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'Unmasking Pain' is an innovative artist-led project to explore creative approaches for telling stories of life with persistent pain. The purpose of this qualitative study was to explore and describe the lived experience of taking part in 'Unmasking Pain' from the perspectives of people living with pain (workshop attendees), artists (workshop facilitators) and pain rehabilitation specialists. Informed by descriptive phenomenology, data was collected via semi-structured interviews with three artists (workshop facilitators), five workshop attendees (all living with persistent pain) and one pain rehabilitation specialist. Data was analysed using thematic analysis for descriptive phenomenology. Three themes emerged from the analysis: Theme 1 Space to Breathe, reflects the context of 'Unmasking Pain' such as the conditions, environment and setting that people experienced; Theme 2 Flexibility to Participate, reflects the experience of the process of 'Unmasking Pain' such as the actions or internal workings/behaviours of the experience; and Theme 3 Possibility for Change, reflects the cognitive or emotional experience of 'Unmasking Pain'. There were nine sub-themes: 1(a) Dissolved hierarchy, 1(b) Human connection, and 1(c) Personally meaningful; 2(a) Go with the flow, 2(b) Enjoyable experience, and 2(c) Curiosity to step into the unknown; and 3(a) Reforming pain, 3(b) Liberating in the moment (now), and 3(c) Gives you a boost (future). In conclusion, the uniqueness of 'Unmasking Pain' was to creatively facilitate curiosity and exploration of pain in a non-clinical, sociocultural, humanised context, to enable the possibility of a different pain experience. The findings from this qualitative study exploring the lived experience of taking part in 'Unmasking Pain' demonstrates the power and opportunity of the Arts sector and artist-led activities to support people with chronic pain to have a better pain experience., Competing Interests: All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. MIJ wishes to declare that in the previous 5 years, his employer has received income for expert consultancy activities from GSK plc, TENSCare Ltd, and LifeCare Ltd. that lie outside of the submitted work. MIJ also declares book royalties from Oxford University Press. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Thompson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Although biliary atresia (BA) is a rare neonatal disorder, it remains the leading cause of pediatric end-stage liver disease. Early diagnosis of BA and treatment with the Kasai procedure can significantly reduce the need for pediatric liver transplant. Current data suggests that performing the Kasai procedure at 30-45 days of life is associated with longer native liver survival rates and reduction of the need for liver transplant. The incidence rate of BA in the state of Hawai'i is nearly double the incidence rate in the continental US. International studies have demonstrated that screening programs for BA reduce the age at diagnosis and treatment. However, there has been no statewide analysis on the ages at diagnosis or at Kasai, nor does a statewide screening program for BA exist. The purpose of this study is to review the age of diagnosis and treatment of BA to determine if the current practice in Hawai'i is in line with the published data. A retrospective chart review of all patients diagnosed with BA at the state's primary children's hospital was performed (2009-2023) and 19 patients who underwent the Kasai procedure were identified. The mean age at diagnosis is 71.4 days (n=19) and the mean age at Kasai procedure is 72.0 days (n=19). Both the average age at diagnosis and treatment for BA in Hawai'i is significantly higher than published data suggesting best outcomes at 30-45 days of life. This review suggests that the implementation of a statewide screening program for BA in Hawai'i is warranted., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2024 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Objective: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee., Design: A randomized-controlled trial., Setting: Special Rehabilitation Services in Taboão da Serra., Participants: Patients with bilateral knee osteoarthritis., Intervention: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks., Main Outcome Measures: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up)., Results: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was -3.08 points (95% confidence interval -4.13; -2.02), p  < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was -2.40 points (95% confidence interval -3.34; -1.45), p  < 0.01 with an effect size of 1.24; and mean difference for disability was -4.08 points (95% confidence interval -5.89; -2.26), p  < 0.01 with an effect size of 1.04., Conclusion: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this study. Mark I. Johnson's declares that in the previous 5 years his employer has received income for expert consultancy services that he has undertaken for GSK plc, TENSCare, and LifeCare Ltd. that lie outside of the submitted work. Mark I. Johnson also declares book royalties from Oxford University Press.

In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a "whole person" approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called "Rethinking Pain" that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service., Competing Interests: In the previous 5 years, MJ employer has received income for expert consultancy activities from GlaxoSmithKline, TENSCare, and LifeCare Ltd. that lie outside of the submitted work. MJ declares book royalties from Oxford University Press. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Johnson, Page, Woodall and Thompson.)