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Research on Pain Measurements and Pain Outcome Variables

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (6 August 2023) | Viewed by 12760

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Special Issue Editor

Dr. Lisa Goudman

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Guest Editor

1. STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
2. Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium
3. Research Foundation—Flanders (FWO), 1090 Brussels, Belgium
Interests: neuromodulation; Persistent Spinal Pain Syndrome; chronic pain; objective measurements

Special Issue Information

Dear Colleagues,

The era of evaluating whether a therapy is effective based on a single pain intensity report is clearly behind us. The importance of individual patient characteristics combined with psychological evaluations, biological information, social influences and other related aspects are the key to properly evaluate the impact of pain on an individual person. Several other outcome mechanisms that might be influenced by pain have been explored as complementary tools or substitutes for a pain intensity report, including output mechanisms of the autonomic nervous system, nociceptive processing, brain adaptations, psychological aspects and epigenetics.

This Special Issue is focusing on innovative pain measurements and pain outcome mechanisms to strive towards a better quantification of the level of pain. Additionally, in the search for new pain measurement strategies, advanced statistical techniques are helping us to unravel potential biomarkers for pain, to define surrogate markers and to construct composite measures. Manuscripts addressing these topics or related topics are invited for this Special Issue, especially those combining a high academic standard coupled with innovative ideas about pain measurements and outcome variables or high-quality statistical analysis. Applications of these methods in specific pain patient populations or related to specific treatment modalities will be eligible as well.

Dr. Lisa Goudman
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

chronic pain
pain measurements
statistical analyses
pain quantification
objective measurements
treatment effects

Published Papers (7 papers)

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Research

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21 pages, 3643 KiB

Open AccessArticle

Evaluation of External Trigeminal Nerve Stimulation to Prevent Cerebral Vasospasm after Subarachnoid Hemorrhage Due to Aneurysmal Rupture: A Randomized, Double-Blind Proof-of-Concept Pilot Trial (TRIVASOSTIM Study)

by Philippe Rigoard, Maxime Billot, Maarten Moens, Lisa Goudman, Hassan El-Hajj, Pierre Ingrand, Amine Ounajim, Manuel Roulaud, Philippe Page, Etienne Babin, Mohamed Et Talby, Jonathan Dany, Simona Johnson, Benoit Bataille, Romain David and Konstantin V. Slavin

Int. J. Environ. Res. Public Health 2023, 20(10), 5836; https://doi.org/10.3390/ijerph20105836 - 16 May 2023

Cited by 1 | Viewed by 1680

Abstract

Cerebral vasospasm remains the most frequent and devastating complication after subarachnoid aneurysmal hemorrhage because of secondary cerebral ischemia and its sequelae. The underlying pathophysiology involves vasodilator peptide release (such as CGRP) and nitric oxide depletion at the level of the precapillary sphincters of the cerebral (internal carotid artery network) and dural (external carotid artery network) arteries, which are both innervated by craniofacial autonomic afferents and tightly connected to the trigeminal nerve and trigemino-cervical nucleus complex. We hypothesized that trigeminal nerve modulation could influence the cerebral flow of this vascular network through a sympatholytic effect and decrease the occurrence of vasospasm and its consequences. We conducted a prospective double-blind, randomized controlled pilot trial to compare the effect of 10 days of transcutaneous electrical trigeminal nerve stimulation vs. sham stimulation on cerebral infarction occurrence at 3 months. Sixty patients treated for aneurysmal SAH (World Federation of Neurosurgical Societies scale between 1 and 4) were included. We compared the radiological incidence of delayed cerebral ischemia (DCI) on magnetic resonance imaging (MRI) at 3 months in moderate and severe vasospasm patients receiving trigeminal nerve stimulation (TNS group) vs. sham stimulation (sham group). Our primary endpoint (the infarction rate at the 3-month follow-up) did not significantly differ between the two groups (p = 0.99). Vasospasm-related infarctions were present in seven patients (23%) in the TNS group and eight patients (27%) in the sham group. Ultimately, we were not able to show that TNS can decrease the rate of cerebral infarction secondary to vasospasm occurrence. As a result, it would be premature to promote trigeminal system neurostimulation in this context. This concept should be the subject of further research. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

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11 pages, 797 KiB

Open AccessArticle

Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy

by Omri Besor, Ronen Brand, Ron Feldman, Yaniv Nudelman, Yair Shahar, Aharon S. Finestone and Noa Ben Ami

Int. J. Environ. Res. Public Health 2023, 20(6), 4854; https://doi.org/10.3390/ijerph20064854 - 09 Mar 2023

Viewed by 1363

Abstract

Low back pain (LBP) is a major cause of discomfort and disability. Physicians’ attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians’ attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 ± 0.48 vs. 16.4 ± 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

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11 pages, 2299 KiB

Open AccessArticle

A Forehead Wearable Sensor for the Objective Measurement of Chronic Pain

by Marcus Orzabal, Ramo Naidu, Kasra Amirdelfan and Alireza Akhbardeh

Int. J. Environ. Res. Public Health 2022, 19(24), 17041; https://doi.org/10.3390/ijerph192417041 - 19 Dec 2022

Viewed by 1370

Abstract

Chronic pain impacts one in five Americans and is difficult to manage, costing ~USD 600 billion annually. The subjective experience of pain is a complex processing of central nervous system input. Recent advances in magnetic resonance imaging revealed the prefrontal cortex as vital to the perception of pain and that changes in the cerebral hemodynamics can be used to detect painful sensations. Current pain monitoring is dependent on the subjective rating provided by patients and is limited to a single time point. We have developed a biomarker for the objective, real-time and continuous chronic pain assessment using proprietary algorithms termed ROPA and cerebral optical spectrometry. Using a forehead sensor, the cerebral optical spectrometry data were collected in two clinical sites from 41 patients (19 and 22, respectively, from sites 1 and 2), who elected to receive an epidural steroid injection for the treatment of chronic pain. Patients rated their pain on a numeric rating scale, ranging from 0–10, which were used to validate the ROPA objective pain scoring. Multiple time points, including pre- and post-procedure were recorded. The steroid injection was performed per standard medical practice. There was a significant correlation between the patient’s reported numeric rating scale and ROPA, for both clinical sites (Overall ~0.81). Holding the subjective pain ratings on a numeric rating scale as ground truth, we determined that the area under the receiver operator curves for both sites revealed at least good (AUC: 64%) to excellent (AUC > 98%) distinctions between clinically meaningful pain severity differentiations (no/mild/moderate/severe). The objective measure of chronic pain (ROPA) determined using cerebral optical spectrometry significantly correlated with the subjective pain scores reported by the subjects. This technology may provide a useful method of detection for the objective and continuous monitoring and treatment of patients with chronic pain, particularly in clinical circumstances where direct assessment is not available, or to complement the patient-reported pain scores. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

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7 pages, 299 KiB

Open AccessArticle

The Relationship between Self-Perceived Health and Clinical Symptoms in Patients with Frozen Shoulders

by Liang-Chien She, Hui-Yi Wang, Mei-Fang Liu, Yen-Ko Lin and Shu-Mei Chen

Int. J. Environ. Res. Public Health 2022, 19(21), 14396; https://doi.org/10.3390/ijerph192114396 - 03 Nov 2022

Cited by 1 | Viewed by 1323

Abstract

Current healthcare is centered on the perception of people’s health. The purpose of this study was to investigate the relationship between self-perceived health (physical, psychological, social, and environmental dimensions) and two main clinical symptoms (shoulder pain and restricted shoulder motion) in patients with frozen shoulders. A total of 49 patients diagnosed with frozen shoulders were recruited and divided into high- and low-disability groups according to the severity of their frozen shoulders. Participants were measured for shoulder passive range of motion, pain intensity, and self-perceived health, using a brief version of the World Health Organization Quality of Life questionnaire. The results showed that the high-disability group had poorer self-perceived health (lower quality of life scores) than the low-disability group (p < 0.05). There was no significant correlation between the quality of life scores and the two clinical symptoms in either the high- or low-disability group. Our findings revealed that the multidimensional self-perceived health of frozen shoulder patients could not be inferred from the severity of shoulder pain and restricted shoulder motions. This study suggests that healthcare providers should pay more attention to patients’ self-perceived health needs while addressing the clinical symptoms in patients with frozen shoulders. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

8 pages, 951 KiB

Open AccessArticle

Associations of Central Sensitization-Related Symptoms with Low Back Pain-Related Factors and Work Status in Caregivers

by Hayato Shigetoh, Teppei Abiko, Michie Ohyama, Eiji Sakata and Shin Murata

Int. J. Environ. Res. Public Health 2022, 19(16), 10135; https://doi.org/10.3390/ijerph191610135 - 16 Aug 2022

Cited by 1 | Viewed by 1886

Abstract

Low back pain (LBP) is associated with psychological factors and central sensitization-related symptoms (CSSs). The relationship between CSSs, LBP-related factors, and work status in caregivers remain unclear. This multicentre, collaborative, cross-sectional study aimed to determine the association between CSS severity, LBP-related factors, and work status in caregivers with LBP. We measured LBP intensity, pain duration, pain sites, CSSs (using the Central Sensitization Inventory-9: CSI-9), psychological factors (using the Pain Catastrophizing and Pain Self-Efficacy scales), and work status (interference, amount of assistance, frequency of assistance, and work environment) in 660 caregivers. CSS severity was categorised as no (CSI-9:0–9), mild (CSI-9:10–19), or moderate/severe (CSI-9:20–36). We further performed multiple comparison analyses and adjusted the residual chi-square to reveal differences between CSS severity groups. Caregivers with more severe CSSs tended to exhibit worse LBP intensity (p < 0.01), widespread pain (p < 0.01), catastrophic thinking (p < 0.01), and pain self-efficacy (p < 0.01), and they also tended to experience work interference (p < 0.01). Caregivers without CSSs tended to receive a smaller amount of assistance with a lower frequency (p < 0.05). The number of participants with an adequate environment and equipment was significantly less in the moderate/severe CSS group (p < 0.01). Thus, our findings may suggest that CSS severity is associated with LBP intensity, widespread pain, psychological factors, and work status in caregivers. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

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13 pages, 356 KiB

Open AccessArticle

Patients’ Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study

by Ron Feldman, Yaniv Nudelman, Sharon Haleva-Amir, Tamar Pincus and Noa Ben Ami

Int. J. Environ. Res. Public Health 2022, 19(10), 6106; https://doi.org/10.3390/ijerph19106106 - 17 May 2022

Cited by 1 | Viewed by 2017

Abstract

This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen’s d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients’ perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

Review

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19 pages, 912 KiB

Open AccessReview

Mechanisms of Transmission and Processing of Pain: A Narrative Review

by Girolamo Di Maio, Ines Villano, Ciro Rosario Ilardi, Antonietta Messina, Vincenzo Monda, Ashlei Clara Iodice, Chiara Porro, Maria Antonietta Panaro, Sergio Chieffi, Giovanni Messina, Marcellino Monda and Marco La Marra

Int. J. Environ. Res. Public Health 2023, 20(4), 3064; https://doi.org/10.3390/ijerph20043064 - 09 Feb 2023

Cited by 5 | Viewed by 2247

Abstract

Knowledge about the mechanisms of transmission and the processing of nociceptive information, both in healthy and pathological states, has greatly expanded in recent years. This rapid progress is due to a multidisciplinary approach involving the simultaneous use of different branches of study, such as systems neurobiology, behavioral analysis, genetics, and cell and molecular techniques. This narrative review aims to clarify the mechanisms of transmission and the processing of pain while also taking into account the characteristics and properties of nociceptors and how the immune system influences pain perception. Moreover, several important aspects of this crucial theme of human life will be discussed. Nociceptor neurons and the immune system play a key role in pain and inflammation. The interactions between the immune system and nociceptors occur within peripheral sites of injury and the central nervous system. The modulation of nociceptor activity or chemical mediators may provide promising novel approaches to the treatment of pain and chronic inflammatory disease. The sensory nervous system is fundamental in the modulation of the host’s protective response, and understanding its interactions is pivotal in the process of revealing new strategies for the treatment of pain. Full article

(This article belongs to the Special Issue Research on Pain Measurements and Pain Outcome Variables)

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