Pain Disability Scores Research Articles

Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults With Mechanical Neck Pain.

To determine pressure pain detection threshold (PPDT) related phenotypes of individuals with mechanical neck pain that may be identifiable in clinical practice. This report describes a secondary analysis of 5 independent, international mechanical neck pain databases of PPDT values taken at both a local and distal region (total N=1176). Minor systematic differences in mean PPDT values across cohorts necessitated z-transformation before analysis, and each cohort was split into male and female sexes. Latent profile analysis (LPA) using the k-means approach was undertaken to identify the most parsimonious set of PPDT-based phenotypes that were both statistically and clinically meaningful. LPA revealed 4 distinct clusters named according to PPDT levels at the local and distal zones: low-low PPDT (67%), mod-mod (25%), mod-high (4%), and high-high (4%). Secondary predictor variables were evaluated for intracluster and cross-cluster significance. Low-low cluster was most affected, as indicated by pain intensity, disability, and catastrophization scores all significantly above the cohort-specific and sex-specific mean, and active range of motion scores significantly below the mean. The results suggest that there are a large proportion of people with neck pain that present with signs indicating dysfunction beyond the local tissues. Ongoing exploration of these presentations may lead to more informed management and improved outcomes.

A Study to Assess the Functional Outcome of Decompression and Posterior Lumbar Interbody Fusion of Low Grade Spondylolisthesis of Lumbar Vertebra

Spondylolisthesis is defined as the forward displacement of one vertebra over the vertebra below. It is often accompanied by spinal canal stenosis and compression, which is the cause of all the symptoms. To assess and study the functional outcome after decompression and Posterior Lumbar Interbody Fusion (PLIF) of isthmic spondylolisthesis of lower lumbar vertebra and to study the complications occurring with this technique. A prospective study was conducted in the Department of Orthopaedics in Justice KS Hegde Charitable Hospital, Mangalore, Karnataka, India from March 2015 to August 2016. A total of 15 diagnosed patients with Grade I and II spondylolisthesis of L4-L5 and L5-S1 vertebrae with no neurological deficits, between the age group of 25-50 were included in the study. An initial two months of conservative treatment of back physiotherapy and flexion exercises was tried. Patients who did not improve with the conservative therapy were taken up for surgery with consent. Decompression and PLIF with bone grafting with interbody cage placement and pedicle screw instrumentation was performed. The patients were discharged on postoperative day 10 after suture removal. They were reviewed at postoperative day 10, week six and week 24. The scoring of the functional outcome of the back was done as per the Modified Oswestry low back pain Disability Questionnaire. The statistical analyses were done using the repeated measures ANOVA, SPSS version 20. The mean Modified Oswestry low back pain Disability score preoperatively was noted to be 42.87+/- 3.46 points. The mean Modified Oswestry low back pain Disability score at postoperative day 10 was noted to be 36.93±3.75 points. The mean Modified Oswestry low back pain Disability score at postoperative week six was noted to be 28.47±3.70 points. The mean Modified Oswestry low back pain Disability score at postoperative week 24 was noted to be 24.27±3.01 points. Improvement in the Modified Oswestry low back pain Disability scores was noted during the follow ups. Foot drop was noted in two cases postoperatively which improved during the final follow up with physiotherapy. Decompression and PLIF is noted to produce good to satisfactory functional results in cases of isthmic spondylolisthesis of lower lumbar vertebra.

Recurrent Lumbar Disc Herniation: Conventional Re-discectomy Versus TLIF with Unilateral Fixation

Background Data: Recurrent lumbar disc herniation is reported from 5 to 11%. Optimal surgical approach for recurrent disc prolapse is controversial. Some authors believe that repeat discectomy is the treatment of choice, with similar clinical results compared to the primary procedure. Some spine surgeons believe that fusion is necessary for treating disc reherniation. Purpose: Our aim is to compare the clinical outcome in patients with recurrent lumbar disc herniation operated by conventional rediscetomy versus those operated by TLIF with unilateral pedicle screw fixation.Study Design: A descriptive controlled, non-randomized, retrospective, clinical study. Patients and Methods: Forty patients underwent surgery for recurrent lumbar disc herniation. They were divided into two groups; re-discectomy group and TLIF with unilateral fixation group. Each group included 20 patients. They were operated between 2008 and 2016. Participants were evaluated pre-operatively and post-operatively every three months. Operative time, hospital stay and complications were assessed. Pain was scored by a VAS for both lower limbs and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. In addition fusion was looked for radiologically. Results: The two groups of patients were fairly homogeneous and comparable. TLIF group showed better clinical outcome parameters including better VAS for low back pain and better Prolo economic, functional rating scale. In comparison the re-discectomy group showed significantly higher complications and reoperation during the follow up period. Conclusion: Patients with recurrent lumbar disc herniation operated by TLIF with unilateral spinal fixation reported less pain & lower disability scores all over the follow up period. This technique is preferable to conventional re-discectomy because it avoids the possibility of recurrence and has less postoperative complications. (2016ESJ124)

Gender Differences in End-Stage Ankle Arthritis

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle arthritis (ESAA) is a debilitating disease that does not affect all individuals equally. Gender differences have been identified in patients with end-stage hip and knee arthritis and have stimulated research to explain these findings. The present study was undertaken to examine if gender has a significant effect on pre-operative disability and post- operative outcomes in patients with ESAA. Methods: Patients undergoing ankle arthrodesis (AA) or total ankle replacement (TAR) with minimum 2-year follow-up were identified in the Canadian Orthopedic Foot and Ankle Society prospective ankle reconstruction database. Demographic data, revision data, patient satisfaction questionnaires, and outcome data using the Ankle Osteoarthritis Scale (AOS) and Short-form 36 (SF-36) health survey were collected. Results: TAR: 384 patients were included, with 198 females and 186 males. Preoperatively females had higher rates of pain and disability, demonstrated by lower SF-36 physical component scores (PCS) (31.0 vs 34.5, p < 0.001), and higher AOS pain (54.7 vs 51.1, p=0.05) and AOS disability scores (66.5 vs 59.6, p < 0.001). Postoperatively, both groups had significant improvement in PCS, AOS pain, and AOS disability scores. Females continued to demonstrate lower PCS scores (38.3 vs 41.9, p < 0.001) and higher AOS disability scores (31.0 vs 25.8, p=0.02) than males. Preoperative PCS, gender, age, and arthritis etiology all had a significant impact on postoperative PCS scores, with preoperative PCS scores having the largest impact. Gender had no significant impact on AOS pain and disability scores postoperatively. AA: Results Pending Conclusion: In patients with ESAA, females tend to have higher pre-operative levels of pain and disability compared to males, which persists post-operatively. This is consistent with the hip and knee arthroplasty literature. This finding may be due to females undergoing surgery at more advanced disease states, arthritis etiology, referral bias, or treatment bias. Both males and females have significant and similar degrees of improvement in pain and disability scores after TAR, and reoperation rates and patient satisfaction rates are similar despite the apparent disparity in outcomes.

The Effect of Harmonic Technique vs End Range Loading Exercises on Pain and Disability in Patients With Non-Specific Chronic Low Back Pain: A Preliminary Study

ObjectiveThe purpose of this study was to compare the effects of end range loading (ERL) vs harmonic technique (HT) on patients with chronic low back pain (LBP). MethodFourteen volunteer patients with LBP were randomly assigned to 2 groups based on a blocked randomization method with 7 patients in the HT group and 7 patients in the ERL group. The patients received 10 sessions of treatment for 5 sessions per week. Pain intensity and disability score were recorded using the numeric pain scale and Roland-Morris Disability questionnaire (RMQ), respectively, before and after the treatment period. ResultsAlthough pain intensity (P = .02) and the RMQ score (P = .03) decreased in the HT technique group, no statistically significant change was found in the ERL group for the RMQ score (P > .05). The effect size for HT was .6 and .3 for numeric pain scale and RMQ, respectively. ConclusionThis preliminary study showed that pain intensity and disability improved in subjects with chronic LBP in the HT group. More investigations with larger sample size are needed to clarify these findings.

The effect of dry needling on the radiating pain in subjects with discogenic low-back pain: A randomized control trial.

Background:Disk herniation is the most common cause of radiating low back pain (LBP) in subjects under 60 years of age. The present study aims to compare the effect of dry needling (DN) and a standard conservative approach on the pain and function in subjects with discogenic radiating LBP.Materials and Methods:Fifty-eight subjects with discogenic radicular LBP were screened and randomized into control (Standard physical therapy, n = 29) and experimental group (Standard physical therapy and DN, n = 29). Radiating pain intensity and disability were measured using visual analog scale (VAS) and Oswestry Disability indices at baseline, at the end of treatment and 2 months after the last intervention session. The changes in pain intensity and disability were studied using a 3 × 2 repeated measures analysis of variance considering time as the within-subject factor and group as the between-subject.Results:Pain intensity and disability scores decreased significantly in both experimental and control groups (experimental group: VAS = 37.24, Oswestry Disability Index [ODI] =28.48, control group: VAS = 45.5, ODI = 32.96), following the intervention. The change continued during the follow-up period (P < 0.001 for all comparisons). Pain and disability improvement, however, were more significant in experimental group, both in post intervention (experimental group: VAS = 25.17, ODI = 22.17, control group: VAS = 42.4, ODI = 30.27) (P = 0.05 and P = 0.03, respectively) and follow-up measures (P = 0.006 and P = 0.002, respectively).Conclusion:Both intervention strategies seem to significantly improve pain and disability immediately following intervention, where the improvement continued during 2 months after the last active intervention. Therefore, supplementary DN application may enhance the effect of the standard intervention considerably.

A cross-sectional study on the association between obesity and changes in the dimensions of the lumbar vertebral column

Aim: Obesity is considered a major public health problem and is becoming very common among the population. Impacts of obesity include increased load and weight bearing on the vertebral column, possibly causing alterations in its structure to maintain stability and subsequent disabling lower back pain (LBP). The present study aimed at investigating the association of overweight and obesity with alterations in the lumbar vertebral column as well as LBP. Methodology: Thirty female attendants of the clinic were interviewed with the Roland Disability Questionnaire and specific angles were measured on their lateral lumbosacral X-rays. Results: Changes in the lumbar vertebral column in both the control and study groups were found, but the association of obesity was only significant with vertebral body height of L2, L3, and L5 as well as the back pain disability score. Discussion: The results obtained from this study were comparable and in line with what has been found from previous studies in this field, namely an association between obesity and disabling LBP. While changes in the lumbar angles could not exclusively be correlated with a higher body mass index, changes in the lumbar vertebral height were found to be significantly correlated. Conclusion: Obesity in Sudanese females attending the physiotherapy clinic in Ribat National University Hospital has been proven to be associated with disabling back pain and specific radiographic changes in the lumbar vertebral column. Obesity and its risks on the vertebral column is an association that leaves room for a wide range of studies that should be conducted on a larger scale for more applicable results.

Cross-cultural adaptation and psychometric properties of an Arabic version of the Shoulder Pain and Disability Index.

The aim of the present study was to translate, culturally adapt, and validate the Arabic version of the shoulder Pain and Disability Index (SPADI). This was an observational reliability and validity study. We recruited 64 patients with shoulder pain and dysfunction with a wide variety of diagnoses. Patients completed the following questionnaires: Arabic SPADI, Quick Disability of the arm, shoulder and hand (Quick DASH), and the numerical rating scale (NRS) for pain. The active shoulder range of motion (ROM) was also assessed. Internal consistency was tested using Cronbach α. Reproducibility was assessed by asking the patients to complete another SPADI questionnaire 2 days after the first. Validity was assessed by calculating the Pearson correlation coefficient between the SPADI and the Quick DASH, NRS, and active shoulder ROM. The Cronbach α values for the pain score (0.96), disability score (0.98), and total score (0.98) of Arabic SPADI were all high. Similarly, the intraclass correlation coefficient (ICC) values for the pain, disability, and total score (ICC, 0.87, 0.96, and 0.95, respectively) of Arabic SPADI were all high. With respect to validity, there was a moderate to strong correlation between the Arabic SPADI and the Quick DASH, NRS, and active shoulder ROM. The translated version of SPADI in the Arabic language showed excellent internal consistency and test-retest reliability. Validity was shown by substantial correlations between SPADI and Quick DASH, NRS, and active shoulder ROM. The Arabic SPADI is recommended for the evaluation of patients with shoulder dysfunction.

Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial

Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears. We conducted a randomized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012; 31 patients were treated conservatively, and rotator cuff repair was performed in 25 patients. Outcome measures, including the Constant-Murley score (CMS), visual analog scale (VAS) pain and VAS disability scores, were assessed preoperatively and after 6 weeks and 3, 6, and 12 months. Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively. At 12 months postoperatively, the mean CMS was 81.9 (standard deviation [SD], 15.6) in the surgery group vs 73.7 (SD, 18.4) in the conservative group (P = .08). VAS pain (P = .04) and VAS disability (P = .02) were significantly lower in the surgery group at the 12-month follow-up. A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients (88.5 [SD, 6.2] vs 73.7 [SD, 18.4]). In our population of patients with degenerative rotator cuff tears who were randomly treated by surgery or conservative protocol, we did not observe differences in functional outcome as measured with the CMS 1 year after treatment. However, significant differences in pain and disabilities were observed in favor of surgical treatment. The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively.

Botulinum Toxin type A injections for patients with painful hallux valgus: a double-blind, randomized controlled study

Hallux valgus (HV) related pain and disability remains a medical challenge to date. We have evaluated the therapeutic effect of intramuscular Botulinum Toxin type A (BTX-A) injection on painful HV in a double-blind randomized controlled trial. Sixteen patients having painful HV in at least one foot from the Department of Physical Medicine and Rehabilitation at a medical center in northern Taiwan have participated. Patients were randomized into two groups to receive intramuscular injections of either BTX-A or normal saline (NS) to the oblique and transverse heads of the adductor hallucis, flexor hallucis brevis and extensor hallucis longus muscles. Primary outcome measurements were selected from the Taiwan Chinese version of the Foot Function Index subscales on pain (questions 1-6, 9) and disability (question 10-18). The secondary outcome measurement was the HV angle. Patients were assessed at baseline and at 1, 2, 3, and 6 months after treatment. The demographic data and measurements were comparable between the two groups at baseline (p>0.05). BTX-A and NS reduced pain and disability one month after injection. Pain reduction induced by BTX-A injection lasted for at least 6 months while that induced by NS lasted for only 1 month. In addition, patients in the BTX-A group showed greater improvement in pain score (p<0.001), disability score (p<0.05), and HV angle (p<0.05) than patients in the NS group. The results reflected that HV-related muscle injection of BTX-A resulted in a marked reduction in pain for up to 6 months.

Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study.

Lateral epicondylitis (LE) is a common disorder that causes pain on the outside of the elbow, as well as pain and weakness during gripping. In this prospective, randomized, controlled, assessor-blinded trial, we planned to investigate the effects of high-intensity laser therapy (HILT) in patients with LE and to compare these results with those of a brace and placebo HILT. Patients were randomly assigned to three treatment groups. The first group was treated with HILT. The second group (sham therapy group) received placebo HILT, while the third group (brace group) used the lateral counterforce brace for LE. The patients were assessed for grip strength, pain, disability, and quality of life. Outcome measurements and ultrasonographic examination of the patients were performed before treatment (week 0) and after treatment (after 4 and 12 weeks). HILT and brace groups showed significant improvements for most evaluation parameters (pain scores, grip strength, disability scores, and several subparts of the short-form 36 health survey (physical function, role limitations due to physical functioning, bodily pain, general health, and vitality)) after treatment (after 4 and 12 weeks). However, the improvements in evaluation parameters of the patients with LE in HILT and brace groups were not reflected to ultrasonographic findings. Furthermore, comparison of the percentage changes of the parameters after treatment relative to pretreatment values did not show a significant difference between HILT and brace groups. We conclude that HILT and splinting are effective physical therapy modalities for patients with LE in reducing pain and improving disability, quality of life, and grip strength.

Temperament and Character Profile in Failed Back Surgery Syndrome: A Cross-Sectional Clinical Study.

Some psychometric properties may predict the development of failed back surgery syndrome (FBSS). The aim of this study was to determine the pain, disability, and depression severity in patients diagnosed with FBSS, and to determine the temperament and character subgroups in comparison with control group. Thirty-eight patients diagnosed with FBSS, and 35 patients with favourable outcome after lumbar spinal surgery were included to the study. Pain intensity, disability, depression scores, temperament and character profile were determined by the visual analogue scale (VAS), Roland Morris Disability Index, Beck Depression Inventory, and Temperament and Character Inventory. Pain intensity, disability, and depression scores were higher in the FBSS group (p < 0.001). There were no significant differences between temperament and character subgroups between study groups except one of the temperament subgroup, reward dependence (p=0.05). There was a negative correlation between self-directedness and leg pain severity in the FBSS group (p=0.01, r=-0.400). No significant differences were found between the FBSS and control groups with respect to temperament and character profile but FBSS was the cause of severe pain, disability, and higher depression scores. This group of patients must therefore be evaluated psychiatrically and should also be subjected to a clinical examination, and they should be managed using a multidisciplinary approach.

Dry Needling Effects on Non-Specific Cervical Radiculopathic Pain and Dysfunction:-A Case Report

Abstract: 19 year old college student was referred to physical therapy department with signs and symptoms of seventh cervical nerve root radicupathic pain. Physical examination of cervical spine had shown that localised pain over left C6-7 junction and radiating down till the dorsal aspect of ring finger. Spurling and upper limb tension tests had shown positive a sign for cervical nerve root irritation. She was treated with intermittent cervical traction, stretching for neck muscles, mobilization for cervical and thoracic spine, and trigger point massage for the period of two week. But, the symptoms were not reduced completely and she had complaints of recurrence of radiating pain. Further examination had revealed that maximum tender points over paraspinal muscle of cervical region and altered function of cervical spine. Later she was treated with dry needling over supraspinous ligament and myofascial trigger points of cervical and shoulder muscles. The dry needling procedure was carried out for two sessions with 72 hour interval and subjective pain intensity and neck disability was assessed using Visual Analog Scale and Neck Disability Index before and after treatment. The post needling pain and neck disability score were reduced compared to before intervention pain and disability score. Pain and neck disability was assessed three months after the treatment which was also shown that sustainability of effects.

Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction: Inefficacious Therapy for a Fictitious Disease

Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction: Inefficacious Therapy for a Fictitious Disease

Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice.

BackgroundLumbosacral radicular syndrome (LRS) is a self-limiting, benign, painful and impairing condition caused by lumbar disc herniation and inflammatory processes around the nerve root. Segmental epidural steroid injections (SESIs) are helpful to reduce radicular pain on a short-term basis. It is unknown whether SESIs are an effective addition to usual pain treatment of LRS in general practice. In our study, we assessed the effectiveness of SESIs on pain and disability as an addition to usual care for acute LRS in general practice.MethodsA pragmatic, single-blinded, randomized controlled trial in Dutch general practice was conducted. Circumstances of daily practice were closely followed. Care as usual (CAU) was compared to care as usual combined with an additional SESI in 63 patients in the acute phase of LRS. To detect a minimal clinically important difference of 1.2 points on a numerical rating scale for back pain and a common within-group standard deviation of 1.7 with a two-tailed alpha of 0.05 and a power of 0.80, we needed 33 subjects in each group. Statistical analysis was carried out using mixed models.ResultsA small significant effect in favour of the intervention, corrected for age, sex and baseline values, was found for back pain, impairment and Roland-Morris disability score. The differences, though statistically significant, were too small to be considered clinically relevant. Patients from the intervention group were significantly more satisfied with the received treatment than patients from the control group.ConclusionWe found a small, statistically significant, but not clinically relevant positive effect of SESIs on back pain, impairment and disability in acute LRS. We do not recommend implementing SESIs as an additional regular treatment option in general practice.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-341) contains supplementary material, which is available to authorized users.

The Roland–Morris disability scale for the assessment of non-specific low back pain outcomes among disability sector workers

Low back pain (LBP) is the most common cause of time lost from work and has significant personal impacts and societal burdens. Caregivers for patients with disabilities have a high LBP prevalence that requires attention in the public health system. This study aimed to understand the LBP disability outcomes and determinants of care workers for people with intellectual, autistic and associated multiple disabilities. Study subjects included 678 care workers in 15 disability institutions who reported that they had experienced acute or chronic nonspecific LBP in the previous year. The effects of the LBP outcome were measured by the Roland–Morris Disability Questionnaire (RDQ), which is a self-rated assessment of pain-related disability used in this study. The mean score of the RDQ was 3.97 (range 0–24). Of the respondents, 14% expressed that they were free from pain disability (score=0), 66.4% subjects expressed they had a little pain disability (score 1–6), 14.7% subjects reported that they were mildly affected by pain disability (score 7–12), 3.8% subjects reported that they were moderately affected by pain disability (score 13–18), and 1% reported they had severe pain disability (score 19–24). A multiple linear regression of the pain disability score revealed that those care workers who expressed that LBP affects their work and living (p<0.001), had ever sought pain care (p=0.008), with moderate (p=0.001) and severe (p=0.001) levels of LBP were significantly associated with a higher score of pain disability than their counterparts (R2=22.6%). This study suggests that a comprehensive assessment of pain disability and treatment strategies for LBP should be undertaken regarding the needs of care workers in disability sectors.

THU0344 The AGE Influence on Therapeutic Outcome in Patients with Subacute Low Back Pain

BackgroundIt is assumed that subacute low back pain treatment will be longer in older patients due to comorbidityObjectivesto determine the influence of age on therapeutic outcome in patients with subacute...

Ulnar shortening osteotomy for ulnar impaction syndrome.

Background Ulnar impaction syndrome is a condition in which the ulna impacts on the ulnar carpus. This most commonly occurs when the ulna is longer than the radius, but it can also occur in wrists with ulnar neutral and ulnar negative variance. Materials and Methods In this paper we outline our surgical technique for ulnar shortening osteotomy. A previously published retrospective case series of 28 patients treated at our center is presented. Fifty consecutive patients who underwent ulnar shortening osteotomy (USO) for ulnar impaction syndrome were approached for study, and 28 consented to review. Mean preoperative ulnar variance was +2.3 mm, and mean postoperative ulnar variance was -0.8 mm. Mean follow-up time was 21.2 months (8 to 41 months) and ten of 28 were receiving workers' compensation. Mean preoperative pain score (visual analog scale; VAS) was 7.9. Univariate analysis was performed to assess clinical and demographic data. In addition, subgroup analysis of workers' compensation patients and smokers was performed. Description of Technique A longitudinal incision over the subcutaneous border of the ulna is used to expose the ulna between the distal and middle third of the ulna from the ulna styloid. Preoperative posteroanterior (PA) X-rays are reviewed to determine the amount of shortening required, with a goal of creating -2 mm variance postoperatively. A 6-hole dynamic compression plate is predrilled distally prior to performing two oblique osteotomies separated by the desired shortening length. The fragments are reduced, controlling for rotation, and plated using compression. In some cases, a lag screw is employed across the oblique osteotomy site. Results Mean pain scores were significantly reduced postoperatively (VAS 7.9 versus 3.1, P < 0.0001). The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 37.2 postoperatively. Flexion, extension, and supination were reduced compared with the contralateral unaffected extremity (84.6%, 85.3%, and 86.9% of normal). Patients receiving workers' compensation and smokers had significantly more pain postoperatively (VAS 5.2 vs. 2.0, P = 0.0002 and VAS 4.4 vs 2.4, P < 0.05, respectively). Eleven of 28 patients required hardware removal for plate irritation, and five of 28 patients had a nonunion. Conclusion We present our surgical technique for ulnar shortening osteotomy. Pain was significantly improved in our population; however, patients receiving workers' compensation and smokers had less improvement in pain and higher disability scores.

(545) Treatment outcomes of an interdisciplinary chronic pain rehabilitation program in smokers and nonsmokers

Previous research suggests there is a relationship between pain and smoking, but there is limited research on the treatment outcomes of people with chronic pain who smoke. This is particularly evident in the context of interdisciplinary chronic pain treatment programs because the only such study (Hooten et al., 2009) has not been replicated. Therefore, the current study examined the immediate treatment outcomes in patients who have been through an interdisciplinary chronic pain rehabilitation program. The treatment outcomes that were examined were depression, anxiety, pain intensity, and pain disability. Depression scores were higher both at admission and discharge for smokers when compared to nonsmokers, anxiety scores and pain intensity scores were higher at admission for smokers, but were no longer significantly different from nonsmokers at discharge, and pain disability scores for smokers and nonsmokers were not significantly different at both admission and discharge. In addition, both smokers and nonsmokers improved on all of these measures between admission and discharge. These data support the findings of Hooten et al. (2009) and provide additional evidence that comprehensive chronic pain rehabilitation programs can be effective for both smokers and nonsmokers, specifically regarding pain intensity, anxiety, depression, and pain disability outcomes.

Patient Versus Parental Perceptions about Pain and Disability in Children and Adolescents with a Variety of Chronic Pain Conditions

Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability. To assess the relationship and merit of the child versus parent perspective. A total of 99 patients (eight to 17 years of age [mean 13.2&nbsp;years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients' and parents' pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman plot and Spearman's correlation coefficient. The association between clinical⁄demographic variables and differences in patient⁄parent pain intensity and disability scores was assessed using multivariable regression. There was significant agreement between patients' self-reports and parents' proxy reports of their child's pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent-proxy pain intensity was associated with patients' self-reported pain intensity (P<0.001). The difference between patient and parent-proxy disability was associated with patient's self-reported pain disability (P<0.001). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients' self-reported pain intensity and disability. While equal merit should ideally be given to pediatric chronic pain patients' self-reports and their parents' proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective.