Pain Severity Index Research Articles

A STUDY OF THE INFLUENCE OF LOW INTENSITY LASER THERAPY ON PAINFUL TEMPOROMANDIBULAR DISORDER PATIENTS

A double-blind clinical trial was conducted on 30 female Temporomandibular Disorders (TMD) patients who had pain as a chief complaint. The patients were randomly allocated into three groups based on Low Intensity Laser (LILT) regimes namely 820 nm Gallium Aluminium Arsenide (GaAlAs) laser at energy densities of 21.4J/cm(2), 107 J/cm(2) and placebo laser. Each patient had three LILT treatments in a week. The pressure pain threshold (PPT) of trigger points in masticatory muscles, unassisted maximum mouth opening without pain (MOSP) and symptom severity index (SSI) were recorded as baseline data and monitored after every treatment. Jaw kinesiology, electromyography (EMG) and pain rating index from McGill pain questionnaire were also recorded as baseline and final results. The analysis of covariance and further analysis showed that the higher energy density laser group had significant increases in PPT and EMG amplitude recorded from voluntary clenching (cEMG) compared with the placebo group at P values 0.0001 and 0.022 respectively. A significantly greater number of patients recovered from myofascial pain and TMJ arthralgia as assessed clinically in the higher energy group compared with the placebo (P value = 0.02 and 0.006 respectively). There was no statistically significant difference in the other parameters of assessment among the groups at a P value 0.05. At a period of 2 to 4 weeks review after LILT, there was an average 52% reduction of pain as assessed by SSI.

Effects of Obesity and Gender on Chronic Pain Severity in a Community Based Cohort

Introduction: Obesity and chronic pain are common problems affecting quality of life for many men and women, however, little is known about gender specific effects of obesity on chronic pain severity. This study examines the relationship between chronic pain severity and Body Mass Index (BMI) in male and female patients from a community neurology clinic. Methods and materials: Cross-sectional analysis of 232 men and 224 women presenting sequentially to a community based general neurology clinic for evaluation of chronic pain. Results: In the combined group of men and women, BMI correlated with pain severity score for neck (R-square = 0.08, SE = 2.9, p = 0.01), back (R-square = 0.07, SE = 2.9, p < 0.01), and joint pain (R-square = 0.08, SE = 3.1, p < 0.01), but not for headache or whole body pain. In men, BMI correlated with pain severity score for neck (R-square = 0.18, SE = 3, p = 0.03), back (R-square = 0.16, SE = 2.9, p < 0.01), and joint pain (R-square = 0.12, SE = 2.5, p < 0.01), but not headache pain. In women BMI correlated with pain severity score for back (R-square = 0.07, SE = 2.9, p < 0.01), and joint pain (R-square = 0.05, SE = 3.5, p = 0.02), but not for headache or neck pain. Conclusions: Obesity affects severity of chronic pain in a variety of pain locations. Reduction in body mass index may be one method for reducing chronic pain severity in men and women.

Pain in neuromyelitis optica and its effect on quality of life

To assess the features of pain and its impact on the health-related quality of life (HRQOL) in neuromyelitis optica (NMO). We analyzed 37 patients with NMO or NMO spectrum disorders seen at the Department of Neurology, Tohoku University Hospital, Sendai, Japan, during the period from November 2008 to February 2009. A total of 35 of them were aquaporin-4 antibody-positive. We used Short Form Brief Pain Inventory (BPI) to assess pain and Short Form 36-item (SF-36) health survey to evaluate the HRQOL. Fifty-one patients with multiple sclerosis (MS) were also studied for comparison. Pain in NMO (83.8%) was far more common than in MS (47.1%). The Pain Severity Index score in BPI was significantly higher in NMO than in MS, and patients' daily life assessed by BPI was highly interfered by pain in NMO as compared with MS. Pain involving the trunk and both legs was much more frequent in NMO than in MS. SF-36 scores in NMO were lower than MS, especially in bodily pain. Our study showed that pain in NMO is more frequent and severe than in MS and that pain has a grave impact on NMO patients' daily life and HRQOL. Therapy to relieve pain is expected to improve their HRQOL.

Characteristics of patients with fibromyalgia in France and Germany

Few studies have comprehensively assessed the burden associated with fibromyalgia (FM). This cross-sectional, observational study evaluates the impact of FM on patients in France and Germany. A total of 299 FM patients were recruited from 33 physician offices in France and Germany during routine visits. Patients completed a survey that included the Brief Pain Inventory-Short Form (BPI-sf), Fibromyalgia Impact Questionnaire (FIQ), EuroQol 5D (EQ-5D) and the Hospital Anxiety and Depression Scale (HADS) to describe their pain, FM and health-related quality of life (HRQOL). FM severity was defined using patients' FIQ total scores with 0 to < 39, 39 to < 59 and 59-100, representing mild, moderate and severe FM, respectively. Site staff completed case report forms using patients' medical records. Mean (standard deviation, SD) age was 54.2 (12.6); 81% of patients were women. The mean (SD) FIQ total score was 53.3 (19.6); 33% and 44% of patients reported moderate and severe FM, respectively. Most patients (91%) were receiving prescription medications for FM during the study. Patients reported a mean (SD) EQ-5D health state valuation of 0.44 (0.33) and a mean (SD) BPI-sf Pain Severity Index score of 4.9 (1.8). Forty-one percent of patients reported some level of disruption in their employment because of FM; employed patients missed a mean (SD) of 2.2 (4.6) workdays during the past 4 weeks. An increase in FM severity was significantly associated with increased pain severity, productivity loss, sleep disturbance and higher anxiety and depression (p < 0.0001). There is a substantial burden of illness including treatment limitations for FM patients in France and Germany.

The role of new cytotoxic agents for the treatment of metastatic breast cancer

In the MONALEESA-3 Phase III trial of patients with hormone receptor–positive human epidermal growth factor receptor–negative advanced breast cancer, ribociclib plus fulvestrant significantly improved progression-free survival (PFS) and overall survival (OS). Here, we present patient-reported outcomes from the trial, including health-related quality of life (HRQOL).Patients were randomized (2:1) to receive ribociclib plus fulvestrant or placebo plus fulvestrant. Time to definitive 10% deterioration (TTD) from baseline in HRQOL (global health status [GHS] from the EORTC QLQ-C30 questionnaire) and pain (BPI-SF questionnaire) were assessed using Kaplan-Meier estimates; a stratified Cox regression model was used to estimate the hazard ratio (HR) and 95% CIs.Deterioration ≥10% in the EORTC-QLQ-C30 GHS was observed in 33% of patients in the ribociclib group vs 34% of patients in the placebo (reference) group (HR for TTD ≥ 10% = 0.81 [95% CI, 0.62–1.1]). Similar findings were noted for TTD ≥5% (HR = 0.79 [95% CI, 0.61–1.0]) and TTD ≥15% (HR = 0.81 [95% CI, 0.60–1.08]). TTD ≥10% in emotional functioning (HR = 0.76 [95% CI, 0.57–1.01]) trended in favor of the ribociclib group, whereas results for fatigue and pain were similar between arms. TTD ≥10% in BPI-SF pain severity index score (HR = 0.77 [95% CI, 0.57–1.05]) and worst pain item score (HR = 0.81 [95% CI, 0.58–1.12]) trended in favor of ribociclib vs placebo.In addition to significantly prolonging PFS and OS compared with placebo plus fulvestrant, adding ribociclib to fulvestrant maintains HRQOL.

Burden and Treatment Patterns of Neuropathic Pain in Patients with Cervical Radiculopathy

AbstractAim: To characterize the impact of neuropathic pain (NeP) related to cervical radiculopathy (CR) on health and employment status and outpatient healthcare utilization, we conducted a cross-sectional survey of 81 patients with CR-related NeP in general practice in six European countries.Methods: Patients and physicians completed a one-time survey. Physicians recorded demographic and treatment information. Patients provided information on CR-related NeP, health impact and utilization.Results: Mean age was 57.0 n13.3 years. The mean Pain Severity Index was 5.2 n 1.8, and 89% reported moderate or severe pain. Patients reported moderate levels of pain-related interference with health domains (mean 4.7 n 2.0) despite 94% of patients receiving prescription medications for NeP. Prescriptions were predominantly for standard analgesics (79%), and multiple physician visits for NeP was common. Disruption in employment occurred in 62% of patients. Increasing pain severity was associated with reduced health val...

Patient Burden of Trigeminal Neuralgia: Results from a Cross‐Sectional Survey of Health State Impairment and Treatment Patterns in Six European Countries

Trigeminal neuralgia (TN) is an uncommon neuropathic condition associated with excruciating facial pain. It is important to determine the effect of TN pain on patient functioning and to characterize relevant pharmacologic treatment patterns and health resource utilization in general practice. Eighty-two patients with TN were identified in a general practice setting during an observational survey of broad neuropathic pain syndromes in six European countries. Patients answered a questionnaire that included pain severity and interference items from the modified Short Form Brief Pain Inventory (mBPI-SF), the EuroQol Survey of functioning and well-being (EQ-5D), and questions related to current treatment, health status, and resource utilization. Physicians provided information on medications prescribed for TN pain and pain-related comorbidities (anxiety, depression, and sleep disturbance). The mean patient age was 62.7 +/- 15.8 years, 46% were > or =65 years, and 66% of patients had TN >1 year of duration. The mean Pain Severity Index was 4.2 (range 0-10), reflecting moderate pain despite 94% of patients taking prescription medications for their TN pain. Prescription medications included carbamazepine (mean daily dose 534.1 +/- 269.8 mg), the recommended first-line pharmacologic therapy for TN. Pain severity was significantly associated with reduced EQ-5D health state valuation (P < 0.001) and greater pain interference (mBPI-SF) (P < 0.001). These findings demonstrate that TN pain presents a substantial patient burden expressed as interference with daily functioning and reduced health status associated with pain severity. This burden may result from both suboptimal management strategies and the frequent resistance of this neuropathic condition to treatment, and suggests a need for more effective pain management strategies.

A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia

Postherpetic neuralgia (PHN) develops in 8-24% of patients with herpes zoster. Few studies have evaluated the patient burden and treatment of PHN in general practice. To determine the patient burden of PHN with respect to pain intensity and impact on patient functioning and to characterise treatment patterns and health resource utilisation in general practice. Eighty-four patients with PHN were identified in general practice settings during an observational survey of neuropathic pain syndromes in six European countries. Patients answered a questionnaire that included: pain severity and interference items from the modified short form brief pain inventory (mBPI-SF); EuroQol (EQ-5D) survey; and questions related to current treatment, health status and resource utilisation. Physicians provided information on medications prescribed for PHN and pain-related co-morbidities (anxiety, depression and sleep disturbance). Mean patient age was 71.0 +/- 12.8 years, 76% were > or = 65 years and 45% of patients had PHN > or = 1 year. The mean pain severity index was 4.2, reflecting moderate pain despite 89% of patients taking prescription medications for PHN. Few medications with demonstrated efficacy against PHN (e.g. carbamazepine and gabapentin) were prescribed, often at suboptimal doses. Pain severity was associated with reduced EQ-5D health state valuation (P<0.001), greater pain interference on all domains (P<0.001) and increased health resource utilisation (P = 0.008). PHN causes substantial patient burden expressed as interference with daily functioning and reduced health status associated with pain severity. This burden may result in part from suboptimal management strategies and suggests a need for more effective pain management.

Burden and Treatment Patterns of Neuropathic Pain in Patients with Cervical Radiculopathy

Aim: To characterize the impact of neuropathic pain (NeP) related to cervical radiculopathy (CR) on health and employment status and outpatient healthcare utilization, we conducted a cross-sectional survey of 81 patients with CR-related NeP in general practice in six European countries.Methods: Patients and physicians completed a one-time survey. Physicians recorded demographic and treatment information. Patients provided information on CR-related NeP, health impact and utilization.Results: Mean age was 57.0 ñ13.3 years. The mean Pain Severity Index was 5.2 ñ 1.8, and 89% reported moderate or severe pain. Patients reported moderate levels of pain-related interference with health domains (mean 4.7 ñ 2.0) despite 94% of patients receiving prescription medications for NeP. Prescriptions were predominantly for standard analgesics (79%), and multiple physician visits for NeP was common. Disruption in employment occurred in 62% of patients. Increasing pain severity was associated with reduced health valuation (P < 0.001) and increased functional interference (P < 0.001).Conclusions: NeP in CR is associated with substantial patient burden. Improved management strategies and physician education may reduce this burden. Additional research is needed to better understand this pain condition.

Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns

Aims To determine the patient burden of painful diabetic peripheral neuropathy (DPN) with respect to pain intensity and impact on patient functioning and to characterize relevant DPN treatment patterns. Methods Patients ( n=140) with painful DPN identified during an observational survey of neuropathic pain syndromes in six European countries were included in the current analysis. Patients primarily recruited from community-based general practices answered a questionnaire that included pain severity and interference items from the modified Short-Form Brief Pain Inventory, the EuroQol survey, and questions related to productivity and health resource utilization. Physicians provided information on disease duration and current medications prescribed for painful DPN and pain-related comorbidities. Results The mean patient age was 65.6±11.2 years; 58% of the patients were ≥65 years. Duration of painful DPN was >1 year in 74% of patients. The mean Pain Severity Index was 5.0±2.0; 57% of patients reported moderate pain and 25% reported severe pain. Patients reported moderate interference with functioning despite 91% of patients reporting use of prescription medications for painful DPN including antiepileptics (56%), standard analgesics (63%), and amitriptyline (26%). Use of prescription medication for concomitant anxiety, depression, or sleep disturbance was reported for 43% of the patients. Disruption in employment was reported by 35% of the patients. Pain severity was significantly associated with reduced health state valuation ( P<.001), greater pain interference scores ( P<.001), greater employment disruption ( P<.05), and more physician visits ( P<.05). Conclusions Painful DPN is associated with substantial patient burden resulting from interference with daily functioning, especially in patients with suboptimal pain management.

The Norwegian Brief Pain Inventory Questionnaire: Translation and Validation in Cancer Pain Patients

The European Association of Palliative Care recommends the Brief Pain Inventory questionnaire (BPI) as a pain assessment tool in clinical studies. After translation into Norwegian, we administered the BPI to 300 hospitalized cancer patients. Cronbach's alphas were computed to assess reliability, and factor analysis was utilized to ascertain construct validity. The BPI interference and pain severity scales were validated against items on pain intensity and pain influence on daily function in the European Organization for Research and Therapy of Cancer (EORTC) QLQ-C30 questionnaire. In total, 235 patients (78%) were able to complete the BPI questionnaire, but 82 (35%) of these questionnaires had one or more missing items. Cronbach's alphas were 0.87 for the pain severity and 0.92 for the interference scales. A factor analysis identified three factors; pain intensity, interference with physical function, and interference with psychological functions/sleep. These three factors explained 82% of the variance. The correlation between BPI pain severity index and the EORTC QLQ-C30 item on pain intensity was 0.70 ( P < 0.001). The correlation between BPI interference index and the EORTC QLQ-C30 item on pain influence on daily living was 0.62 ( P < 0.001). We conclude that BPI has satisfactory psychometric properties, but is not completed by a significant proportion of patients. Further research is needed to establish pain assessment tools for patients unable to answer a comprehensive pain questionnaire, to establish routines for analysis of missing values, and to investigate if pain interference items also reflect disease-related impairment.

Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications

OBJECTIVE: The irritable bowel syndrome (IBS) and the fibromyalgia syndrome (FS) coexist in many patients. We conducted complementary studies of the prevalence of FS in IBS patients and matched controls, and of IBS in FS patients and the implications of concomitant IBS and FS on health-related quality of life (HRQOL). METHODS: A study of 79 IBS patients with 72 matched controls (IBS study), and a study of 100 FS patients (FS study). All participants underwent tests of tender point sites and threshold of tenderness and answered questionnaires including personal and medical history, GI symptoms, and indices of HRQOL. RESULTS: In the IBS study, 25 of the 79 IBS patients (31.6%) and 3 of the 72 controls (4.2%) had FS ( p < 0.001). Statistically significant differences were found among the study groups in terms of global well-being ( p < 0.001), sleep disturbance ( p < 0.001), physician visits ( p = 0.003), pain ( p < 0.001), anxiety ( p < 0.001), and global severity index (SCL-90-R) ( p < 0.001), with patients with IBS and FS having the worst results. IBS patients had significantly more tender points than controls ( p < 0.001). In the FS study, 32 of the 100 FS patients (32%) had IBS. Patients with both disorders had significantly worse scores for physical functioning ( p = 0.030) and for all but one of a 16-item quality of life questionnaire. CONCLUSIONS: FS and IBS coexist in many patients. Patients with both disorders have worse scores on HRQOL indices than patients with either disorder alone, or controls. Physicians treating these patients should be aware of the overlap, which can affect the presentation of symptoms, health care utilization, and treatment strategies.

Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications.

The irritable bowel syndrome (IBS) and the fibromyalgia syndrome (FS) coexist in many patients. We conducted complementary studies of the prevalence of FS in IBS patients and matched controls, and of IBS in FS patients and the implications of concomitant IBS and FS on health-related quality of life (HRQOL). A study of 79 IBS patients with 72 matched controls (IBS study), and a study of 100 FS patients (FS study). All participants underwent tests of tender point sites and threshold of tenderness and answered questionnaires including personal and medical history, GI symptoms, and indices of HRQOL. In the IBS study, 25 of the 79 IBS patients (31.6%) and 3 of the 72 controls (4.2%) had FS (p < 0.001). Statistically significant differences were found among the study groups in terms of global well-being (p < 0.001), sleep disturbance (p < 0.001), physician visits (p = 0.003), pain (p < 0.001), anxiety (p < 0.001), and global severity index (SCL-90-R) (p < 0.001), with patients with IBS and FS having the worst results. IBS patients had significantly more tender points than controls (p < 0.001). In the FS study, 32 of the 100 FS patients (32%) had IBS. Patients with both disorders had significantly worse scores for physical functioning (p = 0.030) and for all but one of a 16-item quality of life questionnaire. FS and IBS coexist in many patients. Patients with both disorders have worse scores on HRQOL indices than patients with either disorder alone, or controls. Physicians treating these patients should be aware of the overlap, which can affect the presentation of symptoms, health care utilization, and treatment strategies.

THERAPEUTIC EFFICACY OF LACTOBACILLUS PLANTARUM 299V IN CHRONIC RECURRENT ABDOMINAL PAIN OF CHILDHOOD

Chronic recurrent abdominal pain of childhood (CRAP) affects one out of 10 school age children, limiting activities and impairing school attendance. Current therapy, consisting of counseling and/or fiber, is often disappointing. Recently, studies from Europe have suggested a beneficial effect of a new probiotic bacteria, Lactobacillus Plantarum 299V (LP299V) in the treatment of adults with IBS. Significant reduction in both pain and gas was reported. We, therefore, undertook a prospective double-blinded, placebo-controlled study of LP299V in the treatment of CRAP in 11 school-age children who failed to respond to counseling and fiber therapy. All had prior diagnostic evaluations relevant to their clinical presentation and physical findings and were considered free of organic disease. After informed consent was obtained, (IRB approved), symptoms were recorded during a 1-week observatory period according to an abdominal pain severity index designed for this study. Patients were randomized to LP299V or placebo for 4 weeks, then crossed to the other therapy for 4 weeks after a 1-week washout period. Symptoms were again assessed at the conclusion of each 4-week period. The pain severity index was then compared among the 3 observation periods by ANOVA using Tukey post test. As shown in the table, patients treated with LP299V had a significant reduction in symptoms when compared to the baseline, whereas placebo treatment did not produce significant improvement. LP299V may have some role in the treatment of CRAP in children. However, further studies will be needed to determine which patients will most likely benefit from this therapy. Figure

A QUANTITATIVE TOOL TO ASSESS CHANGES IN ABDOMINAL PAIN IN CHILDREN

Background: Abdominal Pain in children is very common but very difficult to assess objectively. We are developing a scoring system for objectively measuring abdominal pain before and after treatment. Methods: To begin to assess the validity of our approach we studied twenty-two children treated with H2 antagonists for acid-peptic disease. An abdominal pain score (APS) was calculated from three component indices: pain frequency (PF), pain severity (PS), and peptic index (PI). Scoring for PF was: 2 =multiple daily episodes of pain; 1.5=one episodes of pain per day; 1=3-4 episodes per week; and 0.5 = 2-3 episodes per month. PS was scored 0 to 10 according to a previously validated affective facial scale **. PI was scored by assigning 1 point to each of the following symptoms: nausea, vomiting, loss of appetite or weight loss, chest pain, epigastric pain, relationship to meals, waking at night with pain and pain on awakening in the morning. Results: Of the 22 children treated for 23 ± 6 days, 11 reported improvement (Responders) and 11 reported no improvement (Nonresponders). Table Conclusion: Initial quantitative assessment of pain (APS) could not predict outcome. However, there was a clear quantitative distinction between those reporting improvement from those reporting no change. This distinction was evident in all three components of the APS. We conclude the demonstrated ability of the APS to quantitate improvement in patients responding to H2 antagonists may be useful in quantitating abdominal pain in groups of children with vague recurrent abdominal pain.

Dialysis-related beta 2 microglobulin-amyloid arthropathy. Improvement of clinical symptoms after a switch of dialysis membranes.

Amyloidosis containing beta 2 microglobulin (beta 2m) and joint pains are frequent complications of long-term hemodialysis. In a prospective study the authors planned to act on dialysis arthropathies (DA) by improving beta 2m depuration: for 8 patients suffering from DA we replaced usual cuprophane membranes (CU) by high permeability polyacrylonitrile membranes (PAN). DA was diagnosed on the presence of severe disabling arthralgias in the absence of any other obvious etiology, and on the presence of at least 3 among 6 criteria. The efficacy of the switch of DM was assessed on 6 criteria including the patient's own evaluation at the end of the study and a joint pain severity index. Clinical evaluation and beta 2m measurement were carried out at the start of the trial and after a mean duration of dialysis on PAN of 6 months. An improvement in joint symptomatology and a decrease of joint severity index were noted in the 8 cases. Our results suggest that the change of DM has a favorable influence on DA. This improvement could result either from a better beta 2m depuration or from a better biocompatibility of PAN than the CU previously used.