Predicted Pain Intensity Research Articles

Predictors of Pain Intensity and Disability After Minor Hand Surgery

To test the null hypothesis that there is no relationship between coping mechanisms and depression measured before surgery, and pain intensity and disability after surgery, as assessed at the time of suture removal. A total of 120 patients (39 electing surgery for carpal tunnel syndrome, 65 for trigger finger, and 16 for a benign tumor) completed questionnaires measuring depression, pain self-efficacy (confidence that one can perform various activities despite pain), pain anxiety (fear and anxiety in response to pain sensations), and pain catastrophizing (maladaptive cognitive activities such as pain-related rumination, magnification, and helplessness) before surgery. Before the surgery and at the time of suture removal (10 to 14 days after surgery) participants completed the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and a numerical pain intensity rating scale. At the time of suture removal, there was a significant correlation between pain intensity and depression (r = 0.45, p<.001), pain catastrophizing (r = 0.41, p<.001), pain anxiety (r = 0.32, p<.01), and self-efficacy (r = -0.29, p<.01). Disability correlated with self-efficacy (r = -0.34; p<.001) and depression (r = 0.49; p<.001), but not with pain anxiety and catastrophizing (p>.05). In multivariate analyses, depression was the sole predictor of both disability and pain intensity and accounted for 26% of the variance in DASH scores and 25% of the variance in pain intensity, after removing the influence of preoperative DASH and diagnosis, which accounted for 14% variance. Psychosocial factors, especially depression, explain a notable proportion of the variation in pain intensity and disability after minor hand surgery. Prognostic I.

Pain after Laparoscopic Cholecystectomy

Background and objective: Although laparoscopic cholecystectomy results in less pain than open cholecystectomy, it is not a pain free procedure. A clinical trial was designed to assess pain after LC in terms of types of pain, intensity and factors that may influence it. Methods: A prospective study on pain was performed on all patients undergoing the operation over the period of 1.5 year (n = 150). Pain was measured by a five point verbal rating scale (VRS). Results: Pain was the most frequent symptom, after the operation. The main type of postoperative pain was intra-abdominal 72%, followed by incisional 60% and shoulder pain 10%.The mean level of pain was 2.12 VRS points 8 h after the operation and declined to 1.01 points next day. In 54 patients (36%) the intensity of pain was higher than 2 VRS points. Female sex was the only predictor of pain intensity. Conclusion: Laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day. As predictors for high intensity of pain were not identified clearly, pain should be monitored and multimodal analgesics should be delivered accordingly.

Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals

This study examines the relationship between anxiety, depression and pain intensity in patients with low back pain who are newly admitted to an acute care hospital setting. Previous studies have supported the idea that anxiety and depression play a significant role in chronic low back pain, but the relationship between anxiety, depression and pain intensity in patients with low back pain who are newly admitted to hospital has not been adequately explored. The study reported here was descriptive correlational in design. The sample was 102 Chinese patients with low back pain who were newly admitted to an acute care hospital in Hong Kong. Data were collected through individual interviews, using an 11-point numerical pain rating scale and the Hospital Anxiety and Depression Scale. In addition, demographic data were identified from the medical record. There were 48 male and 54 female adult participants in the study. The average anxiety and depression level of the participants was 19.46 (SD 9.02) on a scale of 0-42, which is higher than the normal level. The level of anxiety and depression was significantly positively correlated with pain intensity (r = 0.471, p < 0.0005) and was also a significant predictor of pain intensity (t = 3.918, p < 0.0005, 95% CI 0.050-0.154). The results of this study showed that anxiety and depression are not only associated with pain intensity but that they also, partly, predict pain intensity in patients with low back pain who are newly admitted to an acute care hospital. Relevance to clinical practice. The results of this study support the assessment of and intervention in anxiety and depression symptoms in the provision of pain-relief nursing treatment in patients with low back pain who are admitted to acute care hospitals.

Multivariate relationships between pain intensity and other aspects of health in rheumatoid arthritis–cross sectional and five year longitudinal analyses (the Swedish TIRA project)

Objectives. This study analyses the relationships between pain intensity and other aspects of health commonly used to assess disease activity and disability in early rheumatoid arthritis and examines whether such relationships were different between women and men.Subjects and methods. This study included the 189 patients (69% women) with early RA (symptoms <12 months at diagnosis) still remaining in the Swedish TIRA cohort 5 years after inclusion. Disease activity and disability was assessed 3, 6, 12, 18, 24, 36, 48, and 60 months (M0-M60) after inclusion by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), number of swollen and tender joints, physicians global assessment of disease activity (PGA), grip force average over 10 seconds (Grippit), Grip Ability Test (GAT), Signals of Functional Impairment (SOFI) in hand, lower limb and upper limb, Health Assessment Questionnaire (HAQ), and pain intensity measured with a visual analogue scale (VAS). The variables were divided into meaningful blocks according to the correlation structure in a principal component analysis (PCA) at M60. Using hierarchical partial least squares (PLS) analyses, this study investigated the blocks cross-sectionally to test for correlations with pain intensity at M0 and M60. The blocks at M0 were also used as predictors of pain intensity at M60 in a hierarchical PLS.Results. The strongest relationship was found between pain intensity and the second block, consisting of HAQ and SOFI-lower limb at the cross-sectional analyses in both women and men. The block representing disease activity (i.e., ESR, CRP, PGA, and swollen and tender joints) had the weakest relation to pain intensity. According to the longitudinal analyses, the disease activity variables (block 1) at M0 had the strongest relationship to pain intensity at M60 in men. In contrast, HAQ and SOFI-lower limb (block 2) at M0 had a strong relation to pain intensity in women.

Predicting outcome of TENS in chronic pain: A prospective, randomized, placebo controlled trial

Transcutaneous electrical nerve stimulation (TENS) is an easy to use non-invasive analgesic intervention applied for diverse pain states. However, effects in man are still inconclusive, especially for chronic pain. Therefore, to explore the factors predicting result of TENS treatment in chronic pain we conducted a prospective, randomized, placebo-controlled trial ( n = 163), comparing high frequency TENS ( n = 81) with sham TENS ( n = 82). Patients’ satisfaction (willingness to continue treatment; yes or no) and pain intensity (VAS) were used as outcome measures. The origin of pain and cognitive coping strategies were evaluated as possible predictors for result of TENS treatment. Results: Fifty-eight percent of the patients in the TENS group and 42.7% of the sham-TENS group were satisfied with treatment result (chi square = 3.8, p = 0.05). No differences were found for pain intensity. Patients diagnosed with osteoarthritis and related disorders (especially of the vertebral column) or peripheral neuropathic pain were less satisfied with high frequency TENS (OR = 0.12 (95% CI 0.04–0.43) and 0.06 (95% CI 0.006–0.67), respectively). Injury of bone and soft tissue (especially postsurgical pain disorder) provided the best results. Treatment modality or interactions with treatment modality did not predict intensity of pain as a result of treatment. We conclude, that predicting the effect of high frequency TENS in chronic pain depends on the choice of outcome measure. Predicting patients’ satisfaction with treatment result is related to the origin of pain. Predicting pain intensity reflects mechanisms of pain behavior and perceived control of pain, independent of treatment modality. Pain catastrophizing did not predict TENS treatment outcome.

Rentenbegehren, selbst eingeschätzte Schmerzintensität und Behinderung von Probanden mit Fibromyalgiesyndrom

The clinical experience that subjects claiming retirement pension tend to aggravate their symptoms in psychometric tests has not yet, to our knowledge, been empirically tested. Pain intensities and the summary score of the Pain Disability Index (PDI) of 83 consecutive subjects diagnosed with fibromyalgia syndrome (FMS) claiming retirement pension in medical assessment for the German Social Court were compared with 43 consecutive patients diagnosed with FMS of an outpatient pain department who did not claim retirement pension. Moreover, the relative predictive value of claiming retirement pension compared to other potential sociodemographic and clinical predictors of pain intensity and self-assessed disability was determined. Subjects claiming retirement pension within the context of medical testimony stated higher pain intensities and disabilities than patients who did not claim retirement pension (P<0.01 in all cases). Claiming disability pension was an independent predictor of minimum pain intensity (r(2)=0.10, P=0.02), of maximum pain intensity (r(2)=0.16, P=0.002) and of the summary score of the PDI (r(2)=0.08, P=0.008). The association between claiming retirement pension and high self-assessed pain and disability should be kept in mind in the context of pain therapy as well of medical expertise.

Electronic Momentary Assessment in Chronic Pain I: Psychological Pain Responses as Predictors of Pain Intensity

Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7,100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed in this regard. Psychological pain responses explained 40% of the total variance in pain intensity: almost 24% concerned pain variance that occurred between the CPD patients and 16% pertained to pain variance due to momentary differences within these patients. Separately tested fear-avoidance and cognitive responses each explained about 28% of the total pain variance, while spousal responses explained 9%. Catastrophizing emerged as the strongest pain predictor, followed by pain-related fear and bodily vigilance. Results did not differ with the duration of chronicity. Exaggerated negative interpretations of pain, and fear that movement will induce or increase pain strongly predicted CPD pain intensity. Spousal responses-assessed only when the spouse was with the patient who at that moment was in actual pain-may more strongly affect immobility due to pain than pain intensity per se (see part II of the study). The findings substantiate the importance of catastrophizing, fear and vigilance identified primarily in low back pain and extend this to other forms of chronic pain. The compelling evidence of momentary within-patients differences underscores that these must be accounted for in chronic pain research and practice.

The Association Between Somatization and Perceived Ability: Roles in Dysmenorrhea Among Israeli Arab Adolescents

The aim of this study was to investigate whether somatization and attitudes toward menstruation predict the incidence of pain intensity and dysmenorrhea among Israeli Arab adolescent females. Participants were 160 Israeli Arab adolescents, including 50 Muslims, 50 Christians, and 60 Druze. A 20-item questionnaire was used to assess attitudes regarding menstruation. The short version of the Brief Symptom Inventory was used to measure the level of somatization. Factor analysis of the Attitudes Toward Menstruation Instrument revealed two significant composites: perceived ability and impurity during menstruation. High levels of somatization predicted pain intensity and low levels of perceived ability predicted the prevalence of dysmenorrhea. Although the Israeli Muslim adolescents revealed higher levels of somatization as compared with their Christian and Druze counterparts and the Druze revealed the lowest levels of perceived ability compared with the other subgroups, no significant role for ethnicity and impurity was found. No differences were found between groups in scores of menstrual pain and prevalence of dysmenorrhea. Higher levels of somatization and lower levels of perceived ability, as well as a greater portion of Muslim and Druze and higher levels of religiosity, were found among rural residents. The role of cultural variables and personality traits in the complexity of dysmenorrhea as a socio-bio-psychological phenomenon is proposed in light of contemporary interactive models. It is suggested that within the Israeli Arab minorities the impact of cultural background on health affects more the perceptual and cognitive levels and are not generalized to overt behavior and morbidity such as dysmenorrhea.

COPING STRATEGY USE: DOES IT PREDICT ADJUSTMENT TO CHRONIC BACK PAIN AFTER CONTROLLING FOR CATASTROPHIC THINKING AND SELF-EFFICACY FOR PAIN CONTROL?

To explore whether coping strategy use predicted levels of adjustment in chronic low back pain after controlling for the influence of catastrophic thinking and self-efficacy for pain control. Eighty-four patients with chronic low back pain completed the Coping Strategies Questionnaire, a pain VAS and the Roland Disability Questionnaire. To derive composite measures of coping, the Coping Strategies Questionnaire subscales, excluding the Catastrophizing subscale and 2 single-item scales, were entered into a principal components analysis. The extent to which scores on the coping measures predicted levels of adjustment after controlling for catastrophic thinking (Catastrophizing subscale) and self-efficacy for pain control (2 single-item scales) was explored using sequential multiple regression analysis. Two coping dimensions emerged from the principal components analysis, which were labelled Distraction and Praying or Hoping, and Denial of Pain and Persistence. Scores obtained on these coping measures explained an additional 5% and 13% of the variance in pain intensity and disability, respectively. Interestingly, however, the scores on the coping measures did not predict pain intensity or disability after controlling for the influence of catastrophic thinking and self-efficacy for pain control. Coping strategy use might only be related to levels of adjustment via the effect it has on catastrophic thinking and self-efficacy for pain control.

Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients

The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chronic low back pain patients who were followed for one week. Attention to pain was hypothesized to mediate the relation between pain-related fear and pain intensity. Further, pain-related fear as a trait characteristic was expected to moderate the relation between attention to pain and pain intensity. Multi-level analysis was used for all analyses. Although the tested mediation models yielded statistically significant mediation effects, the sizes of these effects were relatively small and clinically irrelevant. Instead, results suggested that pain-related fear and attention to pain independently predicted pain intensity. No evidence for moderation of the relation between attention to pain and pain intensity by pain-related fear as a trait characteristic was found. Implications of the results from this study are discussed and suggestions for future research are provided.

Categorizing Patients With Occupational Low Back Pain by Use of the Quebec Task Force Classification System Versus Pain Pattern Classification Procedures: Discriminant and Predictive Validity

Quebec Task Force Classification (QTFC) and pain pattern classification (PPC) procedures, including centralization and noncentralization, are common classification procedures. Classification was done to estimate validity of data obtained with QTFC and PPC procedures for differentiating patient subgroups at intake and for use in predicting rehabilitation outcomes at discharge and work status at 1 year after discharge from rehabilitation. Patients (n=171, 54% male; mean age=37 years, SD=10, range=18-62) with acute work-related low back pain referred for physical therapy were analyzed. Patients completed pain and psychosocial questionnaires at initial examination and discharge and pain diagrams throughout intervention. Physical therapists classified patients using QTFC and PPC data at intake. Patients were classified again at discharge by PPC (time-dependent PPC). Analysis of variance of showed QTFC and PPC data could be used to differentiate patients by pain intensity or disability at intake. Analysis of covariance showed that intake PPC predicted pain intensity and disability at discharge, but QTFC did not. Logistic regression showed that PPC predicted work status at 1 year, but QTFC did not. Classifying patients over time using time-dependent PPC data reduced the false positive rate by 31% and increased percentage of change in pretest-posttest probability of return to work by 16% compared with classifying patients at intake. Results support the discriminant validity of the QTFC data at intake and predictive validity of the PPC data at intake. Tracking PPC over time increases predictive validity for 1-year work status.

Routine drug monitoring of serum concentrations of morphine, morphine-3-glucuronide and morphine-6-glucuronide do not predict clinical observations in cancer patients.

The clinical importance of routine drug monitoring of serum concentrations of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) during chronic morphine therapy is not established. We measured morphine, M6G and M3G serum concentrations in cancer pain patients receiving oral (n = 263, median dose 80 mg/24 hours) or subcutaneous (sc) (n = 35, median dose 110 mg/24 hours) morphine. Regression analyses were performed to investigate if serum concentrations of morphine, M3G and M6G predicted pain intensity (Brief Pain Inventory), health-related quality-of-life variables (EORTC QLQ-C30) and cognitive function (Mini-Mental Score). Serum concentrations were also compared in patients categorized as morphine 'treatment successes' and 'treatment failures'. We observed that serum concentrations of morphine, M6G or M3G did not predict pain intensity, cognitive function, nausea or tiredness. 'Treatment failures' caused by nausea, tiredness, cognitive failure or constipation did not have statistically significant different morphine, M6G and M3G serum concentrations than patients classified as 'treatment successes'. In conclusion, this study did not observe any concentration-effect relationships of morphine, M3G or M6G with pain intensity, nausea, constipation, tiredness or cognitive failure in blood samples obtained during routine clinical drug monitoring in cancer patients. This result suggests that therapeutic drug monitoring as a routine tool during chronic morphine treatment has limited value for clinical decision making.

The child version of the pain catastrophizing scale (PCS-C): a preliminary validation

Catastrophizing about pain has emerged as a critical variable in how we understand adjustment to pain in both adults and children. In children, however, current methods of measuring catastrophizing about pain rely on brief subscales of larger coping inventories. Therefore, we adapted the Pain Catastrophizing Scale ( Sullivan et al., 1995) for use in children, and investigated its construct and predictive validity in two studies. Study 1 revealed that in a community sample (400 boys, 414 girls; age range between 8 years 9 months and 16 years 5 months) the Pain Catastrophizing Scale for Children (PCS-C) assesses the independent but strongly related dimensions of rumination, magnification and helplessness that are subsumed under the higher-order construct of pain catastrophizing. This three factor structure is invariant across age groups and gender. Study 2 revealed in a clinical sample of children with chronic or recurrent pain (23 girls, 20 boys; age range between 8 years 3 months and 16 years 6 months) that catastrophizing about pain had a unique contribution in predicting pain intensity beyond gender and age, and in predicting disability, beyond gender, age and pain intensity. The function of pain catastrophizing is discussed in terms of the facilitation of escape from pain, and of the communication of distress to significant others.

Postherpetic neuralgia: a descriptive analysis of patients seen in pain clinics

Background and Objective: Postherpetic neuralgia (PHN) is a common ailment that pain specialists must often cope with. The goal of the present survey is to investigate the pain characteristics of 119 PHN patients with persistent pain seen at different pain clinics. Methods information on demographic features, pain characteristics (MPQ-SV, VAS, VRS), and treatment was recorded by means of a standard case report form. Results: Gender, age, location, and treatment were consistent with previous reports. Antidepressant, antiepileptic, and analgesic drugs were the most commonly used by patients. The patients seen in pain clinics are probably a subset of severe cases of PHN, where delayed referral to these units plays an important role. The most frequent qualitative features of the disease were the McGill Pain Questionnaire-Spanish Version (MPQ-SV). These features may change in relation to illness evolution; electric shocklike pain and emotional distress were significantly higher after 6 months of evolution and age (those younger than 70 were more able to locate painful areas and to feel pain as pricking or sharp), and gender (men selected spatial pressure and traction pressure more frequently). None of the explored variables was relevant to predicting pain intensity. Conclusions: This study reveals a subset of patients, mostly suffering from long-term PHN, where pain persists. The most frequent qualitative traits of PHN patients are described. Some variables were involved in modulation of pain characteristics in these patients. The effect of study design in interpretation of results is discussed.

Postoperative pain after adenoidectomy in children

We have investigated if pain intensity or analgesic requirements in hospital predicted pain intensity, pain duration or analgesic requirements at home in 611 children, aged 1-7 yr, after day-case adenoidectomy. We also investigated if ketoprofen 0.3-3.0 mg kg-1, administered pre-emptively i.v. during operation, modified pain at home. In hospital, a prospective, randomized, double-blind, placebo-controlled study design was performed. A standard anaesthetic technique was used in all children and fentanyl i.v. was available for rescue analgesia. After discharge, the study design was open, experimental, prospective and longitudinal. On return home, children were prescribed ketoprofen tablets 5 mg kg-1 day-1. Parents were asked to complete an analgesia diary; non-responders were contacted by telephone. The response rate was 91%. The number of doses of fentanyl given in hospital correlated with pain intensity at home (P < 0.001). There were no other correlations and no pre-emptive effect of ketoprofen.

Pain coping and the pain experience in children with juvenile chronic arthritis

This study examined the pain experience and pain coping of children with juvenile chronic arthritis (JCA). The purpose of the study was to describe present pain and the pain coping strategies utilized by children with juvenile chronic arthritis and examine pain coping strategies and pain efficacy as a predictor of pain intensity and distribution. Fifty-six children with JCA rated their present pain using two measures of pain intensity, the Oucher and the pain thermometer, and reported on the number of pain locations using a body map. In addition, each child completed the Child Version of the Coping Strategies Questionnaire (CSQ-C) and health status was determined by a physician's disease activity rating. On average, children reported current pain in the low to middle range on the different pain scales, although there was considerable variability in pain ratings. Up to 30% of all children had pain ratings higher than or equal to the middle range on both the Oucher and the pain thermometer. On average, children reported pain in more than two body areas. Correlational analyses were conducted to examine how the composite factors on the CSQ-C (Pain Control and Rational Thinking, and Coping Attempts) related to variations in reported pain intensity and location. Children who scored higher on the Pain Control and Rational Thinking factor of the CSQ-C had much lower ratings of pain intensity and reported pain in fewer body areas. Hierarchical regression analyses indicated that disease activity and scores on the Pain Control and Rational Thinking factor of the CSQ-C each accounted for a unique, statistically significant proportion of variance in the measures of pain intensity and pain location. Behavioral and cognitive therapy interventions designed to increase pain coping efficacy may be useful adjuncts in treating pain in children with chronic arthritis.

Predictors of childbirth pain and maternal satisfaction.

There is little multivariate, multiphasic research on childbirth pain and satisfaction. We explored the relationship of demographic, medical, psychological, and environmental variables at different times to multiple indices of pain and satisfaction in 70 primiparae and multiparae. Induced labor, desirability of pregnancy, and coach's helpfulness predicted sensory pain. Duration of labor, depression, and outcome expectancy that childbirth education would facilitate medication-free childbirth predicted affective pain. Physician-anticipated complications, induced labor, and motivation to be medication-free predicted pain intensity. Grade level predicted-satisfaction. The results also demonstrated differences between primiparae and multiparae in the pattern of variables that explained pain and satisfaction as well as the temporal sensitivity of pain predictors. We discuss the implications of our findings for research and practice.