Relationship between Pain, Physical Activity, and Quality of Life in Patients with Haemophilia a and Haemophilia B

Introduction: The extended half-life (EHL) registry was established in 2016 to ascertain the long-term outcomes in patients with HaemophiliaA(HA) and B(HB) receiving replacement therapy. The aim was to quantify disease burden and quality of life at baseline and after switching to EHLs. Method(s): The study is a prospective, observational cohort study that enrolled patients switching EHLs or on standard replacement therapy after informed consent following local ethics approval and was registered at www.clinicaltrials.gov (NCT02938156). The study was paused during the COVID pandemic. Here the baseline results are presented for pain, activity and quality of life and their correlations. Pain evaluation was assessed through the brief pain inventory (BPI) 7-day recall, quality of life by EuroQol-5 Dimension (EQ5D5L) and physical activity through the international physical activity questionnaire (IPAQ). The BPI assess severity of pain and the interference with activities. IPAQ assess physical activity undertaken across a comprehensive set of domains. Three levels of physical activity are used to classify the populations: 'low', 'moderate', and ' high'. Result(s): A total of 231 HA and 97 HB were included in the analysis, of whom 231 had switched to EHL products and 96 were on standard replacement therapy. The levels of Physical Activity were similar between Haemophilia types, with approximately 46%, 32% and 22% of patients reporting high, moderate, and low physical activity, respectively. BPI mean (+/-SD) severity score in HA was 2.86 (+/-2.1), HB 3.24 (+/-2.0);interference score HA 3.22 (+/-2.8), HB 3.09 (+/-2.5), mean EQ5D5L visual analogue scale (VAS) for HA 72.92 (+/-15.5) and HB 71.10 (+/-18.2). Within instruments, IPAQ sub-scores and BPI average scores were highly correlated. Between instruments, the strongest linear correlations were seen between theVAS and the BPI scores (R=-0.59, p< 0.0001, n=206 for the average interference score, R=-0.57, p< 0.0001, n=208 for the average pain severity, v.s. the VAS). Correlations between the IPAQ total score and either VAS or BPI scores were weaker, even when limiting to patients with moderate or high activity and using a log scale given the skewed distribution of the IPAQ summary measure. Discussion/Conclusion: The study demonstrates for the first time a strong correlation between pain and quality of life, and weaker correlation between physical activity and quality of life.

PATIENTS REFERRED TO ANORECTAL MANOMETRY BEFORE AND DURING THE COVID PANDEMIC: ARE THEY DIFFERENT?

Background and aim: The SARS-CoV 2 pandemic has provoked drastic lifestyle changes and distracted the attention of doctors and patients towards “urgent” diseases. Consequently, it could have influenced also the features of the patients referred to a “nonurgent” diagnostic test such as anorectal manometry (ARM). The aim of this study was to evaluate possible differences in the features of patients undergoing ARM before and during the pandemic. Materials and methods: Demographic and clinical information was collected in 388 patients (m 99, f 289;mean age:53 ± 16.4 years) undergoing ARM according to the London Protocol from July to December 2019 (154 pts.), 2020 (101 pts.), 2021 (133 pts.). Information was collected using also dedicated scales: HADS, PACSYM, ODS, SF-12 and Wexner. Results: The indications for ARM were chronic constipation, fecal incontinence, chronic anal pain, evaluation after rehabilitation or before surgery. No difference was detected regarding indications and demographic features in the three different periods apart from the following: - duration of symptoms: in 2019, there was a lower prevalence of long-lasting symptomatology (>10 years) compared to 2020 and 2021 (p = 0.029). - ODS score (constipated patients): mean ODS score was lower in 2020 (11.22 ± 4.37) and in 2021 (10.89 ± 4.64) than in 2019 (14.82 ± 5.09) (p < 0.01). - HADS score mean values were always below the cutoff for diagnosing anxiety or depression. However, the mean score of depression was lower in 2020 (6.64 ± 3.24) and 2021 (5.16 ± 4.62) than in 2019 (7.58 ± 4.84) (p < 0.05). Manometric diagnostic conclusions were not significantly different in the three periods. Conclusions: The features of patients referred to a manometric evaluation were quite similar before and after the pandemic. The pandemic could have partially selected the patients with a long-lasting symptomatology, more prevalent in 2020 and in 2021. The slight differences we detected in the ODS and HADS scores may be related to lifestyle changes imposed by the forced lockdown, which resulted in changes in bowel habits. Our results are different from those reported in the literature regarding a worsening of functional disorders during pandemic. ARM is a niche exam and cannot be considered a mirror of functional disorders because they are very prevalent in the general population, while there are very few patients who undergo ARM. A multicenter study that can validate our conclusions is desirable.

Nurses Use Innovation to Perform Symptom and Pain Assessments

The article offers information on how nurses use innovation to perform symptom and pain assessments. It mentions that symptom and pain assessment tools can measure multiple aspects of a patient's pain experience in both ambulatory and acute care settings. It discusses that how symptom management can make a positive difference in patients' lives and ability to tolerate cancer treatment.

SYSTEMIC IMMUNOMODULATING THERAPIES FOR STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS IN A COVID-19 PATIENT. A CASE REPORT

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare serious disorders that affect the skin and mucous membranes. These reactions are most commonly caused by drugs and, rarely, infections. While discontinuing the offending drug and supportive care are primordial, there are no consensus treatment guidelines on the optimal use of systemic immunomodulatory agents. Here, we report a case of a 57-year-old woman, who had recently recovered from COVID-19 infection, with Stevens-Johnson syndrome/toxic epidermal necrolysis overlap most likely triggered by dorzolamide eye drops. The patient was successfully treated with a single subcutaneous dose of etanercept combined with oral cyclosporine, corticosteroids and intravenous immunoglobulins. The progression of skin lesions ceased after administration of etanercept. In addition, a significant clinical improvement was observed a few days after treatment with immunoglobulins, without complications or important side effects.

Digitalization and Tele-Health Care Concept of Complementary of Traditional Medical practices by Using BIOCERAMIC Technique

Objective: Tele-health care service of alternative practice for chronic pain disease is worthwhile of developing, especially in the period of COVID- 19 pandemic. Targeting on myofascial trigger points, this study was performed to assess the possible short-term pain relief and functional improvement in patients by applying the device of BIOCERAMIC material enhanced by frequencies of tempo sound and visible light spectrum (BioS & L). Methods: Fourteen patients who participated in the procedure for the selection of trigger points for the BioS &L treatment, assessment of pain levels using a visual analog scale (VAS) analysis, and detection of abnormal resonance of 12 harmonic frequencies using a quantum resonance spectrometer (QRS). Results: Comparing the pre- and post-treatment of BioS &L on pain score of 12 HFs (V1-V12) as measured by VAS estimated by mixed model showed 91.7% (11/12) improvement with statistically significant results. The distribution of differences in the QRS score estimated by the mixed model among participants with pre-test QRS level ≥ 2 showed 83.3% (15/16) of HFs with statistically significant results. Conclusion: Treatment of BioS &L at trigger points providing pain relief is explained by the hypothesis of microvascular physiology and physics of wave propagation. This study provides a workshop with a concept of digitalization of complementarity and traditional medical service and tele-health care, which fulfills distant data connection and remote practice. In the period of epidemic spread, it helps to decrease close contact on both health care providers and patients.

Pain experience and social support of endometriosis patients during the COVID-19 pandemic in Germany - Results of a web-based cross-sectional survey

Background: Endometriosis is a chronic pain condition in premenopausal women. Pain is mainly characterized by pain intensity and may induce disability in all areas of daily life. Nevertheless, pain is influenced by emotional and social factors as well. Social distancing measures or quarantine, as reaction to rapidly rising infections with the COVID-19 virus due to the SARS-CoV-2 pandemic, were implemented across Europe to prevent the spread of the virus and social distancing measures were imposed by the German government by beginning of March 2020 with initiation of the lockdown by the end of March 2020. The objective of this study was to assess, how social distancing measures during the lockdown impacted the various aspects of pain perception in a group of chronic pain patients, such as women suffering from endometriosis. Methods: Between 6th to 27th April 2020, an online questionnaire was activated at internet platforms of endometriosis patients support groups. Participants were asked retrospectively at one time point about their visual pain intensity measured by the visual analogue scale (VAS) and pain disability via pain disability index (PDI) prior to initiation of social distancing measures in Germany (VASP, PDIP), as well as the pain intensity and pain disability since implementation of social distancing measures (VASI, PDII). Differences of VAS and PDI previous and after implementation of social distancing measures were displayed as DELTAVAS and DELTAPDI. Pain experience and social support were assessed by a 5-point Likert scale. Results: 285 participants completed at least one question regarding pain intensity, disability, pain experience or social support. Dysmenorrhea, the symptom with the highest level of pain assessed by VAS, decreased significantly during the SARS-CoV-2 pandemic compared to the time period prior to social isolation (45.30% respondents experienced improvemenet vs 40.50% who experienced worsening;p = 0.025). The global physical impairment improved significantly (improvement of pain induced disability in 48.20% vs 40.90% with worsening of pain symptoms;p = 0.032) after the implementation of social distancing measures. Pain experience was negatively affected by social distancing measures, since frequency of pain awareness increased in 43.6% (p < 0.001) of participants and 30.0% (p < 0.001) more participants experienced pain as a threat. Verbalization of pain experience was reduced in 36.6% (p = 0.001) of participants and 14.6% (p = 0.91), 21.9% (p < 0.001) and 31.5% (p < 0.001) of participants reported less social support from their partner, family and friends. Conclusions: Physical pain and disability on one hand and emotional and social pain experience on the other were differentially affected by the emerged emotional, social and health care constraints related to the SARS-CoV-2 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards.

Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0-45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards: (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer's overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (≥0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research.

Dental Emergencies Management in COVID-19 Pandemic Peak: A Cohort Study.

Due to the global coronavirus disease 2019 pandemic, the high risk of cross-contamination and the overload of hospital facilities have resulted in a real urgency for restricting dental emergency patient flow. In this context, the objectives of the current work were to 1) measure the ability of a triage-based management strategy to limit patient admission and 2) evaluate the success rate of both on-site and remote emergency management regarding symptom relief and pain control over a 1-mo period. We included all patients contacting the dental medicine department for an emergency consultation during the lockdown, between April 1 and April 30, 2020 (N = 570). Following a telephone consultation and based on preestablished admission guidelines, a decision was made at baseline (T0) to either admit the patient for treatment or perform remote management by providing advice and/or drug prescription. Patients were then followed up systematically at 1 wk and 1 mo. Management failure was defined as the need for emergency admission for patients managed remotely since T0 and for new emergency admission for those admitted at T0. The global follow-up rate of patients with a complete data set was 91.4% (N = 521). Of included patients, 49.3% could be managed without admission for emergency reasons for 1 mo. The proportion of successful management was 71.8% and 90.2% at 1 mo for remote and on-site management, respectively. To conclude, the proposed triage-based emergency management strategy with systematic follow-up was a good compromise between limiting patient admission and ensuring effective symptom relief and pain control. The strategy can be useful in situations where regulation of the emergency patient flow is required.