Pain Disability Index Scores Research Articles

Comparing Relationships Between Pain Coping Levels and Pain, Functional Capacity, and Disability Among Patients with Fibromyalgia and Healthy Controls.

We compared the relationships between pain coping levels and pain, functional capacity, and disability among 48 patients with fibromyalgia and 48 healthy control participants. Specific characteristics of those diagnosed with fibromyalgia syndrome were documented. Participants were evaluated with the Visual Analog Scale (VAS), Pain Coping Scale (PCQ), Pain Disability Index (PDI), and Fibromyalgia Impact Questionnaire (FIQ). According to the 10cm long VAS, fibromyalgia patients recorded pain intensity at 7cm, significantly higher than in the control group (p < .001). All sub-scores of the PDI score were higher among patients with fibromyalgia compared to controls (p < .001). Scores on the PCQ score were higher for patients with fibromyalgia than controls on the sub-parameters of helplessness (p < .001) and medical remedies (p < .001). Functionality was lower among patients than controls (p < .001). Pain coping and pain-related disability (in areas of recreation, social activity, sexual behavior, total score) were significantly related in patients with fibromyalgia. These findings underscore the importance of comprehensive pain management and customized interventions for fibromyalgia patients to address their elevated pain intensity, reduced functionality, increased pain-related disability, and variable coping mechanisms compared to healthy controls. Understanding these correlations between pain coping strategies, functional status, and disability levels can help optimize treatment approaches and improve the quality of life for individuals living with fibromyalgia.

Patient expectations and understanding of diagnosis entering an interdisciplinary chronic pelvic pain program: A cross-sectional study

Background: Chronic pelvic pain is a complex condition. Few studies have focused on patient expectations of diagnosis and treatment in female chronic pelvic pain populations. Not knowing this information can lead to disparity and frustration between provider care and patient expectations resulting in poor patient outcomes. The aim of this study was to explore patient expectations and understanding of diagnosis prior to engaging in an interdisciplinary pelvic pain program. Methods: This is a cross sectional study of women enrolled in a tertiary Chronic Pain Center pelvic pain program in May 2019. Data were extracted from intake questionnaires to classify demographic variables and analyzed using descriptive statistics. Expectations and diagnoses were clustered in themes. Student’s t-test was used to compare biomedical focus and biopsychosocial focus groups to the Pain Disability Index (PDI) and the EQ-5D results, and to compare self-reported diagnoses with treatment expectations between groups. Results: When asked about perceived diagnosis, 74% reported a gynecologic cause for their pain, 25.7% reported musculoskeletal causes, and 21.9% reported other health conditions. For treatment expectations: 46.6% believed they required rehabilitation, 30.8% responded “I don’t know”, and 21.2% reported perceived need for medication. There was no difference in PDI or EQ-5D scores between patients who identified perceived treatment options and those who reported “I don’t know”. Conclusions: Most patients identified a perceived cause for their pain, but there was uncertainty and ambiguity about treatment options. Understanding and addressing the perception and expectations of individuals is imperative to patient-centered care and can lead to improved outcomes.

Effects of Low-Level Laser Therapy on Shoulder Pain, Functional Disability and Range of Motion in Patients with Type II Slap Tear

BACKGROUND: Low-level lasers may occasionally replace surgery or medications without adverse effects, so studying them stands to reason. It heals, regenerates tissue, reduces inflammation, discomfort, and boosts immunity. Research is continuing. It may help physical therapy, healthcare, and the community by being cost-efficient, simple, and successful. OBJECTIVE: To compare the effects of low-level laser therapy and routine physical therapy on shoulder pain, functional disability, and range of motion in patients with Type II SLAP tear. METHODS: It was a Randomized Controlled Trial conducted at Physical therapy department, Sialkot Medical and Physiotherapy Center Branches Pasroor and Sambrail. The estimated sample size is 52, and adjusting for an expected 20% dropouts, the sample size was 62, allocated 31 in each group. Both male and female patients with Age between 50-70 years having Type II SLAP tear, Visual analogue scale (VAS) score above 3 and the patients diagnosed by physician, orthopedic physician or surgeon or rheumatologist were included. The included patients were allocated in group A, routine physical therapy, and Group B low level laser. All the patients were assessed at baseline, at 4th week of Treatment and at 8th week of Treatment for pain, shoulder pain and disability index and shoulder ranges. RESULTS: The results regarding age showed mean and standard deviation to be 1.8387±.77875 in routine physical therapy group while 1.8065±.79244 in low level laser therapy group. The comparison of mean SPADI total score at 8th week of assessment it was found to be respectively 58.3226±4.57083 and 50.3871±4.85577 with a significant mean difference of 7.935 in favor of low-level laser therapy as shown by p value 0.000. Other outcome measures including pain and shoulder ranges were also significantly improved in low level laser therapy group, p value &lt; 0.05. CONCUSSION: The findings of the study concluded that low level plays the therapy is significantly more effective improving pain disability and shoulder range of motions in patients with slap tear, except for abduction range of motion which was improved equally in both groups. Moreover, within routine physical therapy and low-level laser therapy group showed significant improvement at pre and post level of assessment except that of total shoulder and pain disability index score which was not improved significantly in routine physical therapy group without combination of low-level laser therapy.

Percutaneous Bioelectric Current Stimulation in the Treatment of Chronic Achilles Tendinopathy: Protocol for a Double-Blind, Placebo-Controlled Randomized Multicenter Trial.

The consensus for the optimal treatment strategy for chronic Achilles tendinopathy (AT) is still debated and treatment options are limited. This results in a significant medical need for more effective treatment options. The aim of this study is to investigate the therapeutic effects of percutaneous bioelectric current stimulation (PBCS) on AT. A multicenter, randomized, double-blind, placebo-controlled clinical trial will be conducted. A total of 72 participants with chronic (ie, >3 months) midpoint AT will be randomized and receive four PBCS sessions-either verum or placebo-over 3 weeks. Both groups will complete daily Achilles tendon loading exercises in addition to the intervention. Evaluation sessions will be completed at baseline and during the intervention (weeks 0-3). Self-reported outcome measures will be completed at follow-up at weeks 4, 12, 26, and 52. The primary outcomes are the Victorian Institute of Sports Assessment-Achilles questionnaire scores and statistical evaluation of intraindividual differences between baseline and 12-week evaluations after initial treatment of verum therapy compared to control. Secondary outcomes will assess Pain Disability Index scores; average pain, using the 11-point Numeric Rating Scale; return to sports; and use of emergency medication. The study began in May 2021. As of October 2022, we randomized 66 out of 72 participants. We anticipate completing recruitment by the end of 2022 and completing primary data analysis by March 2023. The study will evaluate the effects of PBCS on pain, physical function, and clinical outcomes. German Clinical Trials Register DRKS00017293; https://tinyurl.com/mvz7s98k. DERR1-10.2196/40894.

Comorbid depressive symptoms can aggravate the functional changes of the pain matrix in patients with chronic back pain: A resting-state fMRI study.

ObjectiveThe purposes of this study are to explore (1) whether comorbid depressive symptoms in patients with chronic back pain (CBP) affect the pain matrix. And (2) whether the interaction of depression and CBP exacerbates impaired brain function.MethodsThirty-two patients with CBP without comorbid depressive symptoms and thirty patients with CBP with comorbid depressive symptoms were recruited. All subjects underwent functional magnetic resonance imaging (fMRI) scans. The graph theory analysis, mediation analysis, and functional connectivity (FC) analysis were included in this study. All subjects received the detection of clinical depressive symptoms and pain-related manifestations.ResultCompared with the CBP group, subjects in the CBP with comorbid depressive symptoms (CBP-D) group had significantly increased FC in the left medial prefrontal cortex and several parietal cortical regions. The results of the graph theory analyses showed that the area under the curve of small-world property (t = −2.175, p = 0.034), gamma (t = −2.332, p = 0.023), and local efficiency (t = −2.461, p = 0.017) in the CBP-D group were significantly lower. The nodal efficiency in the ventral posterior insula (VPI) (t = −3.581, p = 0.0007), and the network efficiency values (t = −2.758, p = 0.008) in the pain matrix were significantly lower in the CBP-D group. Both the topological properties and the FC values of these brain regions were significantly correlated with self-rating depression scale (SDS) scores (all FDR corrected) but not with pain intensity. Further mediation analyses demonstrated that pain intensity had a mediating effect on the relationship between SDS scores and Pain Disability Index scores. Likewise, the SDS scores mediated the relationship between pain intensity and PDI scores.ConclusionOur study found that comorbid depressive symptoms can aggravate the impairment of pain matrix function of CBP, but this impairment cannot directly lead to the increase of pain intensity, which may be because some brain regions of the pain matrix are the common neural basis of depression and CBP.

Determinants of Pain-Induced Disability in German Women with Endometriosis during the COVID-19 Pandemic.

(1) Background: The main aim of this research was to examine the factors leading to pain-induced disability by assessing the impact of demographic, endometriosis-specific, pandemic-specific, and mental health factors. (2) Methods: Women with endometriosis who attended online support groups were invited to respond to an online survey during the first wave of the COVID-19 pandemic in Germany. The Pain Disability Index (PDI) was employed to assess disability-related daily functioning. Independent predictors of pain-induced disability were determined using univariate and multivariate logistic regression analyses. (3) Results: The mean PDI score of the study population was 31.61 (SD = 15.82), which was significantly higher (p < 0.001) than that reported in a previously published normative study of the German population. In the present study, a high level of pain-induced disability, as defined by scores equal to or higher than the median of the study population, older age (OR 1.063, 95% CI 1.010–1.120, p = 0.020), dysmenorrhea (OR 1.015, 95% CI 1.005–1.026, p = 0.005), dysuria (OR 1.014; 95% CI 1.001–1.027, p = 0.029), lower back pain (OR 1.018, 95% CI 1.007–1.029, p = 0.001), and impaired mental health (OR 1.271, 95% CI 1.134–1.425, p < 0.001) were found to be independent risk factors. Pandemic-specific factors did not significantly influence the pain-induced disability of the participants in this study. (4) Conclusions: The level of pain-induced disability was significantly higher among the women with endometriosis than among women in the normative German validation study. Our findings identified risk factors for experiencing a high level of pain-induced disability, such as demographic and specific pain characteristics. Pandemic-specific factors did not significantly and independently influence the pain-induced disability during the first wave of the COVID-19 pandemic in Germany. Impaired mental health negatively influenced functioning during daily activities. Thus, women with endometriosis should be managed by a multidisciplinary team of healthcare professionals to prevent negative effects of pain-induced disability on their quality of life.

0436 Effect of sleep on the relationship between pain related disability and neural correlates of pain processing in adults with fibromyalgia and insomnia

Abstract Introduction Up to 80% of adults with fibromyalgia experience insomnia. While sleep and pain are known to be associated, sleep's role in the association between pain related disability and neural correlates of pain processing is unknown. We evaluated whether sleep moderates the association between brain activity in response to painful stimuli and pain related disability in adults with fibromyalgia and insomnia (FMI). Methods Twenty-nine adults with FMI (Mage=57.2, SD=13.1) wore Actiwatch 2s over 14 days, completed the Pain Disability Index (PDI), and underwent fMRI using a quantitative sensory testing (QST) protocol involving thermal stimuli. Twelve brain regions with significant activation changes to QST (identified previously, PMID34310276) were included as dependent variables, PDI score as independent variable and actigraphic sleep variables (Sleep Onset Latency (SOL), Total Sleep Time (TST), Sleep Efficiency (%SE)) as moderators in the analysis. For moderation at significance levels of p&amp;lt;0.05 (and trends at p&amp;lt;0.1), significance of simple slopes at high (1 SD above), average and low (1 SD below) sleep levels were examined. Results %SE moderated the relationship between right cingulate gyrus (rCG) activity and PDI score (B=0.0009, SE=0.0003, p=.016, R^2=0.22). At lower values of %SE (but not at average or higher levels), there was a negative association between rCG activity and PDI score (B=-0.0166, SE=0.0064, p=0.016). Moderating impact of SOL (B=-0.0002, SE=0.0001, p=.05, R^2=0.14) and TST (B=0.0002, SE=0.0001, p=.06, R^2=0.15) trended towards significance. [MCS1] PDI and rCG activity showed negative associations at highest levels of SOL, while PDI and right inferior frontal gyrus activity showed positive associations at highest levels of TST. Conclusion Since the rCG is involved in gating, integration and classification of pain signals, decreased activation in rCG could reflect reduced modulation of pain processing in the region. Preliminary results indicate that at lower levels of sleep efficiency, this decrease in modulation of pain processing is associated with greater perceptions of disability related to pain. Further studies in larger samples are warranted to understand the causal effects, if any, of sleep on pain related disability and the neural correlates of pain processing. Support (If Any) NIAMS-R01AR055160/S1; PI-McCrae

0650 Does pain related disability moderate the relationship between subjective insomnia and anxiety in comorbid fibromyalgia and insomnia?

Abstract Introduction Fibromyalgia is a chronic widespread pain condition with up to 90% of patients experiencing comorbid sleep disorders (e.g., insomnia) and up to 64% experiencing comorbid anxiety disorders. Past research has shown: 1) a bidirectional relationship between insomnia and anxiety, 2) associations between pain and insomnia and 3) associations between pain and anxiety. However, research has yet to explore the role of pain, specifically pain related disability, in moderating the association between insomnia and anxiety. The present study evaluated the moderating impact of self-reported pain related disability on the relationship between subjective sleep variables and anxiety scores in adults with fibromyalgia and insomnia (FMI). Methods Two-hundred and nineteen adults with FMI (Mage=51.53, SD=1.89, 92.8% female) completed daily sleep diaries over fourteen days, the Pain Disability Index (PDI), and the State-Trait Anxiety Inventory Form Y-1 (STAI-Y1) as part of the baseline for a larger randomized clinical trial (SPIN, NCT#02001077). Moderation analyses included STAI-Y1 as the dependent variable, sleep variables averaged over 14 days (Sleep Onset Latency- SOL, Wake After Sleep Onset-WASO, Total Sleep Time-TST, Sleep Efficiency-%SE) as independent variables, PDI as the moderator, and age and years of education as covariates. For moderation at significance levels of p&amp;lt;0.05, significance of simple slopes at high (1 SD above), average, and low (1 SD below) PDI scores were examined. Results PDI moderated the relationship between SOL and STAI-Y1 (B=0.0052, SE=0.0019, p=0.01, R2=0.04). At high PDI scores (but not average), higher SOL was associated with higher STAI-Y1 scores (B=0.0748, SE=0.0310, p=0.02). At low PDI scores, higher SOL was associated with lower STAI-Y1 scores (B=-0.0844, SE=0.0453, p=0.06; trend). Conclusion Results indicate that at higher levels of perceived pain related disability, greater difficulty falling asleep is associated with increased levels of anxiety in FMI. At lower levels of pain related disability though, difficulty falling asleep and anxiety levels may have an inverse relationship. This points to a possible complex interplay between sleep difficulties, pain related disabilities and anxiety in the FMI population. Future research is warranted to examine potential causal relationships between pain, sleep, and anxiety. Support (If Any) NIAMS-R01AR055160(PI-McCrae)

Pain severity ratings in the 11th revision of the International Classification of Diseases : a versatile tool for rapid assessment.

An improved classification of chronic pain is included in the 11 th revision of the International Classification of Diseases and Related Health Problems . For all diagnoses of chronic pain, an optional dimensional code for the chronic pain severity will supplement the categorical diagnoses. Pain severity combines pain intensity, pain-related interference, and pain-related distress. Each component is rated by the patient on a numerical rating scale (NRS) from 0 to 10 and subsequently translated into severity stages ("mild," "moderate," and "severe"). This study aimed to evaluate this severity code by comparing the ratings with established psychometric measures of pain-related interference and distress. An online survey was posted to self-help groups for chronic pain, and 595 participants (88.7% women, 59.5 ± 13.5 years) rated each of the severity parameters (pain intensity, pain-related interference, and pain-related distress) on an NRS from 0 to 10 and completed the Pain Disability Index and the Pain Coping Questionnaire (FESV, 3 subscales). The participants reported a mean pain intensity of 6.4 ± 1.9, mean pain-related interference of 6.7 ± 2.1, and mean pain-related distress of 5.7 ± 2.5. The respective NRS ratings showed substantial correlations with the Pain Disability Index score ( r = 0.65) and the FESV subscales ( r = 0.65, r = 0.56, r = 0.37). The extension code for pain severity is a valid and efficient way of recording additional dimensional pain parameters, which can be used to monitor the course of chronic pain and its treatment. The specifier's efficiency makes it possible to use the code when a questionnaire would not be feasible due to time constraints, such as in primary care.

Early Unprotected Weight Bearing and Pre-Scheduled Supervised Rehabilitation Program after Surgical Treatment of Ankle Fractures.

Ankle fractures represent one of the most common orthopedic injuries in the lower extremity. Weight-bearing and rehabilitation protocols after surgical treatment of ankle fracture have recently evolved from traditional methods to full weight-bearing protocols. However, more evidence is needed on unprotected immediate weight-bearing along with a standardized rehabilitation program. The purpose of this study was to evaluate effects of unprotected immediate weight-bearing as tolerated and an eight-week prescheduled supervised rehabilitation program on the mid-term clinical and functional outcomes of surgically treated ankle fractures, and to compare functional results with the unaffected side. Eighty patients (24F and 56M) who underwent rigid fixation of bimalleolar ankle fractures were included (mean age 41.57±13.22 years). Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. The fractures were classified using Lauge-Hansen classification system. Ankle ROMs, Pain Disability Index (PDI), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form-36 scores were evaluated. Patients were allowed unprotected weight-bearing on the immediate postoperative period and a standardized supervised prescheduled rehabilitation program was undertaken following surgery. The mean follow-up period was 30.32±6.91 months. Based on Lauge-Hansen classification, supination-external rotation injuries were found in 32(40%) patients, supination adduction injuries in 14(17.4%) patients, pronation-external rotation injuries in 28(35%) patients, and pronation-abduction fractures in 6(7.6%) patients. The solid union was achieved in all patients at the final follow-up. The mean PDI score was 12.78±14.78, and the AOFAS score was 80.93±17.24. Although patients' health-related quality of life was at a good level, the injured-side ankle ROM was lower than the healthy side (p ≤ 0.05). Satisfactory clinical and functional outcome can be achieved at mid-term with unprotected weight-bearing as tolerated and pre-scheduled supervised eight-week rehabilitation program following rigid internal fixation of ankle fractures. However, this protocol is not studied in patients with associated comorbidities.

The Pain Disability Index: Effects of performance and symptom validity in mild traumatic brain injury litigants with persistent Post-Concussion pain complaints

Objective Objectives of the current study were to cross validate the Pain Disability Index (PDI) as a measure of symptom validity in a large sample of mild traumatic brain injury (MTBI) litigants with persistent post-concussive pain complaints, and investigate the effects of performance and symptom validity testing on PDI scores. Methods Participants included 91 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT), and the MMPI-2-RF Symptom Validity Scale (FBS-r) as a measure of symptom validity (SVT). Results Participants who failed PVT and SVT scored significantly higher on the PDI compared to participants who passed both. Failing both was associated with a large effect size. Failing PVT, but passing SVT, was associated with a medium effect on PDI scores, while passing PVT, but failing SVT demonstrated a small effect. A PDI cutscore of 49 was associated with .90 specificity and .47 sensitivity. Conclusion The PDI demonstrates external validity as a self-report measure of symptom validity in MTBI litigants with persistent post-concussive pain complaints. A dose response relationship exists between PVT, SVT and PDI scores. Forensic examiners should include both PVT and SVT to optimize clinical decision making when evaluating MTBI litigants with complaints of pain-related disability years post-incident.

Assessing the Influence of Pain and Resiliency Scores on Post-Operative Outcomes

Category:Other; Ankle; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Resilience is defined as the ability to recover after stressful events and has been shown to correlate with surgical outcomes across multiple fields. To date, there has been minimal research on the impact of patient resiliency on outcomes of foot and ankle surgery. Thus, this study aimed to look for an association between resilience, as measured by the Brief Resilience Scale (BRS); pain, as measured by the Pain Disability Index (PDI) and Pain Catastrophizing Scale (PCS); and post-operative outcomes after foot and ankle surgery.Methods:At a single academic medical center, a retrospective review of prospectively collected data was conducted on orthopaedic foot and ankle (n=201) and podiatric (n=7) patients who completed a pre-operative BRS and underwent surgery between 2019 and 2020 (N=208). The cohort consisted of 46 post-operative opioid users and 162 non-users. Data collected included demographics, comorbidities, diagnoses, procedure (i.e., removal of implant=22, Brostrom=15, tenolysis of flexor or extensor tendons=11, 1st MTP fusion=11, cheilectomy=10, etc.), PDI and PCS scores, complications, outcome markers, and pre- and post-operative opioid and benzodiazepine use. Data was analyzed with one-way ANOVA and linear and multivariate regressions formulated by SPSS software.Results:The PDI score significantly correlated with post-operative benzodiazepine (p=.011) and opioid use (p=.006), the BRS score significantly correlated with post-operative benzodiazepine use (p=.007), and the PCS score significantly correlated with longer length of follow-up (p=.011). Pre-operative opioid use was associated with an increased rate of 30-day readmission (users=6.52%, non-users=2.47%; p<.001). The multiple regression analysis indicated that the BRS score remained significantly correlated to post-operative benzodiazepine use (p=.004). Results of the multiple regression analysis also indicated that higher PCS scores were significantly correlated with increased rates of 30-day readmission (p=.047) and longer length of follow-up (p=.005). No outcome measure was significantly correlated with PDI score, according to the multiple regression analysis.Conclusion:In conclusion, the PCS was not shown to be an effective tool for measuring post-operative outcomes in orthopaedic foot and ankle patients, despite evidence of the contrary in other fields of orthopaedics. Additionally, the BRS and PDI were only valuable in their association with post-operative narcotic usage. Pre-operative opioid use was shown to correlate with worse higher rates of readmission and limited follow up, as corroborated by numerous previous studies. This study did not find the BRS, PDI, or PCS as useful indicators of surgical outcomes in foot and ankle patients.

LAND BASED EXERCISES VERSUS POOL BASED EXERCISES FOR SWIMMER’S SHOULDER IN COMPETITIVE SWIMMERS: RANDOMIZED CLINICAL TRIAL

To compare the effect of Land based exercises and Pool based exercises for shoulder strength to reduce shoulder pain in competitive swimmers using Shoulder Pain Disability Index (SPADI) score, Hand-Held dynamometer (HHD), Randomized Clinical trial.29 competitive swimmers with age group between 8 to 18 years were evaluated for shoulder pain using Shoulder Pain Disability Index Score [SPADI] and shoulder strength was evaluated using Hand Held Dynamometer [HHD] before and after the study. Then all the subjects were divided into 2 groups, for Group A Pool based exercises were given and for Group B Land based exercises were given. Statistically there is significant difference in values of outcome measures after the study in both groups but there is more significant difference in Group A than Group B. Pool based exercises showed more significant effect on shoulder pain than land based exercises in swimmer’s shoulder.

Clinical Outcomes of a Multidisciplinary Female Chronic Pelvic Pain Program

The aim of this study was to describe patient-reported longitudinal outcomes in a multidisciplinary female chronic pelvic pain (CPP) program. We conducted a retrospective cohort study for women cared for in a tertiary, multidisciplinary, female (CPP) program between 2012 and 2017. Patient demographics were collected from electronic medical records. Patients completed the numerical rating scale for pain, Pain Disability Index (PDI), and Patient Global Impression of Improvement scale at each visit. Mixed-effects models were used to assess change in patient responses over time. Patients (N = 317) with a mean age of 44.3 years (SD, 14.6) and median duration of symptoms of 3 years (interquartile range, 1.0-7.0) were assessed in this analysis. The primary diagnosis was pelvic floor myofascial pain (67%). On multivariable analysis, numerical rating scale scores decreased by -0.11 point [95% confidence interval (CI), -0.20 to -0.01] every 3 months (P = 0.03). On multivariable analysis, total PDI score decreased by -0.88 point (95% CI, -1.43 to -0.33) (P = 0.003), and PDI sexual subscores decreased by -0.29 point (95% CI, -0.44 to -0.14) (P < 0.001) every 3 months. A higher (worse) Patient Global Impression of Improvement score was associated with a higher (worse) PDI score at follow-up (odds ratio, 1.04; 95% CI, 1.01-1.07; P = 0.01). Patients in a multidisciplinary CPP program demonstrated improvement over time in pain disability that was associated with an overall global impression of improvement.

Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain

Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations. To compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP. This prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial recruited participants with nonspecific subacute or chronic LBP from a tertiary care center in France starting February 17, 2014, with follow-up completed on October 23, 2017. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 22, 2018, to December 5, 2018. Six sessions (1 every 2 weeks) of standard OMT or sham OMT delivered by nonphysician, nonphysiotherapist osteopathic practitioners. The primary end point was mean reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index (score range, 0-100). Secondary outcomes were mean reduction in LBP-specific activity limitations; mean changes in pain and health-related quality of life; number and duration of sick leaves, as well as number of LBP episodes at 12 months; and consumption of analgesics and nonsteroidal anti-inflammatory drugs at 3 and 12 months. Adverse events were self-reported at 3, 6, and 12 months. Overall, 200 participants were randomly allocated to standard OMT and 200 to sham OMT, with 197 analyzed in each group; the median (range) age at inclusion was 49.8 (40.7-55.8) years, 235 of 394 (59.6%) participants were women, and 359 of 393 (91.3%) were currently working. The mean (SD) duration of the current LBP episode was 7.5 (14.2) months. Overall, 164 (83.2%) patients in the standard OMT group and 159 (80.7%) patients in the sham OMT group had the primary outcome data available at 3 months. The mean (SD) Quebec Back Pain Disability Index scores for the standard OMT group were 31.5 (14.1) at baseline and 25.3 (15.3) at 3 months, and in the sham OMT group were 27.2 (14.8) at baseline and 26.1 (15.1) at 3 months. The mean reduction in LBP-specific activity limitations at 3 months was -4.7 (95% CI, -6.6 to -2.8) and -1.3 (95% CI, -3.3 to 0.6) for the standard OMT and sham OMT groups, respectively (mean difference, -3.4; 95% CI, -6.0 to -0.7; P = .01). At 12 months, the mean difference in mean reduction in LBP-specific activity limitations was -4.3 (95% CI, -7.6 to -1.0; P = .01), and at 3 and 12 months, the mean difference in mean reduction in pain was -1.0 (95% CI, -5.5 to 3.5; P = .66) and -2.0 (95% CI, -7.2 to 3.3; P = .47), respectively. There were no statistically significant differences in other secondary outcomes. Four and 8 serious adverse events were self-reported in the standard OMT and sham OMT groups, respectively, though none was considered related to OMT. In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable. ClinicalTrials.gov Identifier: NCT02034864.

Validity of the Somatic Complaints Scales of the MMPI-2-RF in an Outpatient Chronic Pain Clinic.

Chronic pain has become a significant medical issue. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a broadband psychological test that has been validated for use across various medical settings and can aid in the assessment and treatment planning of chronic pain. In the current investigation, it was hypothesized that the somatic complaints scales of the MMPI-2-RF would demonstrate good convergent validity from a structured psychodiagnostic interview and other measures of pain and somatization, and lack gender bias. Patients (n = 200) who produced valid MMPI-2-RFs in an outpatient chronic pain clinic were included in the study. Patients were also administered the Modified Somatic Perception Questionnaire (MSPQ), Pain Disability Index (PDI), and the Structured Clinical Interview for DSM-IV-TR (SCID). Zero-order and partial correlations (controlling for gender) were calculated between MMPI-2-RF scale scores and other criteria. Stepdown hierarchical regression analyses were used to detect bias. By and large, higher scale scores on the somatic/cognitive scales of the MMPI-2-RF were modestly or substantially correlated with MSPQ scores, PDI scores, and SCID Somatization symptom count, even after controlling for gender. Regression analyses suggested that the MMPI-2-RF scale scores were not biased as a function of gender. These findings support the validity of specific MMPI-2-RF scales to help identify somatization and psychosocial functioning among patients with chronic pain. Identification of somatization early within the course of treatment of chronic pain may help focus treatment targets, including referrals for psychological interventions such as cognitive behavior therapy for chronic pain.

Catastrophic thinking and functional disability in Primary Health Care chronic pain patients

ABSTRACT BACKGROUND AND OBJECTIVES: Catastrophic thoughts are an important evaluative factor because they interfere with pain management and degree of disability since they affect responses to pain. The study aimed to investigate the relationship between catastrophic thoughts and the dimensions of functional disability in patients with chronic musculoskeletal pain in primary health care. METHODS: A cross-sectional descriptive study that included 50 patients of both genders, aged 18 to 59 years, with chronic musculoskeletal pain, with intensity from 3 to 7 by the visual analog scale. To evaluate pain catastrophization, the Brazil validated Pain Catastrophizing Scale (B-PCS) was used and the interference of pain on function was assessed by the Pain Disability Index (PDI). RESULTS: The majority of patients were female (94%), mean age 42±10.3 years, median pain 7 [6-7], basic schooling level (62%), unemployed (66%), and sedentary (76%). Catastrophizing (56%). The regions with the highest prevalence of pain were thoracolumbar (38%), anterior knees (32%), lumbosacral and face (30%). There was a direct and significant correlation between the PCS and PDI scores (ρ=0.56; p<0.01), as well as between the PDI scores and the subdomains: rumination (ρ=0.34; p <0.01), magnification (ρ=0.57; p <0.01) and helplessness (ρ=0.53; p <0.01). CONCLUSION: People with chronic pain demonstrate a tendency towards the most unpleasant aspects of pain, resulting in less participation in daily activities, with impacts on functional capacity.

The Effect of Short-Wave Diathermy and Exercise on Depressive Affect in Chronic Low Back Pain Patients.

Objective:The aim of this study was to compare exercise, continuous short-wave diathermy (SWD) and intermittent SWD treatment modalities and to evaluate the effects of these treatments on chronic back pain and depression.Methods:This study is an intervention trial which evaluated patients who applied to our clinic due to chronic low back pain between 2008-2009. The study group consisted of 90 patients between the ages of 40-65 who had had low back pain for more than 6 months. The patients were randomized into three groups. The first group received placebo short-wave diathermy, the second group received continuous short-wave diathermy, and the third group received pulsed short-wave diathermy. Pain was evaluated by Visual Analog Scale (VAS) and the Pain Disability Index (PDI).The Modified Oswestry Low Back Pain Disability Questionnaire Form was used for the measurement of functional deficiency and the Beck Depression Inventory (BDI) was used for the evaluation of depression.All scales were performed before the treatment, immediately after treatment and 3 months after treatment.Results:Significant decreases in PDI and VAS scores were found in all groups (p<0.05 for each). Similarly, there was a significant improvement in all groups in terms of functional deficiency(p<0.001 for each), while no differences were found between groups (p = 0.895). In terms of BDI scores, there was no improvement in those receiving only exercise, while Group 2 and 3 had significant improvements (p <0.05). When groups were compared for BDI scores, no differences were found between any of the groups (p = 0.189).Conclusion:Continuous SWD treatment with exercise was found to be more effective in reducing pain in patients with chronic low back pain than other treatment modalities used in our study. Although there was no significant difference between the groups in terms of depressive mood, it was found that those receiving continuous and pulsed SWD treatment had significant improvements in depression as measured by the BDI.

Effect of Telephone Call and Text Message Reminders on Patient Return to Acupuncture Follow-Up Treatment: A Pilot Randomized Controlled Trial.

Background: Telephone calls and text messages function as cues to elicit patient behavior. Objective: We tested the effect of telephone call and text message reminders on patient return to acupuncture follow-up treatment. Design: This is a randomized controlled trial. Setting and Subjects: We recruited adults visiting an acupuncture clinic for a new treatment consultation. Our sample contained 120 participants with 40 per study group. Interventions: Consenting patients were randomized to 1 of 3 study exposures: single voice call, single text message, or treatment as usual (TAU/no reminder). Exposures were sent 3 days after patient's initial treatment. Outcome Measures: Data from clinic charts were abstracted to quantify the absence/presence of a follow-up treatment return in the 30 days after initial treatment. Participants provided self-report of pain symptoms 10 and 30 days after initial treatment on the pain disability index (PDI) to measure change in PDI by return to follow-up treatment as a secondary outcome. Results: Telephone call (56%, P = 0.98) and text message (57%, P = 0.99) groups showed similar proportion of follow-up treatment returns compared with TAU group (57%). Presence of a follow-up appointment scheduled at the initial treatment predicted patient treatment return (odds ratio: 5.87, P < 0.01). Follow-up treatment return predicted reduced PDI scores at day 30 (β = -3.09, P = 0.02). Conclusions: Adding a 1-time telephone call or text message reminder to standard clinic practice did not improve patient return to acupuncture follow-up treatment within 30 days of initial treatment. Scheduling a future appointment date at initial treatment visit may improve treatment return, and return attendance appears protective of pain disability in the short term.

A Prospective, Multi‐Center, Clinical Trial of a 10‐kHz Spinal Cord Stimulation System in the Treatment of Chronic Pelvic Pain

BackgroundChronic pelvic pain (CPP) is a debilitating condition that often leads to disability and does not respond to conventional treatments. This study was conducted to evaluate the effects of paresthesia‐independent 10‐kHz spinal cord stimulation (SCS) in subjects with CPP.MethodsThis prospective, single‐arm pilot study enrolled subjects with clinical diagnoses of CPP and mean pain scores of ≥ 5.0 cm on a 10‐cm VAS. Subjects underwent trial stimulations with 10‐kHz SCS, and those who had successful trial stimulations (≥40% pain relief) received permanently implanted devices and were followed for 12 months.ResultsOf the 21 subjects who underwent the 10‐kHz SCS trial, 17 were successful and 14 subjects received permanent implants. No neurological deficits were observed in any subjects and all adverse events (AEs) were resolved without sequelae during the study period. Over 12 months, mean VAS scores decreased by 72% from baseline, and 10 of 13 subjects (77%) were responders (≥50% pain relief). Pain remission (VAS score ≤ 3.0 cm) was reported by 8 of 13 subjects (62%), and mean pain scores on the short‐form McGill Pain Questionnaire 2 decreased as well. Pain Disability Index scores declined by 29 points, and 85% of the subjects reported satisfaction.ConclusionsParesthesia‐independent stimulation with 10‐kHz SCS reduced pelvic pain in subjects with CPP and was not associated with any unexpected AEs. While larger, controlled studies are needed, results of this study suggest that this therapeutic modality could potentially treat patients with CPP while improving their quality of life.