Aims. The aim of this study was to describe the prevalence and patterns of neuropathic pain over one year in a cohort of patients with chronic post-surgical pain at three months following total knee arthroplasty (TKA). Methods. Between 2016 and 2019, 363 patients with troublesome pain, defined as a score of ≤ 14 on the Oxford Knee Score pain subscale, three months after TKA from eight UK NHS hospitals, were recruited into the Support and Treatment After Replacement (STAR) clinical trial. Self-reported neuropathic pain and postoperative pain was assessed at three, nine, and 15 months after surgery using the painDETECT and Douleur Neuropathique 4 (DN4) questionnaires collected by postal survey. Results. Symptoms of neuropathic pain were common among patients reporting chronic pain at three months post-TKA, with half reporting neuropathic pain on painDETECT (191/363; 53%) and 74% (267/359) on DN4. Of those with neuropathic pain at three months, half continued to have symptoms over the next 12 months (148/262; 56%), one-quarter had improved (67/262; 26%), and for one-tenth their neuropathic symptoms fluctuated over time (24/262; 9%). However, a subgroup of participants reported new, late onset neuropathic symptoms (23/262; 9%). Prevalence of neuropathic symptoms was similar between the screening tools when the lower cut-off painDETECT score (≥ 13) was applied. Overall, mean neuropathic pain scores improved between three and 15 months after TKA. Conclusion. Neuropathic pain is common in patients with chronic pain at three months after TKA. Although neuropathic symptoms improved over time, up to half continued to report painful neuropathic symptoms at 15 months after TKA. Postoperative care should include screening, assessment, and treatment of neuropathic pain in patients with early chronic postoperative pain after TKA. Cite this article: Bone Joint J 2024;106-B(6):582–588

Introduction. The regionalisation of major trauma in the UK has significantly improved outcomes for patients with severe, lower limb injuries. Chronic pain after complex lower limb injuries is well documented, but seems to remain a problem despite better clinical and radiological outcomes. We hypothesised that pain was mediated through the saphenous nerve, especially as most tibial injuries affected the soft tissues medially. As a proof of concept, we undertook adductor canal blocks to understand pain aetiology. Materials & Methods. Patients with chronic pain following complex lower limb trauma or congenital deformity correction have been selected and underwent an adductor canal block by one of our trauma anaesthetist that specialises in this procedure. Their outcomes were recorded in their clinical records and patients were contacted by phone to document their experiences. Results. 14 patients with chronic, treatment refractory lower limb pain who were being managed in our orthoplastics clinic following complex, lower limb trauma were identified. Six of those patients had required plastic coverage. Of these 14 patients, all stated their pain completely resolved after the procedure and then returned between 24 hours and 4 weeks after the procedure. Two patients underwent a saphenous nerve diversion after conduction of the blocks, reporting subsequent resolution of their complaints. Conclusions. As a proof of concept, we report that the saphenous nerve underlies chronic pain in patients with complex lower limb injuries. An adductor canal block is an effective diagnostic tool for these patients. Saphenous diversion may offer a permanent solution in patients who respond well to saphenous nerve block. A prospective study is planned to objectively measure pain and quality of life scores after treatment of complex injuries and pre and post adductor canal block

Introduction. There is a lack of evidence-based treatments for patients with chronic pain after total knee arthroplasty (TKA). It is well-established that knee extensor and flexor muscle strength are markedly impaired following TKA, but no studies have examined muscle strength and power in patients with chronic pain after TKA. Therefore, the aim was to investigate if neuromuscular exercises and pain neuroscience education (PNE) were superior to PNE alone for improvement of muscle strength and power in patients with chronic pain after TKA. Method. This report presents the exploratory analysis of a randomized controlled trial (NCT03886259). Participants with chronic moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least one year after primary TKA were included. Participants were randomized to receive either supervised neuromuscular exercise and PNE or the same PNE sessions alone. The outcomes were changes from baseline to 12-months for peak leg extension power and maximum muscle strength, measured during maximal voluntary isometric contractions, for the knee extensors and flexors. Result. Sixty-nine participants (age 62.2±7.2, 40 females) were included. No between-group differences were observed for peak leg extension power (difference 13.6 Watts, 95% CI -22.2 to 49.3), maximum knee extensor muscle strength (difference -20.9 Newtons, 95% CI -65.8 to 24.0) or maximum knee flexor muscle strength (difference 8.6 Newtons, 95% CI -11.9 to 29.1). Peak leg extension power (26.3 Watts, 95% CI 4.3 to 48.3) and maximum knee flexor muscle strength (19.7 Newtons, 95% CI 7.6 to 31.9) improved significantly in the neuromuscular exercise and PNE group with no significant improvements observed in the PNE alone group. Conclusion. Neuromuscular exercise and PNE did not improve muscle strength and power compared to PNE alone in patients with chronic pain after TKA. Acknowledgements. This study was funded by the Danish Rheumatism Association, the Svend Andersen Foundation and Lions Club Denmark

Background. Serious traumatic injury is a leading cause of death and disability globally, with the majority of survivors developing chronic pain. Methods. The aims of this study were to describe early predictors of poor long-term outcome for post-trauma pain. We conducted a prospective observational study, recruiting patients admitted to a Major Trauma Centre hospital in England within 14 days of their injuries, and followed them for 12 months. We defined a poor outcome as Chronic Pain Grade ≥ II and measured this at both 6-months and 12-months. A broad range of candidate predictors were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariate models were used to identify the strongest predictors of poor outcome, which were entered into multivariate models. Results. 124 eligible participants were recruited. At 6-months, 19 (23.2%) of 82 respondents reported a good outcome, whereas at 12-months 27 (61.4%) of 44 respondents reported a good outcome. The multivariate model for 6-months produced odds ratios for a unit increase in: number of fractures, 3.179 (0.52 to 19.61); average pain intensity, 1.611 (0.96 to 2.7); pain extent, 1.138 (0.92 to 1.41) and post-traumatic stress symptoms, 1.044 (0.10 to 1.10). At 12-months, equivalent values were: number of fractures, 1.653 (0.77 to 3.55); average pain intensity, 0.967 (0.67 to 1.40); pain extent, 1.062 (0.92 to 1.23) and post-traumatic stress symptoms, 1.025 (0.99 to 1.07). Conclusion. A poor long-term pain outcome from musculoskeletal traumatic injuries can be predicted by measures recorded within days of injury. Conflicts of interest: No conflicts of interest. Sources of funding: This study was funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC)

Background and aims: The aim of this study is to investigate how people with chronic pain cope with everyday problems. Methods: Subjects (202 men and 323 women) were patients with chronic pain referred to a rehabilitation unit. The Utrecht Coping List (Dutch version of the WCC – ways of coping checklist) was used to measure their coping style at referral. It has 7 factors: approach and avoidance, palliative behaviour, social support, depressive/passive reaction, expressing emotion and comforting cognitions. Results: Men with chronic pain have lower scores on active problem solving behaviour, and higher scores on palliative behaviour and depressive reaction than men without pain (p< .001). Women with chronic pain have also lower scores on active problem solving behaviour than women without pain, but also on social support and expressing emotion. Like the men scores for women are higher on palliative behaviour (p< .001) and depressive reaction (p< .01), but also on avoidant behaviour (p< .01) and comforting cognitions (p< .001). Data shows that women with pain have higher scores than men with pain on all scales, except for expressing emotion. Differences on palliative behaviour, avoidant behaviour, social support and comforting cognitions are significant (p < .001). Conclusions: People – women as well as men – with chronic pain show less active coping behaviour, have a higher score on depressive reaction on problems and use more palliative behaviour in problem situations than people without somatic complaints. It is important to stress the differences between women and men with chronic pain in problem solving behaviour

The superior analgesic effects of minodronate compared with other bisphosphonates has been previously reported. However, to our knowledge, there are no studies analyzing the analgesic effects of bisphosphonates on chronic pain. The purpose of the present study was to evaluate the analgesic effects of minodronate (MIN), alendronate (ALN), and pregabalin (PRG) on chronic pain caused by chronic constriction injury (CCI) of the sciatic nerve. Four-week-old female Wister rats underwent ovariectomy. At 8 weeks old, the left sciatic nerve was ligated to induce the chronic pain model (CCI side), and sham surgery was performed on the right posterior limb as a CCI control (control side). The rats were divided into the following four groups: 1) MIN group, administered with minodronate (0.15 mg/kg/week) (n = 10); 2) ALN group, administered with alendronate (0.15 mg/kg/week) (n = 10); 3) PRG group, administered with pregabalin (10 mg/kg) (n = 9); and 4) Control group, administered with vehicle (n = 10). Treatments were administered subcutaneously every week for 2 weeks immediately after CCI. To quantify the sensitivity to a tactile stimulus, paw withdrawal in response to a tactile stimulus was measured using von Frey filaments at 0, 1, and 2 weeks after CCI. Von Frey filaments were applied to the plantar surface of the hindpaws for 3 s, and this was repeated three times. Paw withdrawal in response to the stimulus was evaluated by scoring as follows: 0, no response; 1, a slow and/ or slight response to the stimulus; 2, a quick withdrawal response; 3, an intense withdrawal response away from the stimulus. The mean value of the score was adopted as the pain score. After evaluating the response, bilateral femurs were harvested for bone mineral density (BMD) measurements. The pain score of the CCI side was significantly higher than that of the sham side in all groups (p < 0.05) at each time point. The pain score for the MIN group, but not the ALN group, of the CCI side was significantly lower (p = 0.05) at 0 and 1 week after CCI. Total femoral BMD of the CCI side was significantly lower in the PRG and Control groups than those of the MIN and ALN groups (p < 0.05). No significant difference was identified for BMD between the MIN and ALN groups. Minodronate showed a significant analgesic effect on chronic pain and suppressed osteoporotic changes caused by CCI

Introduction: The principal aim of total knee replacement (TKR) surgery is to relieve chronic knee pain. However, following recuperation from surgery, 10–30% of patients report chronic pain in the replaced joint. There has been little research investigating the impact of this continuing pain on patients’ lives or exploring the way in which individuals adjust to this pain. Therefore, the aim of this study is to explore, from their own perspectives, patients’ experiences of chronic pain following this end-stage treatment of TKR. Participants and Methods: Participants were twenty-eight patients who had undergone a TKR with the National Health Service at Bristol, Southwest UK, and who reported chronic pain in the replaced knee joint at least one year post-operatively. Purposive sampling was used in order to recruit participants both of a range of ages and with moderate to severe chronic pain. In-depth, semi-structured interviews were conducted with participants. Interviews explored individuals’ perceptions of the identity of their condition, its cause, duration and consequences and whether they had any control over it. Data was analysed using thematic analysis. Results: Analysis revealed that, while all participants experienced chronic pain which necessitated the use of pain relief medication, there was great variation among individuals in terms of their adjustment to their condition: while some were well adjusted and accepting of their pain, for others the pain constituted a source of ongoing distress. Regardless of their expectations concerning level of pain following TKR, those participants who perceived an improvement in pain as a result of their TKR were less likely to expect a cure for their residual pain and were either very well or reasonably well adjusted to the pain. Nevertheless, those who had moderate expectations of outcome were more likely to perceive an improvement than those with high expectations. Those individuals who reported having held high expectations of TKR outcome and subsequently experienced increased pain were likely to experience distress in relation to their pain; those who also felt that a cure for their current pain may be possible experienced particularly high levels of distress. Discussion: The findings show the significance of cognitions, beliefs and expectations to individuals’ adjustment to chronic pain following TKR. They highlight a group of patients for whom adjustment may be problematic, which could indicate the need for assessment and intervention. There could be potential for surgeons to influence their patients’ adjustment positively by attempting to instil realistic expectations both prior to surgery and when chronic pain is experienced after recovery from TKR

We conducted a community survey of the prevalence, health impact and location of chronic pain. We explored the relationship and patterns of chronic pain that commonly occur, with a view to understanding why some treatment approaches may be more appropriate than others for particular patterns of pain. In 2002, 2504 randomly sampled patients from 16 General Practices in the South East of England responded to a postal questionnaire about chronic pain. Those with chronic pain completed a pain drawing. We calculated descriptive statistics, relative risk and correlations to identify the associations and risks of having linked pain. The highest prevalences were low back (23%), shoulder (20%) and knee (18%) pain. The number of pain sites experienced was age related in men but less so in women. Lower body pain was more age related than upper body and non musculoskeletal pain. Multi site pain was more common than single site pain. Of those with low back, knee and shoulder pain, 14%, 4.5 % and 1.9% had only low back, knee and shoulder pain respectively. Correlations and minimum spanning trees showed that chronic upper and lower body pain are distinct and axial pain link the two. Chronic pain is more likely to be multi site, especially at middle age. Research, physical treatments and approaches to managing chronic pain are often site specific, therefore specialising treatment to one area eg low back pain often negates the bigger issue. This may help explain the self perpetuating problem of persistent chronic pain

Abstract. Introduction. Approximately 15–20% of patients report chronic pain three months after total knee replacement (TKR). The STAR care pathway is a clinically important and cost-effective personalised intervention for patients with pain 3 months after TKR. The pathway comprises screening, assesment, onward referral for treatment and follow-up over one year. In a multicentre randomised controlled trial comparing the pathway with usual care, the pathway improved pain at 6 and 12 months. This study examined the longer-term clinical and cost-effectiveness of the STAR care pathway. Methodology. STAR trial participants were followed-up at a median of 4 years post-randomisation. Co-primary outcomes were self-reported pain severity and interference in the replaced knee, assessed with the Brief Pain Inventory (BPI). Resource use from electronic hospital records was valued with UK reference costs. Results. Of the 337 participants active at trial completion, 326 had confirmed vital status, and 226 (69%) provided outcome data at a median of 4 years. The between-group difference in mean BPI severity score was −0.42 (95% CI −1.07, 0.23; p=0.20) and for BPI interference was −0.64 (95% CI −1.41, 0.12; p=0.10), favouring the intervention. Multiple imputation analyses led to attenuations of about 0.2 points. Mean hospital admission costs over four years were £2461.49 (95% CI £1354.42, £3568.57) in the intervention arm and £3791.68 (95% CI £2095.12, to £5488.24) in usual care. Conclusion. These data are consistent with sustained benefits from the STAR care pathway at 4 years, albeit attenuated and with wider confidence intervals, in part attributable to attrition after 1 year

Background. Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalised sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Methods. Data were analysed from 254 patients receiving THR and 239 patients receiving. TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. Results. In both the THR and TKR cohort, lower PPTs (heightened widespread pain. sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. Conclusions. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. Level of Evidence. 2. Approvals. The APEX trials were registered as an International Standardised Randomised Controlled Trial (96095682), approved by Southampton and South West Hampshire Research Ethics Committee(09/H0504/94) and all participants provided informed written consent

Due to limitations of existing pharmacological therapies for the management of chronic pain in osteoarthritis (OA), surgical interventions remain a major component of current standard of care, with total joint replacements (TJRs) considered for people who have not responded adequately to conservative treatment. This study aimed to quantify the economic burden of moderate-to-severe chronic pain in patients with OA in England prior to TJR. A retrospective, longitudinal cohort design was employed using Clinical Practice Research Datalink GOLD primary care data linked to Hospital Episode Statistics secondary care data in England. Patients (age ≥18 years) with an existing OA diagnosis of any anatomical site (Read/ICD-10) were indexed (Dec-2009 to Nov-2017) on a moderate-to-severe pain event (which included TJR) occurring within an episode of chronic pain. 5-year TJR rates from indexing were assessed via Kaplan-Meier estimates. All-cause healthcare resource utilisation and direct medical costs were evaluated in the 1–12 and 13–24 months prior to the first TJR experienced after index. Statistical significance was assessed via paired t-tests. The study cohort comprised 5,931 eligible patients (57.9% aged ≥65 years, 59.2% female). 2,176 (36.7%) underwent TJR (knee: 54.4%; hip: 42.8%; other: 2.8%). The 5-year TJR rate was 45.4% (knee: 24.3%; hip: 17.5%; other: 6.8%). Patients experienced more general practitioner consultations in 1–12 months pre-TJR compared with 13–24 months pre-TJR (means: 12.13 vs. 9.61; p<0.0001), more outpatient visits (6.68 vs. 3.77; p<0.0001), more hospitalisations (0.74 vs. 0.62; p=0.0032), and more emergency department visits (0.29 vs. 0.25, p=0.0190). Total time (days) spent as an inpatient was higher in 1–12 months pre-TJR (1.86 vs. 1.07; p<0.0001). Mean total per-patient cost pre-TJR increased from £1,771 (13–24 months) to £2,621 (1–12 months) (p<0.0001). Resource-use and costs incurred were substantially greater in the 12 months immediately prior to TJR, compared with 13–24 months prior. Reasons for increased healthcare and economic burden in the pre-TJR period deserve further exploration as potential targets for efforts to improve patient experience and efficiency of care

Introduction: Chronic joint pain is the primary reason for individuals electing to undergo TKR and therefore pain relief is an extremely important outcome after surgery. Although the literature suggests that TKR produces excellent pain relief, the prevalence of chronic pain after TKR is often masked in the reporting of mean pain scores. The aim of this study was to explore the prevalence, impact and onset of pain at 1-year after TKR. Methods: 243 patients (251 knees) were recruited into a multi-centre randomised controlled trial comparing the outcomes of the Kinemax Plus fixed-bearing and mobile-bearing implant. Patients were assessed pre-operatively and then 3 months, 1-year and 2-years post-operatively. At each assessment time patients completed the WOMAC, KOOS quality of life scale, SF-12, American Knee Society Score, Satisfaction Scale for Joint Replacement Arthroplasty and a clinical examination. As part of the clinical assessment patients were asked to rate the pain in their knee as none, mild, occasionally moderate, continually moderate or severe. Results: To date, 240 knees have reached their 1-year follow-up. Complete data regarding pain ratings was available for 198 patients. The mean age of patients was 68 years (range 40–81) and 52% were male. At 1-year after TKR, 13% of patients had occasionally moderate pain, 6% had continually moderate pain and 6% of patients had severe pain. In total, 25% patients reported moderate-severe pain at 1-year after TKR. 60% patients with pain at 1-year post-operative also experienced moderate-severe pain at 3 months post-operative. Using a Mann-Whitney U test, patients with moderate-severe pain at 1-year after TKR had significantly worse physical function (p< 0.001), knee-related quality of life (p< 0.001) and mental health scores (p< 0.05) than those patients with no-mild pain. Conclusion: This study suggests the prevalence of pain after TKR is high, with 25% of patients reporting moderate-severe pain at 1-year after TKR. Pain experienced at 1-year post-operative was most frequently preceded by pain at 3-months post-operative, suggesting that for many patients a pain-free period after surgery is not experienced. The pain present at 1-year after TKR affected several domains of life, including functional ability, quality of life and mental health. Future research will focus on developing a pre-operative screening protocol to identify patients at risk of chronic pain after TKR. This research was supported by funding from Stryker UK

There have been no studies assessing the acceptability of opioid tapering in the pre-arthroplasty setting. This qualitative study aimed to (1) explore barriers and facilitators to opioid tapering amongst patients with chronic non-cancer pain (CNCP), and (2) explore the similarities and differences in acceptability of opioid tapering between pre-arthroplasty patients and those participating in a biopsychosocial pain management program. From January 2021, adult participants diagnosed with CNCP and taking opioids daily (any dose at time of screening for a period of 3 months) were recruited from either Fairfield Orthopaedic Hip and Knee Service (FOHKS) or Liverpool Hospital Pain Clinic (LHPC). Semi-structured interviews underwent thematic analysis using the framework method. 17 participants were recruited (FOHKS, n=9, mean age 67, female 77%, LHPC, n=8, mean age 54, female 63%). Both groups had participants who; (i) were reluctant to use opioid medications and used them out of “necessity”, (ii) were reluctant to taper due to concerns of worsening pain, quality of life, (iii) believed opioids were “toxins” causing bodily harm. Some FOHKS participants believed tapering should be a post-operative focus, whilst others believed tapering opioids pre-operatively will assist in post-op pain management. Few LHPC participants felt dependent/addicted to opioids, thus driving their intention to taper opioids. The belief of tapering opioids causing worse pain was based on either previous experiences or concerns alone. Some FOHKS participants were more inclined to taper opioids if they were educated on the chronic and peri-operative risks associated with using opioids at time of arthroplasty. Opioid users recognise the harms associated with chronic opioid use and believe they are used out of desperation for adequate analgesia, function, and quality of life. Tapering opioids in the pre-arthroplasty context may need coupling with patient education highlighting the importance of opioid tapering pre-operatively

Introduction. Pain is an expected and appropriate experience following traumatic musculoskeletal injury. By contrast, chronic pain and disability are unhelpful yet common sequelae of trauma-related injuries. Presently, the mechanisms that underlie the transition from acute to chronic disabling post-traumatic pain are not fully understood. The aim of this study is to identify prognostic factors for risk of developing chronic pain and disability following acute musculoskeletal trauma. Methods. A prospective observational study will recruit two temporally staggered cohorts (n=250 each cohort; 10 cases per candidate predictor) of consecutive acute musculoskeletal trauma patients aged ≥16 years, who are emergency admissions into a Major Trauma Centre in the United Kingdom, with an episode inception defined as the traumatic event. The first cohort will identify prognostic factors to develop a screening tool to predict development of chronic and disabling pain, and the second will allow evaluation of the predictive performance of the tool (validation). The outcome being predicted is an individual's absolute risk of poor outcome measured at 6-months follow-up using the Chronic Pain Grade Scale (poor outcome ≥Grade II). Candidate predictors encompass the four primary mechanisms of pain: nociceptive (e.g. injury characteristics), neuropathic (e.g. painDETECT), inflammatory (biomarkers), and central hypersensitivity (e.g. quantitative sensory testing). Concurrently, patient-reported outcome measures will assess general health and psychosocial factors. Risk of poor outcome will be calculated using multiple variable regression analysis. Conclusion. A prognostic screening tool for post-trauma pain will inform precision rehabilitation, targeting interventions to individual patients to improve clinical and cost effectiveness. Conflicts of interest: None. Sources of funding: NIHR Surgical Reconstruction and Microbiology Research Centre

Background. There is growing evidence for an important role of central sensitization (CS) in the development and maintenance of chronic pain. Consequently, alleviation of CS might be helpful, as was demonstrated for pregabalin. For tapentadol this is unknown. Tapentadol is a drug with a dual mechanism: 1) it acts on the mu-opioid receptor (µ-OR) and 2) it inhibits the reuptake of noradrenalin in the central nervous system3. The noradrenergic effect might involve a modulation of descending pain pathways and thereby reduce or alleviate CS. Aim. The aim of the present study is to determine the alterations in CS parameters by tapentadol in patients with chronic visceral (endometriosis) pain and deep somatic (low back) pain, using pregabalin as comparator. Hypothesis. In both visceral and deep somatic pain when using tapentadol or pregabalin a decrease in pain (NRS) correlates to a decrease in CS. Method/design. Prospective, open label 2×2 randomized cross-over study in 30 patients with proven endometriosis and 30 patients with chronic (>3 months) low back pain radiating to the leg (CLBPr). Each group of patients will start with either pregabalin of tapentadol for 8 weeks, followed by a wash out period of one week, after which the second drug is used for 8 weeks. Discussion. The rationale for this study is to provide more insights about the affect tapentadol has on CS parameters in comparison to pregabalin in patients suffering from chronic pain that has a visceral or deep somatic origin. No conflict of interest. Sources of funding: Grünenthal

Background. Chronic pain is a significant burden and represents a major issue for world healthcare systems. Interventions include medication, surgery, pain management programmes, and social support through peer support groups. These groups are often informal, providing informational, emotional, and social support to members. The aim of this project is to co-produce guidance on how to establish a peer support programme for people living with chronic, non-cancer pain that is informed by evidence, theory, and stakeholder experience. Methods. This project is using Steps 1–4 of the Intervention Mapping (IM) approach to inform the research. Online workshops consisting of people living with chronic pain, third sector representatives, healthcare professionals, and researchers are being used to co-produce the guidance. Results. To date, 2 of the 4 planned workshops have been conducted. These have identified the needs of people living with chronic pain, goals for the peer support programme, and expectations of how a peer support programme should be executed. Topics for inclusion in the programme and their content have been identified, with further workshops to refine this planned. The final stage of this project will identify methods of delivery, specific resources that should be developed, and the training to be provided to peer support volunteers. Conclusion. The project has identified the diverse needs of people living with chronic pain and how these may be addressed by a peer support programme. It has identified flexible options that can be recommended to those who want to set up a programme and a variety content that may be included. Conflicts of Interest. None. Sources of Funding. Robert Gordon University

Purpose of the study: There are no previous studies for psychometric properties of Finnish version of Tampa Scale of Kinesiophobia questionnaire (TSK-FIN). The aim of this study was to examine test-retest reliability and comparability of two different methods (paper and computer) for the completion of the TSK-FIN among chronic pain patients. Material and methods: Reliability was tested by 94 subjects who participated in the in-patient rehabilitation program. Mean age was 46.8 yrs(SD 7.5). The mean Oswestry index was 34.4% (SD 15.2). All subjects completed both versions at the interval of eight hours in two consecutive days. Test-retest reliability of TSK-FIN for the paper and computer sum scores were tested by Intra-class Correlation Coefficient (ICC). Internal consistency was measured by Chronbach’s alfa. Results: Mean (SD) scores of the paper version were 35.3 (7.8) and 35.6 (7.8). Mean (SD) scores of computer version were 37.1 (8.2) and 36.3 (8.5). Test-retest reliability (ICC) for the paper and computer versions were 0.887 and 0.877 respectively which are both excellent. Intertest reliability (ICC) between paper and computer versions was 0.773 which is acceptable. Both versions demonstrated good internal consistency, Cronbach’s alpha was 0.797 for the paper version and 0.815 for the computer version. Conclusion: Reliability and internal consistency found in this study were consistent with previous studies. Both versions of TSK-FIN demonstrated acceptable test-retest and intertest reliability and internal consistency suggesting suitability for clinical use. However there was tendency that subjects scored higher (t= 3.564, p=0.001) when using computer version. Further research is required to detect clinical importance of the difference

Purpose and background. Acute and chronic spinal pain are major causes of disability, and many patients use analgesics to treat their pain. However, increased use of analgesics, particularly prescription opioids have the potential to be overused and cause dependence. Psychological factors such as stress, anxiety, depression, pain acceptance, pain catastrophising and alexithymia influence both the pain response and analgesic use, yet to date no studies have explored these variables in spinal pain patients. Therefore, the aim of this study is to assess the nature, prevalence and correlates of analgesic dependence among patients with acute or chronic spinal pain. Methods and results. Patients over the age of 18 attending outpatient services at the Royal Derby Hospital with complaints of either acute or chronic spinal pain and currently using analgesics to treat their pain completed the Current Opioid Misuse Measure, the Depression, Anxiety and Stress Scale-21, the Chronic Pain Acceptance Questionnaire-8, the Pain Catastrophising Scale, the Toronto Alexithymia Scale-20, and the Leeds Dependence Questionnaire, a measure of analgesic dependence. Preliminary findings from 52 patients (16 males and 36 females) with chronic spinal pain ranging from 23–88 years old, show that greater pain catastrophising is a significant predictor of analgesic dependence (t = 2.74, df = 51, p = 0.009). Conclusion. The study findings can inform the development of appropriate interventions targeting pain catastrophising to prevent and/or treat analgesic dependence, as well as contributing to potential future research on the understanding of tapering spinal pain patients off analgesic medication. No conflicts of interest. No funding obtained

Background and study purpose. Low back pain with no identified underlying cause is categorised as primary musculoskeletal pain by the International Association for the Study of Pain. In April 2021, the National Institute for Care and Excellence (NICE) published updated guidance for the management of primary chronic pain conditions in England. As part of the De-STRESS pain study, we explored the perspectives of GPs on the updated guideline and impact upon clinical practice. Methods and results. Semi-structured interviews were conducted with 21 GPs in England. Data were analysed using thematic analysis and constant comparison techniques. GPs agreed with the recommendations restricting pharmacological options for pain management and reflected that they now had an expert reference to back-up their decision-making and could use the guidance in potentially difficult conversations with patients. Frustration was expressed by GPs about the lack of alternative options to medication, as the non-pharmacological recommendations were difficult to implement, had lengthy waiting lists, or were unavailable in their locality. Conclusion. Although GPs discussed benefits of the updated NICE guideline in potentially reducing prescriptions of ineffective and potentially harmful medications, frustration about the lack of alternative strategies added to the difficulties encountered in managing people with persistent back pain in primary care. Conflicts of interest: No conflicts of interest. Sources of funding: This study was funded by Versus Arthritis – grant number 22454; Carolyn A Chew-Graham is part-funded by NIHR Applied Research Collaboration (ARC) West Midlands

Purpose. Factors contributing to chronic postoperative pain (CPOP) are poorly defined in young people and developmental considerations are poorly understood. With over 5 million children undergoing surgery yearly and 25% of adults referred to chronic pain clinics identifying surgery as the antecedent, there is a need to elucidate factors that contribute to CPOP in young people. The present study includes patients undergoing hip preservation surgery at a children's hospital. Methods. The HOOS and the SF-12 Health Survey were administered to 614 patients prior to surgery with 422 patients completing follow-up data (6-months, 1-year, and 2-years post-surgery). Examining baseline characteristics for those who completed follow-up versus those who did not, the only significant difference was that patients with more than one surgery were less likely to complete follow-up measures. Pain, quality of life, and functioning across time were examined using SAS PROC TRAJ procedure, a mixture model that estimates a regression model for each discrete group within the population. Longitudinal pain trajectories were empirically grouped. Baseline preoperative characteristics of age, gender, preoperative pain, quality of life, functioning, and mental health that could potentially distinguish trajectory groups were examined. Results. A three trajectory model (low pain, pain improvement, and high pain) emerged indicating three different treatment responders. Pain trajectory groups did not differ significantly on gender, presurgical age, BMI, prior hip surgery, surgical type, joint congruence, or Tönnis grade. The pain trajectory groups differed significantly from each other on presurgical pain, pain chronicity, quality of life, and functioning. Those in the high pain group and pain improvement group endorsed having presurgical depression at significantly higher rates and lower presurgical quality of life compared to those in the low pain group (p<.01). Similarly, those in the high pain group reported significantly worse functioning prior to surgery compared to the pain improvement group (p<.0001) and those in the low pain group (p<.0001). Conclusions. Chronic pain is a common problem and surgery can be a trigger. There may be a subset of hip preservation surgery patients who are predisposed to chronic pain independent of hip health. The results demonstrate the need for preoperative screening prior to hip preservation surgery. A prospective, interventional study to identify patients at risk for a poor pain trajectory is underway. Significance. This is the largest study to date to examine longitudinal pain, quality of life, and functioning trajectories for adolescent and young adults undergoing hip preservation surgery. Chronic pain is a serious public health concern, with the United States spending $19 billion annually on pain-related disability. Identifying predictors of poor long-term outcomes in adolescents and young adult samples with postoperative pain may prevent the development of chronic pain into adulthood as well as inform presurgical preparation and postsurgical care