Should cancer pain still be considered a separate category alongside acute pain and chronic non-cancer pain? Reflections on ICD-11

IntroductionTraditionally, cancer pain has often been viewed as an independent third major category in pain medicine alongside acute pain and chronic non-cancer pain. However, the new chronic pain category MG30 in the eleventh version of International Classification of Diseases (ICD-11) includes cancer-related pain as one of its seven subgroups. In light of this, the aim of the paper is to investigate whether the traditional trichotomy should be replaced by a dichotomy between acute pain and chronic pain, cancer-related pain being part of both groups depending on the duration of pain.MethodsThe rationale for viewing cancer pain as a separate category is reviewed.ResultsCancer being a deadly disease, cancer pain has a life-and-death and existential dimension that is different from non-cancer pain. It seems sensible to believe that this is an additional dimension to the suffering caused by cancer pain, and that clinicians should therefore take this existential dimension into consideration when assessing pain.ConclusionWithout challenging the place of chronic cancer-related pain under the MG30 heading, it is concluded that while using ICD-11 in the future, pain clinicians should continue being mindful of the fact that the reality of death shapes the experience of cancer pain. The traditional trichotomy is therefore still valid and mirrors the fact that human beings are vulnerable (acute pain), temporal (chronic pain) and mortal (cancer pain)

Математическое моделирование производственной программы сельскохозяйственной организации как инструмент принятия управленческих решений

Материалы IX Междунар. науч.-практ. конф., Гомель, 26-27 ноября 2015

Eleven neurology-related proteins measured in serum are positively correlated to the severity of diabetic neuropathy

About 20% of patients with diabetes suffer from chronic pain with neuropathic characteristics. We investigated the multivariate associations between 92 neurology-related proteins measured in serum from 190 patients with painful and painless diabetic neuropathy. Participants were recruited from the Pain in Neuropathy Study, an observational cross-sectional multicentre study in which participants underwent deep phenotyping. In the exploration cohort, two groups were defined by hierarchical cluster analyses of protein data. The proportion of painless vs painful neuropathy did not differ between the two groups, but one group had a significantly higher grade of neuropathy as measured by the Toronto Clinical Scoring System (TCSS). This finding was replicated in the replication cohort. Analyzing both groups together, we found that a group of 11 inter-correlated proteins (TNFRSF12A, SCARB2, N2DL-2, SKR3, EFNA4, LAYN, CLM-1, CD38, UNC5C, GFR-alpha-1, and JAM-B) were positively associated with TCSS values. Notably, EFNA4 and UNC5C are known to be part of axon guidance pathways. To conclude, although cluster analysis of 92 neurology-related proteins did not distinguish painful from painless diabetic neuropathy, we identified 11 proteins which positively correlated to neuropathy severity and warrant further investigation as potential biomarkers

Pain tolerance in chronic pain patients seems to be more associated with physical activity than with depression and anxiety

OBJECTIVE: To explore the associations between habitual self-reported physical activity, pain sensitivity and patient-reported outcomes (including pain intensity) in patients with chronic pain. DESIGN: Cross-sectional, experimental study. SUBJECTS: Patients (n = 78), age range 18–65 years, with different chronic pain conditions (> 3 months) were compared with age- and sex-matched healthy controls (n = 98). METHODS: Multivariate correlations between self-reported physical activity, pressure pain sensitivity, and patient-reported outcome measures were assessed. RESULTS: Lower perceived health status (p < 0.001, Cohen’s d = 2.34), higher levels of depression (p < 0.001, Cohen’s d = 1.77), and lower pain tolerance threshold (p < 0.001, Cohen’s d = 1.66) were the most prominent variables discriminating patients from controls. In patients, bivariate and multivariate analyses showed that higher pressure pain tolerance was associated with male sex, lower pain intensity and fewer painful regions, higher self-efficacy and more self-reported physical activity, but not with lower levels of anxiety and depression. CONCLUSION: Pain tolerance thresholds, as well as degree of depression and perceived health status discriminated between patients and controls, and there was an association between pain tolerance thresholds and level of self-reported physical activity in patients. This study highlights the importance of further research into how increased physical activity may improve pain sensitivity in patients with chronic pain

A population-based study of inflammatory mechanisms and pain sensitivity

This is a non-final version of an article published in final form in Schistad, E. I., Kong, X. Y., Furberg, A.-S., Bäckryd, E., Grimnes, G., Emaus, N., ... Nielsen, C. S. (2019). A population-based study of inflammatory mechanisms and pain sensitivity. Pain, 161(2), 338-350. https://doi.org/10.1097/j.pain.0000000000001731Two recent studies suggest that experimental pain sensitivity is associated with low-grade systemic inflammation. However, only 2 biomarkers have been identified, and the studies were conducted in adult individuals where confounding effects of comorbid diseases cannot be excluded. We therefore tested associations between pain sensitivity and 119 inflammation-related serum biomarkers in 827 healthy adolescents (15-19 years) in the population-based Tromsø Study: Fit Futures. The main outcome measure was cold-pressor pain tolerance (CPT), tested by placing the dominant hand in circulating cold (3°C) water for a maximum of 105 seconds. Secondary outcomes were heat and pressure pain threshold and tolerance. Twelve proteins and 6 fatty acids were significantly associated with CPT after adjustment for possible confounding factors and correction for multiple comparisons. Of these, all fatty acids and 10 proteins were protective, ie, higher biomarkers levels were associated with increased CPT, whereas 2 biomarkers were associated with lower tolerance. Taken together, these biomarkers predicted completion of the tolerance test with a C-statistic of 0.65. Results for heat and pressure pain tolerance were remarkably similar, strengthening the generalizability of our findings. In this cohort of young healthy individuals, we found a relationship between inflammation-related biomarkers and pain tolerance and thresholds. Biomarkers with anti-inflammatory and analgesic effects predominated, suggesting that the development of prophylactic dietary or pharmaceutical treatments may be possible

Accelerated optimization method for low-embodied energy concrete box-girder bridge design

[EN] Structural optimization is normally carried out by means of conventional heuristic optimization due to the complexity of the structural problems. However, the conventional heuristic optimization still consumes a large amount of time. The use of metamodels helps to reduce the computational cost of the optimization and, along these lines, kriging-based heuristic optimization is presented as an alternative to carry out an accelerated optimization of complex problems. In this work, conventional heuristic optimization and kriging-based heuristic optimization will be applied to reach the optimal solution of a continuous box-girder pedestrian bridge of three spans with a low embodied energy. For this purpose, different penalizations and different initial sample sizes will be studied and compared. This work shows that kriging-based heuristic optimization provides results close to those of conventional heuristic optimization using less time. For the sample size of 50, the best solution differs about 2.54% compared to the conventional heuristic optimization, and reduces the computational cost by 99.06%. Therefore, the use of a kriging model in structural design problems offers a new means of solving certain structural problems that require a very high computational cost and reduces the difficulty of other problems.The authors acknowledge the financial support of the Spanish Ministry of Economy and Competitiveness, along with FEDER funding (Project: BIA2017-85098-R).Penadés-Plà, V.; García-Segura, T.; Yepes, V. (2019). Accelerated optimization method for low-embodied energy concrete box-girder bridge design. Engineering Structures. 179:556-565. https://doi.org/10.1016/j.engstruct.2018.11.015S55656517

The benefits and risks of nostalgia: analysis of a fictional case with special reference to ethical and existential issues

BackgroundIn a previous paper in Philos Ethics Humanit Med, the 1937 Swedish novel Somnlos (Swedish for sleepless) by Vilhelm Moberg was used as background for a thought experiment, in which last centurys progresses concerning the safety of sleeping pills were projected into the future. This gave rise to a theoretical discussion about broad medico-philosophical questions such as (among other things) the concept of pharmaceuticalisation.MethodsIn this follow-up paper, the theme of insomnia in Somnlos is complemented by a discussion of the concept of nostalgia. The core of the paper is a theoretical discussion about the benefits and risks of nostalgia, bringing together some aspects of recent psychological research about the construct of nostalgia with the main story line of the novel.Results and ConclusionNostalgia is portrayed as being, in some sense at least, ultimately beneficial for the protagonist of Somnlos. This is congruent with recent psychological research. However, the story also shows that nostalgia may lead to problematic behaviours, at least when viewed from a virtue ethics perspective. Hence, nostalgia is both what leads the protagonist into ethically problematic behaviour and that which (paradoxically) ultimately saves him from his initial lack of courage, justice, temperance and practical wisdom. Moreover, the protagonist does not only "grow" ethically but also existentially. Hence, the novel opens up the possibility that insomnia and nostalgia might be viewed as bearers of important existential information (cf. sociologist of religion Peter L. Berger and his concept of "signals of transcendence")

Gender differences in dispensed analgesics in Sweden during 2006-2015 - an observational, nationwide, whole-population study

A potentially illuminating way of looking at gender differences in health and disease is to study differences in drug utilization. The aim of this study was to describe gender differences in dispensed analgesics (including nonsteroidal anti-inflammatory drugs [NSAIDs]) in Sweden during 2006-2015

Pain assessment 3 x 3: a clinical reasoning framework for healthcare professionals

Objectives: To give an overview of central aspects of pain medicine-specific clinical reasoning when assessing a pain patient. Clinical reasoning is the thinking and decision-making processes associated with clinical practice.Methods: Three core pain assessment areas that are crucial for clinical reasoning in the field of pain medicine are discussed, each of them consisting of three points.Results: First, it is important to distinguish acute, chronic non-cancer, and cancer-related pain conditions. This classical and very simple trichotomy still has important implications treatment-wise, e.g., concerning the use of opioids. Second, the pain mechanism needs to be assessed. Is the pain nociceptive, neuropathic, or nociplastic? Simply put, nociceptive pain has to do with injury of non-neural tissue, neuropathic pain is caused by a disease or lesion of the somatosensory nervous system, and nociplastic pain is believed to be related to a sensitized nervous system (c.f. the concept of "central sensitization "). This also has implications concerning treatment. Some chronic pain conditions are nowadays viewed more as diseases rather than the pain being merely a symptom. In the new ICD-11 pain classification, this is conceptualized by the characterization of some chronic pains as "primary ". Third, in addition to a conventional biomedical evaluation, psychosocial and behavioral aspects must also be assessed, the pain patient being viewed as an active agent and not merely as the passive recipient of an intervention. Hence, the importance of a dynamic bio-psycho-social perspective. The dynamic interplay of biological, psychological, and social aspects must be taken into account, putative behavioral "vicious circles " thereby being identified. Some core psycho-social concepts in pain medicine are mentioned.Conclusions: The clinical applicability and clinical reasoning power of the 3 x 3 framework is illustrated by three short (albeit fictional) case descriptions.Funding Agencies|ALF Research Grants; Region Ostergotland</p