[Pain therapy in children following ophthalmic surgery]

Pain following eye surgery is often described as being relatively moderate; however, there are also procedures that lead to a pronounced pain experience. Particularly in pediatric patients, pain therapy is often insufficient due to a lack of knowledge and fear of complications. These individual and organizational deficits lead to unnecessary discomfort for children and parents. Each institution providing surgical treatment must have pain management concepts in its portfolio for the appropriate age groups. This includes a child-oriented setting, age-appropriate information, systematic pain assessment, and pain protocols. Pain management should be planned prior to surgery and individually adapted as it progresses. Children have a right to a perioperative course with low stress and pain.

A Randomized Controlled Trial Examining the Effect of Topical Refrigerant Spray on the Perception of an Instantaneous Noxious Stimulus

Purpose

Topical refrigerant spray is commonly used with routine hand injections despite mixed evidence about its efficacy in reducing the pain experience. We hypothesize that the use of topical refrigerant spray decreases the pain experience of an instantaneous noxious stimulus.

Methods

Eighty adult volunteer participants were enrolled in the study. We constructed an instrument using the smooth end of a Kirschner wire mounted to the spring of a ballpoint pen to apply an instantaneous noxious stimulus to the long (middle) finger proximal nail fold. Participants completed two trials and were randomized to receive the topical refrigerant spray before either the first or second stimulus and on either the left or right side. Participants were asked to rate the pain of each experience using an 11-point Likert scale and indicate which condition they preferred, if any.

Results

The mean pain ratings for the spray and no-spray conditions were 2.0 and 4.3, respectively, giving a mean difference of -2.3 (P < .001, α = 0.05). Subgroup analysis showed no significant effect of sex or medical versus nonmedical occupation (P = .28 and .11 respectively) on the mean difference in pain rating between the two conditions. Participants who received the spray first had a higher mean difference in pain rating (2.7) than that in those who received it second (1.9). Fifty-nine participants preferred the spray, whereas 21 participants either preferred no spray or had no preference (P < .0001).

Conclusions

The use of topical refrigerant spray significantly decreased the perception of pain from an instantaneous noxious stimulus. A significant majority of participants also preferred the topical refrigerant spray condition. The use of topical refrigerant spray for painful procedures, such as needle insertions, may improve the overall patient experience.

Type of study/level of evidence

Therapeutic I.

Early life factors associated with the experiences of pain in later life: evidence from a population based study in India

BACKGROUND

The influence of early life factors is becoming increasingly apparent as studies investigate how experiences, resources, and constraints in childhood affect health and well-being later in life. The present study contributes to this literature by examining the association between several early life factors and self-reported pain among older adults in India.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study of India (LASI). The sample size includes 28,050 older adults aged 60 and above (13,509 men and 14,541 women). Pain is a self-reported, dichotomous measure where participants responded to whether they were often troubled with pain and whether this experience interfered with their ability to carry out daily household chores. Early life factors, which are retrospective accounts of experiences, included the respondent's position in birth order, their health status, school absenteeism, being bedridden, family socioeconomic status (SES), and their parent's experience with chronic disease. Logistic regression analysis is employed to examine the unadjusted and adjusted average marginal effects (AME) of selected domains of early life factors associated with the probability of experiencing pain.

RESULTS

22.8% of men and 32.3% of women reported pain that interfered with daily activities. Pain was higher among men (AME: 0.01, confidence interval (CI): 0.01-0.03) and women (AME: 0.02, CI: 0.01-0.04) with third or fourth birth order compared to counterparts with first birth order. Both men (AME: -0.02, CI: -0.04-0.01) and women (AME: -0.07, CI: -0.09 - -0.04) having a fair childhood health status reported a lower probability of pain. The probability of pain was higher among both men (AME: 0.03, CI: 0.01-0.07) and women (AME: 0.07, CI: 0.03-0.13) who were bedridden due to sickness in their childhood. Similarly, the pain likelihood was higher among men who missed school for more than a month due to health problems (AME: 0.04, CI: -0.01-0.09). Men and women with poor financial condition in their childhood reported (AME: 0.04, CI: 0.01-0.07) a higher probability of experiencing pain relative to their peers who reported a more financially advantaged early life.

CONCLUSIONS

Findings of the present study add to the empirical literature on the association between early life factors and later life health and well-being. They also are pertinent to health care providers and practitioners working in pain management, as this knowledge better positions them to identify older adults most susceptible to pain. Moreover, findings of our study underscore that the interventions to ensure health and well-being in later life must start far earlier in the life course.

Pain experience of cancer patients receiving care in a multidisciplinary pain management clinic

BACKGROUND

Few longitudinal studies have focused on patients' cancer pain experience when receiving care in a multidisciplinary pain management clinic (MPMC). This study aimed to evaluate the experiences of a cohort of cancer patients newly engaged in a MPMC.

METHODS

This study was based on a longitudinal approach in which data were collected over a 6 months period at the King Hussein Cancer Centre in Jordan. The study adopted the Arabic version of the Brief Pain Inventory to identify the level and prevalence of cancer pain, and to identify the impact of receiving care at the MPMC on patients' pain experience. Data were collected over four time points, and the period between these points ranged from 2 to 3 weeks.

RESULTS

The majority of patients demonstrated improvement in their pain after receiving treatment at the MPMC, while a third still experienced severe pain. Significant improvement was reported at T1, and no further decline in pain was noted after this point. This indicates that exposure to the intervention provided by the MPMC generated, on average, an improvement in patients' pain experience.

CONCLUSION

The MPMC may be an effective pain management strategy in the treatment of cancer pain.

Dance for chronic pain conditions: A Systematic Review

OBJECTIVES

Globally, 20-25% of people will experience chronic pain in their lifetime. Dance is a physical activity with psychosocial benefits which may positively impact pain. This review aimed to investigate the effect of dance interventions on the experience of pain, by quantitative measures and qualitative themes.

METHODS

Seven major databases were searched from inception to January 2021. Two independent reviewers screened articles at each stage. Qualitative and quantitative studies were included if the dance interventions lasted over 6 weeks, participants reported pain longer than 3 months, and pain was an outcome of the study. All articles were critically appraised using appropriate Joanna Briggs Institute tools and data were collated using results-based convergent synthesis.

RESULTS

From 23,628 articles 34 full papers were included, with a total of 1254 participants (75.2% female). Studies predominantly investigated individuals with Fibromyalgia (26%) and generalised chronic pain (14%), with aerobic dance (20.7%) and Biodanza (20.7%) the most common dance genres investigated. Overall, 74% of studies noted either reduced pain through quantitative pain measures or qualitative themes of improved pain experience (88% for chronic primary pain and 80% for chronic secondary musculoskeletal pain).

DISCUSSION

There were positive effects of dance on chronic primary and secondary musculoskeletal pain across diverse populations. A variety of study designs and interventions noted improved pain measures and themes around pain coping and acceptance, with all dance therapies showing improvements, particularly when performed for 60-150 minutes duration weekly. Dance should be considered as an effective adjunct in the management of chronic pain.

Chronic neuropathic pain is more than a perception: Systems and methods for an integral characterization

The management of chronic neuropathic pain remains a challenge, because pain is subjective, and measuring it objectively is usually out of question. However, neuropathic pain is also a signal provided by maladaptive neuronal activity. Thus, the integral management of chronic neuropathic pain should not only rely on the subjective perception of the patient, but also on objective data that measures the evolution of neuronal activity. We will discuss different objective and subjective methods for the characterization of neuropathic pain. Additionally, the gaps and proposals for an integral management of chronic neuropathic pain will also be discussed. The current management that relies mostly on subjective measures has not been sufficient, therefore, this has hindered advances in pain management and clinical trials. If an integral characterization is achieved, clinical management and stratification for clinical trials could be based on both questionnaires and neuronal activity. Appropriate characterization may lead to an increased effectiveness for new therapies, and a better quality of life for neuropathic pain sufferers.

No Differences in Pain Scores and Treatment Response in Patients from Different Socioeconomic Areas Within the City of Chicago

BACKGROUND

It is well established that the experience of chronic pain significantly differs among ethnic-racial groups. There is mixed evidence to suggest that societal influences may contribute to pain prevalence among cultural groups and their treatment response. One possible explanation for differences in pain experience are the differences in socioeconomic status among patients with chronic pain.

OBJECTIVE

To determine whether there is any difference in pain scores or treatment responses among patients with different socioeconomic status.

STUDY DESIGN

Retrospective analysis.

SETTING

Outpatient pain clinic.

METHODS

After approval from the Advocate Healthcare Institutional Review Board, we included 1,149 patients treated for different chronic pain conditions who were followed for at least 12 months. Patients were stratified into quartiles determined by median income according to ZIP code.

RESULTS

Of the sampled patients, 207 patients lived in ZIP codes with median incomes > $51,294; 515 in ZIP codes with median incomes between $40,083 and $51,294; 332 in ZIP  codes with median incomes between $30,625 and $40,083; and 95 in ZIP codes with median incomes < $30,625. Groups differed in age (P = 0.047), race (P < 0.001), body mass index (BMI) (P = 0.019), utilization of opioid medications (P = 0.011), morphine milligram equivalents (MME) on first visit (P = 0.036), and utilization of membrane stabilizers such as gabapentin (P = 0.019). There were no significant differences among groups in terms of gender (P = 0.531), type of pain experienced (P = 0.679), or time since pain onset (P = 0.174). Groups were treated similarly, with no statistically significant differences in the proportions of patients who had taken various nonopioid medications throughout their treatment course other than membrane stabilizers, the number of patients who received interventional pain management procedures, or MME at last visit. Average pretreatment numeric rating scale pain scores were not significantly different among quartiles (P = 0.079), posttreatment pain scores (P = 0.767), and subjective percent improvement (P = 0.434).

LIMITATIONS

This is a single center study and may have limitations in extrapolating to the general population.

CONCLUSION

The results of our study show that there are no differences in pain perception or treatment responses in patients from different socioeconomic statuses despite differences among groups in age, BMI, race, utilization of opioid medications, and MME at first visit. Patients at this pain practice appear to have been treated with similar modalities regardless of socioeconomic status.

The Experiences of Individuals Experiencing Pain During COVID-19 Infection: A Phenomenological Study

AIM

This research was conducted to determine the pain experience of individuals who experience pain during COVID-19 infection.

METHOD

The research was carried out with the phenomenological qualitative design, and was completed with 15 participants. The data of the study were collected with the descriptive characteristics form, a semi-structured interview form about pain experienced during COVID-19 infection and Numeric Rating Scale. Descriptive and content analysis methods were used in the evaluation of qualitative data.

RESULTS

The data of the research were examined in 6 themes: 1) "pain from the perspective of participants"; 2) "characteristics of pain experienced during COVID-19 infection"; 3) "the effect of pain experienced during COVID-19 infection on daily life"; 4) "management of pain experienced during COVID-19 infection"; 5) "fear of re-experiencing the pain experienced during COVID-19 infection"; and 6) "metaphors for pain experienced during COVID-19 infection".

CONCLUSIONS

Participants generally defined pain as a feeling that hurts and causes people to suffer. The participants used many methods to relieve the intense pain they experienced. However, nearly half of the participants stated that their pain did not completely disappear despite the many methods they used. The approximately two-thirds of the participants were afraid of re-experiencing this pain. For effective pain management, it is important to define the pain behaviors of the patients correctly, to determine the opinions of the patients about the pain, and to evaluate the effects of the pain experienced.

Orofacial musculoskeletal pain: An evidence-based bio-psycho-social matrix model

Pain is a multidimensional experience comprising sensory-discriminative, affective-motivational, and cognitive-evaluative dimensions. Clinical and research findings have demonstrated a complex interplay between social burdens, individual coping strategies, mood states, psychological disorders, sleep disturbances, masticatory muscle tone, and orofacial musculoskeletal pain. Accordingly, current classification systems for orofacial pain require psychosocial assessments to be an integral part of the multidimensional diagnostic process. Here, we review evidence on how psychosocial and biological factors may generate and perpetuate musculoskeletal orofacial pain. Specifically, we discuss studies investigating a putative causal relationship between stress, bruxism, and pain in the masticatory system. We present findings that attribute brain structures various roles in modulating pain perception and pain-related behavior. We also examine studies investigating how the nervous and immune system on cellular and molecular levels may account for orofacial nociceptive signaling. Furthermore, we review evidence pointing towards associations between orofacial musculoskeletal pain and neuroendocrine imbalances, sleep disturbances, and alterations of the circadian timing system. We conclude with several proposals that may help to alleviate orofacial pain in the future.

Effects of (in)validation and plain versus technical language on the experience of experimentally induced pain: A computer controlled simulation paradigm

BACKGROUND AND OBJECTIVES

Amongst social contextual influences on pain, the manner in which pain and painful procedures are communicated to patients is considered an important contributor to the subjective experience of pain. Threatening information, e.g., by the use of technical language, is suggested to increase pain reports. Validation, or communicating understanding towards another person reporting personal experiences, is suggested to reduce pain. The current study examines effects of both information language (technical vs. plain language) and validation (validation vs. invalidation) on the subjective experience of experimentally induced pain.

METHODS

Pain-free participants (N = 132) were randomly assigned to one of four groups as formed by manipulations of validation and information language. After reading a description concerning the upcoming thermal stimulus formulated in technical or plain language, participants engaged in a computer controlled simulation (CCS; based on virtual reality technology). Participants received three thermal stimuli while interacting with an avatar who either validated or invalidated their experience during the CCS. Pain intensity and pain unpleasantness were assessed after each stimulus.

RESULTS

The validation manipulation showed to be effective, but the information language manipulation did not induce differential threat expectancies. Results show no effect of validation or information language on subjective pain reports.

LIMITATIONS

Suboptimality of the information language manipulation and shortcomings of the CCS procedure might account for current findings.

CONCLUSIONS

The study offers an interesting model for the further experimental study of isolated and combined effects of (social) contextual factors on pain. Diverse future research avenues are discussed.

The similar past pain experience evokes both observational contagious pain and consolation in stranger rat observers

Laboratory rodents have been shown to have an ability to recognize the injury site and negative emotional state of their conspecifics in pain, resulting in empathic consoling behaviors and observational contagious pain (OCP). However, these empathic responses have been shown to be familiarity-dependent. In this report, we further explored whether the past pain experience could evoke empathic response in stranger observers. In our rodent model, two types of empathic response have been identified from naive cagemate observer (CO_naive) during and after a priming dyadic social interaction (PDSI) with a cagemate demonstrator in pain (CD_pain): the consolation and OCP. Consolation is represented by allolicking and allogrooming behaviors toward the CD_pain, while the OCP is represented by a long-term mechanical pain hypersensitivity. The current results showed that: (1) neither the consolation nor OCP could be identified in the naive noncagemate observer (NCO_naive) during and after a PDSI with a noncagemate demonstrator in pain (NCD_pain); (2) nor were the two types of empathic response seen in the NCO, who had just experienced acute pain (NCO_painexp), during and after a PDSI with a naive unfamiliar conspecific (NCD_naive). However, both the consolation and OCP were dramatically identified in the NCO_painexp during and after a PDSI with a NCD in pain (NCD_pain). The current results demonstrated that the past pain experience can evoke both consolation and OCP in stranger rat observers when witnessing a conspecific in pain, implicating that the processing of empathy for pain can be modulated by past negative mood experience.

Comparison of perceived pain and patients’ satisfaction with traditional local anesthesia and single tooth anesthesia: A randomized clinical trial

BACKGROUND

Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients. Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry, many studies have compared its efficacy and safety to conventional anesthesia. However, very few studies have compared single tooth anesthesia (STA) and traditional local anesthesia.

AIM

To compare pain rating, changes in blood pressure, and heart rate during the local anesthetic injection. The secondary objectives were to measure the patients’ level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.

METHODS

A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study. The patients were evaluated for their general physical status and oral clinical findings before enrollment. Information regarding perceived pain, changes in heart rate and blood pressure, and patients’ satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.

RESULTS

No significant difference was noted in perceived pain (P = 0.59) and systolic blood pressure (P = 0.09) during anesthetic injection using both traditional and STA techniques. STA patients had a significantly higher heart rate during anesthesia, although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia. During the restorative procedure, less pain was perceived by STA patients on the Wong-Baker FACES pain scale, which was statistically significant (P < 0.001). Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future (P = 0.04).

CONCLUSION

STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.

Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue

Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p < 0.05 - p < 0.001). Shoulder Strength, pain experience, and psychological status were significantly different between the two groups (P < .05). Lower tendency to fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition.

Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana

Background

Women have experienced severe labour pain over the years and various attempts have been made to effectively manage labour pain. However, there is paucity of literature on the labour pain experience and perceptions about labour pain with the contemporary Ghanaian health system. Therefore this study sought to gain an in-depth understanding on labour pain experiences and perceptions of post-partum women.

Methods

The study adopted an exploratory descriptive qualitative approach and collected data through individual interviews. Informed consent was obtained from all the participants who were purposively sampled. After transcription of interviews, the data were analyzed inductively using content analysis techniques.

Results

Women in this study experienced pain during labour rated as mild, moderate and severe and the pain was felt at the waist area, vagina, lower abdomen and the general body. The women expressed labour pain through crying, screaming and shouting. They prayed to God to help reduce the severe pain. Some women endured the pain, cried inwardly and others showed no sign of pain. Some women believed that crying during labour is a sign of weakness. Pain reliefs such as pethidine (Meperidine) was occasionally given. Non-pharmacologic measures employed included walking around, deep breathing, side-lying, waist holding, squatting, taking a shower and chewing gum. The individuality of pain experience and expression was emphasized and the socio-cultural orientation of women made some of them stoic.

Conclusion

We concluded that it is necessary for all health professionals to manage labour pain effectively taking the socio-cultural context into consideration.

The effect of office based flexible and rigid cystoscopy on pain experience in female patients

Purpose

Rigid and flexible cystoscopies are both routinely used in female patients. Literature is conflicting whether flexible cystoscopy is less painful compared to rigid cystoscopy. The aim of this study was therefore to investigate whether using flexible cystoscopy leads to less discomfort and pain compared to rigid cystoscopy in female patients who underwent first time cystoscopy.

Materials and Methods

One hundred eighty-nine female patients, who never had undergone cystoscopy, were randomized into 2 groups: 92 patients underwent rigid cystoscopy and 97 patients flexible cystoscopy. Directly after the cystoscopy procedure all patients were asked to fill out their pain experience on a 100-mm visual analogue pain scale (VAS).

Results

Median VAS score was significantly lower for women undergoing flexible cystoscopy (0 [0–20]) compared to rigid cystoscopy (15 [0–38], p<0.001). In addition, age was inversely associated with VAS score, indicating that younger females experienced more pain (R=−0.30, p=0.001). The use of flexible cystoscopy was associated with a decrease in VAS score and remained significant after adjustment for age, sex of urologist, performing urologist and indication (standardized β=−0.17, p=0.048).

Conclusions

The use of flexible cystoscopy resulted in a significantly lower pain experience compared to rigid cystoscopy. Based on patient's pain experience during cystoscopy, this study implicates to use flexible cystoscopy in female patients who undergo first time cystoscopy.

Quantitative sensory testing of temperature, pain, and touch in adults with Down syndrome

The spinothalamic pathway mediates sensations of temperature, pain, and touch. These functions seem impaired in children with Down syndrome (DS), but have not been extensively examined in adults. The objective of the present study was to compare the spinothalamic-mediated sensory functions between adults with DS and adults from the general population and to examine in the DS group the relationship between the sensory functions and level of intellectual functioning. Quantitative sensory testing (QST) was performed in 188 adults with DS (mean age 37.5 years) and 142 age-matched control participants (median age 40.5 years). Temperature, pain, and touch were evaluated with tests for cold-warm discrimination, sharp-dull discrimination (pinprick), and tactile threshold, respectively. Level of intellectual functioning was estimated with the Social Functioning Scale for Intellectual Disability (intellectual disability level) and the Wechsler Preschool and Primary Scale of Intelligence--Revised (intelligence level). Overall, the difference in spinothalamic-mediated sensory functions between the DS and control groups was not statistically significant. However, DS participants with a lower intelligence level had a statistically significant lower performance on the sharp-dull discrimination test than DS participants with higher intelligence level (adjusted p=.006) and control participants (adjusted p=.017). It was concluded that intellectual functioning level is an important factor to take into account for the assessment of spinothalamic-mediated sensory functioning in adults with DS: a lower level could coincide with impaired sensory functioning, but could also hamper QST assessment.

Cross-cultural examination of the structure of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R)

This study investigated the cross-cultural factor stability and internal consistency of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R), a measure of the quality of postoperative pain management used internationally. We conducted exploratory factor analysis (EFA) of APS-POQ-R data from 2 point prevalence studies comprising 268 and 311 surveys of Danish and Australian medical-surgical patients, respectively. Parallel analysis indicated 4- and 3-factor solutions for Danish and Australian patients, respectively, which accounted for 58.1% and 52.9% of variance. Internal consistency was unsatisfactory among both Danish (Cronbach α = .54) and Australian (Cronbach α = .63) cohorts. There was a high degree of between-group similarity in item-factor loadings of variables coded as "pain experience," but not "pain management." This finding reflected cross-cultural differences in ratings of treatment satisfaction. For Danish patients, satisfaction was associated with the degree of pain severity and activity interference, whereas for Australian patients, satisfaction was associated with their perceived ability to participate in treatment. To facilitate further cross-cultural comparison, we compared our findings with past research conducted in the United States and Iceland. EFA supported the construct validity of the APS-POQ-R as a measure of "pain experience" but indicated that items measuring "pain management" may vary cross-culturally. Findings highlighted the need for further validation of the APS-POQ-R internationally.

PERSPECTIVE

This study revealed the APS-POQ-R as a valid measure of postoperative pain experience for Danish and Australian patients. Measures of patients' perception of pain management were not robust to group differences in treatment expectations and demonstrated cross-cultural instability. Results highlighted the difficulties in establishing stable cross-cultural, cross-population subscales for the APS-POQ-R.

Pain experience using conventional versus angled anterior posts during stereotactic head frame placement for radiosurgery

Stereotactic frame placement for radiosurgery is assumed to be an uncomfortable experience. We developed angled anterior posts for the Leksell frame to avoid pin penetration of the temporalis muscle. This study aimed to determine the frequency of angled post requirement and quantify the patient pain experience from frame placement. We prospectively enrolled 63 patients undergoing radiosurgery. Angled posts were used when conventional post trajectory was posterior or within 3mm of the superior temporal line to avoid temporalis muscle penetration. Pain scores (0 to 10) were collected prior to frame placement, immediately after frame placement, before radiosurgery, after radiosurgery, and a day after radiosurgery. A total of 63 patients were enrolled: 33 (48%) patients required angled posts. Women were significantly more likely to require angled posts than men (60.0% versus 33.3%, respectively; p=0.034). Mean pain scores were very low, ranging from 0.33 to 2.23. There were no significant differences in pain outcomes between both groups at all time points. Stereotactic frame placement is not perceived to be a painful procedure. This information may be useful when counseling patients about the pain experience with frame application and the option of using angled anterior posts.