Pain Perception in Latino vs. Caucasian and Male vs. Female Patients: Is There Really a Difference?

Anticipation, perception, and recollection of acute pain from local anesthesia injection prior to Mohs surgery

Subcutaneous local anesthetic injection is universally used in dermatologic surgery to achieve anesthesia. While multiple factors have been identified as influential in chronic pain, little is known about factors that contribute to acute pain. The purpose of this article is to elucidate trends and factors that contribute to the perception of acute pain. Patients scheduled to undergo Mohs surgery at our institution were surveyed regarding their anticipated, perceived, and recalled pain from local anesthetic injection prior to ("Before"), during ("During"), immediately after ("After"), and on the evening ("Evening") of their procedure. Demographic data, relevant past medical history (PMH) and medication use, tobacco use, and prior history of Mohs surgery were collected from subsequent chart review. On average, pain intensities were significantly different between all four time points except between After and Evening. Patients with relevant PMH, patients who were having Mohs surgery on the head and neck, patients with no history of prior Mohs surgery, and never-smokers anticipated their pain to be greater than it actually was. Subsets of patients who anticipated their local anesthetic injection to be more painful than it actually was may benefit from increased anticipatory guidance and preoperative education.

Impact of Demographics and Psychological Factors on Three-Day Postoperative Pain Perception Following Hand Surgery

Background: Effective pain management is crucial for both comfort and outcomes, yet predicting and managing this pain is difficult. This study aimed to analyze postoperative pain in patients undergoing hand surgery at the Mayo Clinic Florida, examining how patient characteristics and anxiety affect pain outcomes. Methods: We conducted a single-arm clinical trial at Mayo Clinic Florida, recruiting patients undergoing hand surgery. Preoperative pain and anxiety were assessed using the Pain Catastrophizing Scale (PCS) and State-Trait Anxiety Inventory (STAI). Postoperatively, patients used an iPhone app to record pain levels and medication use every four hours. Devices were collected three days after surgery. We analyzed the relationship between demographics, PCS, STAI scores, and pain levels using linear and logistic regression models. All statistical tests were two-sided with significance set at p < 0.05, analyzed with R4.2.2. Results: Data were collected from 62 patients (62.9% women, 37.1% men) undergoing hand surgery. Participants were mainly White (90.3%), with 50% being in the middle-aged adult group. Most had low anxiety levels (80.6% STAI-S, 82.3% STAI-T) and low catastrophizing (61.3% PCS). Postoperative pain was low, with median scores between 1.0 and 2.0 over three days. Demographics, anxiety, and catastrophizing were not significant predictors of pain levels. Logistic regression showed time as a significant factor, with pain levels peaking on Day 3. Conclusions: Postoperative pain after hand surgery was generally low, with time being a significant predictor of increased pain. Demographic factors, anxiety, and catastrophizing did not significantly affect pain levels. Pain management should emphasize time-sensitive interventions and ongoing monitoring.

Pressure algometry in the general adult population: Age and sex differences

Experimental pain studies have revealed inter-individual variations in pain perception that are influenced by age, sex, and country of origin. This study aimed to explore the age and sex differences in pressure pain thresholds within the Iranian general population. To assess the pressure pain thresholds, a handheld pressure algometer was applied bilaterally to the middle fingers of both hands. The participants also completed the short form of the McGill Pain Questionnaire to provide a clinical pain rating. This cross-sectional study included 1610 adult subjects (54.96% female, mean age 40.13 ± 10.18 years). The findings indicated that females generally exhibited lower pain thresholds than males when assessing pain detection and tolerance parameters (P < .001). Females also demonstrated a significant lower pressure thresholds and clinical pain ratings compared with men (P < .001). Additionally, significant differences were observed between age groups in terms of pain detection and tolerance thresholds (P = .02 and P = .03, respectively). However, the interaction between sex and age was not significant. No significant differences in pain detection thresholds were observed between the right and left hand (P = .11). This study underscores the potential utility of algometry as a valuable tool for objectifying pain in the Iranian population.

The normative values of pain thresholds in healthy Taiwanese

OBJECTIVE

Quantitative sensory testing is widely used in clinical and research settings to assess the sensory functions of healthy subjects and patients. It is of importance to establish normative values in a healthy population to provide reference for studies involving patients. Given the absence of normative values for pain thresholds in Taiwan, the aim of this study was to report the normative values for future reference in the Taiwanese population and compare the differences between male and female participants.

METHODS

Healthy adults without any chronic or acute pain condition were recruited. The pain thresholds were assessed over the cephalic (supraorbital area and masseter muscle) and extracephalic (medio-volar forearm and thenar eminence) areas. The heat, cold, mechanical punctate, and pressure pain thresholds were measured with a standardized protocol. Comparisons between male and female participants were performed.

RESULTS

One hundred and thirty healthy participants (55 males: 30.4 ± 7.4 years; 75 females: 30.5 ± 8.1 years) finished the assessments. Male participants were less sensitive to mechanical stimuli, including pressure over masseter muscle (male vs. female: 178.5 ± 56.7 vs. 156.6 ± 58.4 kPa, p = .034) and punctate over medio-volar forearm (male vs. female: 116.4 ± 45.2 vs. 98.7 ± 65.4 g, p = .011), compared to female participants. However, female participants were less sensitive to cold stimuli, indicated by lower cold pain thresholds over the supraorbital area (male vs. female: 18.6 ± 8.4 vs. 13.6 ± 9.3°C, p = .004), compared to male participants. No significant differences were found between sexes in other pain threshold parameters.

CONCLUSIONS

We provided the normative values of healthy male and female adults in Taiwan. This information is crucial for comparison in future pain-related studies to identify potential hypoalgesia or hyperalgesia of tested subjects.

Cultural Framing and the Impact On Acute Pain and Pain Services

PURPOSE OF REVIEW

Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management.

RECENT FINDINGS

The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.

Prospective paired crossover evaluation of potential impact of investigator gender on perceived pain intensity early after acute or scheduled surgery

BACKGROUND

Postoperative pain is common but often difficult to assess, and there are many potential confounders. Over the last decades, the gender of investigator as well as participant has been found to influence pain perception in both preclinical and clinical studies. However, to our knowledge this has not been studied in various postoperative patients. Objectives of this study were to test the hypotheses that pain intensity levels early after acute or scheduled in- or out-hospital surgery are lower when evaluated by a female investigator, and higher when reported by a female patient.

METHODS

In this prospective observational paired crossover study, two investigators of opposite genders independently obtained individually reported pain intensity levels with a visual analogue scale in a mixed cohort of adult postoperative study patients at Skåne University Hospital in Malmö, Sweden.

RESULTS

In total, 245 (129 female) study patients were included and then one female excluded. The study patients rated their intensity of postoperative pain lower when evaluated by a female than by a male investigator (P = 0.006), where the male patients constituted the significant difference (P < 0.001). Pain intensity levels did not differ between female and male study patients (P = 0.210).

CONCLUSIONS

Main findings of lower pain intensity reported by males to a female than to a male investigator early after surgery in this paired crossover study in mixed postoperative patients, indicate that potential impact of investigator gender on pain perception should be considered and further evaluated in clinical bedside practice. Trial registration Retrospectively registered in the ClinicalTrials.gov research database on 24th June 2019 with TRN number NCT03968497.

Equity Reporting in Systematic Reviews of Opioid Treatment of Chronic Non-Cancer Pain with Patient-Reported Outcomes

Chronic non-cancer pain can affect a patient's social life, ability to work, and overall quality of life (QoL). Opioid therapy is often prescribed as therapeutic treatment in chronic pain. Systematic reviews (SRs)-the pinnacle of research quality-are often used in guideline development; however, pain may differ across cultures and communities. Thus, examination of equity reporting in such SR is necessary. This study examines reporting using the PROGRESS (Place of resident, Race, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital)-Plus framework to examine equity within SRs with patient reported outcomes of chronic, non-cancer pain. A systematic search for SRs was conducted, which were evaluated for PROGRESS-Plus items and study characteristics were extracted. Among the 46 included SRs, seven did not include any PROGRESS-Plus items. The most commonly reported items were age, included within 34 SRs, followed by gender (30/46), and duration of pain (14/46). All other items were reported in five or less studies. Our investigation revealed a deficiency in SR's reporting of equity measures for opioid treatment of chronic non-cancer pain. Given the need to address healthcare disparities among minorities, implementing the PROGRESS-Plus framework may influence QoL and patient-centered care.

A qualitative assessment of factors contributing to Spanish-speaking federally qualified health center patients' chronic pain experiences

People of Hispanic or Latino ethnicity (Latinx people) experience pain diagnosis, treatment, and care disparities relative to non-Latinx Whites. Those whose preferred language is Spanish may experience additional disparities when receiving care in a language-discordant environment. In order to better understand medically underserved Spanish-speaking Latinx patients' pain care experience in primary care, we conducted semi-structured qualitative interviews with federally qualified health center staff members (n = 9) and Spanish-speaking adult Latinx patients with chronic pain (n = 12) to capture data on their perspectives. Interview data were mapped to the individual (microsystem), interpersonal (mesosystem), organizational (exosystem), and environmental (macrosystem) levels of Bronfenbrenner's Ecological Systems Theory and analyzed using thematic content analysis informed by the Framework Method. Findings suggest that Spanish-speaking patients and English-speaking care team members may interpret information about pain state and severity differently, may have misaligned expectations about care, treatment methodologies, and treatment goals, and may experience difficulty forming a mutual understanding during health care encounters due to cross-linguistic and cross-cultural miscommunication. Patients preferred to describe their pain in words rather than with numbers or standardized scales, and both patients and frontline care team members expressed frustration with medical interpretation services, which added time and complexity to visits. Patients and health center staff emphasized the diversity of experiences among Spanish-speaking Latinx people, and the need to account for both linguistic and cultural differences during care encounters. Both groups supported hiring more Spanish-speaking, Latinx healthcare personnel who better resemble the patient population, which has the potential to improve linguistic and cultural concordance and competence, with the aim of improving care outcomes and patient satisfaction. Further study is warranted to examine how linguistic and cultural communication barriers impact pain assessment and treatment in primary care, the extent to which patients feel understood by their care teams, and their confidence in their ability to understand and interpret treatment recommendations.

Racial Differences in Pain, Nutrition, and Oxidative Stress

Investigating the disproportionate rates of chronic pain and their related comorbidities between Black and non-Hispanic White (White) individuals is a growing area of interest, both in the healthcare community and in general society. Researchers have identified racial differences in chronic pain prevalence and severity, but still very little is known about the mechanisms underlying them. Current explanations for these differences have primarily focused on socioeconomic status and unequal healthcare between races as causal factors. Whereas these factors are informative, a racial gap still exists between Black and White individuals when these factors are controlled for. One potential cause of this racial gap in chronic pain is the differences in nutrition and dietary intake between groups. Certain foods play a key role in the inflammatory and oxidative stress pathways in the human body and could potentially influence the severity of the pain experience. Here, we review the previous literature on the surrounding topics and propose a potential mechanism to explain racial differences in the chronic pain population, based on established racial differences in diet and oxidative stress.

Medical Spanish Musculoskeletal and Dermatologic Educational Module

INTRODUCTION

While many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts.

METHODS

An 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels.

RESULTS

Students demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups.

DISCUSSION

An intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

Sociodemographic predictors of pain in old people : Serbian population-based study

BACKGROUND

With the growing increase in the older proportion of the world population, there is also an increase in specific age-related chronic diseases and conditions, including pain. We aimed to evaluate the association of sociodemographic factors with the presence and different degrees of pain intensity in people aged 65 years and older.

METHODS

The population-based study, conducted in 2013, included 3540 individuals from Serbia. As pain predictors, we analyzed further sociodemographic characteristics: gender, age, body mass index, level of education, marital status, and wealth index. For pain assessment, we used the pain domain of the SF-36 version 2.0 questionnaire.

RESULTS

People over the age of 85 years are 27% more likely to have moderate pain than younger respondents; however, pain is less likely reported by men (by 42%), persons with overweight (by 23%) or obesity (by 21%), respondents with secondary (by 50%) or university education (29%), as well as those belonging to the upper household wealth index (by 22%), than by their counterparts.

CONCLUSION

Pain is less likely in people of age below 85 years, male gender, those with higher educational level and higher wealth index, as well as overweight or obese individuals. Also, we have demonstrated that sociodemographic predictors differently correlate with the onset of the pain and its severity degree in persons of 65 years and older.

Pain in the Prehospital Setting in Rwanda: Results of a Mixed-Methods Quality Improvement Project

Introduction

Pain is a universal human experience tied to an individual's health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study.

Materials and Methods

Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications given. Then, anonymized, semistructured interviews of ambulance staff were conducted until thematic saturation was achieved. Data were analyzed using a grounded theory approach.

Results

SAMU managed 11,161 patients over the study period, of which 6,168 (55%) were documented as reporting pain and 5,010 (45%) received pain medications. Men had greater odds of receiving pain medications compared to women (OR = 3.8, 95% CI (3.5, 4.1), p < 0.01). Twenty interviews were conducted with SAMU staff. They indicated that patients communicate pain in different ways. They reported using informal ways to measure pain or a standardized granular numeric scale. The SAMU team reviewed these results and developed plans to modify practices.

Conclusions

We reviewed the existing quality of pain management in the prehospital setting in Kigali, Rwanda, assessed the SAMU staff's perceptions of pain, and facilitated standardization of prehospital pain management through context-specific guidelines.

International Cross-Sectional Study on the Effectiveness of Okada Purifying Therapy, a Biofield Therapy, for the Relief of Various Symptoms

Objective: To investigate whether differences exist in the effectiveness/safety of a single session of Okada Purifying Therapy (OPT), a type of biofield therapy, among those from different ethnicity/cultures, and to analyze factors associated with the outcomes in a real-world setting.

Design: Pre–post test design using convenience sampling methods.

Setting: Home setting.

Subjects: A total of 11,303 individuals aged 16 years or older from 14 different countries (>1000 individuals each from Japan, the United States, Thailand, Chile/Peru, and <200 individuals each from Portugal, Spain, Argentina, Mexico, Brazil, South Korea, Taiwan, Belgium, and France). More than 50% of the subjects were themselves OPT practitioners, and more than 50% of the treatments were administered in an environment where the practice of OPT was promoted.

Intervention: Participants received a single session of OPT lasting 30 min or longer from the volunteer practitioners. They self-reported the changes in overall symptoms, physical pain, anxiety/depression, and dizziness/palpitation.

Outcome measures: Improvement/exacerbation rates of each symptom and factors associated with symptom improvement were analyzed.

Results: Of the participants, 77.5%, 75.6%, 78.4%, and 73.8% reported an improvement of overall symptoms, physical pain, anxiety/depression, and dizziness/palpitation, respectively. The improvement rates were consistently higher among participants from Chile/Peru than those from Japan, the United States, and Thailand (p < 0.001), and among those who had received a longer therapy (p < 0.001). Spanish/Portuguese speaking countries almost always showed high improvement rates; conversely, Japan showed a lower rate in each symptom. Participants' gender, reasons for participation, previous experience, and location of the session were also associated with the improvement of different symptoms. These findings occurred regardless of the participants' age or presence/absence of illness. In terms of safety, the exacerbation rates of symptoms were 2.8%, 2.5%, 0.8%, and 1.7%, respectively. Of those who expressed symptoms exacerbation, 71.6% recovered in a few hours. None of them needed emergency medical treatment.

Conclusions: In those who were often sympathetic to OPT and/or in an authorized location, OPT was effective and safe across countries with ethnic/cultural differences; however, participants' country of residence and duration of the session were independently associated with the changes in various symptoms. (ClinicalTrials.gov NCT03994809).

Immune System Sex Differences May Bridge the Gap Between Sex and Gender in Fibromyalgia

The fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, sleep disturbances, fatigue, and cognitive alterations. A limited efficacy of targeted treatment and a high FMS prevalence (2–5% of the adult population) sums up to high morbidity. Although, altered nociception has been explained with the central sensitization hypothesis, which may occur after neuropathy, its molecular mechanism is not understood. The marked female predominance among FMS patients is often attributed to a psychosocial predisposition of the female gender, but here we will focus on sex differences in neurobiological processes, specifically those of the immune system, as various immunological biomarkers are altered in FMS. The activation of innate immune sensors is compatible with a neuropathy or virus-induced autoimmune diseases. Considering sex differences in the immune system and the clustering of FMS with autoimmune diseases, we hypothesize that the female predominance in FMS is due to a neuropathy-induced autoimmune pathophysiology. We invite the scientific community to verify the autoimmune hypothesis for FMS.

Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid

BACKGROUND

The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis.

METHODS

The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 U.S. states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9.

RESULTS

During the 2013 through 2015 study period, among the more than 1,008,400 Medicaid patients with a dental diagnosis, 19.8% filled an opioid prescription within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid prescription for pain management of a dental condition than were men (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.49 to 1.52). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.12; 95% CI, 2.05 to 2.19; OR, 1.90; 95% CI, 1.84 to 1.96, respectively). Patients receiving oral health care in an emergency department were more than 7 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 7.28; 95% CI, 7.13 to 7.43). Patients with a dental condition diagnosed were more than 4 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 4.31; 95% CI, 4.19 to 4.44). Opioid use was substantially higher among African American female patients (OR, 2.02; 95% CI, 1.93 to 2.10) and non-Hispanic white female patients (OR, 2.16; 95% CI, 2.07 to 2.24) than among Hispanic female patients.

CONCLUSIONS

Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States.

PRACTICAL IMPLICATIONS

Dentists are providing substantially fewer opioid prescriptions compared with their medical colleagues for pain treatment after a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.

The perception of procedural vascular laser pain and discrepancies amongst patients, physicians, and industry

BACKGROUND

The inherent subjectivity of pain perception makes pre-procedural pain counseling especially challenging. Setting the wrong pain expectations will negatively impact the patient's experience and affect their physiologic and emotional state. Best practices for sourcing pain related information about a given procedure, however, remains understudied. This retrospective study explores the accuracy of industry materials for describing procedural pain in a clinical trial when compared to subject reported pain scores from the same clinical trial.

METHODS

Median and mode pain scores were collected from the data of a past clinical trial investigating a dual wavelength laser used for 4 different types of treatments. Industry provided materials were reviewed to ascertain language regarding procedural pain. The principal investigator was interviewed about setting pain expectations during the trial. Subject-reported pain scores and verbal pain descriptors were transferred to validated pain scales, the Numerical Rating Scale and the Verbal Rating Scale, for comparison.

RESULTS

A total of 85 procedural pain scores were collected from 22 subject charts. The average procedural pain scores for 3 of 4 treatment types reported by subjects were translated to entirely different verbal and numerical categories of pain than that described by industry materials.

CONCLUSIONS

Industry materials failed to capture the range of procedural pain scores reported by subjects for 3 of 4 treatment types in a clinical trial setting. When counseling patients on procedural pain, physicians should take extra care to not mislead patients and cause undue physiological or emotional stress.

Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid

BACKGROUND

The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis.

METHODS

The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 US states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9.

RESULTS

During the 2013-2015 study period, among the more than 890,000 Medicaid patients with a dental diagnosis, 23% received an opioid within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid for pain management of a dental condition than were men (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.52 to 1.55). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.11; 95% CI, 2.05 to 2.17 and OR, 1.88; 95% CI, 1.83 to 1.93, respectively). Patients receiving oral health care in an emergency department were nearly 5 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 4.66; 95% CI, 4.59 to 4.74). Patients with a dental condition diagnosed were nearly 3 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 2.64; 95% CI, 2.57 to 2.70). Opioid use was substantially higher among African American female patients (OR, 3.29; 95% CI, 3.18 to 3.40) and non-Hispanic white female patients (OR, 3.24; 95% CI, 3.14 to 3.35) than among Hispanic female patients.

CONCLUSIONS

Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States.

PRACTICAL IMPLICATIONS

Dentists are providing substantially less opioid prescriptions compared to their medical colleagues for pain treatment following a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.