Pain Changes Research Articles

Evaluating Pain in Orthopedic Patients: Can the Visual Analog Scale be used as a Long-term Outcome Instrument?

Study background: An analysis of the relationship between visual analog scale (VAS) pain scores and Likert pain scores over a period of up to a year in patients who sustained a distal radius fracture (DRF) in order to assess the reliability of using a VAS pain score as a long-term outcome instrument. Methods: Retrospective review was performed of prospectively collected data on all DRF's treated at our institution from 2010-2012 with consented patients. At the initial and each follow-up visit, patients indicated their level of injured extremity pain at rest by using a VAS (VAS-Rest) and when actively using the extremity (VAS-Active). At followup visits, patients completed a question asking what their perceived change in injured wrist pain was since their last orthopedic visit. This Change in Pain (CP) question consisted of a five-level Likert item. Patients' clinic visits were grouped into independent data sets consisting of 3 data points (VAS-Rest, VAS-Active, and CP score). Incomplete data sets were excluded. The difference in VAS pain scores between consecutive visits and the CP score were compared using Spearman's correlation coefficient and linear regression analysis. Results: A total of 74 DRF patients and 119 complete two-visit data sets were included in the study. CP scores and VAS-pain scores were collected at periods of two weeks, four weeks, six weeks, eight weeks, three months, six months, and one year post treatment. Spearman's correlation coefficients between VAS pain scores and patients' CP score were minimal (r<0.3). Linear regression analysis showed a weak relationship between VAS pain scores and CP scores. Conclusion: Although VAS pain scores play a vital role in assessing pain in the short-term setting, the VAS seems to be a poor instrument for comparing treatment outcomes of long-term orthopedic interventions. Multi-dimensional pain questionnaires may be preferable for assessing long-term orthopedic outcomes.

Dose and other factors associated with decreased pain intensity among patients initiating buprenorphine/naloxone

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e221 activities in each category focusing on the first three and will describe an app developed for professionals. Conclusions: Informed planning of dissemination activities by a trusted source such as a professional association that attends to members’ concerns may increase acceptance of evidence-based practices. Some barriers, however, remain difficult to overcome. Financial support: AHRQ provides partial support. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.067 Dose and other factors associated with decreased pain intensity among patients initiating buprenorphine/naloxone William Becker1,2, Dara Ganoczy3, David Fiellin2, Amy S. Bohnert3 1 VA Connecticut, West Haven, CT, United States 2 Yale University, New Haven, CT, United States 3 Ann Arbor VA, Ann Arbor, MI, United States Aims: Opioid use disorder (OUD) and pain often co-occur, complicating the treatment of each condition. Owing to its partial agonist properties, buprenorphine/naloxone (BUP/NX) may confer advantages over full agonist opioids for treatment of both conditions. The optimal dose of BUP/NX for comorbid pain is not known. We examined dose and other factors associated with decreased pain intensity among patients initiating BUP/NX for OUD. Methods: We studied 1171 patients initiating BUP/NX treatment for OUD from 2004 to 2010. Eligible patients had >1 pain intensity numerical rating score (NRS) within 30 days before BUP/NX initiation (baseline) and >1 NRS between 15 and 90 days after BUP/NX initiation (within treatment). The primary outcome wasa clinically significantNRSdecrease (2or greater) frombaseline to within treatment. We used descriptive statistics to summarize baseline characteristics and BUP/NX doses and bivariate measures to assess the relationship between independent variables and change inpain intensity.Weusedgeneralized estimating equations to model odds of ≥2 NRS decrease, with BUP/NX dose as the independent variable of interest in the subset of patientswith a baseline NRS>2. Results: The samplewas94%male and73%white.Meanagewas 50. 30% of the sample had PTSD, 63% had major depression, while 44%hadalcohol usedisorder and75%hadnon-opioid substanceuse disorders. In bivariate analysis, patients without major depression and patients with cancer were more likely to have improved pain intensity with initiation of BUP/NX. In the subset analysis, the following demographic and clinical correlates were associated with a clinically significant decrease in pain intensity: age 18–29 (compared to 30–39 and40–49); absence of PTSDand absence of chronic pain. BUP/NXdosewasnotassociatedwithdecreasedpain intensity in bivariate or multivariable analysis. Conclusions: These findings suggest that factors other than BUP/NX dose contribute to improved pain intensity among those initiating it. Financial support: VA HSRD SUD QUERI (SUDQ-LIP1302). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.068 The effect of marijuana commercialization on adolescent polysubstance use and treatment Katherine Belendiuk1, Taylor Black1, Christian Thurstone1,2 1 Department of Psychiatry, University of Colorado, Aurora, CO, United States 2 Denver Health and Hospital Authority, Denver, CO,

Adopting Pain Management Competencies

Conflict of Interest/Disclosure Summary: Dr. Herrreceived an honorarium in the amount of $1,000 forher work as an executive committee participant in the“Summit for Interprofessional Consensus on PainManagement Competencies” and for her contributionto the development of the core pain managementcompetencies. This honorarium was made possiblethrough a grant by the Mayday Fund. Mr. Koebnerreceived no support outside of his normal salary as afaculty member in the Department of Anesthesiologyand Pain Medicine at University of California, Davis,School of Medicine.Gaining interprofessional consensus on the core painmanagement competencies for all prelicensure healthprofessional education is a significant achievement, yetthe value of this effort will be diminished if the com-petencies are not translated into practice. Production ofknowledge may be a prerequisite for change inpain management, but it is not sufficient in and of itself[1]. Adoption of the core pain management competen-cies by academic programs and professional groups isan important next step in modifying pain managementpractices to better meet the needs of people in pain. Toassure that the model pain management competenciesadvanced in this issue of

BODILY CHANGES IN PAIN, HUNGER, FEAR AND RAGEBODILY CHANGES IN PAIN, HUNGER, FEAR AND RAGE. CannonWalter B., 1929. D. Appleton &amp; Company, New York and London. Pp. 404.

Journal Article BODILY CHANGES IN PAIN, HUNGER, FEAR AND RAGE Get access BODILY CHANGES IN PAIN, HUNGER, FEAR AND RAGE. Walter B. Cannon, 1929. D. Appleton & Company, New York and London. Pp. 404. Endocrinology, Volume 14, Issue 1, 1 January 1930, Page 33, https://doi.org/10.1210/endo-14-1-33a Published: 01 January 1930