OBJECTIVES: This study evaluated the unique incremental predictive value of brief psychological assessments on pain intensity, pain interference, and physical function after musculoskeletal injury. METHODS: Participants...OBJECTIVES: This study evaluated the unique incremental predictive value of brief psychological assessments on pain intensity, pain interference, and physical function after musculoskeletal injury. METHODS: Participants (N=135) completed baseline assessments during hospitalization following a traumatic injury and follow-up data 3 months later. Predictive assessments were depression, anxiety, traumatic injury distress, and pain anxiety, while concurrent assessments included pain acceptance, valued activity, and pain self-efficacy. Regression analyses determined the added explanatory value (Δ R2 ) of psychological variables beyond pain intensity and medical/injury factors. RESULTS: Follow-up pain intensity, pain interference, and physical function were predicted by traumatic injury distress (Δ R2 =0.08, P <0.001; Δ R2 =0.16, P <0.001; Δ R2 =0.05, P =0.003, respectively), and pain anxiety (Δ R2 =0.04, P =0.005; Δ R2 =0.06, P <0.001; Δ R2 =0.04, P =0.006). Pain acceptance was associated with pain interference at 3 months (Δ R2 =0.03, P =0.036). Both pain intensity and interference were associated with valued activity (Δ R2 =0.03, P =0.013; Δ R2 =0.02, P =0.035) and pain self-efficacy (Δ R2 =0.06, P <0.001; Δ R2 =0.06, P <0.001). Greater physical function at follow up was associated with less traumatic injury distress (Δ R2 =0.03, P =0.024) and greater pain self-efficacy (Δ R2 =0.05, P =0.002). DISCUSSION: Psychological assessments conducted early in recovery offer additional predictive value beyond medical and injury-related factors. These findings underscore the importance of comprehensive psychological evaluations following traumatic injury.
OBJECTIVES: The aim of this study was to explore the diverse aspects of sexual pain experiences among affected women. MATERIALS AND METHODS: We conducted an interpretive description qualitative study and collected data u...OBJECTIVES: The aim of this study was to explore the diverse aspects of sexual pain experiences among affected women. MATERIALS AND METHODS: We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were purposefully recruited for one-on-one semi-structured online interviews. Two independent reviewers analyzed the transcripts, and coding was finalized through consensus. RESULTS: The study consisted of 31 women who self-identified as experiencing sexual pain with a mean age of 29 (SD=9.72) years and a mean pain duration of 53 (SD=41.93) months. We identified 6 main themes, including experience of living with pain, beliefs, behavior, search for help, treatments, and expectations. DISCUSSION: This study revealed that sexual pain often begins with the first sexual encounter and may persist, deeply affecting personal and marital well-being. Pain was linked to factors such as trauma and biological dysfunctions. Participants employed various coping strategies and sought multiple treatments, though outcomes and satisfaction levels varied. Key facilitators of effective treatment were professional support and access to information, while significant barriers included shame and financial constraints. Satisfaction with health care largely depended on receiving a diagnosis, with future outlooks varying from hopelessness to optimism.
Zhang J, Chen Q, Shen Q
… +8 more, Yan C, Jiang T, Li J, Sayer S, Ai Z, Yu X, Zeng Q, Chen G
Clin J Pain
· 2025 Oct · PMID 40775700
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OBJECTIVES: This study aimed to investigate the effectiveness of transcutaneous auricular vagal nerve stimulation (taVNS) in alleviating postoperative pain following thoracoscopic lobectomy. METHODS: In this randomized c...OBJECTIVES: This study aimed to investigate the effectiveness of transcutaneous auricular vagal nerve stimulation (taVNS) in alleviating postoperative pain following thoracoscopic lobectomy. METHODS: In this randomized controlled trial, 70 adult patients were randomly assigned in a 1:1 ratio to receive either active or sham taVNS. Stimulation was initiated in the preoperative room, maintained throughout surgery, and discontinued after extubation in the postanesthesia care unit, at which point the device was removed. Additional 2-hour sessions were conducted each morning on postoperative days 1 and 2. Patient-controlled intravenous analgesia and serratus anterior plane block were provided to all the patients. The primary outcome was sufentanil consumption during the first 24 hours after surgery. RESULTS: A total of 67 participants completed the study. Sufentanil consumption showed no statistically significant difference between the active group (33 ± 13 μg) and the sham group (32 ± 9 μg) (mean difference=1.20, 95% CI=-4.23 to 6.63, P -value=0.661). Compared with the sham group, taVNS produced a statistically significant reduction in the numerical rating scale for resting pain ( P -value=0.001) and deep breathing pain ( P -value<0.001) postoperatively. taVNS also significantly reduced the incidence of rebound pain (58% vs. 18%; P -value=0.001) and chronic postsurgical pain at 3 months (27% vs. 6%; P -value=0.018). DISCUSSION: taVNS did not reduce postoperative opioid consumption but alleviated acute postoperative pain, lowered the incidence of rebound pain and chronic postsurgical pain. These preliminary findings have uncertain clinical significance and require further investigation. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400081062).
Ramasawmy P, Antal A, Gamboa Arana OL
… +2 more, Petzke F, Kästner A
Clin J Pain
· 2025 Nov · PMID 40772698
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OBJECTIVES: Mindfulness-based interventions (MBIs) appear to improve emotion regulation (ER) in disorders involving emotional dysregulation like fibromyalgia (FM). Despite the therapeutic potential of transcranial direct...OBJECTIVES: Mindfulness-based interventions (MBIs) appear to improve emotion regulation (ER) in disorders involving emotional dysregulation like fibromyalgia (FM). Despite the therapeutic potential of transcranial direct current stimulation (tDCS) in FM, its concurrent application with mindfulness meditation (MM) has not yet been explored. Potential synergistic effects may arise from aligning neural mechanisms underlying both interventions. This study evaluated the impact of a 4-week MBI and a combined tDCS and MM intervention on ER, implementing a responder analysis approach for FM patients. METHODS: Following the MBI, 40 participants with FM were randomly allocated to receive 10 days of 20 minutes MM combined with either anodal tDCS of the primary motor cortex (M1) or sham tDCS. ER was gauged using a composite score integrating 4 self-report questionnaires. We performed assessment at 6 time points (baseline, post-MBI, immediately postcombined intervention, 4 wk, 8 wk, and 12-wk follow-ups). Clinical responders were defined as patients exhibiting a clinically relevant reduction in FM symptom load. RESULTS: Responders to the MBI showed better ER than nonresponders, lasting for 6 weeks. Interestingly, responders to the combined intervention in the sham group reported larger improvements in ER than nonresponders, which was not observed in the anodal tDCS group. No significant interaction between responder status and time was found for responders to either intervention. DISCUSSION: Our findings evidence that mindfulness practice is able to improve ER in FM. However, the add-on combination of MM with M1-tDCS abolishes this mindfulness-induced effect. Therefore, based on our data, combining MM and M1-tDCS must be reconsidered as a therapeutic intervention targeting ER in FM.
OBJECTIVES: The current study assessed health care utilization (HCU) by pediatric patients with functional abdominal pain disorder (FAPD) and compared rates of HCU between youth who received cognitive-behavioral therapy...OBJECTIVES: The current study assessed health care utilization (HCU) by pediatric patients with functional abdominal pain disorder (FAPD) and compared rates of HCU between youth who received cognitive-behavioral therapy (CBT) as part of a randomized clinical trial and those who received medical treatment as usual (TAU). MATERIALS AND METHODS: Participants between the ages of 9 to 14 were randomly assigned to receive either CBT (n=39) or TAU (n=39). Participants in the active arm received the Aim to Decrease Anxiety and Pain Treatment (ADAPT), an evidence-based CBT intervention targeting abdominal pain and mental health symptoms. The frequency of HCU 12 months postintervention was examined using objective data via the electronic medical record (EMR). HCU variables included outpatient gastroenterology (GI) clinic visits, outpatient psychology/psychiatry visits, Emergency Department visits, and hospitalizations. Count regression models tested the effect of ADAPT on HCU. RESULTS: In the total sample, HCU of subspecialty and emergency treatment services was overall low. ADAPT participants may have had fewer GI clinic visits (IRR=0.86, CI=0.45-1.68), psychology/psychiatry visits (IRR=0.84, CI=0.10-6.88), and hospitalizations (IRR=0.37, CI=0.04-3.68) than TAU participants, though wide confidence intervals were noted. DISCUSSION: Findings suggest variation in HCU between youth with FAPD who received CBT and those who received TAU. More work is needed to examine how cognitive-behavioral interventions may impact HCU in pediatric patients with FAPD and related Disorders of Gut-Brain Interaction.
OBJECTIVES: Preliminary evidence suggests that children and adolescents with high-impact chronic primary pain benefit from intensive interdisciplinary pain treatment involving both patients and their caregivers. While it...OBJECTIVES: Preliminary evidence suggests that children and adolescents with high-impact chronic primary pain benefit from intensive interdisciplinary pain treatment involving both patients and their caregivers. While it is important for patients and caregivers to be satisfied with the treatment, previous studies have not observed an association between treatment satisfaction and other treatment outcomes, such as pain symptoms. We hypothesized that the helping alliance-both between patients and health care professionals (HCPs) and between caregivers and HCPs-plays a role in treatment satisfaction. The aim of this study was to examine the role of the helping alliance in treatment satisfaction for pediatric chronic pain patients and their caregivers. MATERIALS AND METHODS: We computed 2 actor-partner interdependence models to analyze the dyadic associations between the predictor helping alliance and the outcome treatment satisfaction. Analyses were based on data from n = 205 patients, n = 191 caregivers, and n = 197 HCPs. RESULTS: Results revealed that patients' and caregivers' treatment satisfaction was positively associated with the quality of their respective helping alliance with their HCP. Notably, patients' perceptions of their alliance with HCPs were positively associated with caregiver treatment satisfaction, and caregivers' perceptions of their alliance with HCPs were linked to patients' treatment satisfaction. CONCLUSION: These findings highlight the importance of viewing pediatric pain patients, caregivers, and HCPs as an interdependent network. Future studies may extend our findings to other clinical settings and longitudinally.
OBJECTIVES: Scientific pain associations recommend that patients with chronic pain should receive specialist treatment in outpatient, day-care, or inpatient clinics by "interdisciplinary multimodal pain therapy" (IMPT)....OBJECTIVES: Scientific pain associations recommend that patients with chronic pain should receive specialist treatment in outpatient, day-care, or inpatient clinics by "interdisciplinary multimodal pain therapy" (IMPT). Existing structural requirements, however, can often not support a full IMPT program for diverse indications. We report on the outcomes of a modified IMPT program implemented at the Pain Center of the University Hospital Mannheim, which is readily adaptable for other regional pain centers seeing a similar broad spectrum of pain diagnoses and variable chronicities. METHODS: The retrospective study on 106 day-care patients with chronic pain investigated the effects on 4 major pain domains (ie, pain characteristics, function and impairment, well-being and quality of life, and mental health, including depression) 2 years after program entry. Patients were categorized according to referral ICD-10 diagnoses into musculoskeletal, neuropathic, and persistent pain with psychosocial factors, plus a small group with tumor-related pain. RESULTS: Most markers of the major pain domains significantly improved, including function and well-being. The improvements were reproduced in the major pain clusters, with best results for specific neuropathic and tumor pain and lesser but significant effects on musculoskeletal pain. Patients with persistent pain disorders responded least. DISCUSSION: The results showed that an individualized IMPT can be put in effect in an outpatient clinic seeing a diversity of chronic pain diagnoses. The success and failure rates for different pain pictures delineate the scope and the limits of generic IMPTs.
Hagikura A, Moriwaki K, Tanaka H
… +12 more, Kawai Y, Hosoi M, Kashimoto M, Satani Y, Yao S, Nagase Y, Nagasawa K, Miyajima A, Inoue N, Umehara E, Kusuyama T, Fukuda D
OBJECTIVES: The optimal local anesthetic for trans-distal radial (TDRA) and trans-radial arterial (TRA) catheterization is unclear and not standardized. This study compared the efficacy and cost-effectiveness of adding a...OBJECTIVES: The optimal local anesthetic for trans-distal radial (TDRA) and trans-radial arterial (TRA) catheterization is unclear and not standardized. This study compared the efficacy and cost-effectiveness of adding a lidocaine patch to standard lidocaine subcutaneous lidocaine injection for TDRA and TRA procedures. METHODS: This was a prospective, single-blind study. Consecutive patients undergoing TDRA or TRA catheterization in patients with ischemic heart and peripheral arterial disease were randomized to receive either a lidocaine patch (lidocaine group, n=41) or a placebo patch (placebo group, n=43) at the planned arterial access site at least 30 minutes before the procedure, followed by lidocaine subcutaneous anesthesia using a 27-G needle. The primary outcome was access site pain measured by visual analog scale (VAS) at predetermined 3 points (1) at the point of lidocaine subcutaneous injection (referred to as "before procedure" hereafter), (2) during the procedure ("during procedure"), (3) postprocedure until the confirmation of arterial hemostasis ("after procedure"). Secondary outcomes included drug-related costs. RESULTS: VAS scores at all 3 points were comparable (lidocaine vs. placebo: at the point of lidocaine infusion 20 mm vs. 19 mm, P =0.55; during the procedure 17 mm vs. 14 mm, P =0.67; after the procedure 9 mm vs. 12 mm, P =0.71). The lidocaine group incurred significantly higher costs, even when considering only the lidocaine patch (0.43 USD vs. 0.00 USD, P <0.001) and the total amount of lidocaine patch and lidocaine subcutaneous infusion (0.62 USD vs. 0.21 USD, P <0.001). DISCUSSION: The addition of a lidocaine patch to standard lidocaine subcutaneous injection for TDRA or TRA catheterization did not improve pain relief or cost-effectiveness.
Laumann LE, Gnall KE, Sinnott SM
… +2 more, Park CL, Cruess DG
Clin J Pain
· 2025 Oct · PMID 40673744
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OBJECTIVES: Chronic pain affects an estimated 8.5% of young adults in the United States. Physical activity is a promising strategy for behavioral pain management, yet research characterizing the prevalence and correlates...OBJECTIVES: Chronic pain affects an estimated 8.5% of young adults in the United States. Physical activity is a promising strategy for behavioral pain management, yet research characterizing the prevalence and correlates of physical activity among young adults with chronic pain is scant. The present study sought to characterize physical activity patterns and identify psychosocial predictors of physical activity in this population. MATERIALS AND METHODS: Participants were 129 young adults with self-reported chronic pain. Fear-avoidance (experiential avoidance, kinesiophobia), mental health (depression, anxiety), and energy-related (sleep disturbance, fatigue) factors were examined as correlates and predictors of moderate-to-vigorous physical activity (MVPA), walking, and sedentary behavior using generalized linear models. RESULTS: Participants reported an average of 51.0 (IQR=16.75, 100.75) minutes of MVPA and 90.0 (IQR=43, 153) minutes of walking per day. Nearly 3 quarters (72.9%) of participants met recommended MVPA guidelines. At baseline, experiential avoidance (95% CI [-0.019, -0.007]), depression (95% CI [-0.100, -0.017]), and fatigue (95% CI [-0.042, -0.007]) were negatively associated with MVPA; depression (95% CI [1.37, 13.71]) was positively associated with sedentary behavior. Experiential avoidance at baseline predicted MVPA at 2-week follow-up (95% CI [-0.015, -0.001]). No psychosocial factors were significantly associated with or predictive of walking. DISCUSSION: On average, young adults with chronic pain in our sample met recommended physical activity guidelines. Experiential avoidance was associated with MVPA at baseline and predicted less MVPA 2 weeks later. Findings suggest that while pain itself may not prevent engagement in MVPA among this population, a desire to prevent discomfort may be prohibitive.
OBJECTIVES: To explore the potential contribution of small fiber pathology (SFP) and COMT enzyme gene Val/158/Met functional polymorphism to neuropathic pain (NP) in female fibromyalgia (FM) patients. METHODS: This case-...OBJECTIVES: To explore the potential contribution of small fiber pathology (SFP) and COMT enzyme gene Val/158/Met functional polymorphism to neuropathic pain (NP) in female fibromyalgia (FM) patients. METHODS: This case-control study was conducted on 60 women with FM and 60 matched healthy women. All patients were subjected to detailed clinical assessment. Sympathetic skin response (SSR) and cutaneous silent period (CSP) were performed to assess small fiber neuropathy (SFN). Catechol-O-methyl-transferase (COMT) SNP, rs4680 (A/G, missense158Val/Met) were genotyped. RESULTS: FM patients had significantly longer latency and lower amplitude of foot and hand SSR ( P <0.001), with 7 patients having unobtainable foot SSR. Also, they had significantly earlier onset latency, longer duration, and more delayed offset latency of CSP ( P <0.001, from most of them). Regarding the relation between COMT genotypes and different disease characteristics, patients with A/A genotypes had a statistically significant increase in pain severity scores compared with those with G/G genotypes ( P =0.013 for McGill and 0.019 for the Visual Analog Scale). Moreover, there was a significant increase in NP scores ( P =0.004 and 0.001, for pain DETEDT and SFNL, respectively) of A/A and A/G compared with G/G genotypes. CONCLUSIONS: Moderate to severe neuropathic pain was experienced by all the studied patients with FM, and small fiber pathology was suggested to be a significant contributor to neuropathic pain. Moreover, the COMT A/A genotype was found to be associated with the NP and pain severity.
Dowling EJ, Simons LE, Crum AJ
… +5 more, Pate J, Chilcot J, Laycock HC, Scott W, Heathcote LC
Clin J Pain
· 2025 Sep · PMID 40590476
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OBJECTIVE: Pain acceptance predicts better quality of life, physical functioning, and treatment outcomes in youth with chronic pain. However, we know little about the factors that promote pain acceptance in youth. This s...OBJECTIVE: Pain acceptance predicts better quality of life, physical functioning, and treatment outcomes in youth with chronic pain. However, we know little about the factors that promote pain acceptance in youth. This study investigated body mindsets and their associations with facets of pain acceptance, specifically pain willingness and activity engagement, in adolescents with chronic pain. METHODS: The sample comprised 102 adolescents with chronic musculoskeletal pain (aged: 8 to 17; 72.3% female, 49.5% Caucasian/White) attending a tertiary pain clinic. Hierarchical linear regression analyses examined associations of body mindsets with pain acceptance, controlling for demographic factors, pain and mental health symptoms, and basic functioning. RESULTS: There was significant variation in the mindsets that adolescents with chronic pain held about their bodies-some endorsed the mindset that their Body is an Adversary, others endorsed the mindsets that their Body is Responsive or Body is Capable. Hierarchical linear regression analyses indicated that endorsing the mindset that their Body is an Adversary was associated with lower willingness to experience pain, while endorsing the mindset that their Body is Capable was associated with greater engagement in valued activities despite pain, even after accounting for demographic factors, pain characteristics, and basic functioning. Together, all 3 mindsets explained 6.6% to 26.8% unique variance in pain acceptance. DISCUSSION: Body mindsets are significantly associated with pain acceptance in youth with chronic pain, even after controlling for pain characteristics and basic functioning. Experimental research should investigate whether body mindsets are modifiable in this population and whether they could represent interventional targets fostering pain acceptance.
OBJECTIVES: The current study investigated the concurrent impact of anxiety and pain catastrophizing on both pain-related impairment (ie, functional disability and pain intensity) and on pain-related psychological treatm...OBJECTIVES: The current study investigated the concurrent impact of anxiety and pain catastrophizing on both pain-related impairment (ie, functional disability and pain intensity) and on pain-related psychological treatment outcomes in youth with Functional Abdominal Pain Disorders (FAPD). METHOD: This is a secondary analysis of data from a psychological treatment study (Aim to Decrease Anxiety and Pain Treatment; ADAPT) for youth with FAPD. Participants completed 6 weeks of ADAPT (psychological intervention) and treatment as usual or treatment as usual alone. Regressions and analysis of covariance models examined the relationship between baseline pain catastrophizing and anxiety on baseline functional disability and pain intensity, while analysis of covariance models assessed the effect of these baseline psychological factors on pain-related outcomes at postassessment (8 wks later) while accounting for group assignment. The effects of ADAPT on postassessment pain catastrophizing and anxiety, as well as their moderating effects on pain-related outcomes were also explored. RESULTS: Results indicated that baseline pain catastrophizing, but not anxiety, predicted baseline functional disability and pain intensity, as well as postassessment functional disability. Participants in the ADAPT group also demonstrated significantly lower pain catastrophizing at postassessment. However, there were no moderating effects of postassessment pain catastrophizing or anxiety on pain-related outcomes. DISCUSSION: Findings suggest that assessment of pain catastrophizing is important to better understand pain-related impairment in FAPD in youth.
OBJECTIVES: The aim of this systematic review was to synthesize the current research on chronic pain in autistic individuals, including epidemiology, assessment, and management. METHODS: We conducted a search of the foll...OBJECTIVES: The aim of this systematic review was to synthesize the current research on chronic pain in autistic individuals, including epidemiology, assessment, and management. METHODS: We conducted a search of the following electronic databases: PubMed/MedLine, CINHAL, PsychINFO, PubPsych, Scopus, and Web of Science, from inception to 31 July 2024. RESULTS: A total of 5603 citations were identified, 87 articles were deemed eligible for further assessment, and 26 articles were included in the final review. Of these, 13 provided data about the epidemiology of chronic pain, 10 were related to pain assessment, and 3 focused on chronic pain treatment. The most commonly studied locations of chronic pain were the abdomen and the head. The assessment tools used were frequently completed by parents or professionals/researchers and only 1 study used self-reported measures. Three studies were on psychological interventions applied to the management of chronic pain in autistic individuals. DISCUSSION: The results of this study provides initial insights into chronic pain in autistic individuals, and show that they experience conditions such as chronic abdominal pain and migraines as the general population does. It also highlights challenges to the accurate assessment and treatment of chronic pain, and emphasizes the need for heightened clinician awareness, early identification, and personalized management strategies.
Rundell SD, Parman N, Phelan EA
… +3 more, Marcum ZA, Jones B, Patel KV
Clin J Pain
· 2025 Sep · PMID 40439071
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OBJECTIVE: To investigate the associations of pain characteristics with trajectories of physical capacity in older adults and determined if bothersome and activity-limiting pain modified the association between the numb...OBJECTIVE: To investigate the associations of pain characteristics with trajectories of physical capacity in older adults and determined if bothersome and activity-limiting pain modified the association between the number of chronic conditions and trajectories of physical capacity. METHODS: We performed a cohort study with 6783 community-dwelling adults ≥65 years old who participated in the National Health and Aging Trends Study from 2011 to 2016. We assessed baseline pain characteristics and the number of self-reported chronic conditions (0 to 12) at baseline. Longitudinal physical capacity outcomes were categorized using previously identified performance-based and self-reported trajectory groups from this cohort. Multinomial logistic regression examined associations of pain characteristics with trajectories of physical capacity, adjusting for demographic and health characteristics. We then tested for effect modification using an interaction term in regression models. RESULTS: Participants who reported bothersome pain, activity-limiting pain, greater number of pain sites, and more frequent pain medication use at baseline were significantly more likely to demonstrate either "consistently very low" or declining physical capacity trajectories compared with a "consistently high" trajectory. The negative impact of chronic disease burden on risk of a declining trajectory for both performance-based and self-reported physical capacity was greater in those with bothersome pain versus those not reporting pain. DISCUSSION: Overall, we found bothersome pain and other pain characteristics were significantly associated with poor and worsening trajectories of physical capacity in older adults. This suggests pain is an important prognostic factor for targeting population-level interventions addressing physical capacity.
Tiong K, Gorrie A, Palmer GM
… +2 more, Sainsbury D, Jaaniste T
Clin J Pain
· 2025 Sep · PMID 40421547
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OBJECTIVES: Attrition from pediatric chronic pain clinics limits patients from receiving maximum benefit from evidence-based interventions, with likely persistence of chronic pain and functional and psychosocial impairm...OBJECTIVES: Attrition from pediatric chronic pain clinics limits patients from receiving maximum benefit from evidence-based interventions, with likely persistence of chronic pain and functional and psychosocial impairments. We aimed to determine attrition prevalence from interdisciplinary pediatric outpatient chronic pain clinics and identify any associated patient and caregiver factors. METHODS: A retrospective analysis was performed of longitudinal data from patients and caregivers attending 10 interdisciplinary pediatric outpatient chronic pain clinics in Australia or New Zealand contributing to the Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC) database. Data were retrieved for patient attrition, patient, and caregiver factors at treatment commencement and subsequent documentation of the episode end for treatment completers and noncompleters. Statistical associations with patient attrition were assessed using logistic regression analyses. RESULTS: The prevalence of patient attrition was 19.3% in the PaedePPOC cohort (N = 1051), occurring steadily over 11 months. Patients ending their treatment prematurely presented with longer pain duration (>12 mo) [χ 2 (1, n=879)=8.23, P =0.004] than treatment completers. In the regression model, only older patient age ( P =0.010) and higher caregiver psychosocial burden ( P =0.025) at treatment commencement were associated with attrition. While pain intensity, patient physical and psychosocial functioning scores, and caregiver partner status were not. DISCUSSION: One in 5 patients commencing an interdisciplinary pediatric outpatient chronic pain clinic intervention did not complete it. Identifying patients at preintervention screening with longer pain duration, older in age, and from families with greater reported caregiver burden and providing tailored supports may minimize attrition, therefore optimizing efficiency of service provision.
OBJECTIVES: Interscalene brachial plexus block (ISBPB) has gained popularity as a pain-relief method following shoulder arthroscopic surgery, significantly reducing the need for analgesics. This study was designed to eva...OBJECTIVES: Interscalene brachial plexus block (ISBPB) has gained popularity as a pain-relief method following shoulder arthroscopic surgery, significantly reducing the need for analgesics. This study was designed to evaluate whether the addition of dexamethasone to different effective concentrations of ropivacaine in ultrasound-guided ISBPB affects postoperative analgesic effect in patients undergoing shoulder arthroscopy surgery. MATERIALS AND METHODS: A total of 140 participants elected for shoulder arthroscopy under ISBPB and general anesthesia, randomized into 6 equal groups. Group A, B, and C received 10 mL 0.25%, 0.5%, and 0.75% ropivacaine mixed with 1 mL 0.9% saline, respectively. Likewise, groups A1, B1, and C1 received the same volumes of ropivacaine with 5 mg dexamethasone. The primary goal was to assess the duration of analgesia with ISBPB, with secondary objectives concerning postoperative nausea and vomiting (PONV) and numerical rating scale (NRS) pain scores. RESULTS: Across a range of ropivacaine concentrations, there was no significant difference in the analgesic efficacy between participants receiving dexamethasone treatment and those who did not. Notably, there was no demonstrable difference in the duration of analgesia among the treatment groups (group A vs. group A1: 510.13±262.39 min, 518.21±395.49 min; P =0.054); (group B vs. group B1: 672.42±306.63 min, 646.05±348.48 min; P =0.281); (group C vs. group C1: 724.42±384.14 min, 680.29±414.30 min; P =0.782). Furthermore, there was no significant difference in the incidence of intraoperative and postoperative complications. CONCLUSION: The present study indicated that the addition of dexamethasone to ropivacaine did not appear to provide any additional advantages in postoperative analgesic efficacy compared with the use of ropivacaine alone for patients undergoing shoulder arthroscopy surgery with ISBPB.