Pain Disability Index Scores Research Articles

10kHz spinal cord stimulation for chronic upper limb and neck pain: Australian experience.

Intractable upper limb and neck pain has traditionally been a challenging pain condition to treat, with conventional spinal cord stimulation (SCS) often inducing positional variation in paraesthesia and/or inadequate coverage of axial neck pain. The purpose of this Australian multi-centre prospective, clinical trial was to assess the safety and effectiveness of paraesthesia-independent 10kHz SCS for the treatment of upper limb and neck pain. Subjects with chronic, intractable neck and/or upper limb pain of ≥ 5cm (on a 0-10-cm visual analogue scale) were enrolled (ACTRN12614000153617) following human research ethics committee approval. Subjects were implanted with two epidural leads spanning C2-C6 vertebral bodies. Subjects with successful trial stimulation were implanted with a Senza® system (Nevro Corp., Redwood City, CA, USA) and included in the safety and effectiveness evaluation at 3 months post-implant (primary endpoint assessment, PEA) and followed to 12 months. Overall, 31/38 (82.6%) subjects reported a successful 10kHz SCS trial and proceeded to a permanent implant. Twenty-three of 30 subjects (76.7%) met the PEA. Subjects reported a reduction in neck pain and upper limb pain from baseline at the PEA (8.1 ± 0.2cm vs. 2.9 ± 0.5cm, 7.3 ± 0.3cm vs. 2.5 ± 0.5cm, respectively, p ≤ 0.0001). Disability, as measured by pain disability index score, decreased from 42.6 ± 2.6 at baseline to 22.7 ± 3.2 at PEA. Results were maintained 12 months post-implant. No neurological deficits, nor reports of paraesthesia, were observed. Stable, long-term results demonstrated that 10kHz SCS is a promising therapy option for intractable chronic upper limb and neck pain.

62: Quantifying anxiety in women at the initial gynecology visit

Anxiety can be measured in various ways. State anxiety is temporary and is sensitive to change. Our study aims to characterize the reasons for anxiety among women presenting for their initial gynecology visit, to measure the change in state anxiety after the visit, and to correlate anxiety improvement with visit satisfaction. New patients presenting to our tertiary Benign Gynecology clinic were invited to participate. Participants were asked to list their pre-visit anxieties and completed pre- and post-visit questionnaires. Pre-visit questionnaires included the Generalized Anxiety Disorder-7 (GAD-7), the Spielberg State Trait Anxiety Inventory (STAI-Y6), the Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI) and Visual Analogue Scale (VAS). Post-visit questionnaires included the STAI-Y6, Patient Global Impression of Improvement (PGI-I) of participant anxiety, visit satisfaction, and the participant’s perception of how their anxiety was addressed. Providers were blinded to responses on the pre- and post-visit questionnaires. Anxieties listed by participants were reviewed and categorized independently by 2 of the authors (AR and TP). 40 women, primarily white (45%), with a median age of 43 years (SD 14.82) were enrolled. Those who were seen for a problem visit (55%) were older than those seen for a preventative visit (37 years vs. 47 years; p=.02). 60% of participants had not seen a gynecologist before and only 1 participant had a known anxiety diagnosis. The average pre-visit STAI score was 40.42 (SD = 14.93), with similar scores observed between those seen for a preventative visit and those seen for a problem visit. Pre-visit STAI scores increased with increasing GAD (Pearson r = 0.57, p<.001), PDI (Pearson r=0.43, p= .005) and PCS scores (Pearson r=0.53, p<.001). Pre-visit STAI score decreased by 9.83 points after the visit (Figure 1). The most reported causes for visit-related anxiety were related to: diagnosis, treatment and personal issues. Post-visit improvement in state anxiety was associated with improvement in PGI-I as those who reported the largest improvement in PGI-I scores had the largest improvement in STAI scores (p = .03). Changes in state anxiety were not associated with visit satisfaction, participant’s perception that anxiety was addressed during visit, visit diagnosis, GAD, PCS, PDI, or VAS scores. Women experience high level of state anxiety prior to their initial gynecology visit, especially those with generalized anxiety (GAD) or high PCS scores. All participants had significant improvement in state anxiety after the visit, regardless of visit satisfaction, participant’s perception of how anxiety was addressed, or measures of generalized anxiety or pain.

Evaluating Disability-Related Quality of Life in Women With Chronic Pelvic Pain.

The primary aim of this study was to describe quality of life (QOL) in women with chronic pelvic pain using the Pain Disability Index (PDI). A secondary goal was to assess the measurement properties and validity of the PDI for this population. This study was a cross-sectional retrospective chart review. In the setting of an outpatient female pelvic pain clinic, we included data from an initial evaluation of patients 16 years and older with chronic pelvic pain (N = 317) from 2012 to 2017. Quality of life was measured using the PDI and previously validated measures for depression and anxiety. The mean PDI score across all patients was similar to previously reported means for similar chronic pain populations. Patients experienced the most disability in their sexual activities. The most common cause of chronic pelvic pain was pelvic floor myofascial pain. Common diagnostic categories covered gynecologic, urologic, gastrointestinal, musculoskeletal, and neurological causes. The PDI was unable to discriminate between diagnoses. On average, patients qualified for mild depression and anxiety diagnoses. Results from a confirmatory factor analysis revealed the original factor structure for the PDI fits this population. The PDI shows promise as a questionnaire for QOL and could be a valuable clinician tool for tracking QOL in the chronic pelvic pain population. Additional research should be focused on assessing its ability to measure minimum clinically significant change over time.

Measuring opioid dependence in chronic pain patients: A comparison between addiction clinic and pain clinic patient populations.

To compare dependence characteristics between patients with chronic pain treated within an addiction medicine setting with those attending specialist pain clinics. Forty patients with chronic non-cancer pain taking opioid analgesics for >1 year were recruited from university-affiliated, tertiary teaching hospital clinics; 20 from an addiction medicine clinic (addiction clinic group) and 20 from specialist pain clinics (pain clinic group). Data regarding demographics, past and current substance use, pain history and current daily opioid intake were collected. Patients completed three questionnaires: the Severity of Opioid Dependence Questionnaire, Leeds Dependence Questionnaire, and Pain Disability Index. A novel "Opioid Problem Checklist score" assessing drug-related problems was also determined for each patient. The addiction clinic group were younger, more likely to have experienced drug overdose and had a shorter duration of chronic pain. No significant differences in dependence questionnaire scores were found between groups. However, higher Pain Disability Index scores and higher Opioid Problem Checklist scores (indicating more drug-related problems) were found for the addiction clinic group. Some degree of dependence was present across both addiction and pain clinic groups, supporting the notion a state of dependence can be identified among chronic pain patients taking opioids long term. Aberrant behaviors were not common in the pain clinic sample, suggesting these patients are unlikely to meet Diagnostic and Statistical Manual of Mental Disorders-V criteria for Substance Use Disorder. However, opioid dependence carries significant risks for relapse, chronicity, morbidity and mortality, warranting specific medical management. Management of such risks should be considered routine care in chronic pain patients taking opioids long term.

Influencing factors on career choice and current occupation analysis of adult survivors of childhood cancer: a special focus on health-related occupations

Planning a career and choosing a profession is an important step in the future development to adolescence. Although cancer and the consequences of the disease have a high impact on the bio-psychosocial level, less is known concerning the profession prevalence of childhood cancer survivors. Therefore, major influencing factors on career choice and current occupations of former Austrian childhood cancer patients have been analysed, especially focusing on health-related occupations. A survey battery including possible influencing factors on career choice was sent by mail. Physical and daily life impairment was evaluated by the quality of life survey (SF-12) and an adapted version of the Pain Disability Index (PDI). In total, 102 survivors with a mean age of 32.8 (SD 4.9) years (50% women) participated. A significantly high proportion of survivors was found currently holding health-related occupations, also when compared to the general Austrian population. Disease and treatment, female gender, social and family circumstances have substantial impact on the choice of a health-related career. Mean SF-12 scores were comparable to a healthy reference group, although scores for mental health were marginally lower in our group, and scores for physical health were slightly higher. The PDI scores were very low, which indicates no major influences in everyday activities. There was found a significant trend that adult survivors of childhood cancer are more likely to work in health-related professions than the average population. Occupational planning should consequently be supported and mental health might be addressed during regular follow-up visits.

Pain-related avoidance and endurance behaviour in migraine: an observational study

BackgroundThe role of avoidance and endurance behaviour is well established in chronic musculoskeletal pain, but less is known about its significance in migraine.MethodsThe Avoidance-Endurance Questionnaire behavioural subscales, the Pain Disability Index (PDI), the Migraine Disability Assessment Scale (MIDAS) and the Hospital Anxiety and Depression Scale (HADS) were obtained from 128 migraine patients (90 episodic, 38 chronic). Sixty nine of them were re-evaluated after 3–6 months.ResultsAt baseline, there were positive relations between avoidance (especially social avoidance behaviour) and pain-related disability as assessed by the PDI (Wald χ2 [1] = 32.301, p < 0.001) and the MIDAS (Wald χ2 [1] = 14.387, p < 0.001). A negative relation of endurance behaviour with PDI scores did not survive multiple regression analysis. In addition, there was a positive relation of social avoidance with the HADS depression score (Wald χ2 [1] = 3.938, p = 0.047) and a negative relation of endurance (especially the humour-distraction subscale) with the HADS anxiety score (Wald χ2 [1] = 6.163, p = 0.013). Neither avoidance nor endurance were related to headache intensity or frequency, or to a diagnosis of episodic vs. chronic migraine. 3–6 months after treatment at our headache centre, headache frequency, intensity and pain-related disability were significantly improved (all p < 0.01) while avoidance and endurance were unchanged.ConclusionsThis indicates that improvement in headache frequency and disability can be achieved in the absence of changes in avoidance or endurance behaviour. However, because of its significant link to headache-related disability, avoidance behaviour (especially social avoidance) should be investigated as a potential additional target of migraine therapy.

Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression.

Minimally invasive lumbar unilateral tubular laminotomy for bilateral decompression has gradually gained acceptance as a less destabilizing but efficacious and safe alternative to traditional open decompression techniques. The authors have further advanced the principles of minimally invasive surgery (MIS) by utilizing working-channel endoscope-based techniques. Full-endoscopic technique allows for high-resolution off-axis visualization of neural structures within the lateral recess, thereby minimizing the need for facet joint resection. The relative efficacy and safety of MIS and full-endoscopic techniques have not been directly compared. A retrospective analysis of 95 consecutive patients undergoing either MIS (n = 45) or endoscopic (n = 50) unilateral laminotomies for bilateral decompression in cases of lumbar spinal stenosis was performed. Patient demographics, operative details, clinical outcomes, and complications were reviewed. The patient cohort consisted of 41 female and 54 male patients whose average age was 62 years. Half of the patients had single-level, one-third had 2-level, and the remaining patients had 3- or 4-level procedures. The surgical time for endoscopic technique was significantly longer per level compared to MIS (161.8 ± 6.8 minutes vs 99.3 ± 4.6 minutes; p < 0.001). Hospital stay for MIS patients was on average 2.4 ± 0.5 days compared to 0.7 ± 0.1 days for endoscopic patients (p = 0.001). At the 1-year follow-up, endoscopic patients had a significantly lower visual analog scale score for leg pain than MIS patients (1.3 ± 0.3 vs 3.0 ± 0.5; p < 0.01). Moreover, the back pain disability index score was significantly lower in the endoscopic cohort than in the MIS cohort (20.7 ± 3.4 vs 35.9 ± 4.1; p < 0.01). Two patients in the MIS group (epidural hematoma) and one patient in the endoscopic group (disc herniation) required a return to the operating room acutely after surgery (< 14 days). Lumbar endoscopic unilateral laminotomy for bilateral decompression is a safe and effective surgical procedure with favorable complication profile and patient outcomes.

Treatment of chronic back pain using indirect vibroacoustic therapy: A pilot study.

Low frequency sound wave stimulation therapy has become increasingly popular in the rehabilitation fields, due to its ease, less fatiguing and time efficient application. This 12-week pilot study examines the efficacy of applying low frequency sound wave stimulation (between 16-160 Hz) through both hands and feet on relieving pain and improving functional ability in patients with chronic back pain. Twenty-three participants with chronic shoulder (eleven participants) or low back pain (twelve participants) underwent a 12-week vibration therapy program of three sessions per week. A low frequency sound wave device comprising four piezoelectric vibration-type tactile tranducers enclosed in separate 5-cm diameter circular plates, which generate sinusoidal vibratory stimuli at a frequency of 16-160 Hz, was used in this study. Primary outcome measure was pain sensation measured using the Visual Analogue Scale (P-VAS). The secondary outcome measures were pain-related disability measured using the pain disability index (PDI) and quality of life measured using the SF-12. At week 12, significant reductions in pain sensation and pain-related disability were observed, with mean reductions of 3.5 points in P-VAS and 13.5 points in the PDI scores. Sixty-five percent of the participants had a reduction of at least 3 points on the P-VAS score, while 52% participants showed a decrease of at least 10 points in the PDI score. Significant improvement was observed in the SF-12 physical composite score but not the mental composite score. The preliminary findings showed that passive application of low frequency sound wave stimulation therapy through both hands and feet was effective in alleviating pain and improving functional ability in patients with chronic back pain.

Deep brain stimulation for intractable neuropathic facial pain.

OBJECTIVE Deep brain stimulation (DBS) is a well-established, evidence-based therapy with FDA approval for Parkinson's disease and essential tremor. Despite the early successful use of DBS to target the sensory thalamus for intractable facial pain, subsequent studies pursuing various chronic pain syndromes reported variable efficacy, keeping DBS for pain as an investigational and "off-label" use. The authors report promising results for a contemporary series of patients with intractable facial pain who were treated with DBS. METHODS Pain outcomes for 7 consecutive patients with unilateral, intractable facial pain undergoing DBS of the ventral posteromedial nucleus of the thalamus (VPM) and the periaqueductal gray (PAG) were retrospectively reviewed. Pain was assessed preoperatively and at multiple postoperative time points using the visual analog scale (VAS), the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), and the Pain Disability Index (PDI). RESULTS VAS scores significantly decreased from a mean ± SD of 9.0 ± 1.3 preoperatively to 2.6 ± 1.5 at 1 year postoperatively (p = 0.001). PDI scores decreased from a mean total of 48.5 to 28.5 (p = 0.01). SF-MPQ-2 scores decreased from a mean of 4.6 to 2.4 (p = 0.03). Notably, several patients did not experience maximum improvement until 6-9 months postoperatively, correlating with repeated programming adjustments. CONCLUSIONS DBS of the VPM and PAG is a potential therapeutic option for patients suffering from severe, intractable facial pain refractory to other interventions. Improved efficacy may be observed over time with close follow-up and active DBS programming adjustments.

Difficulties in emotion regulation and chronic pain-related disability and opioid misuse

Risk for opioid misuse is a crucial consideration for patients with chronic pain, given the recent high rates of opioid-related deaths in the U.S. Emotion regulation difficulties may be associated with chronic pain outcomes such as opioid misuse, but may also be amenable to intervention. The aim of this study was to examine associations between difficulties with emotion regulation and disability and risk for opioid misuse among Appalachian chronic pain patients. The Difficulties in Emotion Regulation scale (DERS-18), Pain Disability Index (PDI), Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP-R), and Current Opioid Misuse Measure (COMM) were collected from 149 patients (age 25–80, 59% female) presenting to a behavioral medicine department for evaluation. The extent to which DERS-18 scores predict risk for opioid misuse and disability was examined via hierarchical regression, logistic regression, and receiver operating characteristic (ROC) curve analyses. DERS-18 scores account for 45% of variance in SOAPP-R, 36% in COMM scores, and 11% in PDI scores. A one-point increase in DERS-18 score is associated with 19% greater odds of being at risk for misuse as measured by the SOAPP-R, and 16% greater odds on the COMM. In ROC analyses, the DERS-18 is a good predictor of risk on the SOAPP-R (AUC = .85) and COMM (.83), with cut-off scores in the mid-30s exhibiting good sensitivity and specificity. Difficulties in emotion regulation are associated with poorer functioning and with greater risk of opioid misuse in this population, but may be amenable to intervention.

Spinal Cord Stimulation for the Treatment of Failed Neck Surgery Syndrome: Outcome of a Prospective Case Series

Spinal cord stimulation (SCS) is an accepted, cost-effective treatment option for a variety of chronic pain syndromes, including failed back surgery syndrome (FBSS). The application of SCS in the cervical spine, particularly for pain after cervical spine surgery, has been drawn into question in recent years by payers due to a purported lack of clinical evidence. To challenge this claim, we analyzed data from a prospective registry to support the use of SCS in the cervical spine for pain after spine surgery. Data from the EMPOWER and PAIN registries were analyzed on patients diagnosed with pain after neck surgery (C-FBSS) for the following outcomes: patient reported percent pain relief (PRPR), pain disability index (PDI), quality of life (QoL), and satisfaction at 3-, 6-, and 12-month post-implantation. Statistical analysis was provided for all measures. Fifteen patients with C-FBSS were successfully implanted with SCS leads in the cervical spine. PRPR was 65.2%, 62.4%, and 71.9% at 3-, 6-, and 12-month post-implantation, respectively. PDI scores were significantly reduced from baseline (51.21-23.70 at 12 months, p = 0.001). At one-year post-implantation, the average overall QoL was reported to be improved/greatly improved and patient satisfaction was rated satisfied/greatly satisfied. For many, the application of SCS in the neck for pain after surgery is based on the obvious similarities to FBSS or anecdotal experience rather than published data. The data contained herein suggest SCS for C-FBSS is an effective therapy that improves QoL and patient satisfaction, as well as decreasing pain and PDI. The use of successful application of neurostimulation as a therapy has largely been predicated on the principles of patient selection, implantation technique, and stimulation parameters. As such, SCS would appear to be an appropriate and valid treatment for C-FBSS that requires further study and investigation to make additional recommendations.

Differences of nature of disease, socioeconomic and psychological factors in chronic low back pain patients between Thailand and Germany

To study the differences of nature of disease, socioeconomic status and psychological factors in chronic low back pain (LBP) patients between Thailand and Germany. Cross-sectional analytic study. Out patient clinic, department of rehabilitation medicine, King Chulalongkorn Memorial Hospital, Thailand and Department of Orthopedics & PM&R, Großhadern Hospital, Germany. Hundred Thai and 100 German patients with chronic LBP more than 6 months. The data from both hospitals were collected before chronic LBP patients received treatment. The data consisted of 4 domains; demographic data, socioeconomic status, nature of disease i.e. Numerical Rating Scale (NRS), Pain Disability Index (PDI), etc. and psychological factors (Center for Epidemiologic Studies Depression Scale: CES-D). The data was analyzed by using statistic program. Mean age of both Thai and German was 47.7 ± 11.7 years old. Majority was female, married, white collar and has LBP duration for more than 3 years. Comparison between Thai and German, the average and maximal NRS were not significantly different. However, German patients had significantly higher than Thai patients in PDI (median 26 and 10, respectively, P = 0.00) and CES-D total scores (median 17 and 4, respectively, P = 0.00). Despite the non-significant difference in LBP severity, there were the differences among Thai and German patients. German patients had more depressive symptom and pain related impairment than Thai patients.

(287) - Descriptive and clinical characteristics of patients receiving a spinal cord stimulator at walter reed national military medical center at one year follow-up

Spinal cord stimulators (SCS) have been shown to effectively treat chronic pain; however, few studies have examined the clinical outcomes for patients who received a SCS implant in the Military Health System. This project examined outcomes in patients from the pain management clinic at Walter Reed National Military Medical Center (WRNMMC) who received a SCS at one year post implant. The WRNMMC SCS cohort includes patients (active duty, veterans, and dependents) who completed a SCS trial and received a permanent implant. This project compared patients for whom we have data pre-SCS trial, as well as at 3 months, 6 months and 1 year after implantation (N = 51). Cohort demographics were primarily active duty, male, with pain from non-combat-related injuries. RANOVA results suggest that pain intensity ratings and Pain Disability Index scores significantly decreased from trial to all follow-up time points. The greatest mean reduction in both occurred from trial to 3 months follow-up. RANOVA analyses suggest that opioid Morphine Equivalent (MEQ) did not change between the trial and follow-up time points. However, descriptive statistics suggest that approximately 60% of patients were either satisfied or very satisfied with their pain relief at each follow-up time point. Findings suggest that pain management clinic patients at WRNMMC who undergo SCS implantation are highly satisfied with their pain relief, show improvements in disability index scores and pain intensity ratings from baseline to all follow-up time points. However, this project did not find that MEQ decreased from baseline to any of the follow-up time points. The results also support that for those patients who receive SCS in our local population, that it is likely to be a beneficial treatment. However, future projects should look at outcomes from a larger sample size and at up to two years post SCS implant.

Efficacy of a Targeted Drug Delivery on-Demand Bolus Option for Chronic Pain.

Intrathecal targeted drug delivery systems historically required physician office visits for dose adjustment to manage fluctuating pain. A wireless device now enables patients to supplement their basal intrathecal infusion with a programmed on-demand bolus dose. We sought to quantify the change in oral breakthrough opioid need associated with the use of an intrathecal bolus in comparison to those treated with the basal infusion alone. Demographic, dosage, bolus usage and longevity data were extracted from the historical medical record of 69 patients (18/51 bolus/nonbolus) followed continuously at our center. Medication consumption and Pain Disability Index measures were obtained at baseline and most recent follow-up. Among patients with the bolus option, only 2 (11%; confidence interval [CI] 0% to 26%) continued to require oral opiates to manage breakthrough pain compared to 29 (57%; CI 43% to 71%) without the bolus option. The Pain Disability Index score decreased by 19% in patients with the bolus option and by 25% in those with the basal infusion. Total daily intrathecal opioid intake was 34% lower in the group with the bolus device. Utilizing an intrathecal bolus to treat incident pain was a safe way to manage unpredictable breakthrough pain and may represent a cost-saving opportunity by eliminating the need for oral analgesic medications.

A Prospective Cohort Study of Outpatient Interdisciplinary Rehabilitation of Chronic Headache Patients.

To evaluate the efficacy of an intensive outpatient program designed to improve functioning and reduce psychological impairment in chronic headache patients. Chronic headaches, occurring 15 or more days per month, for three or more months, may arise from multiple International Classification of Headache Disorders diagnoses: Chronic Migraine, Chronic Tension Type Headache, New Daily Persistent Headache, Chronic Post Traumatic Headaches, and Medication Overuse Headache. Several interdisciplinary programs that treat patients with chronic headaches have reported decreases in headache frequency. This study sought to evaluate the effect of a 3 week interdisciplinary treatment program for patients with chronic headache disorders on headache severity, functional status, and psychological impairment. Subjects were 379 patients admitted to an outpatient chronic headache treatment program. Assessments of headache severity, psychological status, and functional impairment were completed by 371 (97.8%) of these at the time of admission. At discharge, 340 subjects (89.7%) provided assessment data, and 152 (40.1%) provided data at 1-year follow-up. Subjects' mean ratings on a 0-10 scale for their headache pain in the prior week declined, and these improvements were maintained at follow-up. (Estimated marginal means on a 0-10 scale for Average pain: admission 6.1, discharge 3.5, follow-up 3.3; for Least pain: admission 3.2; discharge 1.5; follow-up 1.3; for Worst pain: admission 8.2; discharge 6.4; follow-up 5.7), and similar results were found for current pain (admission 4.7; discharge 2.8; follow-up 2.4): Measures of functional impairment also improved following treatment, and these gains were maintained at 12 month follow up (Estimated marginal mean Headache Impact Test-6 score: admission 66.1, discharge 55.4, follow-up 51.9; Estimated marginal mean Pain Disability Index score: admission 36.2, discharge 14.1, follow-up 11.6). As measured by the Depression, Anxiety and Stress Scale, anxiety and reactivity to stress decreased following treatment, and remained improved at follow-up (Estimated marginal mean score for Anxiety: admission 8.7, discharge 5.2, follow-up 4.4; Estimated marginal mean score for stress: admission 14.9, discharge 7.2, follow-up 7.6). Depression decreased with treatment, but while 1-year follow-up depression scores remained significantly lower than at admission, they were also significantly higher than at discharge (Estimated marginal means: admission 13.3, discharge 4.1, follow-up 6.6). The study supports the efficacy of the treatment model. Limitations of the study and suggestions for future research are also discussed.

Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing.

Objectives: The 0–10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients’ catastrophizing and their sex on these cut-off points.Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS). Cut-off point schemes were tested using ANOVAs with and without using the PSC scores or sex as co-variates and with the interaction between CP scheme and PCS score and sex, respectively. The variability of the optimal cut-off point schemes was quantified using bootstrapping procedure.Results and conclusion: The study showed that NRS scores ≤ 5 correspond to mild, scores of 6–7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Bootstrapping analysis identified this optimal NRS cut-off point scheme in 90% of the bootstrapping samples. The interpretation of the NRS is independent of sex, but seems to depend on catastrophizing. In patients with high catastrophizing tendency, the optimal cut-off point scheme equals that for the total study sample, but in patients with a low catastrophizing tendency, NRS scores ≤ 3 correspond to mild, scores of 4–6 to moderate and scores ≥7 to severe pain in terms of interference with functioning. In these optimal cut-off schemes, NRS scores of 4 and 5 correspond to moderate interference with functioning for patients with low catastrophizing tendency and to mild interference for patients with high catastrophizing tendency. Theoretically one would therefore expect that among the patients with NRS scores 4 and 5 there would be a higher average PDI score for those with low catastrophizing than for those with high catastrophizing. However, we found the opposite. The fact that we did not find the same optimal CP scheme in the subgroups with lower and higher catastrophizing tendency may be due to chance variability.

Spinal Cord Stimulation Provides Pain Relief with Improved Psychosocial Function: Results from EMP3OWER.

The EMP3OWER™ study evaluated spinal cord stimulation (SCS) safety and efficacy and the associated changes in psychosocial and functional outcomes. Upon informed consent and IRB approval, 620 eligible subjects were enrolled prior to SCS trial evaluation and were assessed at baseline, 3, 6 and 12 months post-implant. Patient-reported pain relief (PRP), numerical rating scale (NRS), satisfaction, quality of life (QOL), and pain disability index (PDI) were assessed at all follow-up visits while the pain catastrophizing scale (PCS), short form-36 (SF-36), short form-McGill pain questionnaire version 2 (SF-MPQ-2), and the state-trait anxiety inventory (STAI) were assessed at the 6- and 12-month follow-up visits. Device and/or procedure-related adverse events were also recorded and reported. Subjects reporting a PRP ≥ 50% were considered responders. Repeated measures analysis of variance (RMANOVA) examined the changes across time for all continuous measures. A total of 401 (71%) subjects received a permanent implant. Mean (±SD) patient-reported pain relief was 59.3% (±26.2), 59.2% (±28.9), and 58.2% (±32.0) at 3, 6, and 12 months, respectively. A majority of enrolled subjects were responders at 3 (75.5%), 6 (74.7%), and 12 months (69.7%). RMANOVA revealed a statistically significant change for NRS, PCS, PDI, SF-36, SF-MPQ-2, and STAI scores. At 3 months, the majority of subjects (85.7%) were either very satisfied or satisfied with their device, with similar results at 6 and 12 months. At 3 months, the majority of subjects (73.3%) reported greatly improved or improved QOL with similar results at 6 and 12 months. Spinal cord stimulation provided pain relief and significant improvement of patient psychological and functional outcome measures.

Results From the Partnership for Advancement in Neuromodulation Registry: A 24-Month Follow-Up.

This longitudinal, clinical outcome study was a multicenter, prospective, observational, registry with a 24-month assessment of patients implanted with spinal cord stimulation (SCS) systems for the management of chronic pain of the trunk and/or limbs. On informed consent and institutional review board approval, 614 patients from 39 sites were enrolled within 30 days following permanent SCS system implantation. Medication usage, patient-reported pain relief (PRP), categorical ratings of pain relief, pain disability index scores (PDI), quality of life (QoL), and patient satisfaction were assessed at enrollment, 3-, 6-, 12-, 18-, and 24-month postimplant. Device-related adverse events (AEs) were recorded and reported. Across all visits, statistically significant improvements were reported on all outcome measures. Mean PRP was 58.5% (± 26.4) at 3 months, 56.8% (± 29.2) at 6 months, 57.7% (± 28.9) at 12 months, 55.6% (± 29.8) at 18 months, and 56.3% (± 30.3) at 24 months. More than 65% of patients at any visit reported a PRP ≥ 50%. Mean PDI scores reduced from 46.9 points at baseline to 32.7, 31.8, 31.5, 32.1, 32.1 points at 3, 6, 12, 18, and 24 months (p ≤ 0.0001), respectively. Greater than 76% of patients at any visit were satisfied with their therapy. The majority of patients categorized pain relief as excellent or good on a 5-item scale and reported overall QoL as greatly improved or improved on a 5-item scale. An average of 88% of patients stopped, decreased, or did not change dose of narcotics/opioids. The most common AE was diminished or loss of pain relief in 11.4% of enrolled patients. Most patients experienced substantial pain relief and a significant improvement in all outcome measures. These results further support the safety, efficacy, and sustainability of SCS in clinical practice.

Reference Values of the Pain Disability Index in Patients With Painful Musculoskeletal and Spinal Disorders: A Cross-national Study.

Cross-sectional study. To examine reference data for the Pain Disability Index (PDI) in Dutch and Canadian patient samples with a variety of musculoskeletal pain disorders and to test which potential factors are independently associated with the PDI score. The PDI is a widely used generic instrument for measuring disability related to pain. It is unknown whether patients with spinal and other musculoskeletal diagnoses have different levels of disability when scored on the PDI. Patients were referred to secondary and tertiary care centers in the Netherlands and Alberta, Canada, between 2009 and 2013. All patients filled out a baseline questionnaire including demographics and the PDI. After first consultation with a medical doctor, diagnoses were set by the medical specialist. Univariate general linear models were used to examine correlations between PDI scores and age, sex, country of residence, diagnosis, and work status. In total 6997 patients were included in this study: 1302 Canadian and 5695 Dutch patients. Mean PDI score of the total group was 37.8 ± 14.2. Reference values are presented and clustered into the following diagnostic groups: spinal nerve and intervertebral disc disorders; nonspecific back pain; rheumatic soft-tissue pain (widespread pain or fibromyalgia); spinal stenosis; and whiplash-associated disorder. The PDI score was significantly and relevantly associated with pain intensity (η explained variance from 20% to 25%), but not relevantly associated with age, sex, country of residence, and diagnostic group (η<3%). In the working subgroup, adding "current sick leave" as covariate increased the explained variance to 34%. Reference values of the PDI are presented. Patient ratings of disability on the PDI are relevantly associated with pain intensity and work status, but not with nationality or diagnostic group. Only minimal differences were identified between the various musculoskeletal diagnoses included. N/A.

EFFECTIVENESS OF DIADYNAMIC CURRENT AND MENS IN HEEL PAIN: A RANDOMIZED CLINICAL TRIAL

Relevance: Heel pain is one of the most common conditions leading to functional disabilities seen worldwide. There are different methods to manage heel pain, conservatively, and/or surgically. Physiotherapy treatment, as a part of conservative management, involves reduction of pain and improvement of functional ability by various approaches like exercise therapy, electrotherapy and manual therapy techniques. Various studies have shown that Diadynamic current and MENS along with conventional treatments give significant beneficial effects in pain reliving. Hence the present study was undertaken to compare and see the effect of Diadynamic current and MENS in heel pain. Participants: 30 subjects (mean age 25.73 ± 6.56) diagnosed with heel pain were recruited from Out-Patient Department of Physiotherapy of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi. Method: Subjects were randomly allocated into 2 groups namely Group A (n=15) who received Diadynamic current along with conventional treatment as Therapeutic ultrasound and strengthening and stretching exercises and Group B (n=15) who received MENS with conventional treatment same as in group A for 7 days. The outcome measures were Visual Analog Scale (VAS) for pain, Pain disability index (PDI) and foot disability index (FDI) for functional disability. Analysis: Within group and between group analyses after intervention was done to assess changes using paired t-test and unpaired t test. Result: Mean difference of VAS scores for Group A was 6.9 ± 1.48 and for Group B was 4.3 ± 2.43. Mean difference of PDI scores for Group A was 274 ± 117 and for Group B was 171 ± 99.Mean difference of FDI scores for Group A was 0.36 ± 0.24 and for Group B was 0.15 ± 0.15. Intra group comparison was statistically significant with p= <0.001 for both the groups in terms of VAS, PDI and FDI respectively. Inter group comparison was statistically significant with p= 0.005, 0.031, 0.007 for VAS, PDI and FDI respectively. Conclusion: Diadynamic current is effective in reducing pain and secondarily improving the functional ability in subjects with heel pain.