Intensive Pain Research Articles

Health professionals\u2019 perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units

BackgroundAudit and feedback aims to guide health professionals in improving aspects of their practice that need it most. Evidence suggests that feedback fails to increase accuracy of professional perceptions about clinical performance, which likely reduces audit and feedback effectiveness. This study investigates health professionals’ perceptions about their clinical performance and the influence of feedback on their intentions to change practice.MethodsWe conducted an online laboratory experiment guided by Control Theory with 72 intensive care professionals from 21 units. For each of four new pain management indicators, we collected professionals’ perceptions about their clinical performance; peer performance; targets; and improvement intentions before and after receiving first-time feedback. An electronic audit and feedback dashboard provided ICU’s own performance, median and top 10% peer performance, and improvement recommendations. The experiment took place approximately 1 month before units enrolled into a cluster-randomised trial assessing the impact of adding a toolbox with suggested actions and materials to improve intensive care pain management. During the experiment, the toolbox was inaccessible; all participants accessed the same version of the dashboard.ResultsWe analysed 288 observations. In 53.8%, intensive care professionals overestimated their clinical performance; but in only 13.5%, they underestimated it. On average, performance was overestimated by 22.9% (on a 0–100% scale). Professionals similarly overestimated peer performance, and set targets 20.3% higher than the top performance benchmarks. In 68.4% of cases, intentions to improve practice were consistent with actual gaps in performance, even before professionals had received feedback; which increased to 79.9% after receiving feedback (odds ratio, 2.41; 95% CI, 1.53 to 3.78). However, in 56.3% of cases, professionals still wanted to improve care aspects at which they were already top performers. Alternatively, in 8.3% of cases, they lacked improvement intentions because they did not consider indicators important; did not trust the data; or deemed benchmarks unrealistic.ConclusionsAudit and feedback helps health professionals to work on aspects for which improvement is recommended. Given the abundance of professionals’ prior good improvement intentions, the limited effects typically found by audit and feedback studies are likely predominantly caused by barriers to translation of intentions into actual change in clinical practice.Trial registrationClinicalTrials.govNCT02922101. Registered 26 September 2016.

(185) - What do parents want to know? a qualitative analysis of stakeholder input in planning a parent-education intervention in the context of an intensive rehabilitation program for youth with chronic pain

Parent factors have been increasingly identified as key intervention targets in the context of treatment programs for youth with chronic pain. However, little research has been done on the most effective or appropriate ways to address these factors. In the process of expanding a parent education curriculum in an intensive interdisciplinary pain rehabilitation program, parents of youth with chronic pain were asked to identify topics across multiple disciplines (e.g., psychology, medicine, occupational therapy, physical therapy) that would be of interest to them to learn more about. Using a Likert-type rating scale to indicate overall level of interest (1, not interested at all to 5, extremely interested), 12 parents/caregivers of youth with chronic pain (youth Mage = 14; Mlength of stay = 5 weeks; Mpain duration = 21 months) rated 22 potential education topics (e.g. how physical therapy works to treat my child's chronic pain, what types of school accommodations are available to my child). Results revealed that parents expressed at least moderate levels of interest in all education topics with “effective general parenting skills” rated least interesting (Mrating = 2.42) and “how I can support my child's physical recovery most appropriately” rated as most interesting (Mrating = 4.67). To explore patterns within parental preferences, two doctoral-level researchers analyzed and thematically categorized content into relevant themes. Independent coding between researchers produced an 86% concordance rate with the content coded into one of three areas: General education on chronic pain and treatment, General parent functioning/support, and Education specific to the child's pain condition and treatment regimen. A pilot parent-education intervention will be formulated based on the relevant themes that were identified. The development of future evidence-based parent education interventions will be important in taking more informed steps to improve psychosocial and pain-related outcomes in youth with chronic pain and their families.

Editorial introductions

Editorial introductions

Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome

In fibromyalgia (FM) a combination of symptoms frequently exists, including impaired cognition, memory changes, widespread pain, and disrupted sleep rhythm, with no sufficient explanations for these bizarre symptoms. Many theories have been developed and it is still not clear whether FM is a chronic stress syndrome caused by many factors, including society or just a part of the spectrum of chronic pain. FM is the second most common rheumatic disorder behind osteoarthritis and, though still widely a puzzling syndrome, is now considered to be a central nervous system disorder, which is responsible for amplified and intensive pain. Over the years, three main ideas of hippocampal function have dominated the literature: Response inhibition, episodic memory, and spatial cognition. Given that the hippocampus plays integral roles in memory, cognition, and sleep regulations the later functions may be influenced by prolonged stress know to exist in FM syndrome. Moreover the hippocampus is an integral component of the limbic system, and as such may contribute to the negative affect and avoidance motivation experienced during pain experience and chronic stress. The aim of the current review is to focus on the physiological roles of the hippocampus and its relation to symptoms production in FM syndrome.

Quality of life in patients with bone tumour

Introduction – in the last decades, scientific research of health related quality of life (QoL) is developing fast worldwide. QoL concept pays attention to emotional experience of disease in patients, particularly to personal sense of possibility to satisfy actual needs and possibility of full social functioning in spite of disease specific limitations. The aim of the study was to reveal the basic aspects and personality factors of QoL in patients with bone tumour. Results: the study revealed that patients with bone metastases assess their health significantly worse than other patients. Besides, patients with osteosarcoma evaluate their general health higher than patients with giant cell tumour. Social functioning in patients with chondrosarcoma is higher than in patients with bone metastases and patients with giant cell tumour. Patients with chondrosarcoma have higher physical functioning and less restricted in daily activities than patients with bone metastases. Patients with bone metastases have the most intensive pain among all patients. Moreover, the study revealed personality significant influence on QoL related to bone tumour. Conclusion – patients with bone metastasis have lower QoL compared to patients with primary bone tumours. Patients with giant cell tumour have the worth quality of life among patients with primary bone tumours. Furthermore the results revealed differences in QoL parameters associated with personality characteristics in patients with bone tumour.

Chronic postsurgical pain in mixed surgical population. Does an acute pain service make a difference?

To investigate the influence of an Acute Pain Service (APS) on the incidence of chronic postsurgical pain (CPSP). To assess the acute pain intensity as a risk factor for CPSP. The impact of an APS on the incidence of CPSP has not yet been studied. Retrospective questionnaire given to randomized cohorts study, performed in two hospitals - Hospital A with an APS and Hospital B without such service. 1444 patients underwent eight different surgical procedures in both hospitals within one year, 175 patients from each hospital were randomized. 208 questionnaires were analysed. There was a significant difference in acute pain intensity in the first 24 hours after surgery. The difference of CPSP incidence between hospitals was not significant (Hospital A nine patients (8.6 %), Hospital B sixteen patients (15.5 %). The patients with CPSP experienced significantly more intensive pain in the first 24 hours and at discharge than patients without CPSP regardless of the hospital. The study did not demonstrate the incidence of CPSP was lower in the hospital with an APS despite the lower postoperative pain scores. However there was a noticeable trend toward higher incidence of CPSP in the hospital without an APS. The study demonstrated that APS decreases intensity of an acute postoperative pain and acute pain intensity is a risk factor for CPSP incidence (Tab. 5, Ref. 27).

Etomidate and propylene glycol activate nociceptive TRP ion channels.

BackgroundEtomidate is a preferred drug for the induction of general anesthesia in cardiovascular risk patients. As with propofol and other perioperatively used anesthetics, the application of aqueous etomidate formulations causes an intensive burning pain upon injection. Such algogenic properties of etomidate have been attributed to the solubilizer propylene glycol which represents 35% of the solution administered clinically. The aim of this study was to investigate the underlying molecular mechanisms which lead to injection pain of aqueous etomidate formulations.ResultsActivation of the nociceptive transient receptor potential (TRP) ion channels TRPA1 and TRPV1 was studied in a transfected HEK293t cell line by whole-cell voltage clamp recordings of induced inward ion currents. Calcium influx in sensory neurons of wild-type and trp knockout mice was ratiometrically measured by Fura2-AM staining. Stimulated calcitonin gene-related peptide release from mouse sciatic nerves was detected by enzyme immunoassay. Painfulness of different etomidate formulations was tested in a translational human pain model. Etomidate as well as propylene glycol proved to be effective agonists of TRPA1 and TRPV1 ion channels at clinically relevant concentrations. Etomidate consistently activated TRPA1, but there was also evidence for a contribution of TRPV1 in dependence of drug concentration ranges and species specificities. Distinct N-terminal cysteine and lysine residues seemed to mediate gating of TRPA1, although the electrophile scavenger N-acetyl-L-cysteine did not prevent its activation by etomidate. Propylene glycol-induced activation of TRPA1 and TRPV1 appeared independent of the concomitant high osmolarity. Intradermal injections of etomidate as well as propylene glycol evoked severe burning pain in the human pain model that was absent with emulsification of etomidate.ConclusionsData in our study provided evidence that pain upon injection of clinical aqueous etomidate formulations is not an unspecific effect of hyperosmolarity but rather due to a specific action mediated by activated nociceptive TRPA1 and TRPV1 ion channels in sensory neurons.

THERAPUTIC ALTERNATIVES FOR PHANTOM LIMB PAIN FOLLOWING SURGERY

A study of different analgesic methods for phantom limb pain has been performed in 35 patients who had undergone limb amputation or exarticulation because of oncological disease or vascular disorders. Postoperative analgesia consisted of cyclooxygenese inhibitor and weak opioid. High intensive phantom limb pain appeared in 17 (48.6%) patients that required an administration of pregabalin followed by adenosine triphosphate infusion as analgotesting procedure: it had a success in 9 (52.9%) patients. Remaining 6 patients received nefopam that was effective in 5 of 8 (65.5%) patients. Epidural anesthesia was used with good results in remaining 3 patients. Thus, our data emphasize the complex of phantom limb pain mechanisms and necessity of study for elaboration of medicine effectiveness with different mechanisms of action for such cases.

Chronic intensive care-related pain: Exploratory analysis on predictors and influence on health-related quality of life.

There is growing evidence for the development of chronic pain after intensive care. Nonetheless, there is only limited knowledge about factors leading to chronic intensive care-related pain (CIRP). Thus, the primary objective was the identification of predictors of CIRP. Moreover, we aimed to assess the impact of CIRP on patients' health-related quality of Life (HRQOL). Comprehensive information on patients' pain before ICU admission and present pain was collected longitudinally by means of the German Pain Questionnaire 6 and 12months after ICU discharge (ICUDC ). In addition, a subsample of patients underwent Quantitative Sensory Testing (QST). We used Generalized Estimating Equations to identify predictors of CIRP with logistic regression models. In total, 204 patients (197/159 at 6/12months after ICUDC ) were available for the analyses. In the multivariate models, moderate to severe average pain in the 4weeks after ICUDC , lower age, female sex, increased inflammation and chronic pain conditions and increased levels of anxiety before ICU admission were predictive for CIRP. In addition, small fibre deficits and lower disease severity were associated with CIRP in the QST subsample (81 patients, 77/55 at 6/12months after ICUDC ). Patients with CIRP reported significantly lower HRQOL than patients without CIRP. Chronic intensive care-related pain is associated with specific decrements in HRQOL. Knowledge about the identified predictors is of clinical and scientific importance and might help to reduce the incidence of CIRP. Chronic intensive care-related pain is associated with specific decrements in health-related quality of life. While most of the identified predictors for CIRP can only be considered as risk factors, especially adequate (post-) acute pain management should be studied as preventive strategy.

Children With Chronic Pain: Response Trajectories After Intensive Pain Rehabilitation Treatment

Intensive pain rehabilitation programs for children with chronic pain are effective for many patients. However, characteristics associated with treatment response have not been well documented. In this article we report trajectories of pain and functional impairment in patients with chronic pain up to 1 year after intensive pain rehabilitation and examine baseline factors associated with treatment response. Patients (n = 253) with chronic pain and functional disability were assessed at 5 time points (admission, discharge, 1-month, 4-month, and 12-month follow-ups). Individual trajectories were empirically grouped using SAS PROC TRAJ. For functional disability, 2 groups emerged: treatment responders (88%) and nonresponders (12%). Using a binomial logistic regression model to predict disability trajectory group, no baseline variables were significant predictors for the disability trajectory group. For pain, 3 groups emerged: early treatment responders (35%), late treatment responders (38%), and nonresponders (27%). Using multinomial regression analyses to predict pain trajectory group, older age, higher pain scores, fewer social difficulties, higher anxiety levels, and lower readiness to change were characteristics that distinguished nonresponders from responders; no significant predictors distinguished the late responders from the early responders. These results provide key information on the baseline factors that influence intensive pain rehabilitation outcomes, including risk factors that predict treatment nonresponse. Our findings have implications for developing more targeted treatment interventions. PerspectiveDeriving groups of individuals with differing treatment response trajectories stimulates new thinking regarding potential mechanisms that may be driving these outcomes.

Adolescents’ Perceived Function at Follow-Up From an Intensive Chronic Pain Program Using Subjective Measures

Adolescents’ Perceived Function at Follow-Up From an Intensive Chronic Pain Program Using Subjective Measures

Health Care Utilization and Cost in Children and Adolescents With Chronic Pain: Analysis of Health Care Claims Data 1 Year Before and After Intensive Interdisciplinary Pain Treatment.

The aim of this study was to analyze changes in health care utilization and cost among a sample of highly impaired children and adolescents who sought a 3-week intensive interdisciplinary pain treatment (IIPT). Claims data from 7 statutory health insurance companies were analyzed for 65 children and adolescents who sought IIPT at the German Paediatric Pain Centre. The annual health care utilization and cost were determined for the following 4 areas: outpatient care, inpatient care, medications, and remedies and aids. We analyzed the changes in resource utilization in the year before (pre_1 y) IIPT and in the subsequent year (post_1 y). Within the first year after IIPT, overall health care costs did not decrease significantly. However, the pattern of health care utilization changed. First, significantly more children and adolescents started outpatient psychotherapy (P=0.001). Second, the number of hospitalized children decreased significantly from 1-year pre to 1-year post (P=0.001). Accordingly, there were significantly fewer hospitalizations for primary chronic pain disorders at 1-year post (P<0.001). The prescription of nonopioids, co-analgesics and opioids was significantly reduced from 1-year pre to 1-year post (all P<0.013). The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.

Pain in Extrapyramidal Neurodegenerative Diseases.

Pain is one of the most common nonmotor symptoms of Parkinson disease (PD) and other Parkinson plus syndromes, with a major effect on quality of life. The aims of the study were to examine the prevalence and characteristics of pain in PD and other Parkinson plus syndromes and patient use and response to pain medications. The cohort consisted of 371 patients: 300 (81%) with PD and 71 (19%) with Parkinson plus syndromes. Data on clinical parameters and pain were collected by questionnaire. Disease severity was measured with the Unified PD Rating Scale for patients with PD. Pain was reported by 277 patients (74%): 241 with PD and 36 with Parkinson plus syndromes. The prevalence of pain was significantly higher in the patients with PD than in the patients with Parkinson plus syndromes (80% vs. 50%, P<0.001) and higher in patients with synucleinopathies than in patients with tauopathies (70% vs. 40%, P<0.001). In the synucleinopathies, the most common pain was central pain (32%), whereas in the tauopathies only 4% of patients had central pain. Anti-Parkinson treatment relieved the pain in 21% of the patients with PD. Only 114 patients (48%) who experienced pain were treated with pain medications. The most beneficial analgesics were nonsteroidal anti-inflammatory drugs and medical cannabis. Pain is prevalent among patients with PD and Parkinsonian plus syndromes. Pain relief can be achieved by more intensive anti-Parkinson medications or pain medications.

Clinical and Economic Long-Term Treatment Outcome of Children and Adolescents with Disabling Chronic Pain.

Disabling pediatric chronic pain is accompanied by a significant burden to those affected and by high societal costs. Furthermore, it bears the risk of aggravation into adulthood. Studies have shown intensive interdisciplinary pain treatment to result in short-term positive effects on pain-related and psychological outcomes. In this study, we aimed to prove the stability of the long-term effects of intensive interdisciplinary pain treatment four years after treatment. This longitudinal observational study followed adolescents who had received intensive interdisciplinary pain treatment over four years. We defined a combined end point, overall improvement (pain intensity, pain-related disability, and school/work absence), and investigated three additional psychological outcome domains (anxiety, depression, pain catastrophizing). We also examined changes to economic parameters (health care utilization, subjective financial burden) and their relationship to patient improvement. Similar patterns were observed for pain-related and psychological outcome domains, with data showing statistically and clinically significant reductions from admission to four-year follow-up. These positive effects were stable from one- to four-year follow-up. Approximately 60% of the adolescents showed an overall long-term improvement. Older age was found to be a risk factor for treatment failure. Economic parameters decreased statistically significantly, particularly for those with an overall improvement of the chronic pain disorder. The results of this study support the long-term effectiveness of intensive interdisciplinary pain treatment and indicate that it can interrupt pain chronification. Future research is warranted to investigate why some of the adolescents did not show improvement and to allow for a more individualized treatment.

The Effectiveness of an Intensive Interdisciplinary Pain Rehabilitation Program in the Treatment of Post-Laminectomy Syndrome in Patients Who Have Failed Spinal Cord Stimulation.

Post-laminectomy syndrome (PLS) patients who have previously undergone spinal cord stimulation and failed to have significant improvement create a unique challenge for ongoing pain management. We hypothesize that, following successful completion of intensive, interdisciplinary pain rehabilitation (IPR), this patient population can achieve a significant reduction in pain, improvement in mood, functional levels, and self-efficacy. A retrospective chart review was conducted comparing the following for patients prior to enrollment in the IPR program and upon completion: numeric rating scale (NRS) pain scores; functional status via the six-minute walk test; mood via the Center for Epidemiologic Studies Depression Scale (CES-D), Multidimensional Pain Inventory (MPI) Life control scores and MPI Interference, and the Pain Catastrophizing Scale (PCS); and self-efficacy via the Pain Self-Efficacy Questionnaire (PSEQ). Forty-three patients met inclusion criteria, with 17 males and 26 females and a mean age of 64 years. Patients demonstrated a statistically significant increase in six-minute walk test distance of 104 m, a decrease in average NRS pain score of 1.4 points, an increase in average MPI life control by 8.3 points, a decrease average MPI interference by 5.3 points, an increase in average Short Form-36 by 6.5 points, an increase in average PCS by 4.4 points, and an increase in average PSEQ score of 18.1. Their average mood via CES-D improved by 4.2 points. Intensive, interdisciplinary pain rehabilitation provides an effective therapeutic modality for patients with post-laminectomy syndrome who have failed spinal cord stimulation by decreasing pain levels and by increasing functional status and self-efficacy.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Gernot MarxGernot MarxDr Gernot Marx, MD, FRCA, is full Professor of Anesthesiology and Critical Care Medicine and Chair at the University RWTH Aachen, Germany. He is Head of the Department of Intensive Care Medicine and Intermediate Care at the University Hospital RWTH Aachen. He is Chairman of the Board of the German Society of Telemedicine. He is full Board Member of the German Society of Anaesthesia and Intensive Care and full Board Member of the German Interdisciplinary Society of Intensive Care and Emergency Medicine. He graduated and took his residency at the Medizinische Hochschule Hannover, Germany. He was Senior Lecturer in Anaesthesia and Intensive Care Medicine at the University of Liverpool, UK, and full Professor for Anaesthesiology, Intensive Care and Emergency Medicine at the Friedrich-Schiller-Universität Jena, Germany. He received the Fellowship by election of the Royal College of Anaesthetists. His research interest is focused on sepsis, fluid therapy and telemedicine. He is Editor of two books, Checklist Intensive Care Medicine and The Intensive Care Medicine. He is Editor in Chief of intensivup2date, Editor of AINS (Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie) and Associate Editor of British Journal of Anaesthesia. Stanley H. RosenbaumStanley H. RosenbaumStanley H. Rosenbaum, MA, MD, is Professor of Anesthesiology, Internal Medicine and Surgery at Yale University School of Medicine, USA. He is the Vice Chairman for Academic Affairs and the Director of the Division of Perioperative and Adult Anesthesia in the Department of Anesthesiology. Dr Rosenbaum has had a long career doing research and publishing numerous papers, monographs and textbooks on various aspects of anesthesiology, critical care medicine and medical ethics. In 2011 he was awarded the Lifetime Achievement Award of the Society of Critical Care Anesthesiologists. Kai ZacharowskiKai ZacharowskiProfessor Kai Zacharowski, MD, PhD, ML, FRCA, holds the position of the Ordinarius and is the Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt, Germany, since 2009. From 2006 until 2008 he was the Chair of Anesthesia and Intensive Care Medicine at the University Hospital Bristol, UK. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, transfusion and clotting, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz, Germany, and his PhD from Queen Mary, University of London, UK, where he was working with the Nobel laureate Prof Sir John Vane who discovered how aspirin works. His scientific contributions have been published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science and were awarded with numerous awards for Innovative Clinical Research. He is serving as Editor-in-Chief for the Journal of Anesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in Critical Care Medicine, Emergency Medicine and Anesthesia and is the CEO of the Lohfert Foundation. He is practicing Anesthesia and Critical Care Medicine in Frankfurt.

(257) Evaluating Self Report and Objective Measures for Adolescents’ Change in Functional Abilities after Completion of an Intensive Chronic Pain Rehabilitation Program

(257) Evaluating Self Report and Objective Measures for Adolescents’ Change in Functional Abilities after Completion of an Intensive Chronic Pain Rehabilitation Program

Moderate hyperoxia induces inflammation, apoptosis and necrosis in human umbilical vein endothelial cells: An in-vitro study.

Perioperative oxygen (O2) therapy can cause hyperoxia. Extreme hyperoxia can injure the cardiovascular system and remote organs. Our primary objective was to test the hypothesis that exposure to moderate hyperoxia will induce injury to human umbilical vein endothelial cells (HUVECs), a model for studying the vascular endothelium under controlled conditions. In-vitro cell culture study. Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Austria. Study period from the beginning of October 2013 to the end of July 2014. HUVECs were isolated from fresh umbilical cords. HUVECs were exposed to constant hyperoxia (40% O2), cyclic hyperoxia/anoxia (40%/0% O2, average 20% O2), constant normoxia (21% O2) and constant anoxia (0% O2) using a cell culture bioreactor. Cell growth, viability and release of IL-6, IL-8 and macrophage migration inhibitory factor were assessed at baseline and after 6, 12, 24 and 48 h of treatment. A phosphokinase array was performed after 60 min of treatment to identify activated cellular signalling pathways. Constant hyperoxia and cyclic hyperoxia/anoxia impeded cell growth, reduced viability, triggered a proinflammatory response, proven by IL-6, IL-8 and migration inhibitory factor release, and induced apoptosis and necrosis. The inflammatory and cytotoxicity responses were highest in the constant hyperoxia group. Phosphokinase arrays revealed that different O2 concentrations activated distinct sets of cytoprotective and cell death-associated kinases, including mitogen-activated protein kinases, Src kinases, p53, Akt, mitogen-activated and stress-activated kinase, Lyn, Lck, p70S6, signal transducers and activators of transcription 5b and 6, glycogen synthase kinase 3a/b and 5' AMP-activated protein kinases 1/2. Continuous moderate hyperoxia and cyclic moderate hyperoxia/anoxia-induced endothelial inflammation, apoptosis and necrosis. Given the large surface area of the vascular endothelium, moderately elevated O2 levels may contribute to cardiovascular inflammation and injury. This in-vitro study was not registered in a database.

Are intensive data collection methods in pain research feasible in those with physical disability? A study in persons with chronic pain and spinal cord injury.

Intensive repeated measures data collection procedures, such as ecological momentary assessment (EMA) and end-of-day (EOD) diaries, are becoming more prominent in pain research. Existing data on the feasibility of such methods is encouraging; however, almost nothing is known about feasibility in clinical populations with significant physical disabilities. Research methodology feasibility is crucial to the inclusion of individuals with physical disability in pain research given the high prevalence and impact of pain in these populations. The aim of this study was to examine study compliance, protocol acceptability, and reactivity of intensive data collection methods in adults with chronic pain and spinal cord injury (SCI). Secondary analysis of data from a 7-day EMA and EOD diary study in a sample of 131 community dwelling adults with SCI. Results showed rates of missing data ranged from 18.4 to 22.8% across measures. Participant compliance was related to time of day/presence of audible prompts, mobility aid use, race, and baseline levels of pain and pain interference, with more missing data at wake and bedtimes/no prompts, and for those who used hand-held mobility devices, identified as black/African American, and/or reported higher baseline pain and pain interference. Participants rated the study methodology as generally highly acceptable and expressed willingness to participate in similar studies of much longer duration. There was no evidence of reactivity, defined as temporal shifts in pain or pain interference ratings. Overall, intensive pain data collection is feasible in persons with SCI with no evidence that the methodology impacts pain intensity or pain interference ratings.

Clinical and emotional/behavioral characteristics of acute and chronic low-back pain

To analyze clinical and emotional/behavioral characteristics of acute and chronic low-back pain that significantly affect quality-of-life. Fifty-three patients with pain syndromes were examined using the painDETECT questionnaire, the Visual Analog Scale for Pain, The McGill Pain Questionnaire and laboratory and instrumental methods of neurological assessment. A 'picture of the patient with acute and chronic pain' was built, a group of patients with neuropathic component of pain was described. The size of herniated discs was not correlated with VAS assessments and the neuropathic component had a mild effect on pain intensity. The significant correlation was found between the severity of pain and coping strategies for pain. The results indicate the importance of effective and safety pain stopping, in particular at the acute stage, to prevent pain chronification. A drug of choice in case of intensive pain and marked nociceptive component are highly effective and safe nonsteroidal anti-inflammatory drugs, in particular etoricoxib (Arcoxia), a selective COX-2 inhibitor.