs and patients with radiculopathy. Patients with lumbar radiculopathy were characterised by a localised loss of function in the symptomatic leg in the MPA (warm, mechanical, vibration detection, mechanical pain threshold, mechanical pain sensitivity p<0.031) and dermatome (mechanical, vibration detection p<0.001), consistent with a nerve root lesion. Pain descriptors did not differ between the two groups with the exception of numbness (p<0.001). Patients with radicular pain did not report symptoms of numbness, while 78% of patients with radiculopathy did. Conclusions Distinct differences in somatosensory profiles and pain experiences were demonstrated for each patient group, suggesting differing underlying pain mechanisms.

Contemporary English Pain Descriptors as Detected on Social Media Using Artificial Intelligence and Emotion Analytics Algorithms: Cross-sectional Study (Preprint)

BACKGROUND Pain description is fundamental to health care. The McGill Pain Questionnaire (MPQ) has been validated as a tool for the multidimensional measurement of pain; however, its use relies heavily on language proficiency. Although the MPQ has remained unchanged since its inception, the English language has evolved significantly since then. The advent of the internet and social media has allowed for the generation of a staggering amount of publicly available data, allowing linguistic analysis at a scale never seen before. OBJECTIVE The aim of this study is to use social media data to examine the relevance of pain descriptors from the existing MPQ, identify novel contemporary English descriptors for pain among users of social media, and suggest a modification for a new MPQ for future validation and testing. METHODS All posts from social media platforms from January 1, 2019, to December 31, 2019, were extracted. Artificial intelligence and emotion analytics algorithms (Crystalace and CrystalFeel) were used to measure the emotional properties of the text, including <i>sarcasm</i>, <i>anger</i>, <i>fear</i>, <i>sadness</i>, <i>joy</i>, and <i>valence</i>. Word2Vec was used to identify new pain descriptors associated with the original descriptors from the MPQ. Analysis of count and pain intensity formed the basis for proposing new pain descriptors and determining the order of pain descriptors within each subclass. RESULTS A total of 118 new associated words were found via Word2Vec. Of these 118 words, 49 (41.5%) words had a count of at least 110, which corresponded to the count of the bottom 10% (8/78) of the original MPQ pain descriptors. The count and intensity of pain descriptors were used to formulate the inclusion criteria for a new pain questionnaire. For the suggested new pain questionnaire, 11 existing pain descriptors were removed, 13 new descriptors were added to existing subclasses, and a new <i>Psychological</i> subclass comprising 9 descriptors was added. CONCLUSIONS This study presents a novel methodology using social media data to identify new pain descriptors and can be repeated at regular intervals to ensure the relevance of pain questionnaires. The original MPQ contains several potentially outdated pain descriptors and is inadequate for reporting the psychological aspects of pain. Further research is needed to examine the reliability and validity of the revised MPQ.

Development of the Bristol Rabbit Pain Scale (BRPS): A multidimensional composite pain scale specific to rabbits (Oryctolagus cuniculus)

A species-specific composite pain scale is a prerequisite for adequate pain assessment. The aim of this study was to develop a multidimensional pain scale specific to rabbits (Oryctolagus cuniculus) called the Bristol Rabbit Pain Scale (BRPS). The scale was developed over five phases using a unique combination of methods: focus groups and behavioural observation. The first two phases aimed at identifying descriptors to describe a rabbit in pain, and then reducing their number, both using focus groups. A total of 72 pain descriptors were grouped under six categories (Demeanour, Posture, Facial expression, Attention to the painful area, Audible and Other) and ‘No pain’ descriptors were added. The third phase aimed to confirm, through video observation of rabbits, the categories and descriptors previously described, to reject those terms that were ambiguous, and identify any new descriptors that had not been included in the previous list of descriptors. This led to the rejection of the categories Audible and Attention to the painful area and of 34 descriptors. Seven new descriptors were identified. The last two phases constructed the final format of the BRPS by refining the categories, ranking the descriptors on an ordinal scale and testing the internal reliability of the scale using Cronbach’s alpha test. This led to a composite pain scale of six categories (Demeanour, Posture, Locomotion, Ears, Eyes and Grooming) with four intensities of pain (0, 1, 2, and 3), a total score of 0–18, and a high Cronbach’s alpha coefficient (alpha = 0.843). This BRPS fills an important gap in the field of rabbit medicine and has the potential to improve the assessment and management of pain in rabbits providing veterinary professionals with a novel multidimensional pain assessment tool. Further studies will investigate the clinical utility, validity and reliability of the BRPS.

Contribution of neurogenic mechanisms to the pathogenesis of chronic joint pain

Objective: to study the contribution of neurogenic mechanisms to the pathogenesis of chronic pain in patients with rheumatoid arthritis (RA), knee osteoarthritis (OAk) and ankylosing spondylitis (AS). To evaluate the effectiveness of an anticonvulsants in complex therapy of RA and OAk.Patients and methods. The study included 518 patients, 208 (40.2%) had definite RA, 160 (30.9%) had OAk and 150 (28.9%) had AS. All patients were rheumatologically and neurologically examined to determine the state of the somatosensory system; DN4 and Pain DETECT questionnaires were used to diagnose pain descriptors characteristic of neuropathic and nocyplastic pain; visual analogue scale (VAS) was used for pain intensity at rest assessment; algometry – for detecting secondary hyperalgesia. Functional, affective disorders and quality of life were assessed as well. Moreover, efficacy of the anticonvulsant in the complex therapy of RA and OAk was evaluated.Results and discussion. 49.5% of RA patients had neuropathic pain. It has been statistically significantly shown that older patients with a long history of the disease, advanced X-ray stage and high level of anxiety and depression experience neuropathic pain more frequently. Disease activity and ESR level did not affect the severity of the neuropathic component of pain. In 37.5% of OAk cases, signs of nociplastic pain were observed. Patients in this group were in pain according to VAS, worse functional state and quality of life, as well as a higher level of anxiety, the differences were statistically significant. 12.7% of AS patients had nociplastic pain. There was no association with the age and duration of the disease. Higher levels of disease activity, pain and depression and worse functional abilities were observed when nociplastic pain was present. The effectiveness of anticonvulsant is demonstrated in the complex therapy of chronic articular pain in RA and OAk, which confirms the role of central sensitization in the pathogenesis of pain in these diseases.Conclusion. Chronic pain in RA, OAk and AS patients in some cases has mixed nature, both inflammatory and neurogenic mechanisms (neuropathic and nociplastic) are involved. It is necessary to examine patients to identify the neuropathic component of pain, which will improve pain control and ensure a holistic approach to therapy. In patients with RA and OAk, having a mixed nature of pain, complex treatment, containing a central action drug from a group of anticonvulsants, is more effective compared with standard anti-inflammatory therapy.