Chronic Pain In Persons Research Articles

Chronic pain in persons with neuromuscular disease

Chronic pain in persons with neuromuscular disease

Chronic Pain in Persons With Neuromuscular Disease

Jensen MP, Abresch RT, Carter GT, McDonald CM. Chronic pain in persons with neuromuscular disease. Arch Phys Med Rehabil 2005;86:1155–63. Objective To examine the nature and scope of pain in persons with neuromuscular disorder (NMD). Design Survey study. Setting University-based rehabilitation research programs. Participants Adults with NMD (N=193). Interventions Not applicable. Main Outcome Measures Pain presence or absence, pain severity, pain quality (Neuropathic Pain Scale), pain interference (Brief Pain Inventory), pain site, quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and pain treatment. Results Seventy-three percent of the sample reported pain, with 27% of these reporting that this pain was severe (≥7 on a 0–10 scale), on average. “Deep,” “tiring,” “sharp,” and “dull” were the words used most frequently to describe NMD pain. Patients with amyotrophic lateral sclerosis and myotonic muscular dystrophies reported the greatest pain interference, and patients with Charcot-Marie-Tooth the least, among all NMD diagnoses. The most frequent pain site, overall, was back (49%), followed by leg (47%), shoulder (43%), neck (40%), buttock and hip(s) (37%), feet (36%), arm(s) (36%), and hand(s) (35%). The study participants reported significantly greater dysfunction than subjects in the SF-36 normative sample (persons without health problems) on a number of the SF-36 scales. However, we found no significant differences between the study participants and the US norms on the SF-36 role-emotional or mental health scales. A number of pain treatments were used by the study sample, but no treatment appeared to be effective for all participants, and some of the treatments reported as most effective (eg, chiropractic care) were used by very few participants. Conclusions Pain is a common problem among patients with NMDs. There are many similarities, but also some important differences, between NMD diagnostic groups on the nature and scope of pain and its impact. More research is needed to identify and test effective treatments for NMD-related pain.

Hypnotic Analgesia for Chronic Pain in Persons with Disabilities: A Case Series1 Abstract

Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment. 1This research was supported by grant number R01 HD42838 from the National Institutes of Health, National Institute of Child and Health, National Center for Medical Rehabilitation Research, grant number H133B031129 from the Department of Education, National Center of Disability and Rehabilitation Research, and the Hughes M. and Katherine G. Blake Endowed Professorship in Health Psychology awarded to MPJ. The authors gratefully acknowledge the assistance of Chiara LaRotonda and Kristin McArthur in data collection and data entry.

Characteristics of chronic pain in persons with spinal cord injury: A differentiated approach

Characteristics of chronic pain in persons with spinal cord injury: A differentiated approach

Hypnotic analgesia for chronic pain in persons with disabilities

Hypnotic analgesia for chronic pain in persons with disabilities

Treatment of chronic pain in persons with dementia: an overview.

The purpose of this review is to identify the common causes of nonmalignant chronic pain in people with dementia, discuss methods for determining the level of pain in patients who are nonverbal, and evaluate pharmacologic treatment for nonmalignant chronic pain.

Pain epidemiology: Chronic pain in persons with neuromuscular disease

Pain epidemiology: Chronic pain in persons with neuromuscular disease

Prediction of outcome: Predicting chronic pain in persons with amputations: The role of pain before and after amputation

Previous research suggests that greater pre-amputation pain may increase the risk of developing phantom limb pain (PLP), although the role of acute pain after amputation is unknown. This longitudinal study was undertaken to determine if chronic phantom limb pain (PLP) could be predicted by pain level before or after amputation. Participants were recruited from consecutive admissions for lower limb amputation. Sixty-five patients scheduled for amputation provided ratings of pre-amputation pain on 0-10 numerical rating scales (NRS). After amputation, participants provided ratings of acute PLP and residual limb pain (RLP) during the first 5 days after amputation, as well as ratings of PLP and RLP at 6, 12, and 24 months after amputation. Multiple regression analyses were used to examine the associations of pre-amputation pain levels and acute post-amputation pain (PLP and RLP, each averaged over post-operative days 4-5) with chronic PLP, controlling for demographic variables and acute post-operative opiate use. Greater pre-amputation pain and acute post-operative PLP intensity were associated with greater chronic PLP intensity at follow-up, accounting for 36%, 50%, and 29% of the variance at 6-, 12-, and 24-months, respectively. Acute post-operative PLP intensity was the strongest individual predictor of PLP intensity at 6 and 12 months (β = 0.48 and 0.54, ps < .001 and .01, respectively), while pre-amputation pain intensity was the strongest individual predictor of PLP intensity at 24 months (β = 0.29, p < .05). Age, gender, acute opiate use, acute RLP, and duration of pre-amputation pain did not predict chronic PLP intensity at any follow-up. Because greater pre-amputation pain and acute post-operative PLP may increase the risk of chronic PLP, future research should further examine their potential role in the development and maintenance of chronic PLP.

Searching the literature for information on traumatic spinal cord injury: the usefulness of abstracts.

Systematic review of abstracts of published papers presumed to contain information on chronic pain in persons with spinal cord injury (SCI). To determine to what degree papers on SCI are abstracted in such a way that they can be retrieved, and evaluated as to the paper's applicability to a reader's questions. US--academic department of rehabilitation medicine. 868 abstracts published in Medline were independently examined by two out of 13 screeners, who answered four questions on the subjects and nature of the paper with 'Yes', 'No' or 'insufficient information'. Frequency of ratings 'insufficient information', and screener agreement were evaluated as affected by screener and abstract/paper characteristics. Screeners could not determine whether the paper dealt with persons with traumatic SCI for 37% of abstracts; whether chronic pain was a topic could not be determined in 18%. Physicians were less willing than other disciplines to assign 'insufficient information'. Screener agreement was better than chance, but not at the level suggested for quality measurement. Screener discipline and task experience did not make a difference, nor did abstract length, structure, or decade of publication of the paper. Authors need to improve the quality of abstracts to make retrieval and screening of relevant papers more effective and efficient. National Institute on Disability and Rehabilitation Research.

Classification of chronic pain associated with spinal cord injuries

Cardenas DD, Turner JA, Warms CA, Marshall HM. Classification of chronic pain associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1708-14. Objectives: To determine interrater reliability of a classification system for chronic pain in persons with spinal cord injury (SCI) and to determine the frequency and characteristics of various pain types as categorized by this system. Design: Independent categorization (based on questionnaires; for 15 persons, questionnaires plus personal interviews) by 2 investigators. Setting: Community. Participants: A total of 163 individuals aged ≥18 years with SCI and pain. Interventions: Not applicable. Main Outcome Measures: Pain categories, Short-Form McGill Pain Questionnaire, and Chronic Pain Grade questionnaire. Results: Among 41 (25%) questionnaires categorized independently by 2 investigators, strength of agreement in categorizing 68 pain problems was substantial (κ=.68). For 15 persons whose pain was categorized in person by 2 investigators, strength of agreement was also substantial (κ=.66). Among 163 survey respondents with pain, the most common worst pain was SCI pain (31.9%). Mean characteristic pain intensity ± standard deviation for worst pain, regardless of type, was 61.02±18.5 on a scale from 0 to 100. On average, for worst pain, respondents reported moderate pain-related disability (43.70±29.4; scale range, 0–100). Although certain pain descriptors were more often associated with a specific type of pain, none was pathognomonic. Conclusions: Substantial interrater reliability was achieved in determining pain categories by use of responses to a questionnaire with a classification system based on presumed pathology. Adding interviews with patients increased our ability to classify pain but did not improve overall interrater reliability. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial

Chronic pain in persons with spinal cord injury (SCI) is a difficult problem for which there is no simple method of treatment. Few randomized controlled trials of medications for pain in persons with SCI have been conducted. This study was designed to determine whether amitriptyline, a tricyclic antidepressant, is efficacious in relieving chronic pain and improving pain-related physical and psychosocial dysfunction in persons with SCI. Eighty-four participants with SCI and chronic pain were randomized to a 6-week trial of amitriptyline or an active placebo, benztropine mesylate. All pre- and post-treatment assessments were conducted by evaluators blind to the allocation. Regression analyses were conducted to examine whether there was a medication group effect on the primary (average pain intensity) and secondary outcome measures. No significant differences were found between the groups in pain intensity or pain-related disability post-treatment, in either intent-to-treat analyses or analyses of study completers. These findings do not support the use of amitriptyline in the treatment of chronic pain in this population, but we cannot rule out the possibility that certain subgroups may benefit.

Depressive symptomatology in relation to emotional control and chronic pain in persons who are HIV positive.

Depressive symptomatology in relation to emotional control and chronic pain in persons who are HIV positive.

Depressive symptomatology in relation to emotional control and chronic pain in persons who are HIV positive.

Depressive symptomatology in relation to emotional control and chronic pain in persons who are HIV positive.