About Entrez
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
LinkOut
Cubby
Related Resources
Order Documents
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
Items 1 - 37 of 37 |
One page. |
A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor.
Halpern SH, Muir H, Breen TW, Campbell DC, Barrett J, Liston R, Blanchard JW.
Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville Street, Toronto, Ontario, M5S 1B2 Canada. stephen.halpern@sw.ca
In this multicenter, randomized, controlled trial, we sought to determine whether patient-controlled epidural analgesia (PCEA) for labor affected the incidence of cesarean delivery when compared with patient-controlled IV opioid analgesia (PCIA). Healthy, term nulliparous patients in 4 Canadian institutions were randomly assigned to receive PCIA with fentanyl (n = 118) or PCEA with 0.08% bupivacaine and fentanyl 1.6 microg/mL (n = 124). There was no difference in the incidence of cesarean delivery-10.2% (12 of 118) versus 9.7% (12 of 124)-or instrumental vaginal delivery-21.2% (25 of 118) versus 29% (36 of 124)-between groups. The duration of the second stage of labor was increased in the PCEA group by a median of 23 min (P = 0.02). Fifty-one patients (43%) in the PCIA group received epidural analgesia: 39 (33%) because of inadequate pain relief and 12 (10%) to facilitate operative delivery. Patients in the PCIA group required more antiemetic therapy (17% versus 6.4%; P = 0.01) and had more sedation (39% versus 5%; P < 0.001). Maternal mean pain and satisfaction with analgesia scores were better in the PCEA group (P < 0.001 and P = 0.02, respectively). More neonates in the PCIA group required active resuscitation (52% versus 31%; P = 0.001) and naloxone (17% versus 3%; P < 0.001). These observations support the hypothesis that PCEA does not result in an increased incidence of obstetrical intervention compared with PCIA. PCEA provides superior analgesia and less maternal and neonatal sedation compared with PCIA.
PMID: 15502060 [PubMed - in process]
-
Increased systemic catecholamines in complex regional pain syndrome and relationship to psychological factors: a pilot study.
Harden RN, Rudin NJ, Bruehl S, Kee W, Parikh DK, Kooch J, Duc T, Gracely RH.
Rehabilitation Institute of Chicago, Center For Pain Studies, 446 E. Ontario, Ste. 1011, Chicago, IL 60611, USA. nharden@rehabchicago.org
We have demonstrated that subjects with complex regional pain syndrome (CRPS) have asymmetric venous pool plasma concentrations of norepinephrine (NE) when affected and unaffected limbs are compared, with most demonstrating decreased NE levels in the affected limb. This pilot study explored whether systemic venous plasma catecholamine levels in CRPS subjects with sympathetically maintained pain (SMP) differ from those found in healthy volunteers. We also explored whether catecholamine levels were correlated with scores on psychometric measures of depression, anxiety, and personality. Venous blood samples from 33 CRPS/SMP patients (from unaffected limbs) and 30 healthy control subjects were assayed for plasma NE and epinephrine (E) concentrations. Plasma NE levels were significantly higher in the CRPS group (P < 0.001). Statistical comparisons of E levels across groups did not achieve significance (P < 0.06), although 52% of CRPS/SMP patients had E levels exceeding the 95% confidence interval based on control data. Significant positive correlations were found between E levels and scores on the Beck Depression Inventory and Scales 1, 3, and 6 on the Minnesota Multiphasic Personality Inventory-2 (all P < 0.05). This preliminary work suggests that increased NE and E levels in CRPS/SMP patients may result from the pain of CRPS, consequent affective distress, or both. Alternatively, our findings could reflect premorbid adrenergic hyperactivity caused by affective, endocrine, or other pathology, which might predispose these individuals to develop the syndrome. Definitive studies are needed to examine these hypotheses in detail.
PMID: 15502052 [PubMed - in process]
-
The efficacy and safety of oral immediate-release oxymorphone for postsurgical pain.
Gimbel J, Ahdieh H.
Arizona Research Center, 2525 W. Greenway Road, Ste. 114, Phoenix, AZ 85023, USA. Azresearch@aol.com
In this double-blind, parallel-group study, we compared 3 oxymorphone immediate-release (IR) doses with placebo for efficacy and with oxycodone IR and placebo for safety in patients with acute moderate-to-severe postsurgical pain. During the single-dose phase (n = 300), patients received oxymorphone IR 10, 20, or 30 mg; oxycodone IR 10 mg; or placebo. All oxymorphone IR doses were superior for providing pain relief for 8 h (P < 0.05), with a significant analgesic dose response (P < 0.001). Significant pain intensity differences occurred by 45 min (20- and 30-mg doses; P < 0.05). Discontinuations for lack of efficacy totaled 42% among placebo-treated patients and 27% among those treated with oxymorphone IR. Patients requiring rescue medication after 3 h were allowed to receive additional study drug every 4 to 6 h as needed for the multiple-dose phase (n = 164). All oxymorphone groups maintained analgesia for 48 h. The median dosing interval was >9.5 h for oxymorphone IR 30 mg and > or =7 h for the other groups. Opioid-related adverse events, similar among groups, were generally mild or moderate. Oxymorphone IR 10, 20, or 30 mg provided significant dose-related pain relief compared with placebo, and this relief was maintained over several days with a safety profile comparable to that of oxycodone IR.
PMID: 15502051 [PubMed - in process]
-
Characterization of a new animal model for evaluation of persistent postthoracotomy pain.
Buvanendran A, Kroin JS, Kerns JM, Nagalla SN, Tuman KJ.
Department of Anesthesiology, 1653 W. Congress Parkway, Rush University Medical Center, Chicago, IL 60612, USA. asokumar@aol.com
Chronic pain after thoracotomy is common, although its basis and therapy have not been well characterized. In this study we characterize the allodynic responses (mechanical and cold) as well as the histopathologic changes after thoracotomy and rib retraction in rats. The antinociceptive effect of systemic and intrathecal analgesics was also evaluated. Male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs surgically exposed. The pleura was opened between the ribs and a retractor placed under both ribs and opened 8 mm. Retraction was maintained for 5, 30, or 60 min. Control animals had pleural incision only. Beginning Day 2 postsurgery, animals were tested for mechanical allodynia using calibrated von Frey filaments and cold allodynia using acetone applied to the incision site. Two weeks after surgery, animals were tested for reduction of allodynia with intraperitoneal and intrathecal injections of analgesics. Intercostal nerve histology was examined at 14 days postsurgery. Allodynia developed in 50% of the animals with 60 min retraction but in only 11% and 10% of animals when the retraction time was 5 and 30 min, respectively, and in none of the control animals. Allodynic animals showed extensive axon loss in the intercostal nerves of the retracted ribs. Allodynia appeared by Day 10 in the rib-retraction model and lasted at least 40 days. Systemic morphine sulfate (50% effective dose [ED(50)], 1.06 mg/kg) and gabapentin (ED(50), 24.2 mg/kg), as well as intrathecal morphine (ED(50), 1.19 nmol), gabapentin (ED(50), 13.8 nmol), clonidine (ED(50), 72.7 nmol), and neostigmine (ED(50), 0.54 nmol) reduced allodynia. Rib-retraction in rats for 60 min produces allodynia that lasts more than 1 mo, and this allodynia is reduced by morphine, gabapentin, clonidine, and neostigmine. This new model may be useful for quantifying the efficacy of techniques to reduce the frequency and severity of long-term postthoracotomy pain.
PMID: 15502048 [PubMed - in process]
Preventing the development of complex regional pain syndrome after surgery.
Reuben SS.
Acute Pain Service, Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA. scott.reuben@bhs.org
PMID: 15505459 [PubMed - in process]
-
Severing the link between acute and chronic pain: the anesthesiologist's role in preventive medicine.
Gottschalk A, Raja SN.
Publication Types:
PMID: 15505440 [PubMed - in process]
Comment on:
Treating chronic prostatitis: antibiotics no, alpha-blockers maybe.
Weidner W.
Publication Types:
PMID: 15492344 [PubMed - indexed for MEDLINE]
-
Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury.
Curatolo M, Arendt-Nielsen L, Petersen-Felix S.
Department of Anesthesiology, University Hospital of Bern, Switzerland. michele.curatolo@insel.ch
OBJECTIVES: To provide insights into the mechanisms underlying central hypersensitivity, review the evidence on central hypersensitivity in chronic pain after whiplash injury, highlight reflections on the clinical relevance of central hypersensitivity, and offer a perspective of treatment of central hypersensitivity. METHODS: A review of animal and human studies focusing on the mechanisms of postinjury central sensitization, an analysis of psychophysical investigations on central hypersensitivity in patients with chronic pain after whiplash injury, and a review of possible treatment modalities. RESULTS: Animal data show that tissue damage produces plasticity changes at different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. Some of these changes are potentially irreversible. There is consistent psychophysical evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after whiplash injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Psychologic distress could contribute to central hypersensitivity via imbalance of supraspinal and descending modulatory mechanisms. Although specific treatment strategies are limited, they are largely unexplored. IMPLICATIONS: Central hypersensitivity may explain exaggerated pain in the presence of minimal nociceptive input arising from minimally damaged tissues. This could account for pain and disability in the absence of objective signs of tissue damage in patients with whiplash. Central hypersensitivity may provide a common neurobiological framework for the integration of peripheral and supraspinal mechanisms in the pathophysiology of chronic pain after whiplash. Therapy studies are needed.
PMID: 15502692 [PubMed - in process]
-
Cost benefit analysis of neurostimulation for chronic pain.
Mekhail NA, Aeschbach A, Stanton-Hicks M.
Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, OH, USA. mekhain@ccf.org
OBJECTIVES: To assess the healthcare utilization of patients with intractable chronic neuropathic pain treated with spinal cord stimulation and peripheral nerve stimulation and to provide a cost-benefit analysis. METHODS: The case records of 222 consecutive patients who received spinal cord stimulation or peripheral nerve stimulation implants at the Cleveland Clinic Foundation between 1990 and 1998 were reviewed retrospectively. Patients were asked to complete a Neurostimulation Outcome Questionnaire designed to gather data on utilization of healthcare resources starting 1 year before surgical implantation. These data were pooled and net differences in events per patient per year, before and after device implantation were calculated and modeled to 2000 cost data obtained from the Medicare Fee Schedule and Healthcare Financing Administration. RESULTS: Neurostimulation Outcome Questionnaires were returned by 128 patients. The mean patient age was 46 +/- 12.5 years (range 21-71 years) and the mean implant duration was 3.1 +/- 2.3 years (range 0.5-8.9 years). The mean per patient total reimbursement of spinal cord stimulation/peripheral nerve stimulation absent pharmacotherapy was $38,187. Patients treated with spinal cord stimulation/peripheral nerve stimulation for pain management achieved reductions in physician office visits, nerve blocks, radiologic imaging, emergency department visits, hospitalizations, and surgical procedures, which translated into a net annual savings of approximately $30,221 and a savings of $93,685 over the 3.1-year implant duration. The large reduction in healthcare utilization following spinal cord stimulation/peripheral nerve stimulation implantation resulted in a net per patient per year cost savings of approximately $17,903. DISCUSSION: The reduced demand for healthcare resources by patients receiving neurostimulation suggests that peripheral nerve stimulation and spinal cord stimulation treatment, although associated with relatively high initial costs, demonstrates substantial long-term economic benefits. Thus, neurostimulation should be considered as a viable option for the early treatment of patients with intractable chronic neuropathic pain.
PMID: 15502691 [PubMed - in process]
-
Factors predicting pain reduction in chronic back and neck pain after multimodal treatment.
Michaelson P, Sjolander P, Johansson H.
Southern Lapland Research Department, Vilhelmina, Sweden.
OBJECTIVES: To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. DESIGN AND METHODS: A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. RESULTS: Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. CONCLUSIONS: Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.
PMID: 15502689 [PubMed - in process]
-
Exaggerated pain behavior: by what standard?
Sullivan M.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA. sullimar@u.washington.edu
This paper provides a philosophical, historical, and clinical analysis of exaggerated pain behavior, focusing on the nature of the standards used to judge behavior as exaggerated. Malingering is understood as a special case of exaggerated pain behavior. Drawing upon the work of philosopher Ludwig Wittgenstein and psychiatrist-anthropologist Horacio Fabrega, I argue that these standards are primarily moral rather than scientific in nature. Pain behavior is not validated by matching public pain behavior with private pain experience. If this pain experience is truly private, it is not available to scientific investigation. Rather, pain behavior is judged as appropriate or exaggerated through complex assessments of the function of this behavior in its social context. As human social contexts have become more complex through history, so have the accommodations made for sick and disabled members of the group. Criteria for legitimate entry to the sick role have evolved with society, with only modern industrial society placing heavy emphasis on tissue damage demonstrated on medical tests. The highly variable relation between clinical pain and tissue damage, as well as the common problem of medically unexplained physical symptoms in primary care, pose serious challenges to this strategy of illness behavior validation. It will remain necessary to triage suffering presented to health care providers into that which should be addressed in the medical setting and that which is better addressed elsewhere. But we need to discard pseudoscientific reliance on medical tests and develop new standards that are openly acknowledged to be moral and social in nature.
PMID: 15502687 [PubMed - in process]
-
Malingering pain in the medicolegal context.
Mendelson G, Mendelson D.
Department of Psychological Medicine, Monash University, Caulfield Pain Management and Research Centre, Caulfield, Victoria, Australia. george.mendelson@med.monash.edu.au
Malingering--the willful, deliberate, and fraudulent feigning or exaggeration of illness--was originally described as a means of avoiding military service. In present-day clinical practice, malingering may occur in circumstances where the person wishes to avoid legal responsibility or in situations where compensation or some other benefit might be obtained. In law, the term malingering is used in relation to persons to whom military regulations apply; in other situations, malingering is regarded as fraud and may lead to charges of perjury or criminal fraud. Assertions that an individual is malingering are particularly common in clinical settings where the complaint is of a subjective nature and is not accompanied by objectively demonstrable organic abnormalities. This may occur in relation to complaints of pain in situations where the person is entitled to receive pain-contingent compensation or is suing for damages. In this article, we will review the literature on pain and malingering and discuss attempts that have been made to develop methods and guidelines for the detection of malingered pain. There are, however, no valid clinical methods of assessment of possible malingering of pain. In our view, the ultimate issue of the veracity of the plaintiff is for the Court to decide, and epithets such as "malingerer" have no place in reports prepared for legal purposes by health care professionals.
PMID: 15502686 [PubMed - in process]
-
Detecting deception in facial expressions of pain: accuracy and training.
Hill ML, Craig KD.
Arthritis Institute, St. Joseph's Hospital, London, Ontario, Canada. marilyn.hill@sjhc.london.on.ca
Clinicians tend to assign greater weight to nonverbal expression than to patient self-report when judging the location and severity of pain. However, patients can be successful at dissimulating facial expressions of pain, as posed expressions resemble genuine expressions in the frequency and intensity of pain-related facial actions. The present research examined individual differences in the ability to discriminate genuine and deceptive facial pain displays and whether different models of training in cues to deception would improve detection skills. Judges (60 male, 60 female) were randomly assigned to 1 of 4 experimental groups: 1) control; 2) corrective feedback; 3) deception training; and 4) deception training plus feedback. Judges were shown 4 videotaped facial expressions for each chronic pain patient: neutral expressions, genuine pain instigated by physiotherapy range of motion assessment, masked pain, and faked pain. For each condition, the participants rated pain intensity and unpleasantness, decided which category each of the 4 video clips represented, and described cues they used to arrive at decisions. There were significant individual differences in accuracy, with females more accurate than males, but accuracy was unrelated to past pain experience, empathy, or the number or type of facial cues used. Immediate corrective feedback led to significant improvements in participants' detection accuracy, whereas there was no support for the use of an information-based training program.
PMID: 15502685 [PubMed - in process]
-
Psychometric perspectives on detection of malingering of pain: use of the Minnesota Multiphasic Personality Inventory-2.
Arbisi PA, Butcher JN.
Minneapolis VA Medical Center, Minneapolis, MN 55417, USA. arbis001@umn.edu
Self-report plays a primary but not exclusive role in pain assessment. As is true of all self-reported experiences, under certain circumstances, the report of chronic pain can be distorted and misrepresented. There are unique challenges associated with the detection and assessment of malingering or self-report distortion in the evaluation of chronic pain. The current paper provides a rationale for the use of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in the comprehensive assessment of chronic pain with an emphasis on the advantage the MMPI-2 provides in the detection of response bias or malingering. A critical review of available MMPI-2 validity scales is presented, and recommendations for use of these scales in the evaluation of patients with chronic pain are made.
PMID: 15502681 [PubMed - in process]
-
Introduction to the special series on pain deception and malingering.
Craig KD, Badali MA.
Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada. kcraig@psych.ubc.ca
PMID: 15502680 [PubMed - in process]
The experience of chronic severe pain in patients undergoing methadone maintenance treatment.
Karasz A, Zallman L, Berg K, Gourevitch M, Selwyn P, Arnstein J.
Albert Einstein College of Medicine (A.K., P.S.) and Montefiore Medical Center (L.Z., K.B., M.G., P.S., J.A.), Bronx, New York, USA.
Recent studies indicate that severe chronic pain is common among patients in methadone maintenance treatment (MMT), but no qualitative studies have examined such patients' experiences of pain and pain treatment. This study used qualitative methods to explore the experiences of MMT patients with chronic pain. Twelve patients screening positive for chronic severe pain on the Brief Pain Inventory were interviewed for the study. Results suggest that chronic severe pain has major consequences in the lives of methadone maintenance patients and may be linked to illegal drug use, social isolation, and role failure. A variety of barriers limited access to effective treatment. A common complaint with care was providers' lack of concern or inability to "listen." Patients who were satisfied with treatment focuses on the psychosocial dimensions of care. These preliminary results suggest that treatment approaches should emphasize emotional support, negotiation of explanatory models, and an emphasis on the psychosocial sequelae of pain. However, more research is needed to guide the development of effective treatment strategies.
PMID: 15504628 [PubMed - in process]
-
A randomized, double-blind, crossover study of the use of transcutaneous spinal electroanalgesia in patients with pain from chronic critical limb ischemia.
Simpson KH, Ward J.
St. James's University Hospital (K.H.S.), Leeds, and Prince of Wales Hospice (J.W.), Pontefract, United Kingdom.
Transcutaneous spinal electroanalgesia (TSE) uses two electrodes placed over the skin of the dorsal spine to deliver pulses of short wavelength, high frequency, and relatively high voltage to the spinal cord without causing paresthesia. TSE has been used to treat pain and may improve limb blood flow. This randomized, double-blind, crossover study assessed the effect of TSE on microcirculation, pain, and activity in 8 patients (3 men, 5 women, median age 66.5 years, range 62-76 years) with chronic critical limb ischemia (CLI). After a one-week baseline period, patients used an active or inactive TSE machine for one hour daily for one week. Following a week of no stimulation, patients repeated the week of treatment with an identical matched machine. Daily use of TSE for one week did not improve microcirculatory perfusion (transcutaneous oxygenation), pain (verbal rating scale, McGill Pain Questionnaire), physical function (Functional Limitations Profile), mood (Beck Depression Inventory, Beck Anxiety Inventory), or sleep. There was no patient preference for the active TSE machines. This study showed that TSE administered daily for one week did not improve microcirculation, pain, or activity in patients with chronic CLI.
PMID: 15504627 [PubMed - in process]
-
Optimization of opioid therapy for preventing incident pain associated with bone metastases.
Mercadante S, Villari P, Ferrera P, Casuccio A.
Anesthesia & Intensive Care Unit (S.M., P.V., P.F.) and Pain Relief & Palliative Care Unit (S.M., P.V., P.F.), La Maddalena Cancer Center, Palermo; and Master of Palliative Medicine, Departments of Anesthesia, Intensive Care and Emergency (S.M.), and Hygiene and Microbiology (A.C.), University of Palermo, Palermo, Italy.
Breakthrough pain is a transitory flare of pain superimposed on an otherwise stable pain pattern in patients treated with opioids. One form of breakthrough pain is incident pain, which is due to movement and is commonly associated with bone metastases. The development of this pain is rapid and no medication, administered "as needed," has such a rapid onset that it parallels this temporal pattern of pain. This study used a construct based on the prevention of this event, and implemented a new experimental paradigm. Specifically, the study determined whether increasing the opioid doses above those sufficient to control pain at rest would reduce the occurrence of these pains. Twenty-five consecutive patients with movement-related episodic pain associated with bone metastases, and no evident fractures, were selected for the study. They received a rapid intravenous titration of the opioid dose to obtain pain relief at rest. Then, opioid doses were increased to challenge the therapeutic window. The dose ceiling was determined by the development of limiting adverse effects, rather than optimal pain control at rest. Opioid dose increases were then stopped, or doses were even reduced, according to patients' satisfaction or development of adverse effects with moderate-severe intensity. Basal pain intensity and pain induced by movement were measured using a numerical scale from 0-10. Opioid-related symptoms were assessed using a scale from 0 to 3 (absent, slight, moderate, severe), and global daily doses of oral morphine and other symptomatic drugs were also recorded at daily intervals, and at time of discharge, when the best balance was presumed to be reached. Basal pain control was achieved after rapid intravenous titration. The day after, pain induced by movement significantly improved using mean doses of oral morphine equivalents of 102 mg. In the following days, the subsequent increase in opioid doses prescribed despite optimal basal pain control allowed an acceptable level of incident pain intensity until patients' discharge. A minority of patients developed adverse effects with an intensity of 2-3 on the scale, requiring symptomatic treatment or decreases in opioid doses. Data from this study suggest that the intensity of incident pain may be reduced by increasing the opioid dose above that effective for controlling pain at rest. This approach is based on experimental bone models showing a hypersensitivity to some innocuous stimuli, such as movement, requiring pre-emptive higher doses of basal opioid medication to reduce the increased pain input.
PMID: 15504626 [PubMed - as supplied by publisher]
-
Acceptable, manageable, and tolerable days: patient daily goals for medication management of persistent pain.
Zelman DC, Smith MY, Hoffman D, Edwards L, Reed P, Levine E, Siefeldin R, Dukes E.
California School of Professional Psychology-Alliant International University (D.C.Z, L.E., P.R.), San Francisco, California; Purdue Pharma L.P. (M.Y.S., D.H., R.S., E.D.), Stamford, Connecticut; and California Pacific Medical Center (E.L.), San Francisco, California, USA.
Although the construct of "a symptom-free day" has been widely applied in asthma and gastric reflux disease, there is no analogous concept in the field of pain management. This study represents the initial development of a "day of acceptable or manageable pain control," a construct which reflects patients' daily strategic use of pain medication in order to allow the accomplishment of desired activities while minimizing side effects. Focus group methodology was used to extract patient-generated themes of "an acceptable day of pain control." Fifty-three outpatients with persistent moderate to severe average pain intensity due to osteoarthritis (n=18), metastatic cancer (n=15), and low back pain (n=20) participated. Participants preferred the term "manageable" or "tolerable" to "acceptable." Thematic analysis revealed components of a manageable/tolerable day of pain control as including: 1) taking the edge off the pain, 2) performing valued activities; 3) relief from dysphoria and irritability; 4) reduced medication side effects; 5) feeling well enough to socialize. Additional cancer-specific themes included relief from fatigue and ability to have a positive day when one's future days were perceived as being limited. The set of themes is presented and their relevance for developing a measure of "a manageable day of pain control" discussed. Study findings identify a novel construct that can inform development of an outcome for evaluating the effectiveness of different pharmacotherapies for pain management.
PMID: 15504624 [PubMed - as supplied by publisher]
-
Perceptions of analgesic use and side effects: what the public values in pain management.
Palos GR, Mendoza TR, Cantor SB, Aday LA, Cleeland CS.
Departments of Symptom Research (G.R.P., T.R.M., C.S.C.) and Biostatistics (S.B.C.), The University of Texas M. D. Anderson Cancer Center; and Department of Behavioral Sciences (L.A.), The University of Texas School of Public Health, Houston, Texas, USA.
In this population-based telephone survey, we evaluated the attitudes of 302 adults toward analgesic use and related side effects. Over half (68%) reported prior experience with 2 or more side effects. Vomiting (34%), confusion (32%), and nausea (17%) were ranked as the worst side effects. Exploratory cluster analysis grouped responses to 6 questions about willingness to use analgesics into two categories. Participants in Cluster I (n=106), "Conservatives," were less willing to take analgesics for pain as compared to those in Cluster II (n=153), "Liberals." Univariate analysis found Hispanics, women, those less affluent or educated, and those with prior side-effect experience were more likely to be Conservative. Experience with side effects (OR=1.3) and being female (OR=2.1) were the strongest predictors of conservative cluster membership. To achieve better pain outcomes, clinicians and patients must identify factors that contribute to conservative decision-making about analgesic use and side effect management.
PMID: 15504623 [PubMed - in process]
Painful sweating.
Goldstein DS, Pechnik S, Moak J, Eldadah B.
Clinical Neurocardiology Section, National Institute of Neurologic Disorders and Stroke, Building 10, Room 6N252, 10 Center Drive, MSC 1620, Bethesda, MD 20892-1620, USA. goldsteind@ninds.nih.gov
OBJECTIVE: The authors report a case of spontaneous and gustatory facial pain and sweating. METHODS: The patient had frequent episodes of pain, sweating, and flushing bilaterally in the hairless skin of the ophthalmic and maxillary distributions of the trigeminal nerve. Gustatory stimuli (e.g., orange juice, pickled onions) reliably evoked episodes, but episodes also frequently came on spontaneously. The problem had begun during adolescence, about the time of topical treatment and then electrocauteries for facial warts. The patient reported benefit from tricyclic antidepressants, guanethidine, and trospium chloride (an anti-cholinergic quaternary amine used in Europe for urinary urgency). There was no pain or excessive sweating in other body areas, nor pain with exercise. RESULTS: Administration of edrophonium IV evoked pain and sweating, and ganglion blockade by IV trimethaphan eliminated pain and sweating and markedly attenuated responses to edrophonium. Trospium chloride also prevented edrophonium-induced pain and sweating. Bicycle exercise produced the same increment in forehead humidity as in a spontaneous episode but did not evoke pain. Tyramine infusion did not bring on pain or sweating, whereas iontophoretic acetylcholine administration to one cheek evoked pain and sweating bilaterally. Topical glycopyrrolate cream eliminated spontaneous, gustatory, and edrophonium-induced episodes. CONCLUSIONS: The findings indicate that facial pain and sweating can result from occupation of muscarinic cholinergic receptors after acetylcholine release from local nerves. The authors propose that after destruction of cutaneous nerves, aberrant regenerant sprouting innervates sweat glands, producing gustatory sweating as in auriculotemporal syndrome (Frey syndrome), and innervates nociceptors, producing pain.
PMID: 15505167 [PubMed - in process]
-
Elevated levels of circulating trace amines in primary headaches.
D'Andrea G, Terrazzino S, Leon A, Fortin D, Perini F, Granella F, Bussone G.
Headache and Comorbidity Center, Department of Clinical Pathology, Este-Monselice Hospital, PD, Italy. giovinavi@libero.it
BACKGROUND: Trace amines, including tyramine, octopamine, and synephrine, are closely related to classic biogenic amines. They have been hypothesized to promote migraines and other types of primary headaches, but there is no direct evidence supporting this hypothesis. METHODS: Using a multichannel electrochemical high-performance liquid chromatography system, the authors evaluated whether changes in circulating trace amines occur in subjects with migraine (with or without aura) during headache-free periods as well as in patients with cluster headache (CH) during the remission and active phases as compared with healthy control subjects. RESULTS: Plasma levels of all trace amines were significantly higher in CH patients, in both the remission and the active phases, when compared with control subjects or subjects with migraine. In addition, intraplatelet levels of octopamine, synephrine, and tyramine were higher in CH patients than in control subjects. In migraine patients, plasma levels of octopamine and synephrine were higher compared with controls, although in migraine with aura, the difference was not significant. CONCLUSIONS: Whereas the elevation of plasma trace amine levels in both migraine and CH supports the hypothesis that disorders of biogenic amine metabolism may be a characteristic biochemical trait in primary headache sufferers, the observation that such alterations are more prominent in patients with CH than migraine patients suggests that they may reflect sympathetic or hypothalamic dysfunction.
PMID: 15159465 [PubMed - indexed for MEDLINE]
Comment on:
Opioid therapy and headache: a cause and a cure.
Lipton RB, Bigal ME.
Publication Types:
PMID: 15159457 [PubMed - indexed for MEDLINE]
Comment on:
Precision averaging.
Bourke DL.
Publication Types:
PMID: 15275807 [PubMed - indexed for MEDLINE]
-
The analgesic effects that underlie patient satisfaction with treatment.
Jensen MP, Mendoza T, Hanna DB, Chen C, Cleeland CS.
Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle 98195-6490, USA. mjensen@u.washington.edu
Patient satisfaction and global ratings of study medications are increasingly used as secondary outcome measures in pain clinical trials. However, little is known about the factors that underlie and contribute to these ratings. 191 patients who participated in a randomized trial of parenteral parecoxib sodium followed by oral valdecoxib for pain following laparoscopic cholecystectomy versus standard care rated their satisfaction with the overall performance of the study medications (postoperative days 1 and 7) and also provided global evaluation of the analgesics on postoperative day 7. Analyses indicated that treatment regimen, age, worst pain experienced, pain interference with functioning, morphine equivalent dose taken, and number of opioid-related symptoms (e.g. nausea, fatigue) were all associated with satisfaction with the overall performance of the study medications at day 1. Controlling for all of the predictors, pain interference and morphine equivalent dose use made independent contributions to the prediction of the day 1 global rating. These results were replicated in the prediction of day 7 ratings, except that at day 7, treatment regimen also made a significant independent contribution to the prediction of satisfaction. These findings indicate that the study participants considered more than one factor when estimating their satisfaction with the study medications, and that the changes produced by the treatment (e.g. decreased pain, opioid-related symptoms) mediated, in part, the effects of treatment on treatment satisfaction.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15275801 [PubMed - indexed for MEDLINE]
-
Determinants of prescribing meperidine compared to morphine in hospitalized patients.
Panda M, Desbiens N, Doshi N, Sheldon S.
Department of Medicine, University of Tennessee College of Medicine, Chattanooga Unit, 960 East Third Street, Chattanooga, TN 37403, USA. pandam@erlanger.org
Morphine is a preferred narcotic since meperidine forms toxic metabolites. Determinants of meperidine use have been poorly described. The objective of this study is to explore factors associated with the ordering of meperidine versus morphine. Retrospective chart review of adult patients, randomly selected based on orders for morphine or meperidine. 1552 orders were written for 670 patients. Of these, 36% were for meperidine. In multivariable analysis, the ordering of meperidine was associated with the following variables in decreasing order of importance: physician specialty, total doses received, hospital location, patient race, age and insurance, and physician gender. More orders for meperidine were written for those receiving fewer doses. Though meperidine has little role in the routine management of hospital pain, we found it continues to be used frequently. Importantly, meperidine is ordered more frequently for patients who receive shorter courses of narcotics. Our study suggests that interventions targeted at more appropriate use of meperidine rather than complete elimination might be more acceptable to physicians while minimizing the risk of toxicity.
PMID: 15275784 [PubMed - indexed for MEDLINE]
-
Antinociceptive mechanism of L-DOPA.
Shimizu T, Iwata S, Morioka H, Masuyama T, Fukuda T, Nomoto M.
Department of Pharmacology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan.
The mechanism of L-DOPA for antinociception was investigated. Nociceptive behaviors in mice after an intrathecal (i.t.) administration of substance P were evaluated. L-DOPA (i.t.) dose-dependently attenuated the substance P-induced nociceptive behaviors. Co-administration of benserazide (i.t.), a DOPA decarboxylase inhibitor, abolished the antinociceptive effect of L-DOPA. The L-DOPA-induced antinociception was antagonized by sulpiride, a D2 blocker, but not by SCH 23390, a D1 blocker. These results suggest that L-DOPA relieves pain after conversion to dopamine, with the dopamine sedating pain transmission by way of the dopamine D2 receptor.
PMID: 15275774 [PubMed - indexed for MEDLINE]
-
Re: Pengel LHM, Refshauge KM, Maher CG. Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine. 2004;29:879-83.
Hart DL, Werneke MW.
Publication Types:
PMID: 15507816 [PubMed - in process]
-
Re: Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain: a systematic review within the framework of the Cochrane collaboration. Spine 2003;28:1978-92.
Manniche C, Jordan A.
Publication Types:
PMID: 15507815 [PubMed - in process]
-
Re: Khot A, Bowditch M, Powell J, et al. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine 2004;29:833-7.
Woodward AH.
Publication Types:
PMID: 15507814 [PubMed - in process]
-
Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain.
Schofferman J, Kine G.
SpineCare Medical Group, San Francisco Spine Institute, Daly City, California, USA. jschofferman@spinecare.com
STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the success rate and duration of relief of repeat radiofrequency neurotomy for lumbar facet joint pain. SUMMARY OF BACKGROUND DATA: Radiofrequency neurotomy is an effective but temporary management of lumbar facet pain. When pain recurs, radiofrequency neurotomy is usually repeated, but the outcome and duration of relief for repeat radiofrequency neurotomies are unknown. METHODS: Record review of consecutive patients who had an initial successful radiofrequency neurotomy, subsequent recurrence of pain, and then repeat radiofrequency neurotomy. Responses of repeat radiofrequency neurotomies were compared with initial radiofrequency neurotomy for success rates and duration of relief. RESULTS: There were 16 women and 4 men. Mean age was 48 years (range, 26-63). Radiofrequency neurotomy denervated one segment in two patients, two segments in 16 patients, and three or more in two patients. There were 10 bilateral and 10 unilateral radiofrequency neurotomies. Mean duration of relief after initial radiofrequency neurotomy was 10.5 months (range, 4-19). To date, two patients had a series of two radiofrequency neurotomies performed, six had three, five had four, three had five, and four had seven or more. Twenty patients had a second radiofrequency neurotomy, which was successful in 17 (85%) but unsuccessful in two. The mean duration of relief in 16 of these 17 patients was 11.6 months (range, 6-19), and relief is continuing in one. Sixteen patients had a third radiofrequency neurotomy, of which 15 were successful and one was unsuccessful. The mean duration of relief in nine of the 15 was 11.2 months (range, 5-23), and relief is continuing in the other six. Eight patients had a fourth radiofrequency neurotomy, which was successful in seven but unsuccessful in one. The mean duration of relief was 9 months (range, 5-14) in three patients, and relief is continuing in the other four. None of these differences is significant. The frequency of success and durations of relief remained consistent after each subsequent radiofrequency neurotomy. CONCLUSIONS: Repeated radiofrequency neurotomies are an effective long-term palliative management of lumbar facet pain. Each radiofrequency neurotomy had a mean duration of relief of 10.5 months and was successful more than 85% of the time.
PMID: 15507813 [PubMed - in process]
-
Clinical course in patients seeking primary care for back or neck pain: a prospective 5-year follow-up of outcome and health care consumption with subgroup analysis.
Enthoven P, Skargren E, Oberg B.
Department of Health and Society, Division of Physiotherapy, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden. paul.enthoven@ihs.liu.se
STUDY DESIGN: Prospective follow-up. OBJECTIVE: To describe the 5-year clinical course in a cohort of patients treated for back or neck pain in primary care and compare results with the 1-year outcome both for the whole group and for subgroups. SUMMARY OF BACKGROUND DATA: A randomized study showed a decrease in perceived pain and disability after treatment by chiropractic or physiotherapy, but many reported recurrence or continual pain at the 1-year follow-up. Knowledge of the clinical course over longer follow-up periods is limited. METHODS: A 5-year follow-up questionnaire was sent to 314 individuals. Main outcome measures were pain intensity, Oswestry score, and general health. Recurrence, health care consumption, and other measures were described. RESULTS: Fifty-two percent of respondents reported pain (visual analog scale, >10 mm) and back-related disability (Oswestry, >10%) at the 5-year follow-up. This was similar to 1-year results, and 84% of these were the same individuals. Sixty-three percent reported recurrence or continual pain, and 32% reported health care consumption at the 5-year follow-up. CONCLUSIONS: In a cohort of individuals of working age seeking primary care for nonspecific back or neck pain, it can be expected that about half of the population will report pain and disability at the 5-year follow-up. A significant proportion will report recurrence or continual pain and health care consumption. Pain and disability were associated with recurrence or continual pain and health care consumption. Further analysis is needed to identify additional predictors for 5-year outcome, taking into account 1-year follow-up results. Since many patients will have recurrence or continual pain, health policies and clinical decision models for long-term outcome must allow for these aspects.
PMID: 15507811 [PubMed - in process]
-
Persistence and change in nonspecific low back pain among adolescents: a 3-year prospective study.
Sjolie AN.
Department of Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. asjolie@hotmail.com
STUDY DESIGN: This is a 3-year prospective study of juvenile low back pain (LBP). OBJECTIVES: To investigate persistence and change in LBP. SUMMARY OF BACKGROUND DATA: Earlier episodes of LBP are a strong risk factor for LBP in adults, while the persistence of LBP through adolescence is not known. METHODS: The material comprised all pupils in eighth and ninth grades (N = 105, mean age 14.7 years), living within two geographic areas in Eastern Norway in January 1997. The analyses included 88 adolescents at baseline, and 85 at follow-up. The questionnaire, which identified LBP as pain or ache in the low back during the preceding year, was answered at baseline in the classroom and at follow-up by post. RESULTS: LBP was reported by 58% at baseline and by 39% at follow-up, and LBP provoked by manual work by 40% at baseline and 26% at follow-up. Thirty-one percent reported LBP at both occasions. LBP more than 7 days was reported by 32% at baseline, by 26% at follow-up, and by 18% at both occasions. Twenty-two percent of those reporting LBP at baseline rejected ever LBP at follow-up. Baseline reports of LBP predicted corresponding reports of LBP at follow-up: Odds ratio was 4.7 (95% confidence interval 1.7-12.7) for LBP generally, 9.1 (3.0-27.2) for LBP more than 7 days, 9.2 (2.9-28.8) for LBP provoked by manual work, and 3.8 (1.3-11.3) for LBP provoked by sitting at school. CONCLUSION: The findings indicate a persistent, but changeable, trend in LBP from midadolescence until late adolescence. The consistency and the high rates of reports of LBP provoked by manual work and sitting imply needs for more research on the persistence of LBP, and on relevant interventions during school age.
PMID: 15507810 [PubMed - in process]
-
Epidural venous plexus enlargements presenting with radiculopathy and back pain in patients with inferior vena cava obstruction or occlusion.
Paksoy Y, Gormus N.
Ultra Goruntuleme Merkezi, Konya, Turkey. yahyapaksoy@yahoo.com
STUDY DESIGN: In the last 2 years, we have examined 9640 patients experiencing back pain or sciatica, using MRI. There were 13 (0.13%) patients who had radicular symptoms that clinically mimicked lumbar disc herniation or spinal stenosis. All of these patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural and paravertebral venous system, causing nerve root compression. OBJECTIVE: To illustrate the imaging characteristics of 13 patients with epidural engorged veins due to inferior vena cava obstruction or occlusion causing sciatica and low back pain. SUMMARY OF THE BACKGROUND DATA: Abnormalities or pathological changes of epidural venous network may give rise to symptoms similar to or mimicking lumbar disc herniation or spinal stenosis. Multiple lumbar epidural varices can cause nerve root and thecal sac compression. Lumbar epidural varices have been infrequently described in the literature. To date, the cause of anterior epidural venous enlargement has been poorly understood, and both congenital and acquired causes have been proposed. This report describes enlarged epidural veins in patients with inferior vena caval thrombosis or obstruction presenting with radicular syndromes. METHODS: The authors have seen 13 patients with radicular symptoms. All of the patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural veins, causing nerve root compression. The ages of these patients ranged from 20 to 53 (mean, 30) years. All of the patients were examined with color Doppler ultrasonography and magnetic resonance scanner. RESULTS: Ten of 13 patients had inferior vena cava thrombosis located just under the renal vein orifices. In two patients, there was compression to inferior vena cava due to parity. In the remaining patient, a huge intra-abdominal mass was observed, and this mass was causing inferior vena cava obstruction and invasion. Enlargements of epidural venous plexus were demonstrated in all of these cases. All of the patients presented with the acute onset of low back pain followed shortly thereafter by acute radicular symptoms. The compression to inferior vena cava could not be treated in one patient because of intra-abdominal malignancy. The remaining 12 patients with inferior vena cava obstruction or occlusion experienced complete resolution of symptoms after treatment or delivery. CONCLUSION: The authors believe that epidural venous engorgement should be considered when the symptoms of patients with deep venous and inferior vena cava thrombosis are accompanied by radicular and/or back pain, because pathologic processes compressing a nerve root can cause pain.
PMID: 15507805 [PubMed - in process]
-
Sensitivity and specificity of outcome measures in patients with neck pain: detecting clinically significant improvement.
Bolton JE.
Anglo-European College of Chiropractic, Bournemouth, England. jbolton@aecc.ac.uk
STUDY DESIGN: Prospective, single-cohort study. OBJECTIVE: To determine the relative sensitivity of a range of outcome measures used in evaluating treatment interventions in patients with neck pain and the magnitude of change scores on the neck Bournemouth Questionnaire and the cutoff score on the Patients' Global Impression of Change scale associated with clinically significant improvement. SUMMARY OF BACKGROUND DATA: Traditionally, evaluation of treatment interventions using subjective outcome measures has been based on the statistical significance of the difference between group mean values. To be clinically meaningful, however, information is required from sensitive outcome measures on the proportion of patients undergoing a clinically important improvement and from this, the number needed to treat for a single patient to benefit. METHODS: Patients with nonspecific neck pain from a number of treatment centers completed a battery of self-report questionnaires, including the Bournemouth Questionnaire, before and after chiropractic treatment. After treatment, patients also completed a retrospective analysis of their overall improvement since the start of treatment (Patients' Global Impression of Change). The a priori definition of clinically significant improvement was defined as a Reliable Change Index on the Bournemouth Questionnaire of >1.96. RESULTS: The best cutoffs with a balance between the highest sensitivity and highest specificity in detecting clinical improvement were a score of 2 or less on the Patients' Global Impression of Change (11-point Numerical Rating Scale: 0 = much better, 5 = no change, and 10 = much worse) and a raw change score of three or more points on each of the seven 11-point Numerical Rating Scale subscales of the Bournemouth Questionnaire. For the total score of the Bournemouth Questionnaire, raw change scores of 13 or more points, percentage change scores of 36% or more, and individual effect sizes of 1.0 or more were all associated with clinically significant improvement. The sensitivity of the Bournemouth Questionnaire in terms of its effect size was comparable with that of pain intensity scales and the Neck Disability Index. CONCLUSIONS: The present findings will assist in the choice of outcome measures in trials on neck pain. The study also illustrates a methodologic framework for interpreting change scores in terms of clinical improvement, facilitating the process of making sense of research data in the clinical setting.
PMID: 15507803 [PubMed - in process]
-
Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise.
Wand BM, Bird C, McAuley JH, Dore CJ, MacDowell M, De Souza LH.
School of Physiotherapy, University of Notre Dame, Fremantle, WA, Australia.
STUDY DESIGN: A single blind randomized controlled trial comparing two models of care for patients with acute simple low back pain. OBJECTIVES: To compare two research-based models of care for acute low back pain and investigate the effect of the timing of physical intervention. SUMMARY OF BACKGROUND DATA: National guidelines offer conflicting information on the delivery of physical treatment in the management of acute low back pain. The guidelines suggest two different models of care. Direct comparisons between these models are lacking in the literature. The present study aims to compare these approaches to the management of acute low back pain. METHODS: Among 804 referred patients, 102 subjects met the specific admission criteria and were randomly assigned to an "assess/advise/treat" group or an "assess/advise/wait" group. The intervention consisted of biopsychosocial education, manual therapy, and exercise. Assessment of short-term outcome enables comparison to be made between intervention and advice to stay active. Assessment of long-term outcome enables comparison to be made between early and late intervention. Study outcomes of reported pain (Visual Analogue Scale), functional disability (the Roland and Morris Disability Questionnaire), mood (Modified Zung Self Rated Depression Score, Modified Somatic Perception Questionnaire, State-Trait Anxiety Inventory), general health (Euroqol), and quality of life (Short Form 36) were assessed at baseline, 6 weeks, 3 months, and 6 months. RESULTS: At 6 weeks, the assess/advise/treat group demonstrated greater improvements in disability, mood, general health, and quality of life than patients in the assess/advise/wait group (P < 0.05). Disability and pain were not significantly different between the groups at long-term follow up (P > 0.05). However, mood, general health, and quality of life remained significantly better in the assess/advise/treat group (P < 0.05). CONCLUSIONS: At short-term, intervention is more effective than advice on staying active, leading to more rapid improvement in function, mood, quality of life, and general health. The timing of intervention affects the development of psychosocial features. If treatment is provided later, the same psychosocial benefits are not achieved. Therefore, an assess/advise/treat model of care seems to offer better outcomes than an assess/advise/wait model of care.
PMID: 15507794 [PubMed - in process]
-
Concurrent comparison of responsiveness in pain and functional status measurements used for patients with low back pain.
Grotle M, Brox JI, Vollestad NK.
Section for Health Science, University of Oslo, Norway. margreth.grotle@helsefag.uio.no
STUDY DESIGN: Prospective study of two samples of patients with acute and chronic low back pain, respectively. OBJECTIVES: To compare the responsiveness of four functional status questionnaires, Roland Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Disability Rating Index (DRI), and Physical Functioning scale of the SF-36 (PFSF-36), and two pain scales, a Numerical Pain Rating Scale (NRS) and Visual Analogue Scale (VAS). SUMMARY OF BACKGROUND DATA: Concurrent comparisons of different outcome measurements in back patients have been requested. METHODS: Norwegian versions of the scales and questionnaires were completed by 54 patients with acute (<3 weeks) and 50 patients with chronic low back pain (>3 months). Clinical change was estimated on a global change index. An alternative external criterion was the expected clinical course in the two cohorts. Mean changes, standardized response mean (SRM), and area under the receiver operating characteristic (ROC) curves with cutoff point for highest sensitivity and specificity were calculated. RESULTS: At the follow-up, 63% of the acute and 41% of the chronic sample reported improvement on the global change index. Large SRMs (1.3-2.0) and areas under the ROC curves (0.84-0.93) were found for the measurements in the acute sample. In the chronic sample, the SRMs (0.4-1.1) and areas under the ROC curves (0.65-0.83) were lower, in particular for the PFSF-36 and the VAS. There was no statistically significant difference between the responsiveness in the measurements, except for higher responsiveness in the NRS compared with the VAS when using expected clinical course as the external criterion for change. CONCLUSION: The results suggest that all the outcome measures were appropriate for measuring changes in functional status and pain in patients with acute low back pain, whereas among chronic patients the RMDQ, ODI, DRI, and NRS were most appropriate.
PMID: 15507789 [PubMed - in process]
|