Pain catastrophizing and associated factors in preoperative total knee arthroplasty in Lanzhou, China: a cross-sectional study

Chain-mediating effects of kinesiophobia and self-efficacy on pain catastrophizing and physical activity in haemophilia patients

BACKGROUND

There is a lack of research on the relationship between pain catastrophizing, kinesiophobia, and physical activity (PA) in people with haemophilia (PWH), and the underlying mechanisms connecting these variables remain unclear.

AIM

The study's aim was to clarify the roles of kinesiophobia and self-efficacy in the relationship between pain catastrophizing and PA in PWH.

METHODS

This cross-sectional study included adult PWH at the Haemophilia Centre of a Tertiary hospital in Beijing, China. The following questionnaires were used to collect data: the general information, the International Physical Activity Short Questionnaire, the Pain Catastrophizing Scale, the Tampa Scale of Kinesiophobia Scale, and the Exercise Self-Efficacy Scale.

RESULTS

The study included a total of 187 PWH, including 154 having haemophilia A and 33 having haemophilia B. The median interquartile range of PA was 594 (198, 1554) MET-min/wk. There were significant differences in PA of patients based on age stage, treatment modality, highest pain score within the last seven days, and presence of haemophilic arthropathy (p < .05). It was showed that pain catastrophizing could directly predict PA (p < .001), accounting for 38.13% of the total effect. Pain catastrophizing also had indirect effects on PA through the mediating factors of kinesiophobia or self-efficacy, and through the chain-mediating effect of kinesiophobia and self-efficacy, accounting for 38.40%, 17.07%, and 6.40%, respectively.

CONCLUSION

The study discovered that PWH have limited PA due to pain catastrophizing. This not only directly affects their activity but also indirectly influences it through kinesiophobia and self-efficacy.

The Effect of Singular Nonverbal Behaviours of Experimenters on Pain Reports

Introduction

Studies suggest facial expressions of caregivers may be important in placebo effects; however, this has not been systematically tested. This experiment investigated the effects of caregivers' singular positive nonverbal behaviours (NBs) on pain reports.

Methods

Fifty-one males and 53 females (total of 104) participants were randomized to four groups that were displayed positive facial expressions, tone of voice, body movement, or neutral NBs of videotaped experimenters. Subjective reports of pain, stress, arousal, and cardiac activity were obtained in a pre-test, a conditioning phase, and at a post-test. Four minutes of heat pain was induced in each test, and a placebo cream was administered before the conditioning and post-test in all groups.

Results

There were no differences between the NB groups in the reduced pain. Males had larger reduction in pain in the post-test, and females had lower arousal than the opposite sex. During the conditioning, females had larger reduction in pain ie, unconditioned pain response (UPR). In females, the UPR predicted the reinforced expectation ie, increase in expectations from conditioning to post-test, and fear of minor pain negatively predicted both the UPR and reinforced expectation.

Discussion

Singular NBs of caregiver were weak to enhance placebo effects. Females had lower pain during conditioning, and the UPR amplitude in females was associated with positive expectations. Moreover, for females, fear of minor pain weakened the UPR and expectations of cream.

Conclusion

No NB of caregivers is more effective in reducing pain. Caregivers' NBs are less effective when displayed individually. Males and females may be different in underlying mechanisms of placebo effects.

NSF DARE-transforming modeling in neurorehabilitation: a patient-in-the-loop framework

In 2023, the National Science Foundation (NSF) and the National Institute of Health (NIH) brought together engineers, scientists, and clinicians by sponsoring a conference on computational modelling in neurorehabiilitation. To facilitate multidisciplinary collaborations and improve patient care, in this perspective piece we identify where and how computational modelling can support neurorehabilitation. To address the where, we developed a patient-in-the-loop framework that uses multiple and/or continual measurements to update diagnostic and treatment model parameters, treatment type, and treatment prescription, with the goal of maximizing clinically-relevant functional outcomes. This patient-in-the-loop framework has several key features: (i) it includes diagnostic and treatment models, (ii) it is clinically-grounded with the International Classification of Functioning, Disability and Health (ICF) and patient involvement, (iii) it uses multiple or continual data measurements over time, and (iv) it is applicable to a range of neurological and neurodevelopmental conditions. To address the how, we identify state-of-the-art and highlight promising avenues of future research across the realms of sensorimotor adaptation, neuroplasticity, musculoskeletal, and sensory & pain computational modelling. We also discuss both the importance of and how to perform model validation, as well as challenges to overcome when implementing computational models within a clinical setting. The patient-in-the-loop approach offers a unifying framework to guide multidisciplinary collaboration between computational and clinical stakeholders in the field of neurorehabilitation.

Postoperative pain-related outcomes and perioperative pain management in China: a population-based study

Background

Postoperative pain poses a significant challenge to the healthcare system and patient satisfaction and is associated with chronic pain and long-term narcotic use. However, systemic assessment of the quality of postoperative pain management in China remains unavailable.

Methods

In this cross-sectional study, we analyzed data collected from a nationwide registry, China Acute Postoperative Pain Study (CAPOPS), between September 2019 and August 2021. Patients aged 18 years or above were required to complete a self-reported pain outcome questionnaire on the first postoperative day (POD1). Perioperative pain management and pain-related outcomes, including the severity of pain, adverse events caused by pain or pain management, and perception of care and satisfaction with pain management were analyzed.

Findings

A total of 26,193 adult patients were enrolled. There were 48.7% of patients who had moderate-to-severe pain on the first day after surgery, and pain severity was associated with poor recovery and patient satisfaction. The systemic opioid use was 68% on the first day after surgery, and 89% of them were used with intravenous patient-controlled analgesia, while the rate of postoperative nerve blocks was low.

Interpretation

Currently, almost half of patients still suffer from moderate-to-severe pain after surgery in China. The relatively high rate of systemic opioid use and low rate of nerve blocks used after surgery suggests that more effort is needed to improve the management of acute postoperative pain in China.

Funding

National Key Research and Development Program of China (No. 2018YFC2001905).

Associations between Optimism and Attentional Biases as Measured by Threat-Avoidance and Positive-Search Tasks

Evidence suggests that optimism has a positive impact on health status. Attentional bias modification (ABM) may be beneficial for enhancing optimism, but its effective application requires a detailed investigation of the association between attentional bias and optimism. This study aimed to determine the association between attentional bias and optimism based on different task types. Eighty-four participants completed the attentional bias measures using the dot-probe task (DPT), emotional visual search task (EVST) paradigms, and psychological assessments. Optimism was assessed using the Life Orientation Test-Revised with subscales for optimism and pessimism. Pearson's correlation coefficient and multivariate linear regression analysis were applied to investigate the association between optimism and attentional bias. Neither the attentional bias derived from DPT nor EVST was significantly correlated with optimism total score or subscales. Regression analysis also showed no association between attentional bias and optimism (DPT, β = 0.12; EVST, β = 0.09), optimism subscales (DPT, β = 0.09; EVST, β = 0.17), or pessimism subscales (DPT, β = -0.10; EVST, β = 0.02). Our findings showed no evidence that attentional biases derived from either the DPT or EVST measures are associated with optimism or pessimism. Further studies are needed to effectively adapt the ABM to enhance optimism.

Psychological Profiles and Their Relevance with Temporomandibular Disorder Symptoms in Preorthodontic Patients

Background

Temporomandibular disorders (TMDs) refer to a group of heterogenous musculoskeletal diseases with diverse clinical symptoms and an undetermined aetiology. The psychological profiles were closely related to the onset and treatment outcomes of TMDs.

Objective

To examine the relevance between psychological profiles and different symptoms of TMDs in preorthodontic patients.

Methods

The study was conducted among 570 preorthodontic patients. TMDs symptoms were recorded by the Diagnostic Criteria for TMD (DC/TMD) symptom questionnaire. The seven-item Generalized Anxiety Disorder Scale (GAD-7), the nine-item Patient Health Questionnaire (PHQ-9), and the Pain Catastrophizing Scale (PCS) were used for the evaluation of anxiety, depression, and pain catastrophizing levels. The relevance of three psychological profiles with TMDs and subtypes was evaluated with Spearman's rank correlation test and logistic regression analysis (P < 0.05).

Results

34.56% of the enrolled preorthodontic patients were diagnosed with TMDs. Scores of GAD-7, PHQ-9, and PCS were significantly higher in the TMDs group than in the non-TMDs group. Participants with anxiety, depression, or high pain catastrophizing had a higher prevalence of both pain-related TMDs symptoms and intra-articular TMDs symptoms. The correlations among pain-related TMDs, intra-articular TMDs, and scores on the psychological scales were significant (P < 0.05). The adjusted logistic regression model revealed that anxiety, depression, and high pain catastrophizing were significant risk factors for TMDs with an odds ratio (OR) of 2.196, 1.741, and 1.601, respectively. Depression was associated with higher pain-related TMDs prevalence (OR = 2.136), while anxiety and depression were associated with higher intra-articular TMDs prevalence (OR = 2.341 and 1.473).

Conclusion

Anxiety, depression, and high pain catastrophizing were comorbid psychological conditions of TMDs. Depression was the top risk factor for pain-related TMDs, while anxiety rendered the highest risk for intra-articular TMDs. Inclusion of psychological assessments in preorthodontic evaluation might yield great benefits in TMDs screening.