Rating Scale For Pain Intensity Research Articles

Topical Amitriptyline and Ketamine in Neuropathic Pain Syndromes: An Open-Label Study

Twenty eight subjects with refractory, moderate to severe peripheral neuropathic pain participated in an open label prospective trial examining perceived analgesic effect, patient satisfaction, and safety of topical amitriptyline 2%/ketamine 1% cream. Outcome measures included an 11-point numerical rating scale for pain intensity (NRS-PI), a 5-point satisfaction scale, blood chemistry screen, drug and metabolite levels, urinalyses, electrocardiogram (ECG), and physical examination. Adverse events were monitored. Twenty-one subjects completed the trial. At 6 months, subjects reported an average long-term reduction in pain of 34% (standard deviation [SD] = 37%); 5 subjects (25%) achieved 50% or greater reduction in pain and 1 subject (5%) achieved 100% reduction in pain. At 12 months, the average reduction in pain was 37% (SD = 40%); 7 subjects (40%) achieved 50% or greater pain reduction. At the end of the study, 89% of subjects rated their satisfaction as 3/5 or greater and 2 subjects (10%) were pain free. Minimal adverse events were reported and there were no serious medication related adverse events. Blood levels revealed minimal systemic absorption. In conclusion, topical 2% amitriptyline/ 1% ketamine cream was associated with long-term reduction (6-12 months) in perceived pain, moderate to complete satisfaction, and was well tolerated in treatment of neuropathic pain. There was no significant systemic absorption of amitriptyline or ketamine. Perspective This study demonstrates that topical 2% amitriptyline/1% ketamine, given over 6-12 months, is associated with long-term perceived analgesic effectiveness in treatment of neuropathic pain. Antidepressants and ketamine both produce multiple pharmacologic effects that may contribute to peripheral analgesia; such actions include block of peripheral N-methyl-D-aspartate receptors, local anesthetic properties, and interactions with adenosine systems.

Women's memory of childbirth at two months and one year after the birth.

Studies of women's memory of labor and birth have generally concluded that women's recall is fairly accurate, but the findings are not unanimous. The aim of this study was to compare women's experiences of labor pain and overall experience of the birth at 2 months and 1 year after the delivery. A longitudinal cohort study of 2,428 women recruited in early pregnancy from all antenatal clinics in Sweden during 3 weeks evenly spread during 1999-2000 was conducted. In addition to a questionnaire in early pregnancy including background data, the women completed a questionnaire at 2 months and 1 year after the birth including the same 7-point rating scale of pain intensity and the same question about overall experience of labor and birth. Forty-seven percent of the women made the same assessment of pain intensity, and 60 percent of childbirth overall, at 1 year as they did at 2 months after the birth. One year after the birth, 35 percent recalled pain as less severe, and 18 percent as more severe, and 24 percent said labor and birth overall was more negative, whereas 16 percent said it was more positive. This study showed great variation in women's memories of labor and birth, and conclusions by some other studies, often based on analyses of group data rather than on the responses of the individual participants were, to some extent, challenged.

Is acupuncture effective in treating chronic pain after spinal cord injury?

Nayak S, Shiflett SC, Schoenberger NE, Agostinelli S, Kirshblum S, Averill A, Cotter AC. Is acupuncture effective in treating chronic pain after spinal cord injury? Arch Phys Med Rehabil 2001;82:1578-86. Objectives: To evaluate the efficacy of acupuncture as a treatment for chronic pain and secondary symptoms after spinal cord injury (SCI) and to identify disease-specific variables associated with response to treatment. Design: A within-subjects design consisting of a 7½-week no-acupuncture baseline period followed by a 7½-week treatment period and a follow-up assessment 3 months posttreatment. Setting: Medical rehabilitation research center. Participants: Twenty-two people with SCI who experienced moderate to severe pain of at least 6 months' duration. Intervention: A course of 15 acupuncture treatments was administered over a 7½-week period. Main Outcome Measures: Numeric Rating Scale of pain intensity; ratings of interference with activity, individualized symptom rating, Center for Epidemiologic Studies–Depression Scale; Speilberger State Trait Anxiety Inventory, and General Well-Being Schedule. Results: Ten patients (46%) showed improvement in pain intensity and pain sequelae after treatment. However, 6 patients (27%) reported an increase in pain that was still present 3 months after treatment. Conclusions: About 50% of the study sample reported substantial pain relief after acupuncture treatment, suggesting that acupuncture may provide pain relief for at least a subgroup of individuals with SCI. Future research is needed to determine what part of this effect is because of acupuncture versus nonspecific effects such as placebo effects and regression to the mean. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Fire retardants

To develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT).A prospective cohort study.An outpatient rehabilitation department in a general hospital.Seventy-five patients with PHP.After completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement.Twenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%.A CPR has been developed to identify patients with PHP likely to benefit from BAPT.

Low-back pain. Perception and tolerance.

The relationship between pain modifying factors, pain duration, and the role of anxiety in low-back pain experience were studied. Three groups of patients with low-back pain were examined using the Tourniquet Pain Test, McGill Pain Questionnaire, Rating Scale of Pain Intensity, State-Trait Anxiety Inventory, and Psychological Discomfort Questionnaire. Significant differences in all measured features emerged between acute and chronic pain groups. Groups of acute and subchronic pain and groups of subchronic and chronic pain differed only in several parameters, suggesting an intermittent phase in acute pain transition into chronicity. While pain prolonged, pain experience gradually but irregularly changed, exaggerating pain perception. The changes concerned mainly emotional factors and were related to the chronicity itself. Anxiety also played a significant role.