Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies Objective: To evaluate the efficacy of intraoperative superior hypogastric plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. Methods: A total of 78 female ASA I-II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfil the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). Results: There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the post-anaesthesia care unit and gynaecology ward, and non-steroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9▒min) (P<0.05). All VAS score assessments were found to be statistically significantly low in the SHP group (P<0.05). No complications related to the SHP blocks were observed. Conclusions: Intraoperative superior hypogastric plexus blocks in abdominal hysterectomies are promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single superior hypogastric plexus blocks provide adequate pain relief and reduce analgesic consumption, these blocks would have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations. Clinical trial registration: NCT03428152. Ahmet Kale and Gulfem Basol: New affiliation: Department of Gynaecology and Obstetrics; University of Health Sciences, Kartal Training and Research Hospital, Istanbul, Turkey. Conflicts of interest: None declared. Funding: None declared. Authors’ contributions and authorship: H.G.A., A.K., G.B., and C.B.: Study design and data analysis; H.G.A., A.K., B.S., and G.B.: Patient recruitment, and data collection; H.G.A., C.B., and T.C. writing up of the first draft of the paper. Conflict of interest: The authors have no conflict of interest. Reprints: Hande Gurbuz Aytuluk, MD, Department of Anaesthesiology and Reanimation; Derince Training and Research Hospital, 41900, Kocaeli, Turkey (e-mail: handegrbz@gmail.com). Received May 8, 2019 Received in revised form August 22, 2019 Accepted September 8, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Less Severe Preoperative Synovitis is Associated with Higher Self-reported Pain Intensity 12 Months After Total Knee Arthroplasty – An Exploratory Prospective Observational Study Objectives: Synovitis is one of the possible pain generators in osteoarthritis (OA) and associated with upregulation of pro-inflammatory cytokines, which can lead to worsening of the postoperative pain. This explorative study aimed to investigate the association between perioperative synovitis and self-reported pain 12-months after total knee arthroplasty (TKA) in patients with OA. Methods: Twenty-six knee OA patients were included in this analysis. Perioperative volume of synovitis in predefined locations was assessed by contrast enhanced magnetic resonance imaging (CE-MRI) and dynamic CE-MRI (DCE-MRI). Perioperative synovitis was assessed histologically from biopsies of the synovium. Highest pain intensity within the last 24-hours (visual analog scale, VAS, 0-100) was assessed before and 12-months after TKA. Patients were divided into a low-pain intensity (VAS≤30) and a high-pain intensity (VAS>30) group based on 12-months postoperative VAS. Results: The high-pain intensity group had significantly lower perioperative CE-synovitis (P=0.025), DCE-synovitis (P<0.04) and a trend towards lower histologically assessed synovitis (P=0.077) compared to the low-pain intensity group. Perioperative synovitis scores were inversely correlated with pain intensity 12-months after TKA (P<0.05), indicating that more severe perioperative synovitis is associated with less severe pain intensity at 12-months. Discussion: Higher degrees of perioperative synovitis scores are found to be associated with less postoperative pain 12-months after TKA. Further, correlation analysis revealed that less severe perioperative CE-MRI and DCE-MRI synovitis was associated with higher pain intensity 12-months after TKA, suggesting that CE and DCE-MRI synovitis grades could be used as imaging markers for prediction of chronic postoperative pain after TKA. Original Paper for: Clinical Journal of Pain. Article Type: Clinical/Basic science research report. The authors declare no conflict of interest. Reprints: Kristian Kjær Petersen, PhD, MSc, Center for Neuroplasticity and Pain (CNAP), Center for Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7 D3, DK-9220 Aalborg, Denmark (e-mail: KKP@HST.AAU.DK). Received March 12, 2019 Received in revised form August 8, 2019 Accepted September 8, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Impact of Emotional Regulation Strategies On Pain Catastrophizing in the Context of Interpersonal Relationships Objectives: The Communal Coping Model suggests that pain catastrophizing may serve to elicit support from others. What is not known is how emotional regulation, namely emotional inhibition, impacts pain catastrophizing within the context of an interpersonal relationship. Individuals who have a greater tendency to emotionally inhibit may have a greater likelihood to use catastrophizing as a means for seeking support, particularly in relationships characterized by satisfaction and emotional validation. Methods: Data were collected from 50 undergraduate couples at the University of Michigan-Dearborn. Participants were videotaped during completion of an acute pain cold pressor task and completed measures involving pain catastrophizing, emotional inhibition, and relationship dynamics (i.e. AEQ, WBSI, DAS). In addition, the videotaped interactions were coded for both invalidation/validation and overt expressions of pain catastrophizing. Results: Emotional inhibition, and both validation and invalidation, were associated with pain catastrophizing. Observed validation and invalidation were not, however, directly associated with relationship satisfaction. Hierarchical linear regression showed a significant interaction between thought suppression and relationship satisfaction to predict pain catastrophizing. Discussion: Results show relationship satisfaction moderates the association between pain catastrophizing and thought suppression in a manner in which couples with high levels of relationship satisfaction who also engage in thought suppression are more likely to use pain catastrophizing as a cognitive strategy to elicit support. This study offers direction into treatment, and suggests that couples based cognitive-behavioral treatments that aim to utilize adaptive cognitive and behavioral coping strategies as well as emotional exploration and validation may be beneficial. The authors declare no conflict of interest. Reprints: Michelle Leonard, PhD, Department of Behavioral Sciences, University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48128 (e-mail: mtleon@umich.edu). Received December 5, 2018 Received in revised form July 25, 2019 Accepted August 30, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Acute Pain Assessment in Prematurely Born Infants Less Than 29 Weeks: A Long Way to Go Objectives: Neonates born extremely prematurely are at high risk of acute and prolonged pain. Effective treatment requires reliable pain assessment, which is currently missing. Our study explores if existing pain assessment tools and physiological indicators measure pain and comfort accurately in this population. Methods: We prospectively collected data in 16 neonates born less than 29 weeks gestational age during three conditions: skin-to-skin care, rest and heelstick procedure for capillary blood sampling in the incubator. The neonates were video recorded in these situations and recordings were coded using five observational pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate, arterial oxygen saturation, regional cerebral oxygenation and number of skin conductance peaks. All measures across the three conditions were compared using general linear modeling. Results: The median gestational age was 27.1 weeks (range 24.1 to 28.7). Forty measurement periods across the three conditions were analyzed. Heart rate was significantly higher during heelstick procedures compared to during rest with a mean difference of 10.7 beats/minute (95% CI 2.7 to 18.6). Oxygen saturation was significantly higher during skin-to-skin care compared to during heelstick procedures with a mean difference of 5.5% (95% CI 0.2 to 10.8). The Premature Infant Pain Profile-revised (PIPP-R) score was significantly higher during heelstick procedures compared to skin-to-skin care with a mean difference of 3.2 points (95% CI 1.6 to 5.0). Discussion: Pain measurement in clinical practice in prematurely born infants <29 weeks remains challenging. The included behavioral and physiological indicators did not adequately distinguish between a painful situation, rest and skin-to-skin care in premature neonates. Acknowledgements: Ko Hagoort is thanked for editorial assistance. Conflicts of Interest and Source of Funding: None declared. Reprints: Naomi Meesters, RN, MSc, Erasmus MC-Sophia Children’s Hospital, Department of Pediatrics, Division of Neonatology Wytemaweg 80, 3015 CN Rotterdam, the Netherlands (e-mail: n.meesters@erasmusmc.nl). Received January 14, 2019 Received in revised form July 23, 2019 Accepted August 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Under Pressure to Perform: Impact of Academic Goal Orientation, School Motivational Climate, and School Engagement on Pain and Somatic Symptoms in Adolescents Objectives: Various academic factors are known to influence pain and somatic symptoms in adolescents, but the role of academic goal orientation, school motivational climate, and school engagement are unknown. This study examined how these understudied academic factors are associated with adolescent pain and somatic symptoms and whether gender moderates the relations. Methods: High school students (n=90) from a high-achieving community completed questionnaires assessing academic variables, various pain characteristics, and somatic symptoms. Results: The majority of adolescents (67%) experienced pain and somatic symptoms in the past month, with 56% reporting multisite pain and 58% reporting at least one severe somatic symptom. Headache and abdominal pain were the most frequently reported “most bothersome” pains, and pain was rated, on average, as moderately severe, typically occurring several times per month, and was primarily chronic in nature (duration ≥3▒mo). Higher levels of ego goal orientation and perceived performance motivational climate were associated with more somatic symptoms, and ego goal orientation was also associated with more intense and frequent pain. Alternatively, greater school engagement was associated with fewer somatic symptoms. Task goal orientation and mastery motivational climate were unassociated with all pain and somatic symptom outcomes. Discussion: This study demonstrates that adolescents from a high-achieving community report more somatic symptoms and pain when they are less engaged in school and when their academic focus is on grades and outperforming peers. Results suggest that de-emphasizing competition and performance outcomes may support physical well-being in adolescents. Disclosures: There are no conflicts of interests to disclose for any of the above listed authors. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Reprints: Edin T. Randall, PhD, 9 Hope Ave, Waltham, MA 02453 (e-mail: edin.randall@childrens.harvard.edu). Received February 28, 2019 Received in revised form July 11, 2019 Accepted August 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The Shared Vulnerability Model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Though many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry. This work was conducted at the University of Cincinnati, Cincinnati OH. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author reports no conflicts of interest. Reprints: Kristen E. Jastrowski Mano, PhD, Department of Psychology, University of Cincinnati, 5130D Edwards One, ML 0376, Cincinnati, Ohio 45221-0376 (e-mail: manokn@ucmail.uc.edu). Received March 13, 2019 Received in revised form August 10, 2019 Accepted August 27, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Relation between Patients’ Beliefs about Pain Medication, Medication Adherence and Treatment Outcome in Chronic Pain Patients: A Prospective Study Objectives: Non-adherence to prescribed pain medication is common in chronic non-malignant pain patients. Beliefs about pain medication have been reported to be associated with non-adherence behaviour in cross-sectional studies. The aim of this study was to prospectively investigate the relation between patients’ beliefs about pain medication and their medication adherence and treatment outcome. Methods: Chronic non-malignant pain patients completed a baseline questionnaire including the 47-item Pain Medication Attitudes Questionnaire (PMAQ), consisting of seven subscales regarding beliefs on prescribed medication. After 11 weeks, medication underuse and overuse were assessed by self-report. In addition, patient satisfaction regarding the effect of prescribed pain medication and satisfaction regarding prescribed medication and care, and the burden of side effects were assessed. Results: One hundred thirty three participants completed the baseline questionnaire, and 99 patients completed the follow-up questionnaire. Concerns over side effects at baseline were positively associated with underuse and the presence of side effects after 11 weeks. Perceived need was positively associated with overuse, whereas concerns over addiction were negatively associated with overuse. Concerns over tolerance were negatively associated with patient satisfaction with medication effects after 11 weeks. Concerns over tolerance and mistrust in the prescribing doctor were negatively associated with satisfaction about medication and care. Conclusion: Attitudes and concerns towards pain medication are associated with adherence patterns and outcome parameters. In order to improve medication adherence and therapy outcome, patient beliefs about pain medication should be taken into account by providing tailored education, adequate follow-up or alternate therapy. Declaration of funding: none. Conflicts of interest: none. Reprints: Leon Timmerman, PhD, St Antonius Hospital, Department of Anesthesiology, Intensive Care and Pain Medicine, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands (e-mail: l.timmerman@antoniusziekenhuis.nl). Received February 12, 2019 Received in revised form August 2, 2019 Accepted August 29, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Psychosocial Factors and Knee Pain among Older People in Japan: The JAGES Cross-sectional Study Objectives: Psychosocial factors are known to affect knee pain. However, the magnitude of depression on the associations between socioeconomic status (SES) and knee pain in older individuals remains unknown. This study aimed to determine (1) the associations between SES and knee pain and (2) how depression mediates the associations between SES and knee pain. Methods: We conducted a survey across 30 Japanese municipalities to collect cross-sectional data. Functionally independent community-dwelling adults aged ≥65 (n=26,037) were eligible for the study. Self-reported knee pain in the past year was used as the dependent variable. Past occupation and equivalized household income were separately added to the models as independent variables. Poisson regression analysis was used to examine the associations between SES and knee pain, adjusting for covariates. Mediation analysis was applied to estimate how depression explains these associations. Results: The one-year prevalence of knee pain was 56.0% in our study population. We found that income levels were significantly associated with knee pain: the lowest income level was more prone to experience knee pain compared with the highest income level at a prevalence ratio of 1.22 (95% confidence interval, 1.15–1.28). Depression explained 36.8% of the association of income with knee pain in females and 41.9% in males. Discussion: Significant socioeconomic inequalities were observed regarding knee pain among older individuals in Japan. Depression somewhat explained the association between SES and knee pain. Contributions: Mr. Takaaki Ikeda: Conception, Methodology, Analysis, Manuscript Composition, and Approval. Dr. Jun Aida: Conception, Methodology, Acquisition of data, Analysis, Manuscript Composition, and Approval. Dr. Toru Tsuboya: Conception, Methodology, Manuscript Composition and Approval. Dr. Kemmyo Sugiyama: Conception, Methodology, Manuscript Composition and Approval. Dr. Katsunori Kondo: Conception, Acquisition of data, Methodology, Manuscript Composition, and Approval. Dr. Ken Osaka: Conception, Acquisition of data, Methodology, Manuscript Composition, and Approval. Competing interest statement: There are no conflicts of interest to declare. Conflicts of Interest and Source of Funding: This study was supported by a grant of the Strategic Research Foundation Grant-aided Project for Private Universities from the Ministry of Education, Culture, Sport, Science, and Technology, Japan, 2009–2013, for the Center for Well-being and Society, Nihon Fukushi University, Grants-in-Aid for Scientific Research (22330172, 22390400, 22390400, 22592327, 23243070, 23590786, 23790710, 24390469, 24530698, 24653150, 24683018, 25253052, 25870573, 25870881, 26285138, 26882010, 15H04781, 15H01972, 16H05556, 16K19267, 18KK0057, 19K19818) from the Japan Society for the Promotion of Science. The study was also supported by a Health and Labour Sciences Research Grant, and grants for Comprehensive Research on Aging and Health (H22-Choju-Shitei-008, H24-Junkankitou- Ippan-007, H24-Chikyukibo-Ippan-009, H24-Choju- Wakate-009, H25-Kenki-Wakate-015, H25-Irryo-Shitei-003 [Fukkou], H26-Choju-Ippan-006, H27-Ninchisyou-Ippan-001, H28-Choju-Ippan-002) from the Ministry of Health, Labour and Welfare, Japan, the Research and Development Grants for Longevity Science from AMED (Japan Agency for Medical Research and development, the Personal Health Record (PHR) Utilization Project from AMED, World Health Organization Centre for Health Development (WHO Kobe Centre), (WHO APW 2017/713981), Japan Foundation for Aging and Health Research Support Grant, as well as grants from National Center for Geriatrics and Gerontology. The research funding bodies had no role in the study design, data collection, data analysis, data interpretation, writing, or submitting of the report. There are no conflicts of interest to declare. Reprints: Jun Aida, DDS, PhD, Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan (e-mail: j-aida@umin.ac.jp). Received September 25, 2018 Received in revised form May 15, 2019 Accepted August 29, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Factors Associated with Long-term Risk of Recurrence after Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion for Patients with Trigeminal Neuralgia: A Multicenter Retrospective Analysis Objective: This study aimed to estimate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of the gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up. Methods: We performed a multicenter retrospective analysis of data from 1481 patients with TN who underwent RFT from 2005 through 2017. Recurrence-free survival (RFS) was assessed by Kaplan-Meier method. Risk factors of all patient characteristics were determined by using univariate and multivariate Cox regression analysis. Prognostic value was determined by prognostic index (PI) with regression coefficients and receiver-operating characteristic curve model. Results: The median of RFS was 136 months (95%CI: 123.5-148.5). The rate of RFS was 85.3% (95%CI: 83.5-87.1%) at 1 year, 74.6% (95%CI: 72.2-77.0%) at 3 years, 68.0% (95%CI: 65.5-70.5%) at 5 years, and 54.9% (95%CI: 51.6-58.2%) at 10 years, respectively. Multivariate analysis showed that atypical facial pain (HR=16.914, 95%CI: 13.117-21.808, P<0.001), BNI (Barrow Neurological Institute) Class II/III facial hypesthesia pre-RFT (HR=2.473, 95%CI: 1.523-4.016, P<0.001)/(HR=3.288, 95%CI: 1.035-10.433, P=0.044), and history of previous MVD (microvascular decompression)/RFT/neurosurgeries≥2 (HR=1.642, 95%CI: 0.941-2.863, P=0.041)/(HR=2.808, 95%CI: 1.819-4.334, P<0.001)/(HR=3.832, 95%CI: 1.802-8.146, P<0.001) were independently associated to RFS. Patients with PI>0.764 were identified as high-risk for TN recurrence with a median RFS of 36 months (95%CI: 23.9-48.1) compared with those with PI<0.764 (HR=6.785, 95%CI: 5.371-8.573, P<0.001). Discussion: Our results indicated which patients have a high risk for recurrence after RFT for treatment of TN. In addition, our findings might provide support for the clinical decision making before RFT procedure. Shuyue Zheng, MD (First author) (requests for reprints) Abbreviations: BNI, Barrow Neurological Institute; CI, confidence interval; CTN, classical trigeminal neuralgia; EMR, electronic medical records; FO, foramen ovale; HR, hazard ratio; IQR, interquartile range; ITN, idiopathic trigeminal neuralgia; MS, Multiple sclerosis; MVD, microvascular decompression; NRS, numeric rating scale; NVC, neurovascular conflict; PI, prognostic index; RFS, recurrence-free survival; RFT, radiofrequency thermocoagulation; ROC, receiver-operating characteristic curve; SRS, stereotactic radiosurgery; STN, secondary trigeminal neuralgia; TN, trigeminal neuralgia; TSEP, trigeminal somatosensory evoked potential. Conflict of Interest: No funding was provided for this study from any source. No financial benefits were provided to the authors. No previous presentation of the research, manuscript, or abstract in any form has occurred. No conflicts of interest were in this study. Reprints: Jiaxiang Ni, MD, Department of Pain Management, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, China, 100053 (e-mail: njxpain@163.com). Received April 30, 2019 Received in revised form July 22, 2019 Accepted August 20, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Clinical Features of Pediatric Complex Regional Pain Syndrome: A 5-Year Retrospective Chart Review Objectives: Complex regional pain syndrome (CRPS) is a painful condition of a limb characterized by a constellation of symptoms. Little is known about the clinical features of pediatric CRPS, with fewer than a dozen studies published to date. The aim of this study was to explore the clinical course of pediatric CRPS, with emphasis on clinical features and disease outcomes. A secondary aim was to discern differences in clinical features of pediatric CRPS with and without related movement disorders, and between children who had a favorable and unfavorable outcome. Methods: Retrospective chart review of children with CRPS who presented to a pediatric Chronic Pain Clinic in Canada over a 5-year period (2012-2016). Results: The study identified 59 children with CRPS (mean age 12.7±2.5; 74.6% female; 72.9% lower extremity). Eighty-seven percent (n=48) of children experienced completely resolution or significantly improvement of CRPS, with a relapse rate of 15%. Twenty-five percent (n=15) had a CRPS-related movement disorder. There were no differences in the clinical features of pediatric CRPS with or without related movement disorders. Children who experienced a favorable outcome had a significantly shorter symptom duration at initial visit in comparison to children who experienced an unfavorable outcome. Discussion: In this cohort, pediatric CRPS was most common in females around the age of 12, usually in the lower extremity, and most experienced a favorable outcome. Further research is needed to better understand the prognosis and relapse rate of pediatric CRPS. Acknowledgements: None. Funding: None. Conflicts of interest: None. Reprints: Giulia Mesaroli, MScPT, 555 University Avenue, Toronto, Ontario, Canada, M5G 1×8 (e-mail: giulia.mesaroli@sickkids.ca). Received April 12, 2019 Received in revised form July 11, 2019 Accepted August 19, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.