Measures Of Pain Severity Research Articles

The Effect of Progressive Relaxation Exercises on Pain, Fatigue, and Quality of Life in Dialysis Patients.

Patients receiving hemodialysis treatment may experience several symptoms at the same time, such as fatigue and pain. Progressive relaxation exercises (PRE) have been reported to have positive effect on the control of these symptoms. In this study, a randomized, controlled, and experimental study was conducted to examine the effect of PRE on pain, fatigue, and quality of life in hemodialysis patients; the study was carried out with 48 intervention and 48 control patients receiving treatment in the hemodialysis units of 2 hospitals. Data were collected by a questionnaire prepared by the researcher, which included questions about sociodemographic variables and the disease; Piper Fatigue Scale; Visual Analog Scale that measures pain severity; and SF-36 Quality of Life Scale. The results of study revealed that mean total fatigue score and mean pain score decreased in the intervention group after the application of PRE; whereas no change was observed in the control group (P < .05). It was also found that quality of life physical component mean score and mental component mean score increased in the intervention group after the application of PRE (P < .05).

The Role of Pain-Related Cognitions in the Relationship Between Pain Severity, Depression, and Pain Interference in a Sample of Primary Care Patients with Both Chronic Pain and Depression.

The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. Cross-sectional design. Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.

The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain.

Low back pain (LBP) is a public health problem that requires accurate assessment for proper management and predicting prognosis. This study aims to assess the agreement between visual analogue scale (VAS) and numeric rating scale (NRS) in measuring LBP severity, and investigate their ability in predicting disability. A cross-sectional study was performed on 100 patients with chronic LBP. Pain severity assessment was performed using VAS, NRS, and pain severity scores of the Brief Pain Inventory (BPI). Disability assessment was done by BPI-Pain interference and Modified Oswestry Disability Index (MODI). There was a significant positive correlation between VAS and NRS (r = 0.92, p < 0.001) with high agreement between both as detected by Bland-Altman method (mean difference = 0.33). Moreover, there was significant (p < 0.001) positive correlation between disability scores and either VAS (r = 0.92 with BPI pain interference; r = 0.75 with MODI) or NRS (r = 0.95 with BPI pain interference; r = 0.68 with MODI). By using receiver operating characteristic curve, a score of 6 in VAS or NRS can predict severe disability, whereas VAS score higher than 4 and NRS score higher than 3 can predict moderate disability. Visual analogue scale and NRS appeared reliable in assessing LBP severity with no significant difference between them. Moreover, either VAS or NRS scores can predict disability of patients with LBP.

DO WARMED BLANKETS CHANGE PAIN, AGITATION, MOOD, OR ANALGESIC USE AMONG NURSING HOME RESIDENTS?

Warmed blankets have not been empirically tested for use in long-term care. The purpose of this study was to describe the use of warmed blankets in a nursing home setting and to determine if use was associated with changes in pain, agitation, mood, or analgesic use. Short-term measures were compared from baseline to post warmed blanket use and longer term differences were compared between those receiving warmed blankets and a randomly selected comparison group. Excluded from eligibility were those using a transdermal drug, with an acute injury, acute inflammatory process, multiple sclerosis, open skin wound, or other condition that could be worsened by superficial heat. Measures included the Revised Faces Pain Scale, PAIN-AD scale, the Brief Agitation Rating Scale, and from the electronic medical record one month measures pain complaints, pain severity, and analgesic use. Long-term measures were taken from the electronic medical record. Of the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the one month study period. There were statistically significant decreases in both pain level and agitation between baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and prn analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures. Warmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.

Negative Affect-Related Factors Have the Strongest Association with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Pain.

Increased opioid prescription to relieve pain among patients with chronic pain is associated with increased risk for misuse, potentially leading to substance use disorders and overdose death. We aimed to characterize the relative importance and identify the most significant of several potential risk factors for the severity of self-reported prescribed opioid misuse behaviors. A sample of 1,193 patients (mean age ± SD = 50.72 ± 14.97 years, 64.04% female) with various chronic pain conditions completed a multidimensional registry assessing four pain severity measures and 14 physical, mental, and social health status factors using the National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS). A validated PROMIS measure of medication misuse was completed by 692 patients who endorsed currently taking opioid medication. Patients taking opioid medications were compared across all measures with those who do not take opioid medications. Subsequently, a data-driven regression analysis was used to determine which measures best explained variability in severity of misuse. We hypothesized that negative affect-related factors, namely anxiety, anger, and/or depression, would be key predictors of misuse severity due to their crucial role in chronic pain and substance use disorders. Patients taking opioid medications had significantly greater impairment across most measures. Above and beyond demographic variables, the only and most significant predictors of prescribed opioid misuse severity were as follows: anxiety (β = 0.15, P = 0.01), anger (β = 0.13, P = 0.02), Pain Intensity-worst (β = 0.09, P = 0.02), and depression (β = 0.13, P = 0.04). Findings suggest that anxiety, anger, and depression are key factors associated with prescribed opioid misuse tendencies in patients with chronic pain and that they are potential targets for therapeutic intervention.

Fine-Grained Mapping of Cortical Somatotopies in Chronic Complex Regional Pain Syndrome.

It has long been thought that severe chronic pain conditions, such as complex regional pain syndrome (CRPS), are not only associated with, but even maintained by a reorganization of the somatotopic representation of the affected limb in primary somatosensory cortex (S1). This notion has driven treatments that aim to restore S1 representations in CRPS patients, such as sensory discrimination training and mirror therapy. However, this notion is based on both indirect and incomplete evidence obtained with imaging methods with low spatial resolution. Here, we used fMRI to characterize the S1 representation of the affected and unaffected hand in humans (of either sex) with unilateral CRPS. The cortical area, location, and geometry of the S1 representation of the CRPS hand were largely comparable with those of both the unaffected hand and healthy controls. We found no differential relation between affected versus unaffected hand map measures and clinical measures (pain severity, upper limb disability, disease duration). Thus, if any map reorganization occurs, it does not appear to be directly related to pain and disease severity. These findings compel us to reconsider the cortical mechanisms underlying CRPS and the rationale for interventions that aim to “restore” somatotopic representations to treat pain.SIGNIFICANCE STATEMENT This study shows that the spatial map of the fingers in somatosensory cortex is largely preserved in chronic complex regional pain syndrome (CRPS). These findings challenge the treatment rationale for restoring somatotopic representations in complex regional pain syndrome patients.

Reductions in Fatigue Predict Occupational Re-engagement in Individuals with Work-Related Musculoskeletal Disorders.

Background Symptoms of fatigue have been shown to be associated with heightened levels of disability in patients suffering from a wide range of debilitating health and mental health conditions. The role of fatigue as a determinant of work disability in individuals with work-related musculoskeletal disorders (WRMD) has received little attention. The present study examined the role of fatigue as a determinant of work-disability in individuals with WRMDs. Methods Participants included 117 individuals with WRMDs who completed measures of pain severity, fatigue, depression and disability before and after participating in a behavioral activation rehabilitation intervention. Results Cross-sectional analyses on pre-treatment measures revealed that fatigue contributed significant variance to the prediction of self-reported disability, beyond the variance accounted for by pain severity and depression. Prospective analyses revealed that reductions in fatigue through the course of treatment predicted occupational re-engagement following termination of the intervention. Conclusions The results of the present study suggest fatigue contributes to occupational disability, independent of the effects of pain and depression. The findings also suggest that meaningful reductions in fatigue might be achieved through psychosocial interventions that promote gradual re-integration into discontinued activities, increase participants' exposure to success and achievement experiences, and reduce the severity of depressive symptoms. Behavioural activation interventions such as the one used in the present study might contribute to more positive occupational outcomes in work-disabled individuals who report high levels of fatigue.

The Mediating Effect of Pain Catastrophizing on PTSD Symptoms and Pain Outcome.

Coprevalence of chronic pain and posttraumatic stress disorder (PTSD) negatively impacts the course of both disorders. Patients diagnosed with both conditions report greater pain, affective distress, and disability when compared with those with either chronic pain or PTSD alone. While the prevalence and complexity of the comorbidity is widely acknowledged, there is a dearth of research examining potential mechanism variables that might account for the relationship between chronic pain and PTSD. The current study utilizes a series of mediation analyses to examine if pain catastrophizing mediates the relationship between PTSD symptomatology and chronic pain outcome. A total of 203 treatment-seeking participants admitted to a 3-week interdisciplinary pain rehabilitation program completed a battery of psychometrically validated measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, and PTSD symptoms at program admission. A series of multiple parallel mediation analyses revealed that pain catastrophizing fully mediated the relationships between PTSD symptoms and pain outcome (ie, pain severity and pain interference) above and beyond the influence of depressive symptoms. Results suggest that pain catastrophizing may represent an important cognitive mechanism through which PTSD symptoms influence the experience of chronic pain. Psychosocial treatment approaches that directly target tendency to catastrophize in response to pain may hold the potential to have salutary effects on both chronic pain and PTSD.

A randomized controlled trial of a novel artificial intelligence-based smartphone application to optimize the management of cancer-related pain.

11514 Background: Cancer pain is a significant problem that impairs patient quality of life and increases healthcare utilization. ePAL is a smartphone application that utilizes patient-reported outcomes (PROs) and artificial intelligence (AI) to optimize cancer pain management. This randomized controlled trial examined the impact of ePAL on cancer pain severity, attitudes toward cancer pain, and healthcare utilization. Methods: Patients with pain from metastatic solid tumors (n = 112) undergoing treatment in a palliative care clinic were randomized to either a control group (n = 56) that received usual care or an intervention group (n = 56) that received ePAL in addition to usual care for 8 weeks. Measures of pain severity (Brief Pain Inventory), attitudes towards cancer treatment (Barriers Questionnaire II) and anxiety (General Anxiety Disorder-7) were assessed. We used repeated measures mixed modeling to assess change in outcome measures over time. We also conducted a chart review to identify pain-related hospital admissions and emergency department (ED) visits and compared risk between study groups. Results: Pain severity (BPI) and negative attitudes toward cancer treatment (BQ-II) decreased significantly for those assigned to ePAL compared to controls (ß = -0.09, p = 0.034 and ß = -0.037, p = 0.042, respectively). Patients assigned to ePAL reported higher anxiety scores compared to controls (ß = 0.21, p = 0.015). Patients assigned to ePAL had significantly fewer pain-related hospital admissions (n = 4 vs. n = 20, per patient risk ratio 0.31, p = 0.018) and fewer pain-related admissions through the ED (n = 2 vs. n = 14, per patient risk ratio 0.18, p = 0.008) compared to control group. Conclusions: To our knowledge, this is the first mobile app to utilize patient reported outcomes and artificial intelligence to significantly decrease pain scores and pain-related hospitalizations in patients with cancer-related pain. Future directions include examining the efficacy of ePAL in settings with limited access to palliative care.

PMH35 TREATMENT-SEEKING BEHAVIOR AMONG UNIVERSITY STUDENTS REPORTING PAIN AND DEPRESSION

Pain and depression are commonly reported health problems among university students, a large proportion of whom may not get adequate treatment for these conditions. This study examined the prevalence of self-reported pain (acute/chronic) and depression among university students and examined the association between depression and pain and between depression treatment and pain. We conducted a web-based survey among students at a large public university using convenience sampling technique to recruit study participants (N=922) from April to June 2017. The survey combined a validated screening instrument, the Patient Health Questionnaire (PHQ) and a validated instrument to measure pain severity, the Brief pain inventory. The Biopsychosocial framework was used to guide the selection of variables that affect self-reported pain among university students with depression. Chi-square test and logistic regression were used to examine associations between pain and depression treatment. A total of 679 students completed the questionnaire. This sample was predominately white (86.7%), female (73.5%), and had private health insurance (82.6%) with mean age 23.2 (SD=5.9) years old. Sixty percent (n=406) of students reported pain, of whom 61.1% (n=258) reported chronic pain. Fifty-eight percent (n=387) were screened positive for major depressive disorder. Among the participants who screened positive, only 32.0% were currently receiving treatment for depression and medications was used more often than psychotherapy (83.1% vs. 33.1%). Among students reported acute pain and depression, 76.1% (n=70) did not receive treatment for depression. In our sample, students receiving depression treatment were less likely to report pain (p=0.058, φ=-0.098). Multivariate logistic regression suggested that students with depressive symptoms were less likely to report chronic pain compared with students who did not have depressive symptoms (OR=0.12). Two common conditions (depression and pain) lack appropriate treatment among university students. Depressive symptoms were significant predictors of chronic pain and depression treatment may help alleviate pain among students.

Pilot randomised controlled trial of a brief mindfulness-based intervention for those with persistent pain

A pilot-randomised controlled trial (RCT) examined the effects of a brief mindfulness-based intervention (MBI) on persistent pain patients and assessed the feasibility of conducting a definitive RCT. A brief (15 min) mindfulness body-scan audio was compared with an active control administered in a clinic and then used independently over 1 month. Immediate effects of the intervention were assessed with brief measures of pain severity, distraction and distress. Assessments at baseline, 1 week and 1 month included pain severity and interference, mood, pain-catastrophizing, mindfulness, self-efficacy, quality of life and intervention acceptability. Of 220 referred patients, 147 were randomised and 71 completed all assessments. There were no significant immediate intervention effects. There were significant positive effects for ratings of intervention ‘usefulness’ at 1 week (p = 0.044), and pain self-efficacy at 1 month (p = 0.039) for the MBI group compared with control. Evidently, it is feasible to recruit persistent pain patients to a brief MBI study. Strategies are needed to maximise retention of participants.Trial registration Current controlled trials ISRCTN61538090. Registered 20 April 2015.

(155) Personalized Activated Care and Training: A PACT with Patients to Prevent Chronic Pain and Addiction

PURPOSE: The Institute of Medicine states that a health professionals’ primary role for chronic pain should be guiding, coaching, and assisting patients with day-to-day self-management. However, providers often lack the time and training to perform this role, and there is limited research on self-management approaches. We propose providers use a transformative care model that integrates robust patient training with evidence-based treatments using tele-coaching and technology to improve long-term outcomes and health chronic pain. METHODS: The Personalized Activated Care and Training (PACT) program was developed to enhance understanding, compliance, and success in self-management of pain conditions and includes risk assessment, on-line risk reduction training, and tele-health coaching to reduce risk factors that contribute to delayed recovery and implement protective actions to reduce chronic pain. We conducted a pilot RCT to refine the program, evaluate evaluate preliminary efficacy at 8 and 16 weeks and feasibility for broad scale implementation. RESULTS: Eighty-one subjects were randomized to PACT and Usual care and survey measures were obtained. Cohen's -d statistic was estimated for survey outcomes and a subset of participants were interviewed regarding their experiences. Participants had a mean age of 46 (PACT), 49 (TSC) and the majority were white and female. Outcomes at 16 weeks in patients with head and neck pain showed improvement in the PACT group relative to UC on measures of pain severity (PACT: 1.22, UC: -.74), pain interference in daily living (PACT: -.49, UC: -.27), and chronic pain self-efficacy (PACT: .45, UC: .27). CONCLUSION: This research demonstrated that transformative care model that includes tele-health coaching and on-line training is both feasible and effective. It provides an accessible, scalable, and transferable method for self-management that can be integrated into routine care without increasing the burden of time demands upon the providers. PACT was developed and tested with grants from NIH/NIDCRU01DE025609.

(121) Pain, Sleep Disturbances, Fatigue, Mood Changes, and Underlying Inflammation: A Study of Patients with Chronic Low Back Pain (CLBP)

CLBP is a highly prevalent (55% adults) and expensive (costs range $84-$624.8 billion) condition in the United States. CLBP is accompanied by distressing behavioral symptoms, such as depressed mood, fatigue, and sleep disturbance, which negatively impact quality of life (QOL). The purpose of the study was to determine the extent to which behavioral symptoms (depressive mood, fatigue, poor sleep), independently or as a cluster, predict pain severity and QOL. Proinflammatory cytokine (IL-6) was evaluated to determine the extent to which inflammation may serve as a common underlying mechanism. Further, these symptoms may share a common inflammatory pathway which in turn influence inflammation-related pain. Patients with CLBP (N=69) were enrolled. Participants completed instruments measuring pain severity and interference due to pain, depressive mood, fatigue, sleep quality, and quality of life. A blood sample was collected to measure IL-6. Latent class analysis will be used to identify symptom clusters, and differences among cluster profiles. Preliminary results revealed that 85% of the sample reported experiencing pain that day. Patients reported elevated fatigue, sleep disturbance, and depressive symptoms. Greater pain severity and/or interference was associated with greater sleep disturbance (r=0.59, p=.000; r=.45, p=.000), fatigue (r=.43, p = .001, r=.46, p=.001), depressive symptoms (r=.41, p = .005), and lower QOL (r=-0.39, p=.007). Those who reported greater pain severity indicated that pain interfered with their mood (r=.60, p =.000), social relationships (r=0.51, p=.000), and enjoyment of life (r=.35, p=.010). Greater depressive symptoms (r= -0.61, p=.000), sleep disturbance (r=-.54, p=.000), and fatigue (r=-.32, p=.022) were associated with poorer QOL. Furthermore, greater pain severity was associated with greater levels of plasma IL-6 (r=.42, p=.001). There is an urgent need to improve QOL for those burdened with CLBP, yet clinical management is only moderately effective. A symptom cluster approach in CLBP can guide the development of more comprehensive interventions.

(164) Negative Affect as a Predictor of Opioid Prescription Misuse and Abuse in Chronic Pain Patients: A Collaborative Health Outcomes Information Registry Study

The widespread misuse and abuse of prescribed opioid pain relievers amongst chronic pain patients is a central contributor to the opioid epidemic. The current study aimed to identify potential risk factors and treatment targets that may reduce and prevent opioid misuse. The NIH's Patient Reported Outcomes Measurement Information System (PROMIS)-Abuse of Prescription Medication item bank (Rx-Abuse) was validated in both community and clinical samples to assess self-reported severity of medication abuse. The Rx-Abuse item bank was included in Stanford University's Collaborative Health Outcomes Information Registry (CHOIR), an open-source healthcare system to monitor chronic pain patients’ health status as part of clinical care, quality improvement, and research. We compared physical, mental and social health status factors of patients taking and not taking opioid medications and examined which of these factors best associated with prescription abuse. We hypothesized that negative affect would predict more opioid misuse in view of its crucial role in managing chronic pain and substance use. A sample of 1193 (age=50.72±14.97; 64.04% female, mean pain=5.24±2.47) patients with a mix of chronic pain disorders presenting for medical evaluations at a tertiary pain clinic completed the CHOIR survey. Participants endorsing current use of prescribed opioid medication (n=692, 58.01%) also completed the Rx-Abuse assessment. Results indicated that patients currently taking opioid medications reported significantly greater symptomatology and impairment across almost all PROMIS and pain severity measures compared to non-opioid taking patients. A data-driven stepwise hierarchical regression analysis (n=589) confirmed that a composite score of negative affect comprising anxiety, anger and depression, was the most significant predictor (β=0.36, p

The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial

Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms. In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression) were completed at baseline and six-week follow-up. Differences between the life stress interview and control conditions at follow-up were tested with analyses of covariance, controlling for baseline level of the outcome and baseline depression. Compared with the control condition, the interview resulted in significantly lower pain severity and pelvic floor symptoms, but the interview had no effect on pain interference or psychological symptoms. An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among women with CUP seen in a tertiary care clinic. This study suggests that targeting stress and avoided emotions and linking them to symptoms may be beneficial for this complex group of patients.

Survey of postoperative pain control in different types of hospitals: a multicenter observational study

BackgroundCurrent pain assessment and treatment does not address every patient’s requirements. Although the Polish national guidelines for post-operative pain management have been published, many patients experience severe pain in the postoperative period. The main goal of our study was to assess pain severity among patients from different types of hospitals (primary, secondary, and tertiary centers) after similar types of surgeries. We also aimed to determine if there were any differences in pain severity associated with anesthesia technique, type of surgery, and the patient’s age and sex.MethodsThis was a prospective, observational study. A questionnaire form was used to collect demographic data, type of hospital, surgery, anesthesia, and patient satisfaction of pain control in the postoperative period. The visual analogue scale (VAS) was used to measure pain severity at four time points after surgery (4, 8, 12, and 24 h).ResultsThe study was conducted from November 2015 to June 2016 in seven hospitals in Eastern Poland, and 269 women and 293 men participated. At the 4-h measurement, 39.32% of patients assessed the pain as moderate and 19.75% as severe. A difference was found in pain intensity between patients treated in primary and secondary hospitals. Vascular surgery patients had the lowest pain intensity (19 (13–26)), especially in comparison to those undergoing thoracic surgery (30 (27–33)). A sudden elevation in pain severity among patients anesthetized with single-shot spinal technique was observed. Only 4.9% of participants received strong opioids during the first 24 h after surgery.ConclusionsPostoperative pain control seems to be unexpectedly poor after single-shot subarachnoid anesthesia. Despite concerns, the use of analgesics may be insufficient in some groups of patients. Our study indicates new variables that influence the severity of pain, such as operated region, anesthetic technique, and type of surgical department. The results obtained in our study are in discrepancy with recommendations presented by the national guidelines for post-operative pain management.

Validation of an index of Sensitivity to Movement-Evoked Pain in patients with whiplash injuries.

Introduction: Sensitivity to Movement-Evoked Pain is a pain summation phenomenon identified in various chronic pain populations.Objectives: This study investigated the validity of a procedure used to assess pain summation in response to a repeated lifting task in individuals with whiplash injuries.Methods: Sixty-five participants completed measures of pain severity and duration, Temporal Summation (TS) of pinprick pain, pain catastrophizing and fear of movement, and work-related disability before lifting a series of 18 weighted canisters. An index of Sensitivity to Movement-Evoked Pain was computed as the increase in pain reported by participants over successive lifts of the weighted canisters. An index of TS was computed by dividing the pain reported in response to the final pinprick by the pain reported in response to the 1st pinprick in a train of 10 pinpricks.Results: Analyses replicated previous findings showing a repetitive lifting task–induced pain summation in approximately 20% to 25% of a sample of individuals with whiplash injuries. Analyses also revealed significant correlations between SMEP, TS, and pain-related psychological variables. Hierarchical regression analyses showed that TS and pain catastrophizing made significant unique contributions to the prediction of SMEP. These findings join a growing body of research on movement-evoked pain in persistent spinal pain conditions.Conclusion: The repeated lifting task used in this study successfully induced pain summation in a group of patients with whiplash injuries.

Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain: a pilot randomised controlled trial

ObjectiveTo evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach.DesignA participant-blinded and assessor-blinded pilot randomised controlled trial.SettingOutpatient physiotherapy departments at two public hospitals...

Reductions in Perceived Injustice Are Associated with Reductions in Posttraumatic Stress Symptoms Among Individuals Receiving Treatment for Whiplash Injury

Research has accumulated to suggest that perceived injustice is a risk factor for poor recovery outcomes in individuals with whiplash injuries. The present study examined the relative contributions of treatment-related reductions in perceived injustice and pain severity, in the prediction of reductions in posttraumatic stress symptoms in individuals with whiplash injury. The study sample consisted of 146 individuals (66 women, 80 men) who sustained whiplash injuries in motor vehicle collisions and were enrolled in a multidisciplinary rehabilitation program designed to promote functional recovery following whiplash injury. Participants completed measures of pain severity, disability, posttraumatic stress symptoms, and perceived injustice prior to treatment and after treatment. Pearson correlations revealed that all study variables were significantly correlated. Regression analyses revealed that, at the time of enrollment in the intervention, perceived injustice accounted for a significant proportion of the variance in posttraumatic stress symptom severity, beyond the variance accounted for by pain severity. Paired sample t-tests revealed significant reductions in perceived injustice, pain severity, and posttraumatic stress symptom severity through the course of treatment. For individuals who scored above clinical threshold on a measure of posttraumatic stress symptoms at the time of enrollment in the intervention (N = 71), regression analyses revealed that reductions in perceived injustice accounted for a significant proportion of the variance in reduction of posttraumatic stress symptoms, beyond the variance accounted for by reduced pain severity. Clinical and theoretical implications of the present findings are discussed.

Combined percutaneous radiofrequency ablation and cementoplasty for the treatment of extraspinal painful bone metastases: A prospective study

IntroductionAbout 50% of patients with cancer develop bone metastasis mainly presenting with distressing, drug-resistant pain. Aim of the workThe study evaluated efficacy and safety of combined cementoplasty and bony radiofrequency ablation in palliation of intractable pain and disability in cancer patients with bony metastases. Patients and methodsThe study included 30 adult patients suffering from localized bony metastases causing refractory moderate to severe pain. Radiofrequency bony ablation performed followed by cementoplasty were done under computed tomography (CT) guidance with conscious sedation and local anesthesia. Final CT check was done to ensure adequate lesion filling and to exclude any cement leakage. Pain, hemodynamic variables, and neurological status were checked for a minimum of 2 h before discharge. The patients were followed up weekly in the pain clinic. The primary outcome measures pain severity and daily opioid consumption. The secondary outcome measures were quality of life and the degree of disability, and procedure-related adverse outcomes. ResultsPain score, daily morphine consumption, and Oswestry Disability Index score decreased significantly after 1 day, and 1, 4 and 12 weeks. None of the patients had serious complications during the postoperative follow up visits. Only 4 patients (13.3%) experienced discomfort during, and few days after the procedure, 3 patients (10%) suffered from local infection, and 2 patients (6.7%) reported cement leakage. ConclusionCombined radiofrequency ablation and cementoplasty is a safe and effective pain relief modality in patients suffering from extraspinal painful bone metastases with improvement of the quality of life.