McGill Pain Scale Research Articles

The effect of smartphone usage on the upper extremity performance among Saudi Youth, KSA

Abstract The current study aims to investigate the effect of smartphone usage on the upper extremity performance among Saudi youth. A goniometer to measure the Range of Motion (ROM), the Smartphone Addiction Scale (SAS), McGill Pain scale and Chattanooga stabilizer were used to perform the current study on a sample of 300 university students from Al-Imam Mohammed Bin Saud University. The results have shown that smartphone addiction is negatively correlated to the elbow flexion, shoulder flexion, shoulder extension, shoulder abduction, shoulder adduction, and both shoulder internal and external rotation. Furthermore, the results have shown that McGill pain scores were positively correlated to elbow flexion, shoulder flexion, shoulder extension, shoulder abduction, shoulder adduction, and both shoulder internal and external rotation. The study has concluded that smartphone usage among Saudi youth negatively affects the upper extremity and causes a significant increase in the pain intensity. The study has recommended that there is an urgent need for a significant awareness campaign to warn the community regarding the impact of using smartphones for long periods of time.

Pain, psychosocial tests, pain sensitization and laparoscopic pelvic surgery.

Individuals with non-acute pain are challenged with variable pain responses following surgery as well as psychological challenges, particularly depression and catastrophizing. The purpose of this study was to compare pre- and postoperative psychosocial tests and the associated presence of sensitization on a cohort of women undergoing elective laparoscopic surgery for non-acute pain defined as pain sufficient for surgical investigation without persistent of chronic pain. The study was a secondary analysis of a previous report (Am J Obstet Gynecol 2014 Oct;211(4):360-8.). The study was a prospective cohort trial of 77 women; 61 with non-acute pain and 16 women for a tubal ligation. The women had the following tests: Pain Disability Index, Pain Catastrophizing Scale, CES-D (Center for Epidemiologic Studies Depression Scale) depression scale and the McGill Pain Scale (short form) as well as their average pain score and the presence of pain sensitization. All test scores were correlated together and comparisons were done using paired t-test. There were reductions in pain and psychosocial test scores that were significantly correlated. Pre-operative sensitization indicated greater changes in psychosocial tests. There was a close association of tests of psychosocial status with average pain among women having surgery on visceral tissues. Incorporation of these tests in the pre- and postoperative evaluation of women having laparoscopic surgery appears to provide a means to a broader understanding of the woman's pain experience.

Effects of Pilates and yoga in patients with chronic neck pain: A sonographic study.

Various studies have shown the efficacy of conventional isometric, Pilates and yoga exercises. However, data on the effects and comparison of these specific exercises on the cervical muscle morphology are insufficient or lacking. To investigate the effects of different exercise treatments on neck muscles in patients with chronic neck pain. A randomized study. Fifty-six patients with chronic neck pain were randomized into 3 groups as follows: Pilates group (n = 20), yoga group (n = 18) and isometric group (n = 18). Demographics and background information were recorded. The thickness and cross-sectional area of neck muscles were evaluated by ultrasound imaging. Cervical motions were measured with a goniometer. Pain severity was evaluated with the McGill Pain Scale, disability with the Neck Disability Index, quality of life with the Nottingham Health Profile, and emotional status with the Beck Depression Inventory. In addition to a conventional physio-therapy programme, 15 sessions of physical therapy, including hot pack, ultrasound, and transcutaneous electrical nerve stimulation (TENS), were provided to all patients. All groups performed the exercises for 6 weeks. The aforementioned assessments were performed before and 6 weeks after the treatment. Although pain, disability, depression and quality of life improved similarly within all groups (all p < 0.05), muscle thickness values as regards the semispinalis capitis were increased only in the Pilates group (p = 0.022). The lack of complex (progressive resistive) exercise treatment protocols, short treatment duration and partial supervision. All 3 types of exercise had favourable effects on pain and functional scores, but no differences were found among the groups, except for the Pilates group, in which the semispinalis capitis muscle increased in thickness.

3D augmented reality mirror visual feedback therapy applied to the treatment of persistent, unilateral upper extremity neuropathic pain: a preliminary study

Objective: We assessed whether or not pain relief could be achieved with a new system that combines 3D augmented reality system (3DARS) and the principles of mirror visual feedback.Methods: Twenty-two patients between 18 and 75 years of age who suffered of chronic neuropathic pain. Each patient performed five 3DARS sessions treatment of 20 mins spread over a period of one week. The following pain parameters were assessed: (1) visual analogic scale after each treatment session (2) McGill pain scale and DN4 questionnaire were completed before the first session and 24 h after the last session.Results: The mean improvement of VAS per session was 29% (p < 0.001). There was an immediate session effect demonstrating a systematic improvement in pain between the beginning and the end of each session. We noted that this pain reduction was partially preserved until the next session. If we compare the pain level at baseline and 24 h after the last session, there was a significant decrease (p < 0.001) of pain of 37%. There was a significant decrease (p < 0.001) on the McGill Pain Questionnaire and DN4 questionnaire (p < 0.01).Conclusion: Our results indicate that 3DARS induced a significant pain decrease for patients who presented chronic neuropathic pain in a unilateral upper extremity. While further research is necessary before definitive conclusions can be drawn, clinicians could implement the approach as a preparatory adjunct for providing temporary pain relief aimed at enhancing chronic pain patients’ tolerance of manual therapy and exercise intervention.Level of Evidence: 4.

The effects of fatigue and pain on daily life activities in systemic lupus erythematosus.

The aim of this study was to determine the effects of pain and fatigue on daily life activities of systemic lupus erythematosus (SLE) patients. The study sample included 74 SLE patients who presented to outpatient departments of a university hospital and two local hospitals between 30.9.2009 and 15.5.2010. Data was collected using the Fatigue Severity Scale, Katz's Activity's Daily Living Index, Lawton and Brody's Instrumental Activities of Daily Living, and the McGill Pain Questionnaire. The mean scores were 6.0 (fatigue) on the Fatigue Severity Scale, 18.0 (independent) on the Daily Life Activities Index, 24.0 (independent) on the Instrumental Daily Life Activities Index, and 1.56 (discomforting) on the McGill Pain Scale for pain felt at the moment of questioning. A low-level negative relationship was observed between the scores on the Fatigue Severity Scale and the Daily Life Activities Index (p<0.05, r=-0.298), and between Fatigue and Instrumental Daily Life Activities scores (p<0.05, r=-0.354). A medium-level positive relationship was observed between the scores on the Fatigue Severity Scale and the McGill Pain Scale (p<0.05, r=0.478). This study determined that pain and fatigue affected the daily lives of SLE patients. The study should be repeated on a larger sample.

Pain management of elderly in nursing homes

The aim of this study was to determine pain management status of the elderly in nursing homes. The descriptive study sample included 82 elderly who presented to two nursing homes in İzmir between February-July 2012. In this study, Elderly Identification Form, Mini-Mental Scale, McGill Pain Scale (MAS) and Pain Management Inventory were used as the data collection tool. It was determined that the highest rates of complaints the elderly individuals had were knee pain (64.6%) and headache (58.5%) in this study. Of the elderly people participating in the study, 96.3% took pain relievers for pain management and according to their statements, of the pain management methods they used, resting and directing attention to something else (X=5.76±0.87) and taking prescribed pain relievers (X=5.69±0.87) were very beneficial. In elderly individuals, it is important to use pharmacological and non-pharmacological methods for pain management. Therefore, it is recommended to determine the most frequently used methods for pain management by the elderly and to integrate them into the care plan.

Pain in Parkinson's disease associated with COMT gene polymorphisms.

Background. PD patients present high incidence of pain with unknown pathogenesis. Objective. We investigated the relation of COMT polymorphisms rs4633 and rs6267 with PD pain. Subjects and Methods. One hundred PD patients and 105 controls were evaluated with simplified Mc GILL pain scale and VAS scale. PD patients were assessed with H&Y grade, UPDRS score, and HAMD scale. Polymorphisms rs4633 and rs6267 were detected by PCR and direct sequencing. Results. Fifty-seven percent of PD patients experienced pain, consisting of PD-related pain (64.91%) (the majority was dystonia pain) and non-PD-related pain (35.09%) (psychogenic pain was most frequent). The frequency of rs6267 genotype “GT/TT” and allele “T” was higher in PD pain. No difference was observed in frequencies of rs4633 between PD pain and without pain. UPDRS and depression score were higher in PD pain. The onset age was earlier in PD-related pain (57.43 ± 19.71) than non-PD-related pain (63.36 ± 6.88). Conclusion. PD patients possess a high prevalence of pain. Dystonia pain was the most frequent type of PD-related pain. COMT gene rs6267 allele “T” associated with PD pain. PD pain was influenced by disease severity and depression. PD onsets earlier in patients with PD-related pain than non-PD-related pain.

Effectiveness of acupuncture intervention for neck pain caused by cervical spondylosis: study protocol for a randomized controlled trial

BackgroundNeck pain caused by cervical spondylosis has become a common health problem worldwide among >40-year-old adults. Acupuncture intervention is one of the most popular treatment measures for this disorder. However, evidence for its efficacy in relieving neck pain and recovering neck physiological function has not been established in randomized, placebo-controlled trials. The primary aim of this trial is to assess the efficacy and safety of active acupuncture compared with sham acupuncture intervention for neck pain caused by cervical spondylosis.Methods/DesignWe will conduct a randomized, double-blind, parallel-group, placebo-controlled trial comparing active acupuncture with placebo (sham acupuncture). A total of 456 patients with neck pain caused by cervical spondylosis who meet the eligibility criteria from outpatient clinics of the Second People’s Hospital of Fujian Province and the Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine will be recruited and randomized into an active acupuncture or sham acupuncture group. The participants will undergo treatment sessions with either active or sham acupuncture intervention five times a week for 2 weeks. Evaluation by blinded assessors at baseline and at intervention for 1 and 2 weeks will include demographic characteristics, validated questionnaires (Northwick Park Neck Pain Questionnaire (NPQ) scale, Short-Form 36 (SF-36) scale, and McGill pain scale), examination of neck physiological function, and adverse events. All included patients will be followed up and investigated for relapse of neck pain at 4, 8, and 12 weeks after intervention.DiscussionThis paper describes the rationale and design of a randomized double-blind, placebo-controlled trial that aims to determine the efficacy and safety of acupuncture intervention for neck pain caused by cervical spondylosis. The primary outcomes are changes in the NPQ score and neck physiological function. Secondary outcome measures include quality of life, adverse events, and relapse of neck pain. If successful, this project will provide evidence of the efficacy and safety of acupuncture for neck pain caused by cervical spondylosis.Trial registrationChinese Clinical Trial Registry: ChiCTR-TRC-12002206.Registration date: 11 May 2012.

Massage Therapy and Labor Outcomes: a Randomized Controlled Trial

Massage is a time-honored method by which women have received comfort throughout the millennia, yet it has not been rigorously evaluated in the modern day delivery suite. No study to date that we are aware of has evaluated the effect of massage therapy by a regulated massage therapist on labor pain. The purpose of this study was to evaluate the effectiveness of massage therapy provided by registered massage therapists in managing pain among women in active labor. BC Women's Hospital, Vancouver, BC. a randomized controlled trial. 77 healthy nulliparous women presenting in spontaneous labor. Swedish massage administered for up to five hours by a registered massage therapist during labor vs. standard care. Main outcome measures include: cervical dilation at the time of administration of epidural, compared using estimated marginal means in an analysis of covariance. We also compared perception of pain at three time periods during labor according to cervical dilation at 3-4 cm, 5-7 cm, and 8-10 cm using the McGill Present Pain Intensity Scale. The mean cervical dilation at the time of epidural insertion after adjustment for station of the presenting part, cervical dilation, and status of membranes on admission to hospital was 5.9 cm (95% CI 5.2-6.7) compared to 4.9 in the control group (95% CI 4.2-5.8). Scores on the McGill Pain Scale were consistently lower in the massage therapy group (13.3 vs. 16.9 at 3-4 cm, 13.3 vs. 15.8 at 5-6 cm, and 19.4 vs. 28.3 at 7-8 cm), although these differences were not statistically significant. Our findings from this pilot study suggest that massage therapy by a registered massage therapist has the potential to be an effective means of pain management that may be associated with delayed use of epidural analgesia. It may therefore have the potential to reduce exposure to epidural analgesia during labor and decrease rates of associated sequelae.

The effects of acupressure on severity of primary dysmenorrhea

BackgroundDysmenorrhea constitutes one of the most frequent disorders in women of a fertile age. The objective of this research was to determine the effects of acupressure at Sanyinjiao (SP6) point and DiJi (SP8) point on pain severity of primary dysmenorrhea and the associated systemic symptoms.Materials and methodsIn this crossover clinical trial, 50 females aged 18–30 years old who met the study criteria and were under the care of Sarpolezahab Health Center were selected. Subjects were randomly assigned to one of two groups and evaluated during three menstrual cycles. We evaluated pain severity using the McGill pain scale and associated systemic symptoms using a verbal multidimensional scoring system. Data acquired from 42 cases were analyzed using SPSS software, with a P value of <0.05 considered significant.ResultsThe findings of our study indicate that the severity of dysmenorrhea pain diminishes significantly for up to 2 hours following treatment with acupressure at the SP6 and SP8 points (P < 0.001). Furthermore, the severity of associated systemic symptoms reduced significantly after acupressure at the SP6 and SP8 points, except for nausea and vomiting. Comparison of the severity of systemic symptoms with acupressure at the SP6 and SP8 points revealed no significant difference except for severity of fatigue, which was reduced significantly further with SP6 point compared to SP8 point (P = 0.004).ConclusionAcupressure at the SP6 and SP8 points can reduce pain severity of dysmenorrhea for up to 2 hours after application, and these points may be used to alleviate the severity of systemic symptoms accompanying dysmenorrhea.

THE EFFECTS OF FATIGUE AND PAIN ON DAILY LIFE ACTIVITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS

OBJECTIVES The aim of this study was to determine the effects of pain and fatigue on daily life activities of systemic lupus erythematosus (SLE) patients. METHODS The study sample included 74 SLE patients who presented to outpatient departments of a university hospital and two local hospitals between 30.9.2009 and 15.5.2010. Data was collected using the Fatigue Severity Scale, Katz's Activity's Daily Living Index, Lawton and Brody's Instrumental Activities of Daily Living, and the McGill Pain Questionnaire. RESULTS The mean scores were 6.0 (fatigue) on the Fatigue Severity Scale, 18.0 (independent) on the Daily Life Activities Index, 24.0 (independent) on the Instrumental Daily Life Activities Index, and 1.56 (discomforting) on the McGill Pain Scale for pain felt at the moment of questioning. A low-level negative relationship was observed between the scores on the Fatigue Severity Scale and the Daily Life Activities Index (p<0.05, r=-0.298), and between Fatigue and Instrumental Daily Life Activities scores (p<0.05, r=-0.354). A medium-level positive relationship was observed between the scores on the Fatigue Severity Scale and the McGill Pain Scale (p<0.05, r=0.478). CONCLUSION This study determined that pain and fatigue affected the daily lives of SLE patients. The study should be repeated on a larger sample.

Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: effects of recurrence and repair technique

To determine the effects of repair technique and hernia recurrence on patient-reported outcomes after incisional hernia repair. This cohort study included patients from sixteen Veteran's Affairs Medical Centers across the United States who underwent elective incisional hernia repair between 1997 and 2002. Technical details and outcomes (repair type and recurrence status) were determined by physician chart review. Patient satisfaction, chronic pain (McGill pain scale and visual analogue scale), and health-related quality of life (Short Form 36) were evaluated with a mailed survey at a median of five years after repair. Multivariable regression modeling was performed to evaluate the effect of repair type and recurrence status on patient-reported outcomes. Of 854 patients alive at the time of survey mailing, 371 responded (43.4%). Patients with active recurrence were more likely to be dissatisfied with their results (odds ratio (OR) 6.2, P < 0.0001), to have chronic sensory hernia site pain (OR 3.2, P = 0.01), to report disturbance from pain (OR 2.1, P = 0.04), and to have significantly worse quality of life on the Physical Function, General Health, and Physical Component Score domains. Repair technique with permanent mesh versus suture had no independent effect on patient satisfaction, chronic pain, or QOL. Recurrence has a substantial negative effect on patient-reported outcomes after incisional hernia repair, whereas the repair technique has no independent effect.

Oral Desipramine and Topical Lidocaine for Vulvodynia

To estimate the efficacy of common treatments for vulvodynia: topical lidocaine monotherapy, oral desipramine monotherapy, and lidocaine-desipramine combined therapy. A 12-week randomized, double-blinded, placebo-controlled trial was conducted on 133 vulvodynia-afflicted women assigned to four treatment arms: placebo tablets-placebo cream, desipramine tablets-placebo cream, placebo tablets-lidocaine cream, and desipramine tablets-lidocaine cream. The tampon test was selected as primary end point using a modified intention-to-treat analysis. Twelve secondary end points were also examined. At completion of the 12-week randomized phase, women were examined "open label" through 52 weeks postrandomization. All treatment arms reported substantial tampon-test pain reduction: 33% reduction placebo cream-placebo tablet, 20% reduction lidocaine cream-placebo tablet, 24% reduction placebo cream-desipramine tablet, and 36% reduction lidocaine cream-desipramine tablet. Compared with placebo, we found no significant difference in tampon-test pain reduction with desipramine (t=0.90; P=.37) or lidocaine (t=1.27; P=.21). Of the remaining 12 outcome measures, only the Index of Sexual Satisfaction, improved with desipramine compared with placebo (t=-2.81; P=.006). During the open-label phase, women undergoing vestibulectomy surgery reported significantly improved pain as measured by cotton swab test and the McGill Pain Scale compared with nonsurgical alternatives. Oral desipramine and topical lidocaine, as monotherapy or in combination, failed to reduce vulvodynia pain more than placebo. Placebo or placebo-independent effects are behind the substantial pain improvement seen in all treatment allocations. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00276068. I.

The clinical efficacy of the Formostar infrared body wrap system on neuromuscular conditions

A combined qualitative–quantitative study was conducted to research the clinical efficacy of the Formostar Far-Infrared Body Wrap System on neuromuscular conditions. A total of 22 participants that met the inclusion criteria were selected at random. Participants consisted of both women and men ranging from 22 to 68 years of age with varying neuromuscular conditions. Participants received 40 min Formostar sessions twice a week for a period of two weeks. The four sessions were offered to participants based on: ensuring continuity of commitment from research subjects. Exploring the efficacy of the Formostar as a device that could assist with a rapid turn around of symptomatic neuromuscular conditions. Quantitative and qualitative data was taken prior to first treatment and 24–48 h after last treatment. Pre-test and post-test data was taken in the form of thermal EMG scan, weight, height, body fat percentage, McGill's pain questionnaire, body circumference measurements, blood pressure, and pulse rate.Results: A review of the demographic data reveals a generalised trend towards improvement in the neuromuscular condition for the majority of the participants. 15 out of the 18 participants demonstrated some pain reduction across a variety of symptoms with an average reduction of pain levels of 4.67 based on the McGill's pain scale, indicating that the Formostar can aid the management of pain.Discussion: The variance of presenting complaints in the demographic field for this research meant that there was no uniform targeting of specific areas of the body, such as the lumbar or the shoulder region. In review, the Formostar does show specific efficacy in its usage and the researchers concluded that it is best used as an adjunct system in the treatment of neuromuscular conditions, assisting with techniques such as soft tissue therapy, spinal manipulation, joint mobilisation techniques, massage therapy to name but a few. The Formostar also appeared to show good results as a post sports intensive rehabilitation machine, where sports athletes such as cyclists and runners were asked to undertake the Formostar and displayed a noticeable decrease in their fatigue and increase in their recovery rates. A combined qualitative–quantitative study was conducted to research the clinical efficacy of the Formostar Far-Infrared Body Wrap System on neuromuscular conditions. A total of 22 participants that met the inclusion criteria were selected at random. Participants consisted of both women and men ranging from 22 to 68 years of age with varying neuromuscular conditions. Participants received 40 min Formostar sessions twice a week for a period of two weeks. The four sessions were offered to participants based on: ensuring continuity of commitment from research subjects. Exploring the efficacy of the Formostar as a device that could assist with a rapid turn around of symptomatic neuromuscular conditions. Quantitative and qualitative data was taken prior to first treatment and 24–48 h after last treatment. Pre-test and post-test data was taken in the form of thermal EMG scan, weight, height, body fat percentage, McGill's pain questionnaire, body circumference measurements, blood pressure, and pulse rate. Results: A review of the demographic data reveals a generalised trend towards improvement in the neuromuscular condition for the majority of the participants. 15 out of the 18 participants demonstrated some pain reduction across a variety of symptoms with an average reduction of pain levels of 4.67 based on the McGill's pain scale, indicating that the Formostar can aid the management of pain. Discussion: The variance of presenting complaints in the demographic field for this research meant that there was no uniform targeting of specific areas of the body, such as the lumbar or the shoulder region. In review, the Formostar does show specific efficacy in its usage and the researchers concluded that it is best used as an adjunct system in the treatment of neuromuscular conditions, assisting with techniques such as soft tissue therapy, spinal manipulation, joint mobilisation techniques, massage therapy to name but a few. The Formostar also appeared to show good results as a post sports intensive rehabilitation machine, where sports athletes such as cyclists and runners were asked to undertake the Formostar and displayed a noticeable decrease in their fatigue and increase in their recovery rates.

Postpartum Perineal Pain in a Low Episiotomy Setting: Association with Severity of Genital Trauma, Labor Care, and Birth Variables

Perineal pain is common after childbirth. We studied the effect of genital tract trauma, labor care, and birth variables on the incidence of pain in a population of healthy women exposed to low rates of episiotomy and operative vaginal delivery. A prospective study of genital trauma at birth and assessment of postpartum perineal pain and analgesic use was conducted in 565 midwifery patients. Perineal pain was assessed using the present pain intensity (PPI) and visual analog scale (VAS) components of the validated short-form McGill pain scale. Multivariate logistic regression examined which patient characteristics or labor care measures were significant determinants of perineal pain and use of analgesic medicines. At hospital discharge, women with major trauma reported higher VAS pain scores (2.16 +/- 1.61 vs 1.48 +/- 1.40; p < 0.001) and were more likely to use analgesic medicines (76.3 vs 23.7%, p = 0.002) than women with minor or no trauma. By 3 months, average VAS scores were low in each group and not significantly different. Perineal pain at the time of discharge was associated in univariate analysis with higher education level, ethnicity (non-Hispanic white), nulliparity, and longer length of active maternal pushing efforts. In a multivariate model, only trauma group and length of active pushing predicted the pain at hospital discharge. In women with minor or no trauma, only length of the active part of second stage labor had a positive relationship with pain. In women with major trauma, the length of active second stage labor had no independent effect on the level of pain at discharge beyond its effect on the incidence of major trauma. Women with spontaneous perineal trauma reported very low rates of postpartum perineal pain. Women with major trauma reported increased perineal pain compared with women who had no or minor trauma; however, by 3 months postpartum this difference was no longer present. In women with minor or no perineal trauma, a longer period of active pushing was associated with increased perineal pain.

Psychological and Biological Correlates of Fatigue After Mild-to-Moderate Traumatic Brain Injury

Relationships between chronic perceived stress, cortisol response (area under the curve) and posttraumatic brain injury fatigue were examined with persons from outpatient settings. Seventy-five injured persons with traumatic brain injury and their relatives/significant others participated in this cross-sectional study. Using interviews and self-reported data from the Neurofunctional Behavioral Inventory, the Perceived Stress Scale, the Profile of Mood States-Fatigue subscale, the McGill Pain Scale, as well as self-collection of salivary cortisol over a 12-hour period (N = 50), we found that perceived chronic stress explained 40% of the variance in fatigue until depressive symptoms and pain were in the model. Hypocortisolemia was evident. Somatic symptom frequency and perceived chronic stress represented 50% of the variability in post-TBI fatigue. Fatigue and stress management interventions, as suggested in the Centers for Disease Control Acute Concussion guidelines, may be beneficial in reducing this common symptom.

Understanding perineal pain: womens descriptions

Women perceive, describe and react to pain differently; it cannot be easily quantified. Pain is a private and personal experience to the individual. It is therefore impossible for another person to know exactly what someone else's pain feels like. When measuring pain there is a need to assess both the intensity and the quality of the pain to gain an insight into a person's experience of pain. During a PhD Study, which involved the investigation of the effectiveness of localised cooling treatments to alleviate perineal pain, women were asked to describe the pain as well as the intensity (Steen and Marchant, 2007). The quality of pain was measured by asking the woman to describe the pain in her own words. These words were analyzed as pain descriptors under the themes of sensory, affective, evaluative and miscellaneous as described by the McGill Pain Scale. In addition, intensity, discomfort, physical symptoms, metaphors used and links to the expectations of the woman were considered (Melzack and Wall, 1996). This article will give an overview of the pain syndrome, discuss measurement of pain methods and the use of word descriptors to assess the quality of pain. The assessment of perineal pain and women's descriptions will be further explored. This insight will give an understanding of the pain experience of women who have perineal trauma following childbirth and this may lead to further research and the development of a specific evaluating tool.

EFFECTS OF AROMATHERAPY AND MASSAGE ON PAIN OF PATIENTS WITH MULTIPLE SCLEROSIS (MS)

BackgroundMultiple sclerosis (MS) is one of common autoimmune diseases with 0.1% incidence in the world population. Pain is one of its clinical manifestations and, according to recent studies, it mostly remains untreated. Pain relief is a primary nursing intervention and, currently, complementary therapies such as massage and aromatherapy are increasingly used for it. PurposeThis quasi-experimental study was conducted to compare between the effects of massage with menthol (aromatherapy) and sweet almond on MS-related pain in patients referring to Mazandaran MS Association in Sari, 2006. Methods80 MS patients were selected by purposive sampling method. Inclusion criteria consisted of age between 20 and 40; no massage prohibition; presence of pain in lumbar or distal extremities; no history of allergy, headache and respiratory diseases. Data were collected by a questionnaire in two parts: demographics and McGill pain scale (0-5). Its validity and reliability were checked by content and internal consistency (r=0.88) methods respectively. Patients were randomly divided into two groups: massage group receiving sweet almond massage and aromatherapy group receiving aromatic (mint abstract) menthol massage. Severity of pain was recorded and compared before and after the intervention. ResultsFinding showed no difference between the groups in terms of demographic data and pain severity before the intervention (P< 0.05). On the other hand, a significant difference was found within (P

Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis

Resting or immobilizing a joint to enhance outcomes following intra-articular (IA) steroid injection is generally advocated. This systematic review aimed to determine the efficacy of IA steroid injections and the influence of post-injection rest. 1. Compare IA steroid injections versus no treatment or placebo. 2. Determine the effects of rest following IA steroid injection in rheumatoid or juvenile idiopathic arthritis. The Cochrane Central Register of Controlled Trials (CENTRAL- Issue 4, 2003), Cochrane Database of Systematic Reviews (CDSR - Issue 4, 2003), Database of Abstracts of Reviews of Effectiveness (DARE - searched 8.1.04), MEDLINE (1966 to August Week 2 2004), EMBASE (1980 to August Week 2 2004) , CINAHL (1982 to December Week 2 2003), Clinical Trials site of the National Institute of Health, (USA - searched 8.1.04), OTseeker (Occupational Therapy Systematic Evaluation of Evidence - searched 8.1.04) and PEDro (Physiotherapy Evidence Database - searched 8.1.04) were searched. Journals and reference lists were hand searched. Eligible were randomised controlled trials of IA steroid injections or of rest following IA steroid injections in rheumatoid or juvenile idiopathic arthritis. Potentially relevant references were evaluated and all data extracted by two independent reviewers. Five trials (n=346) examining IA steroid injection in the knee joint were included. It was not possible to pool data as outcome measures, timing of follow up and the methods of data reporting differed between trials. There was inconclusive conflicting evidence from two trials that walking time was reduced. There was evidence from one moderate quality trial that pain was reduced at 1-day post-injection (0-100 VAS from 28.33 to 13.46; McGill Pain Scale from 8.89 to 3.96) but not at 1 week or 7-12 weeks post-injection. There is some evidence that IA injections improved knee flexion (by 14 degrees) and reduced knee extension lag (by 20 degrees), knee circumference (median reduction = 0.3 cm) and morning stiffness (reduced from 60 mins to 7.6 mins). One trial (n=91) examined the effects of rest following injection in the knee. The rested group achieved significant improvement in pain, stiffness, knee circumference, and walking time when compared with the non-rested group (no point estimates provided). One trial evaluated rest following injection of the wrist (n=117). Relapse rate was higher in the rested group (rest relapse rate = 24/58, no-rest group = 14/59); but there were no differences between the rested and non-rested groups on pain, joint circumference, wrist function, grip strength or ROM. There is some evidence to support the use of IA steroid injections and resting a knee following injections but that wrists should not be rested following injections. The included studies involved adult participants so any conclusions can only cautiously applied to children. Further research is required to examine the use and type of rest and the differential responses of different joints following injections.

Evaluating the Influence of Dose-Rate on Outcome with Gamma-Knife Stereotactic Radiosurgery in the Treatment of Trigeminal Neuralgia

Purpose/Objective: To date there has been no published clinical data evaluating the effect of dose-rate on the treatment outcome of patients treated with gamma-knife stereotactic radiosurgery (GK-SRS) for trigeminal neuralgia (TN).Materials/Methods: A total of 61 patients were treated with GK-SRS for TN at the University of Maryland Medical Center in the year immediately prior to (Group I, n=31) or the year immediately following the Co-60 source change (Group II, n=30), which occurred in 1999. A median prescription dose of 75 Gy (range, 70–80 Gy) was delivered to the involved trigeminal nerve root entry zone. Treatment outcomes were assessed through patient self-reports of pain control, medication usage, and facial numbness during follow-up visits. In addition, patients responded to a standard questionnaire containing the Barrow Neurologic Institute Pain Scale and selected sections of the McGill Pain Scale.Results: The median follow-up was 30 months (range 15–49). The median dose-rates for Groups I and II were 161.6 cGy/min (151.4–179.4) and 342.9 cGy/min (range 321.1–366.2), respectively. A total of 19 of 31 patients (61.3%) in Group I reported pain relief, while 25 patients of 30 patients (83.3%) in Group II reported pain relief (p=0.05). 5 patients (16%) in Group I and 3 patients (10%) in Group II reported facial numbness (p=0.34).Conclusions: GK- SRS provides considerable pain relief in the majority of patients treated for TN. This is the first clinical report evaluating the effect of dose rate on the treatment of TN. There is a significant difference between effectiveness immediately prior to and after a source change. These findings have significant clinical implications. Our data suggests if the dose-rate falls below 179.4 cGy/min, consideration should be made for dose escalation of GK-SRS for the treatment of TN. Purpose/Objective: To date there has been no published clinical data evaluating the effect of dose-rate on the treatment outcome of patients treated with gamma-knife stereotactic radiosurgery (GK-SRS) for trigeminal neuralgia (TN). Materials/Methods: A total of 61 patients were treated with GK-SRS for TN at the University of Maryland Medical Center in the year immediately prior to (Group I, n=31) or the year immediately following the Co-60 source change (Group II, n=30), which occurred in 1999. A median prescription dose of 75 Gy (range, 70–80 Gy) was delivered to the involved trigeminal nerve root entry zone. Treatment outcomes were assessed through patient self-reports of pain control, medication usage, and facial numbness during follow-up visits. In addition, patients responded to a standard questionnaire containing the Barrow Neurologic Institute Pain Scale and selected sections of the McGill Pain Scale. Results: The median follow-up was 30 months (range 15–49). The median dose-rates for Groups I and II were 161.6 cGy/min (151.4–179.4) and 342.9 cGy/min (range 321.1–366.2), respectively. A total of 19 of 31 patients (61.3%) in Group I reported pain relief, while 25 patients of 30 patients (83.3%) in Group II reported pain relief (p=0.05). 5 patients (16%) in Group I and 3 patients (10%) in Group II reported facial numbness (p=0.34). Conclusions: GK- SRS provides considerable pain relief in the majority of patients treated for TN. This is the first clinical report evaluating the effect of dose rate on the treatment of TN. There is a significant difference between effectiveness immediately prior to and after a source change. These findings have significant clinical implications. Our data suggests if the dose-rate falls below 179.4 cGy/min, consideration should be made for dose escalation of GK-SRS for the treatment of TN.