Director, Research Institute of the Hebrew Home of Greater Washington, and Professor, Department of Health Care Sciences and of Prevention and Community Health, George Washington University, Rockville, Maryland; and Coordinator, Odyssey Certificate Program in Aging Studies, The Johns Hopkins University, Baltimore, Maryland, U.S.A.
[Record supplied by publisher]
OBJECTIVES: The aims of this study were to (1) identify behaviors that occur in noncommunicative nursing home residents that are perceived by nurses to be indicators of pain, (2) determine factors affecting the differentiation of pain behaviors from similar behaviors due to other causes, and (3) assess nurses' perceptions of the prevalence and importance of specific indicators of pain as well as barriers to the detection of pain in this population. SETTING AND PATIENTS: Seventy-two staff members of three nursing homes were interviewed and surveyed about specific behaviors associated with pain. Focus groups were conducted with staff to validate pain indicators and investigate perceptions of their own ability to identify pain. RESULTS: Nursing staff members agreed on a core group of behaviors that they perceive as pain indicators in elderly persons suffering from dementia. These indicators include specific physical repetitive movements, vocal repetitive behaviors, physical signs of pain, and changes in behavior from the norm for that person. The nursing staff members' level of familiarity with the residents was reported to have a significant effect on staff members' ability to identify and differentiate pain behaviors from other behaviors of impaired residents. Barriers to the detection of pain pertain to staff issues, resident behaviors, and resident-staff relationships. CONCLUSIONS: The study of pain among the noncommunicative elderly and, in particular, the development of a tool that can be used to assess their pain may greatly improve the quality of life of the estimated 20% to 35% of nursing home residents who cannot adequately express their needs.
PMID: 11803305
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Clin J Pain 2002 Mar;18(1):56-63
Department of Psychology, Wofford College, Spartanburg, South Carolina, and Pain Prevention and Treatment Research, Duke University Medical Center, Durham, North Carolina, U.S.A.
[Medline record in process]
OBJECTIVE: The assumption that individuals are capable of accurately recalling past painful experiences has been a fundamental tenet of a number of cognitive-behavioral theories of pain, including the gate control theory. However, there has been very little research on the topic in the past, and the results have often been contradictory. A general conclusion that can be drawn is that memory for pain is variable, and there is need to identify what factors contribute to this variability in memory for pain. The current study examined the relation of catastrophizing to the recall of persistent pain associated with rheumatoid arthritis. METHODS: Participants in this study were 45 individuals with persistent pain due to rheumatoid arthritis. Each participant was asked to complete a daily pain diary for a period of 30 days. Participants were subsequently asked to recall the pain they experienced over the entire period of time rather than provide a single, average rating. RESULTS: The results of a series of hierarchical regression analyses indicated that level of catastrophizing was related to the recall of both pain intensity and pain variability. This relation was statistically significant even after controlling for actual pain and variability and other background variables. CONCLUSIONS: Participants who scored higher on catastrophizing demonstrated better accuracy in the recall of general pain intensity and pattern over a 30-day diary period. The results of the study are discussed in terms of future studies as well as their potential clinical importance.
PMID: 11803304, UI: 21661720
Clin J Pain 2002 Mar;18(1):48-55
Pain Relief Unit, Department of Neurosciences, Ospedale Molinette, Torino, Italy.
OBJECTIVE: Extradural cortical stimulation is a recent addition to the armamentarium of functional neurosurgery. This article reviews results of treatment of chronic central and neuropathic pain. CONCLUSIONS: It is concluded that extradural cortical stimulation may be effective in several refractory cases.
PMID: 11803303, UI: 21661719
Clin Orthop 2002 Jan;(394):303-6, 309-12
Summa Health System, Akron, OH 44309-2090, USA.
Publication Types:
PMID: 11795747, UI: 21654056
Spine 2002 Jan 15;27(2):206-10
School of Social Sciences, University of Teesside, Middlesbrough, the Dryburn Hospital, Durham, the Hartlepool General Hospital, Hartlepool, and the Middlesbrough General Hospital, Middlesbrough, UK.
STUDY DESIGN: A prospective test-retest study was conducted to investigate both new and follow-up patients with low back pain presenting to an orthopedic surgeon specializing in back pain. OBJECTIVES: To further validate the internal consistency and test-retest reliability of the Low Back Outcome Score, and to compare these results with other condition-specific disability scales. SUMMARY OF BACKGROUND DATA: To be useful in clinical practice, health-specific questionnaires must demonstrate reliability and validity. Several disease-specific questionnaires for low back pain have been validated to different extents. METHODS: In this study, 102 new and 42 follow-up patients consecutively attending a consultant clinic completed the Low Back Outcome Score on their visit, then again after an interval of 1 week in postal form. This instrument also was completed by 230 patients presenting to a physiotherapist. RESULTS: A response rate of 90% was achieved for the postal questionnaire. A test of internal consistency conducted with the study sample achieved a Cronbach alpha coefficient of 0.85. Overall agreement for test-retest reliability was 84%, and the reliability coefficient (K) reached a range of 0.51 to 0.86 (P < 0.05). A Bland/Altman plot was calculated, demonstrating that only 5% of patient scores change by more than 11.6 scale points between test and retest, which is not sufficient to change outcome categories. CONCLUSION: The Low Back Outcome Score appears to have good internal consistency and test-retest reliability for use in clinical practice.
PMID: 11805669, UI: 21664545
Spine 2002 Jan 15;27(2):201-5
Department of Anesthesiology, the Section of Neurosurgery, and the Spine Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
STUDY DESIGN: A cross-sectional analysis of data obtained from patients with spinal and radicular pain and their spine center treating physicians was performed. OBJECTIVES: To identify characteristics of patients treated with opioids that distinguish them from similar patients not treated with opioids in a large population of patients with spine and radicular pain, and to determine the prevalence of opioid use. SUMMARY OF BACKGROUND DATA: The use of opioids with patients who have chronic pain remains controversial. The long-term risks and benefits are poorly described. The efficacy of this treatment has not been proved, yet the large majority of pain specialist physicians manage chronic pain with opioids. METHODS: Descriptive data from the initial visits of 25,479 patients with spinal pain were reviewed. Patients were grouped according to whether or not opioids were recommended, prescribed, or continued. The prevalence of opioid use and patient characteristics were compared using standard statistical tests. RESULTS: Overall, 3.4% of the patients had opioids included in their plan of care. There was no difference in age, gender, education, or compensation status between the two groups. Patients were more likely to be treated if the duration of their symptoms had been less than 3 months. However, 75% of the patients with opioids in their plan had experienced symptoms longer than 3 months. A greater incidence of objective findings was identified in the opioid group. CONCLUSIONS: The authors cannot comment on the prevalence of opioid use because, to the best of their knowledge, no other similar studies are available for comparison.
PMID: 11805668, UI: 21664544
Spine 2002 Jan 15;27(2):196-200
Spine and Joint Centre, Rotterdam, the Netherlands, the Departments of Biomedical Physics and Technology, Rehabilitation Medicine, and General Practice Medicine, Erasmus University, Rotterdam, the Netherlands.
STUDY DESIGN: A cross-sectional analysis was performed with a group of women meeting strict criteria for posterior pelvic pain after pregnancy. The active straight leg raise test and common severity measurement scales of lumbopelvic pain were scored. OBJECTIVE: To assess the validity of the active straight leg raise test as a disease severity scale for patients with posterior pelvic pain after pregnancy. SUMMARY OF BACKGROUND DATA: Various diagnostic tools are used to measure disease severity in patients with posterior pelvic pain after pregnancy, but simple tests with high reliability and validity still are needed. METHODS: The investigation was performed with 200 women who had posterior pelvic pain after pregnancy. The validity of the active straight leg raise test as a severity scale was investigated by comparing the test score with the medical history, scores on self-reported disability scales, pain and tiredness, and pain provocation tests. The usefulness of the active straight leg raise test as a severity scale was compared with that of the Quebec Back Pain Disability Scale. The influence of several demographic and anthropometric variables on the active straight leg raise score was investigated. RESULTS: The active straight leg raise score ranged from 0 to 10 and correlated as expected with all severity scales. The correlation between the scores on the active straight leg raise test and the Quebec Back Pain Disability Scale was 0.70. No association was found between the active straight leg raise score and age, parity, duration of the postpartum period, height, or weight. CONCLUSION: The active straight leg raise test can be recommended as a disease severity scale for patients with posterior pelvic pain after pregnancy.
PMID: 11805667, UI: 21664543
Spine 2002 Jan 15;27(2):187-95
Rehabilitation Unit, Don Carlo Gnocchi Foundation ONLUS, Care and Research Institute, Milan, Italy.
STUDY DESIGN: A cross-sectional study was conducted. OBJECTIVES: To investigate schoolchildren's subjective perceptions of their daily backpack loads, to ascertain whether an association exists between these sensations or the load itself and back pain, and to identify the school, family, and personal factors that determine the backpack load, and that might, with a view to primary prevention, be addressed with specific interventions. SUMMARY OF BACKGROUND DATA: Backpack carrying has been shown to constitute a considerable daily "occupational" load of the spine in schoolchildren. Although society perceives backpack carrying as a problem, the scientific community currently offers very few answers. The backpack load borne by schoolchildren exceeds, proportionally, the legal load-bearing limits set for adults, and the association with low back pain is questioned. METHODS: All the backpacks of the 237 year 6 children in a school catchment area of Milan were weighed on six school days. The data were analyzed in groups according to the schools and classes involved, the single children, and the days of the week. A validated questionnaire also was administered to 115 schoolchildren (54 boys and 61 girls; average age, 11.7 years) whose anthropometric characteristics and loads carried daily were known. The associations among features of backpack carrying, subjective perceptions of the load (fatigue, feeling it to be heavy, pain) and back pain (point and life prevalence) were assessed and verified. RESULTS: School backpacks are felt to be heavy by 79.1% of children, to cause fatigue by 65.7%, and to cause back pain by 46.1%. Fatigue during and time spent backpack carrying, but not the backpack's weight, are associated with back pain. The determining factors were found to be classes (e.g., range, 8.87-10.59 kg), days of the week (e.g., range, 5.75-12.74 kg.), and single students (e.g., range, 4.2-9.5 kg.), but not individual schools. CONCLUSIONS: Daily backpack carrying is a frequent cause of discomfort for schoolchildren. There is an association between this load and back pain, although the relationship is not direct. The results suggest the existence of personal physical and psychological factors that need to be investigated. Reduction of the daily backpack load borne by schoolchildren is recommended both on the basis of the current results and because it exceeds, proportionally, the legal load limits set for adults. All the different parties involved (school system, parents, children) play a role, and if the aim is to reduce this "weight of culture," all should be targeted through specific interventions. Recommendations are supplied for the achievement of this aim.
PMID: 11805666, UI: 21664542
Spine 2002 Jan 1;27(1):E1-8
School of Physiotherapy, Curtin University of Technology, Shenton Park, Western Australia, Australia.
STUDY DESIGN: An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted. OBJECTIVE: To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern. SUMMARY OF BACKGROUND DATA: The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise. METHODS: In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography. RESULTS: The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement of pelvis stability via manual compression through the ilia reversed these differences. CONCLUSIONS: The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury.
PMID: 11805650, UI: 21664525
Spine 2002 Jan 1;27(1):92-8
Injury Prevention Research Centre, University of Auckland, New Zealand.
STUDY DESIGN: A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later. OBJECTIVE: To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain. SUMMARY OF BACKGROUND DATA: Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage. METHODS: At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants' computerized records. RESULTS: The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1-4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05). CONCLUSIONS: Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.
PMID: 11805644, UI: 21664519
Spine 2001 Dec 15;26(24 Suppl):S161
PMID: 11805623, UI: 21665392
Spine 2001 Dec 15;26(24 Suppl):S146-60
Department of Neurological Surgery, Oregon Health Sciences University, Portland, Oregon.
STUDY DESIGN: A comprehensive survey of literature on the proposed mechanisms and treatment of pain and spasticity after spinal cord injury (SCI) was completed. OBJECTIVES: To define the current understanding of these entities and to review various treatment options. SUMMARY OF BACKGROUND DATA: The neurophysiologic basis of spasticity after SCI is well established. The mechanism of neuropathic pain after SCI remains conjectural, although considerable new data, much of it from animal models, now add to our understanding of this condition. METHODS: A comprehensive search and review of the published literature was undertaken. RESULTS: Treatment options for spasticity are effective and include oral medication (baclofen, tizanidine), intrathecal baclofen, and rarely, surgical rhizotomy or myelotomy. Selected patients with post-SCI pain can respond to surgical myelotomy (DREZ lesions) or intrathecal agents (e.g., morphine + clonidine), but the majority continue to suffer. CONCLUSIONS: Medical and surgical treatments for spasticity are established and highly successful. Management of post-SCI pain remains a clinical challenge, as there is no uniformly successful medical or surgical treatment.
PMID: 11805622, UI: 21665391
Spine 2001 Nov 15;26(22):2516-7
PMID: 11707721, UI: 21564578
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