The role of #touch in regulating inter-partner physiological coupling during empathy for #pain
https://www.nature.com/articles/s41598-017-03627-7

The human ability to synchronize with other individuals is critical for the development of social behavior. Recent research has shown that physiological inter-personal synchronization may underlie behavioral synchrony. The results indicate that the partner touch increased interpersonal respiration coupling under both pain and no-pain conditions and increased heart rate coupling under pain conditions. In addition, physiological coupling was diminished by pain in the absence of the partner’s touch.

Critically, we found that high partner’s empathy and high levels of analgesia enhanced coupling during the partner’s touch.

Collectively, the evidence indicates that social touch increases interpersonal physiological coupling during pain. Furthermore, the effects of touch on cardio-respiratory inter-partner coupling may contribute to the analgesic effects of touch via the autonomic nervous system.

Musculoskeletal #pain associated with recreational #yoga participation: A prospective cohort study with 1-year follow-up
http://www.sciencedirect.com/science/article/pii/S1360859217301225

Yoga is a popular complementary therapy for musculoskeletal pain. There are few studies however, that have examined the risks of recreational participation for causing musculoskeletal pain.

Results

The final sample included 354 participants from two suburban yoga studios. The incidence rate of pain caused by yoga was 10.7%. More than one-third of incident cases resulted in lost yoga participation time and/or symptoms lasting more than 3 months. None of the risk factors at baseline increased the risk for subsequent incident cases of pain caused by yoga.

Conclusions
Yoga can cause musculoskeletal pain. Participants may benefit from disclosure of practice to their healthcare professionals and by informing teachers of injuries they may have prior to participation. Yoga teachers should also discuss the risks for injury with their students.

The effects of #Cannabis Among Adults With Chronic #Pain and an Overview of General Harms: A Systematic Review

http://annals.org/aim/article/2648595/effects-cannabis-among-adults-chronic-pain-overview-general-harms-systematic

Cannabis is increasingly available for the treatment of chronic pain, yet its efficacy remains uncertain From 27 chronic pain trials, there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations. According to 11 systematic reviews and 32 primary studies, harms in general population studies include increased risk for motor vehicle accidents, psychotic symptoms, and short-term cognitive impairment. Although adverse pulmonary effects were not seen in younger populations, evidence on most other long-term physical harms, in heavy or long-term cannabis users, or in older populations is insufficient

Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects

Stable High-Sensitivity Cardiac #Troponin T Levels and Outcomes in Patients With Chest #Pain
http://www.onlinejacc.org/content/70/18/2226

.. Cox regression was used to estimate risks for all-cause, cardiovascular, and noncardiovascular mortality, MI, and heart failure at different levels of troponins A total of 19,460 patients with a mean age of 54 ± 17 years were included. During a mean follow-up of 3.3 ± 1.2 years, 1,349 (6.9%) patients died. Adjusted hazard ratios (with 95% confidence intervals) for all-cause mortality were 2.00 (1.66 to 2.42), 2.92 (2.38 to 3.59), 4.07 (3.28 to 5.05), 6.77 (5.22 to 8.78), and 9.68 (7.18 to 13.00) in patients with hs-cTnT levels of 5 to 9, 10 to 14, 15 to 29, 30 to 49, and ≥50 ng/l, respectively, compared with patients with hs-cTnT levels <5 ng/l. There was a strong and graded association between all detectable levels of hs-cTnT and risk for MI, heart failure, and cardiovascular and noncardiovascular mortality.

Conclusions

Among patients with chest pain and stable troponin levels, any detectable level of hs-cTnT is associated with an increased risk of death and cardiovascular outcomes and should merit further attention

Effect of a Single Dose of Oral #Opioid and #Nonopioid Analgesics on Acute Extremity #Pain in the Emergency Department
A Randomized Clinical Trial
https://jamanetwork.com/journals/jama/article-abstract/2661581

The choice of analgesic to treat acute pain in the emergency department (ED) lacks a clear evidence base. The combination of ibuprofen and acetaminophen (paracetamol) may represent a viable nonopioid alternative Of 416 patients randomized, 411 were analyzed (mean SD age, 37 12 years; 199 48% women; 247 60% Latino). The baseline mean NRS pain score was 8.7 (SD, 1.3). At 2 hours, the mean NRS pain score decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen and acetaminophen group; by 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and acetaminophen group; by 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and acetaminophen group (P = .053). The largest difference in decline in the NRS pain score from baseline to 2 hours was between the oxycodone and acetaminophen group and the hydrocodone and acetaminophen group (0.9; 99.2% CI, −0.1 to 1.8), which was less than the minimum clinically important difference in NRS pain score of 1.3. Adverse events were not assessed.

Conclusions and Relevance For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics. Further research to assess adverse events and other dosing may be warranted

Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute #Chest #Pain
A Secondary Analysis of the ROMICAT-II Randomized Clinical Trial
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2663304

The incremental benefit of noninvasive testing in addition to clinical evaluation (history, physical examination, an electrocardiogram ECG, and biomarker assessment) vs clinical evaluation alone for patients who present to the emergency department (ED) with acute chest pain is unknown

Patients who underwent clinical evaluation alone experienced a shorter LOS (20.3 vs 27.9 hours; P < .001), lower rates of diagnostic testing (P < .001) and angiography (2% vs 11%; P < .001), lower median costs ($2261.50 vs $2584.30; P = .009), and less cumulative radiation exposure (0 vs 9.9 mSv; P < .001) during the 28-day study period. Lack of testing was associated with a lower rate of diagnosis of ACS (0% vs 9%; P < .001) and less coronary angiography and percutaneous coronary intervention (PCI) during the index visit (0% vs 10%; P < .001, and 0% vs 4%; P = .02, respectively). There was no difference in rates of PCI (2% vs 5%; P = .15), coronary artery bypass surgery (0% vs 1%; P = .61), return ED visits (5.8% vs 2.8%; P = .08), or MACE (2% vs 1%; P = .24) in the 28-day follow-up period.

Conclusions and Relevance In patients presenting to the ED with acute chest pain, negative biomarkers, and a nonischemic ECG result, noninvasive testing with CCTA or stress testing leads to longer LOS, more downstream testing, more radiation exposure, and greater cost without an improvement in clinical outcomes.

!!
Effect of #cannabis use in people with chronic non-cancer #pain prescribed opioids: findings from a 4-year prospective cohort study

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30110-5/fulltext?code=lancet-site


At 4-year follow-up, compared with people with no cannabis use, we found that participants who used cannabis had a greater pain severity score (risk ratio 1·14, 95% CI 1·01–1·29, for less frequent cannabis use; and 1·17, 1·03–1·32, for daily or near-daily cannabis use), greater pain interference score (1·21, 1·09–1·35; and 1·14, 1·03–1·26), lower pain self-efficacy scores (0·97, 0·96–1·00; and 0·98, 0·96–1·00), and greater generalised anxiety disorder severity scores (1·07, 1·03–1·12; and 1·10, 1·06–1·15). We found no evidence of a temporal relationship between cannabis use and pain severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation.

Interpretation
Cannabis use was common in people with chronic non-cancer pain who had been prescribed opioids, but we found no evidence that cannabis use improved patient outcomes. People who used cannabis had greater pain and lower self-efficacy in managing pain, and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect. As cannabis use for medicinal purposes increases globally, it is important that large well designed clinical trials, which include people with complex comorbidities, are conducted to determine the efficacy of cannabis for chronic non-cancer pain

!!
#Pain Susceptibility Phenotypes in Those Free of Knee Pain with or at Risk of Knee Osteoarthritis: The Multicenter #Osteoarthritis Study

https://onlinelibrary.wiley.com/doi/abs/10.1002/art.4075

Why some individuals develop pain with knee osteoarthritis (OA) is not clear. We sought to identify pain susceptibility phenotypes (PSPs) and their relation to incident persistent knee pain (PKP) 2 years later

852 participants were included (mean age 67; BMI 29.5 kg/m2, 55% women). Four PSPs were identified, primarily characterized by varying proportions (low/absent, moderate, or high) of the presence of pressure pain sensitivity and of facilitated TS, reflecting different measures of sensitization. The PSP with high proportion of pressure pain sensitivity + moderate proportion of facilitated TS was twice as likely to develop incident PKP over 2 years OR 2.11 (95% CI 1.06 4.22) compared with the PSP having low proportion of sensitization by both measures.

Conclusions
Four PSPs were identified, of which three were predominated by QST evidence of sensitization, and one was associated with developing PKP 2 years later. Prevention or amelioration of sensitization may be a novel approach to preventing onset of persistent knee pain in OA

!!
Prevalence of #foot #pain across an international consortium of population based cohorts

https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23829

Despite the potential burden of foot pain, some of the most fundamental epidemiological questions surrounding the foot remain poorly explored. The prevalence of foot pain has proved difficult to compare across existing studies due to variations in case definitions.

Results
The precise definition of foot pain varied between the cohorts. The prevalence of foot pain ranged from 13 to 36% and was lowest within the cohort that used a case definition specific to pain, compared to the four remaining cohorts that included components of pain, aching or stiffness. Foot pain was generally more prevalent in women, the obese and generally increased with age, being much lower in younger participants (20‐44 years).

Conclusion
Foot pain is common and is associated with female sex, older age and obesity. The prevalence of foot pain is likely affected by the case definition used, therefore consideration must be given for future population studies to use consistent measures of data collection.

!!
Compounded Topical Pain #Creams to Treat Localized Chronic #Pain: A Randomized Controlled Trial

https://annals.org/aim/article-abstract/2724041/compounded-topical-pain-creams-treat-localized-chronic-pain-randomized-controlled

Pain creams compounded for neuropathic pain (ketamine, gabapentin, clonidine, and lidocaine), nociceptive pain (ketoprofen, baclofen, cyclobenzaprine, and lidocaine), or mixed pain (ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine), or placebo.

For the primary outcome, no differences were found in the mean reduction in average pain scores between the treatment and control groups for patients with neuropathic pain (−0.1 points [95% CI, −0.8 to 0.5 points]), nociceptive pain (−0.3 points [CI, −0.9 to 0.2 points]), or mixed pain (−0.3 points [CI, −0.9 to 0.2 points]), or for all patients (−0.3 points [CI, −0.6 to 0.1 points]). At 1 month, 72 participants (36%) in the treatment groups and 54 (28%) in the control group had a positive outcome (risk difference, 8% [CI, −1% to 17%]).

Compounded pain creams were not better than placebo creams, and their higher costs compared with approved compounds should curtail routine use.

!!
How the #weather affects the #pain of citizen scientists using a smartphone app

Weather has been thought to affect symptoms in patients with chronic disease since the time of Hippocrates over 2000 years ago.1 Around three-quarters of people living with arthritis believe their pain is affected by the weather..

..Precipitation was not associated with an increased odds of a pain event (OR 0.996 (0.989–1.003) per 1 mm daily rainfall amount)..

..This study has demonstrated that higher relative humidity and wind speed, and lower atmospheric pressure, were associated with increased pain severity in people with long-term pain conditions. The most significant contribution was from relative humidity. The effect of weather on pain was not fully explained by its day-to-day effect on mood or physical activity.

The overall effect sizes, while statistically significant, were modest. For example, the ‘worst’ combination of weather variables would increase the odds of a pain event by just over 20% compared to an average day. Nonetheless, such an increased risk may be meaningful to people living with chronic pain..

https://www.nature.com/articles/s41746-019-0180-3

!!
Altruistic #behaviors relieve physical #pain

..Across 2 pilot studies and 3 experiments, we showed a pain-relieving effect of performing altruistic behaviors. Acting altruistically relieved not only acutely induced physical pain among healthy adults but also chronic pain among cancer patients. Using functional MRI, we found that after individuals performed altruistic actions brain activity in the dorsal anterior cingulate cortex and bilateral insula in response to a painful shock was significantly reduced.

This reduced pain-induced activation in the right insula was mediated by the neural activity in the ventral medial prefrontal cortex (VMPFC), while the activation of the VMPFC was positively correlated with the performer’s experienced meaningfulness from his or her altruistic behavior. Our findings suggest that incurring personal costs to help others may buffer the performers from unpleasant conditions.

https://bit.ly/36wEVo8

Association of Therapies With Reduced #Pain and Improved Quality of Life in Patients With #Fibromyalgia
https://2medical.news/2020/10/29/association-of-therapies-with-reduced-pain-and-improved-quality-of-life-in-patients-with-fibromyalgia/

..To investigate the effectiveness of therapies for reducing pain and improving quality of life (QOL) in people with fibromyalgia.. ..A total of 224 trials including 29 962 participants were included. High-quality evidence was found in favor of cognitive behavioral therapy (weighted mean difference [WMD], −0.9; 95% CI, −1.4 to −0.3) for pain in the short term and was found in favor of central nervous system depressants …

#Smile (or grimace) through the #pain? The effects of experimentally manipulated facial expressions on needle-injection responses.
https://2medical.news/2020/12/28/smile-or-grimace-through-the-pain-the-effects-of-experimentally-manipulated-facial-expressions-on-needle-injection-responses/

Smiling has been previously shown to improve stress responses. We replicated and expanded this work by testing whether smiling helps with a potent real-world stressor: a vaccination-like needle injection. We also extended past research by examining grimacing, a facial expression known to naturally occur during stress and pain and one that shares some of the same facial action units as smiling. Participants (n = 231; …

#Pain and fatigue are longitudinally and bi-directionally associated with more #sedentary time and less standing time in #rheumatoid arthritis
https://2medical.news/2021/02/19/pain-and-fatigue-are-longitudinally-and-bi-directionally-associated-with-more-sedentary-time-and-less-standing-time-in-rheumatoid-arthritis/

The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. Methods People living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to …

Sex- and age-specific genetic analysis of chronic back #pain
https://2medical.news/2021/03/29/sex-and-age-specific-genetic-analysis-of-chronic-back-pain/

Sex differences for chronic back pain (cBP) have been reported, with females usually exhibiting greater morbidity, severity, and poorer response to treatment. Genetic factors acting in an age-specific manner have been implicated but never comprehensively explored. We performed sex- and age-stratified genome-wide association study and single nucleotide polymorphism-by-sex interaction analysis for cBP defined as “Back pain for 3+ months” in 202,077 males and 237,754 females …

#Virtual reality for #pain management in hospitalized patients with #cancer: A randomized controlled trial

https://2medical.news/2024/04/10/virtual-reality-for-pain-management-in-hospitalized-patients-with-cancer-a-randomized-controlled-trial/

Effectiveness and cost-effectiveness of an individualised, progressive #walking and education intervention for the prevention of low back #pain recurrence in Australia (WalkBack): a randomised controlled trial

https://2medical.news/2024/07/08/effectiveness-and-cost-effectiveness-of-an-individualised-progressive-walking-and-education-intervention-for-the-prevention-of-low-back-pain-recurrence-in-australia-walkback-a-randomised-control/