Present Pain Intensity Scores Research Articles

A clinical study to compare the efficacy and safety of pregabalin sustained release formulation with pregabalin immediate release formulation in patients of diabetic peripheral neuropathic pain

Objective:To compare the efficacy and safety of sustained release (SR) formulation of pregabalin with immediate release (IR) formulation in patient with diabetic peripheral neuropathic pain.Materials and Methods:In this open label, randomized, comparative, multicentric study, the primary efficacy measure was reduction in visual analogue scale (VAS) of short form McGill pain questionnaire (SF-MPQ) score from baseline to last visit. The secondary evaluation measures included reduction in SF-MPQ descriptive score and present pain intensity score and change in clinical global impression - improvement of illness (CGI-I) and clinical global impression - severity of illness (CGI-S) from baseline to last visit. Total duration of the study was 12 weeks. Safety evaluation was done by recording treatment emergent adverse events and laboratory investigations at baseline and end of treatment.Results:Of 265 randomized patients, 133 received pregabalin SR tablets and 132 pregabalin IR. Patients randomized to both treatments responded to respective treatments. The least square means of VAS score in both the groups were reduced significantly (P <0.01). Reduction in both groups was similar (P = ns). At the end of the trial in both the groups, there was a significant reduction in the SF-MPQ descriptive score (P <0.01), severity of illness as well as clinically significant improvement in the symptoms. Difference between the groups for CGI-I (P = 0.37) and CGI-S (P = 0.41) score was not statistically significant. Treatment in both the groups was found safe and well tolerated.Conclusion:The study shows that the pregabalin SR is safe and effective in patients of diabetic peripheral neuropathic pain. The results of the study demonstrated that pregabalin SR has comparable efficacy and safety as pregabalin IR.

Effects of music therapy on pain among female breast cancer patients after radical mastectomy: results from a randomized controlled trial

Music therapy has been used in multiple health care settings to reduce patient pain, anxiety, and stress. However, few available studies have investigated its effect on pain among breast cancer patients after radical mastectomy. The aim of this study was to explore the effects of music therapy on pain reduction in patients with breast cancer after radical mastectomy. This randomized controlled trial was conducted at the Surgical Department of Oncology Center, First Affiliated Hospital of Xi'an Jiaotong University from March to November 2009. A total of 120 breast cancer patients who received Personal Controlled Analgesia (PCA) following surgery (mastectomy) were randomly allocated to two groups, an intervention group and a control group (60 patients in each group). The intervention group accepted music therapy from the first day after radical mastectomy to the third admission to hospital for chemotherapy in addition to the routine nursing care, while the control group received only routine nursing care. Pain scores were measured at baseline and three post-tests using the General Questionnaire and Chinese version of Short-Form of McGill Pain Questionnaire. The primary endpoint was the change in the Pain Rating Index (PRI-total) score from baseline. Music therapy was found to reduce the PRI-total score in the intervention group significantly compared with the control group with a mean difference (95% CI) of -2.38 (-2.80, -1.95), -2.41 (-2.85, -1.96), and -1.87 (-2.33, -1.42) for the 1st, 2nd, and 3rd post-tests, respectively. Similar results were found for Visual Analogue Scale (VAS) and Present Pain Intensity (PPI) scores. The findings of the study provide some evidence that music therapy has both short- and long-term positive effects on alleviating pain in breast cancer patients following radical mastectomy.

Single CT-Guided Chemodenervation of the Anterior Scalene Muscle with Botulinum Toxin for Neurogenic Thoracic Outlet Syndrome

To examine pain relief in patients with neurogenic thoracic outlet syndrome (NTOS) after a single, low dose injection of botulinum toxin A (Botox) into the anterior scalene muscle (ASM) under computed tomographic (CT) guidance. Prospective longitudinal study. Academic medical institution. Patients 18 years of age and older were evaluated for potential scalenectomy and first rib resection using the transaxillary approach at the study institution between 2005 and 2008. All patients had failed physical therapy. A total of 29 procedures on 27 participants were studied. A single, 20-unit injection of Botox into the ASM under CT-guidance. Short-form McGill Pain Questionnaire (SF-MPQ) prior to and at 1, 2, and 3 months post-Botox toxin injection. There was a decline in pain during the 3 months subsequent to Botox injection as noted by the following components of the SF-MPQ: sensory (P = 0.02), total (P = 0.05), visual analog scale (VAS [P = 0.04]), and present pain intensity (PPI) score (P = 0.06). The proportion of patients reporting more intense pain scores did not return to the pre-intervention level at 3 months post-Botox injection. Patients experienced substantial pain relief in months 1 and 2 following a single Botox injection into the ASM under CT guidance. Significant pain reduction was noted for 3 months after Botox injection with respect to both sensory and VAS scores, and the total and PPI scores approximated statistical significance. After 3 months, patients experienced a 29% decrease in the sensory component of their pain as well as an approximate 15% reduction in their VAS score. A single, CT-guided Botox injection into the ASM may offer an effective, minimally invasive treatment for NTOS.

Mood, side of motor symptom onset and pain complaints in Parkinson's disease

Patients with Parkinson's disease (PD) present with a variety of non-motor symptoms including sensory complaints and mood disturbances. In the current pilot study, we aimed to explore pain complaints and the association between mood and pain in PD. We hypothesized that pain ratings would be elevated in patients with PD relative to controls. As PD is lateralized at onset and studies have found lateralization of some non-motor symptoms in PD, we also hypothesized that PD patients would exhibit differing pain profiles depending on side of onset of the disease. Twenty-three PD patients (11 right-onset (RPD), 12 left-onset (LPD) disease), and 11 control participants (CS) completed a mood questionnaire (Depression Anxiety Stress Scale; DASS) as well as the short form of the McGill Pain Questionnaire. Both PD groups reported higher present pain intensity scores (p = 0.001), more evaluative pain intensity (p = 0.02), and more overall pain (p = 0.02) than control participants. There was a significant association between mood and all of the McGill pain ratings in the LPD patients, with those reporting more mood symptoms rating higher on all pain scales (all p-values < 0.001). This association was not found in the RPD group. Our results suggest an association between mood and pain in patients with PD that may be related to the differential contribution of right-hemispheric neural networks in processing of mood and pain states. These findings merit further investigation into the relation between mood and pain in patients with PD.

Use of pain at baseline and pain progression to predict overall survival (OS) in patients (pts) with docetaxel pretreated metastatic castration-refractory prostate cancer (CRPC): Results from the SPARC trial

5148 Background: First-line chemotherapy trials have reported that pain predicts OS in CRPC. We report relationships between OS and baseline pain –a major component of CRPC patient reported outcomes (PRO) –and pain at progression, for docetaxel pre-treated patients in a second-line chemotherapy trial in CRPC. Methods: Docetaxel pre-treated pts (N = 488) were analyzed from the multi-national, randomized, double-blind SPARC trial, comparing second-line satraplatin + prednisone vs placebo + prednisone in 950 metastatic CRPC pts. Daily pain intensity and narcotic analgesic use were recorded as a PRO from one week prior to randomization until end-of-study. Pain was measured by the 6-point Present Pain Intensity (PPI) component of the McGill-Melzack Pain Questionnaire. After randomization, weekly PPI scores were calculated as the mean of the daily PPI scores (using ≥3 daily measurements/week). Baseline pain was the mean of ≥5 daily PPI scores recorded during 7 days preceding randomization. An independent blinded review committee (IRC) determined pain progression (defined as an increase in weekly PPI score ≥1 point from baseline or ≥2 points from nadir, or a &gt;25% increase from baseline in weekly average analgesic score for ≥2 consecutive weeks). To examine the effects of pain on OS, pts were categorized as “no pain” (PPI ≤1) or pain (PPI ≥2) by baseline assessment; and, as either pain progressors or pain non-progressors. Results: Shortened OS was observed in pts with baseline pain; median survival of 178 pts with pain was 44 weeks vs 72 weeks for 287 pts without pain (Strat. Log-rank p &lt; 0.0001, Strat. HR 0.59; 95% CI: 0.48–0.74). IRC found disease progression in 414 (84.4%) of the docetaxel pre-treated pts with 196 of these pts showing pain progression. Pain progression was strongly linked to OS with 196 pain progressors having median OS of 47 weeks compared to 71 weeks for 292 pain non-progressors (Strat. Log-Rank p = 0.0022; Strat. HR 0.71; 95% CI: 0.57–0.87). Conclusions: Both pain at baseline and pain at progression are important prognostic indicators of OS in metastatic CRPC pts failing first-line docetaxel. [Table: see text]

Self-Management, Amitriptyline, and Amitripyline plus Triamcinolone in the Management of Vulvodynia

To conduct a prospective study to determine the efficacy of self-management interventions, amitriptyline, and amitriptyline plus topical triamcinolone in reducing vulvar pain in women with vulvodynia. This was a randomized, prospective study of 53 women between the ages of 18 and 72 with vulvodynia. Participants undertook one of three treatment interventions for a period of 12 weeks: self-management, oral amitriptyline (10-20 mg/day), or topical triamcinolone plus oral amitriptyline (10-20 mg/day). The McGill Pain Questionnaire (MPQ) was used to measure changes in qualitative pain using the pain rating index (PRI) and in quantitative pain using the present pain intensity (PPI) scale. Of the 53 randomized subjects, 43 completed the trial. There were no statistically significant differences in PRI or PPI scores among the three treatment groups. Significant within-group differences were observed in the self-management group on the PRI and in the amitriptyline group on the PPI. This first randomized, prospective trial suggests that self-management has a modest effect and that low-dose amitriptyline (with and without topical triamcinolone) is not effective in reducing pain in women with vulvodynia.

“Painless” Bone Marrow Aspiration by Slow Suctioning Does Not Affect Peripheral Blood Contamination of the Specimen: Randomized Prospective Crossover Trials

The pain during bone marrow aspiration (BMA) can be best explained by negative pressure inside the bone marrow cavity. Although most standard textbooks recommend rapid suctioning with high negative pressure to minimize peripheral blood contamination, this technique might be associated with more pain. To date, there is no evidence that rapid suctioning can reduce peripheral blood contamination. To find a technique that reduces pain without loss of specimen quality, we conducted two trials. The first was a randomized, crossover trial comparing slow aspiration with low negative pressure (L method) and rapid aspiration with high negative pressure (H method). To evaluate pain during the procedure, 49 patients with hematological malignancy who required BMA more than once were randomly assigned to receive either the first aspiration by the L method and the second by the H method or vice versa. Under local anesthesia, a 16-gauge BMA needle was inserted into the BM cavity. A 1-mL syringe (L method) or a 30-mL syringe (H method) was used to aspirate 0.5 mL of BM fluid. To ensure accuracy of aspiration volume in the H method, an extension tube was connected between the 30-mL syringe and needle, and clamped by forceps when the aspirated volume reached 0.5 mL. Pain during each procedure was evaluated using a visual analog scale (VAS), verbal descriptor scale (VDS), and McGill pain questionnaire (MPQ). In the first trial, repeated measures one-way analysis of variance design was used for serial measurement of pain, and the one-tailed Wilcoxon's test was used to compare pain between the two groups. The second trial compared aspirate quality between the L and H methods. Sixteen allogeneic transplantation donors (median age, 33.5 years; range, 22 to 62 years), underwent the first puncture of the harvest procedure under general anesthesia. BMA was drawn simultaneously from the right and left posterior iliac crest with a 1-mL and a 30-mL syringe; the aspiration side and syringe size were randomized. Nucleated cell counts (NCC) of the BM specimens were determined by automated hematology analyses. The non-inferiority margin was defined as less than 25% on the basis of the absolute difference of NCC between the L and H methods. In the first trial, 34 of the 49 patients (67%; 21 men and 13 women; median age, 49 years; age range, 17 to 77 years) completed the study and provided VAS, VDS and MPQ score data after two consecutive BMA. Present pain intensity (PPI) score of the MPQ was significantly decreased with L method when compared with H method (median absolute difference 0, P=0.037) (Table 1). VAS score and total pain rating index (PRI) of the MPQ were also lower with the L method (median absolute differences −0.6 and −0.5), although these results did not reach statistical significance. There was no significant ordinal interaction in repeated measurement of any scores except the affective-PRI of the MPQ, which was significantly higher at the first aspiration, regardless of the negative pressure intensity (P=0.024). In the second trial, the geometric mean of NCC with the L method was non-inferior to the mean with the H method (P=0.025) (Table 2). These findings indicated that BMA with low negative pressure tended to be less painful, while maintaining specimen quality. There remains difficulty in evaluating the impact of psychological factors on the results. Nonetheless, on the basis of our results we recommend suctioning slowly with low negative pressure using a small syringe in order to reduce pain during BMA.Table 1L methodH methodP-valuemedian (range)median (range)VDS1 (0 to 3)1 (0 to 3)0.212VAS2.2 (0 to 8.4)3.2 (0 to 9.0)0.055MPQPRI-S3 (0 to 16)4 (0 to 30)0.080PRI-A0 (0 to 7)0 (0 to 9)0.192PRI-E0 (0 to 4)0 (0 to 4)0.414F'RI-M2 (0 to 11)3 (0 to 11)0.093PRI-T6 (0 to 32)7.5 (0 to 53)0.063PPI1 (0 to 4)1 (0 to 5)0.037Table 2L methodH methodP-valueGenomic mean of NCC (×104/μL) (95%IC)6.6 (4.6–9.5)7.8 (5.9– 10.4)0.025

Patient-reported outcomes of therapy with two brands of ibuprofen.

To investigate patients' reported outcome following medication with two brands of 400 mg ibuprofen used to alleviate musculoskeletal pains. Adult peasant manual laborers (85) who met criteria were randomly assigned to receive either of the brands (A or B). Data on pain alleviation were gathered using the Short-Form McGill Pain Questionnaire (SF-MPQ), Visual Analogue Scale (VAS), Present Pain Intensity (PPI), and Clinical Global Impression of Improvement (CGII) scales. Interval data obtained from the two brands were compared using the Students' t-test at 95% confidence interval. There were 42 participants, mean age=29.2 (SD=1.37) assigned to brand A and 43 (mean age=28.8 SD=1.14) in brand B of ibuprofen 400 mg. Brand B was consistently rated higher than brand A. Scores for medication efficacy were 10.4 (SD=1.65) (brand A) and 11.4 (SD=1.68) (brand B); t=2.768, P=0.007. Alleviation of pain symptoms: 10.8 (SD=1.64) and 11.6 (SD=1.72); t = 2.194, P=0.031. Similarly, rated scores on the impact of pain on quality of life were 10.5 (SD=2.00) and 12.1 (SD=1.85); t=3.830, P<0.001. There was a reduction in Present Pain Intensity scores by 32.7% and 34.3% for Brand A and brand B participants respectively. The decrease in Visual Analog pain scale score was 35.9% and 37.3% for brand A and brand B participants respectively. The decrease in SF-MPQ was by 85.1% and 69.9% for the brand A and brand B groups respectively. The clinical global impression of improvement for both groups of patients indicated an improvement rate of 71.4% and 61.9% for brand A and 81.4% and 74.4% for brand B participants. This clinical study infers that though the two brands of ibuprofen 400 mg are legally pharmaceutical equivalent, they are not clinically equivalent. In most of the parameters evaluated, brand B was rated more efficacious than brand A. This explains the patients' preferences and demand for this brand of ibuprofen in the Nigerian community.

Safety and Efficacy of Ureteroscopic Lithotripsy for Ureteral Calculi Under Sedoanalgesia – A Prospective Study

To establish the safety and efficacy of ureteroscopic lithotripsy (URSL) under sedoanalgesia. This study was conducted at Department of Urology (Banaras Hindu University, India) among 124 patients with ureteral stones, between July 2000 and August 2003. Majority of the patients (59.68%) presented with lower ureteric calculi, 24.19% presented with upper ureteric calculi and 16.13% had middle ureteric calculi. All patients were given injection diclofenac sodium (75 mg) promethazine hydrochloride (12.5 mg) deep intramuscular 30 minutes the before procedure. Injection midazolam 0.03 mg/kg body weight slowly given intravenously immediately before the procedure for achieving sedation. Injection fentanyl 50 mcg intravenously given slowly just before introducing the ureteroscope into ureter for achieving intravenous analgesia. Patients were observed for few hours after completion of procedure and oral questions were asked as per proforma, which included tolerance, intensity of pain and percentage of pain experienced by the patients. Patients were discharged thereafter. 87.10% of patients opined that the procedure was acceptable. Only 4.84% opined this procedure was painful. According to present pain intensity score (PPI) in this study 79.03 patients experienced only mild pain, 11.29% cases rated procedure as discomforting, 6.45 rated procedure as distressing and only 3.23% rated as horrible procedure. As per visual analogue scale for assessment of pain 80.65 of cases rated only 20% pain score (in a scale of 0-100). 9.68% cases rated 30% and 6.45% rated 50%. Only two patients in middle ureteric group rated 100% pain. Overall success rate in fragmenting stone was 91.94, where as for lower ureteric calculi it was 97.30%; for upper and, middle ureteric calculi it was 86.66% and 80%, respectively. Ureteroscopic lithotripsy can be performed on day care basis under sedoanalgesia which is fairly tolerated by the patients with unremarkable complications and difficulty.

Relief of painful diabetic peripheral neuropathy with pregabalin: A randomized, placebo-controlled trial

This was a 6-week, randomized, double-blind, multicenter study evaluating the efficacy of pregabalin in the treatment of painful diabetic neuropathy. Two hundred forty-six men and women with painful diabetic neuropathy received pregabalin (150 or 600 mg/day by mouth) or placebo. The primary efficacy variable was mean pain score at the end of treatment. Efficacy results indicate that pregabalin 600 mg/day significantly decreased mean pain score to 4.3 (vs 5.6 for placebo, P = .0002) and increased the proportion of patients who had a ≥50% decrease from baseline pain (39% vs 15% for placebo, P = .002). Pregabalin also significantly reduced sleep interference, past week and present pain intensity, sensory and affective pain scores, and bodily pain and decreased by ≥50% the number of patients describing their pain as gnawing, sickening, fearful, and punishing-cruel. More patients receiving pregabalin 600 mg/day than placebo showed improvement, as rated on the Clinical and Patient Global Impression of Change scales, 73% vs 45% and 85% vs 47%, respectively. Pregabalin 150 mg/day was essentially no different from placebo. Dizziness was the most common side effect. These study results show pregabalin 600 mg/day to be safe and effective in reducing the pain and other associated symptoms of painful diabetic neuropathy. Perspective Painful diabetic peripheral neuropathy is a challenging neuropathic pain syndrome. This randomized controlled trial demonstrates that pregabalin, a new drug that interacts with the α 2-δ protein subunit of the voltage-gated calcium channel, is an efficacious and safe treatment for the pain of this condition.

Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled study

Post-herpetic neuralgia is difficult to treat. Divalproex sodium (valproic acid and sodium valproate in molar ratio 1:1) has been used successfully in the management of various painful neuropathies. To study the effectiveness and safety of divalproex sodium in the management of post-herpetic neuralgia. Randomized double-blind placebo-controlled trial. We enrolled 48 consecutively attending out-patients with post-herpetic neuralgia, out of whom three were excluded (two had insufficient pain, one withdrew consent). Quantification of pain was by Short Form-McGill pain questionnaire (SF-MPQ), visual analogue scale (VAS), present pain intensity score (PPI) and 11 point Likert scale (11 PLS) at the beginning of the study, after 2 weeks, 4 weeks and at the end of the study (8 weeks). We also assessed patients' global impression of change by questionnaire at the end of the study. After 8 weeks treatment with 1000 mg/day divalproex sodium, there was significant reduction in pain: SF-MPQ, 20.47 +/- 2.29 to 11.90 +/- 6.52 (p < 0.0001); PPI 4.0 +/- 0.52 to 1.95 +/- 1.29 (p < 0.0001); VAS 70.17 +/- 9.21 to 31.27 +/- 29.74 (p < 0.0001) and 11 PLS 6.97 +/- 0.73 to 3.63 +/- 2.34 (p < 0.0001) in comparison to placebo (means +/- SEM). The 'global impression of change' questionnaire showed much or moderate improvement in pain in 58.2% of patients receiving divalproex vs. 14.8% of those receiving placebo. The drug was well tolerated by all patients, except one who developed severe vertigo after 10 days of treatment. Divalproex sodium provides significant pain relief in patients of post-herpetic neuralgia, with very little incidence of adverse reactions. These data provide a basis for longer trials in a larger group of patients.

Randomized double-blind comparison of serotonergic (Citalopram) versus noradrenergic (Reboxetine) reuptake inhibitors in outpatients with somatoform, DSM-IV-TR pain disorder

Objectives: Whether the effect of tricyclic antidepressants on Pain Disorder arises from their noradrenergic or serotonergic actions or both remains unclear. We compared the selective serotonin reuptake inhibitor (SSRI) citalopram and the noradrenergic reuptake inhibitor (NARI) reboxetine in outpatients with Pain Disorder. We also distinguished the drugs' analgesic and antidepressant effects. Methods: In this 8-week, randomized double-blind study, 35 patients with a DSM-IV-TR diagnosis of Pain Disorder were randomly assigned to receive either citalopram 40 mg/day ( N=17 patients) or reboxetine 8 mg/day ( N=18). The Present Pain Intensity (PPI) scale and the Total Pain Rating Index (tPRI) of the McGill Pain Questionnaire were used to measure the effect on pain symptoms. Changes in the Zung Self-Rating Depression Scale (Zung-D) scores were evaluated to monitor a possible antidepressant effect. For all patients who had at least one assessment, an intent-to-treat analysis was performed. Results: No significant differences were found in the demographic variables or clinical characteristics of the two treatment groups. In the citalopram group, PPI and tPRI scores measured at baseline decreased after treatment (tPRI: 41.9 vs. 30.0, p=.004; PPI: 3.5 vs. 2.8, p=.045) whereas in the reboxetine group differences were not statistically significant (tPRI: 35.2 vs. 31.5; PPI: 3.7 vs. 3.1). The Zung-D showed no significant changes between baseline and endpoint assessment in either group. Conclusions: Our study suggests that the SSRI citalopram may have a moderate analgesic effect in patients with Pain Disorder, and that this analgesic activity appears to be not correlated to changes in depressive scores. If confirmed in a larger sample, this evidence suggests that patients who are intolerant or resistant to tricyclic antidepressants, may be treated with SSRIs.

Anticonvulsants: Efficacy and tolerability of oxcarbazepine in the treatment of neuropathic pain

The objective of this trial was to evaluate the safety, tolerability, and efficacy of oxcarbazepine in the treatment of painful neuropathies. This was an open-label, nine-week trial, consisting of a one-week prospective Screening Phase followed by an eight-week Treatment Phase. Treatment with oxcarbazepine was initiated at 150 mg/day and the daily dose was increased on a 2-3 days basis to tolerability over four weeks, up to 1200 mg/day. This was followed by a four-week fixed-dose Maintenance Phase during which patients were maintained on oxcarbazepine. The primary efficacy variable was the change in the weekly pain rating scale assessed on the VAS of the short-form McGill Pain Questionnaire (SF-MPQ) between the Screening Phase and the Treatment Phase. In addition, the short-form 36 Quality of life (SF-36 QOL) was completed at the baseline visit and at the end of the treatment phase. All analysis were performed on the intent-to-treat population. Twenty patients were enrolled in the trial. The mean daily oxcarbazepine dose during the Maintenance Phase was 870 mg. The mean VAS score dropped from 69.85 during the Screening Phase to 29.45 at the end of the trial (p <0.0001), for a mean reduction of - 40.40 (42.16 %). Moreover there were significant improvements in the total pain score and present pain intensity scores from the SF-MPQ and SF-36 QOL. Oxcarbazepine was well tolerated with the most common adverse events consisting of dizziness, and gastric symptoms. The results suggest that oxcarbazepine administered as monotherapy is an efficacious and safe option for the symptomatic treatment of pain associated with neuropathies. These results will need to be confirmed in large, double-blind, placebo controlled, randomized clinical trials

Patterns of advanced cancer pain in home hospice patients.

The purpose of this descriptive study was to provide a description of advanced cancer pain in home hospice subjects. The McGill Pain Questionnaire, Parts 1 and 2, measured pain in a convenience sample of 76 patients who were terminally ill with cancer. Analysis of the McGill Pain Questionnaire Part 1 delineated the following mean scores: total score (11.24), number of words chosen (5.89), sensory (5.71), affective (3.07), evaluative (1.09), and miscellaneous (1.96). The Present Pain Intensity Scale revealed a mean of (1.66) for Part 2. Descriptive statistics were used to analyze choices from the 78 possible word selections that categorize the four dimensions of the McGill Pain Questionnaire: sensory, affective, evaluative, and miscellaneous. Subjects selected 444 words from these four pain components, and their rank order from the highest to the lowest numbers were sensory (227), affective (90), miscellaneous (75), and evaluative (52). Although a mean Present Pain Intensity score of 1.66 demonstrated good pain management, patients with advanced cancer in home hospice care chose words that described four main pain patterns: "tiring and exhausting" (11.5%), "troublesome and annoying" (8.8%), "dull and aching" (7.7%), and "nauseating and sickening" (6.8%).

A randomized, double-masked, clinical study of the efficacy of four nonsteroidal anti-inflammatory drugs in pain control after excimer laser photorefractive keratectomy

Objective This study assessed the efficacy of 4 nonsteroidal anti-inflammatory drugs (NSAIDs) after excimer laser photorefractive keratectomy (PRK). Background Inadequate control of pain after PRK surgery can be a severe source of distress to patients and can interfere with their willingness to undergo a second PRK procedure. Methods This randomized, double-masked, placebo-controlled clinical study was conducted in 125 patients. Four NSAIDs (diclofenac, flurbiprofen, ketorolac, and indomethacin) were tested against a placebo group (artificial tears). Pain levels after PRK were quantified using Present Pain Intensity (PPI) and Pain Rating Indices based on rank values (PRI[R]) scores, both of which were calculated using patient responses to a modified McGill Pain Questionnaire. The PRI(R) consisted of 4 subscales—sensory (S), affective (A), evaluative (E), and miscellaneous (M)—as well as a total score (T). Results Three hours after PRK, no differences in PPI scores were found between the ketorolac, diclofenac, and indomethacin groups, whereas placebo was significantly less effective than the NSAIDs. Patients who received flurbiprofen reported PPI scores that were significantly lower ( P < 0.001) than those of patients who received diclofenac and indomethacin, but PPI scores in the flurbiprofen and the ketorolac groups did not differ significantly. Twenty-four hours after surgery, patients treated with flurbiprofen, ketorolac, and diclofenac reported the lowest PPI scores compared with those treated with indomethacin and placebo ( P < 0.001). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores ( P < 0.001). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours ( P < 0.001). The PRI(R)A score was significantly higher in the placebo and indomethacin groups compared with the other groups ( P < 0.001). At the 48- and 72-hour time points, flurbiprofen-treated patients again reported significantly lower PPI and PRI(R)T scores ( P < 0.001 for both) in pairwise comparisons with the other treatment groups. The number of patients who selfadministered additional oral analgesics did not differ significantly between the groups. However, the mean number of analgesic tablets used was significantly higher in the placebo group than in any NSAID group ( P < 0.001). The ketorolac group had the largest number of patients complaining of itching ( P < 0.043). No other subjective symptoms were significantly different across groups. Finally, all NSAIDs, except flurbiprofen, prolonged the mean reepithelialization period slightly ( P < 0.001). Conclusion Flurbiprofen appeared to be the most effective NSAID for the treatment of pain, even at 24 hours after surgery when pain was at a maximum.

Evaluation of the use of a pain diary in chronic cancer pain patients at home

Systematic assessment of pain is the basis for adequate pain treatment. In the home situation, however, it is difficult to assess patients' pain intensity. A group of 159 cancer patients who had been admitted to a cancer hospital with pain caused by cancer, cancer therapy, or illness that persisted for at least 1 month received a pain diary. These patients were asked to register their pain intensity at home. Patients were instructed by a nurse to record their Present Pain Intensity on a scale from 0–10 once every morning and every evening for a period of 2 months. In this study, the use of a pain diary in cancer pain patients at home was evaluated. To determine the effects of the pain diary, patients were interviewed at baseline, at 2, 4, and 8 weeks postdischarge. Pain intensity scores were obtained both by patient interviews and from the pain diary. Results show that the use of a pain diary is an appropriate way to assess patients' pain intensity at home. Patients' compliance was high (86%), even in seriously ill patients. When comparing pain scores obtained by patient interview with scores obtained by pain diary, results showed that Present Pain Intensity scores, rather than Average Pain Intensity scores, should be used in both the clinical and the home setting because patients' recall accuracy depends, in part, on the stability of the pain. Because the pain intensity scores fluctuate greatly during the day and over a period of time, the use of a pain diary is useful in the home setting. In 60% of the patients, completing the pain scores helped them to cope with the pain.

The value of SPECT scans in identifying back pain likely to benefit from facet joint injection.

Lumbar facet disease is sometimes implicated in low back pain. Identification is difficult and this may account for a variable response. Single photon emission computerized tomography (SPECT) is a scanning technique which enables localization of facet joint pathology. We determined whether recognition of facet disease by this method improved the response to corticosteroid injection treatment. Fifty-eight patients with low back pain and displaying accepted clinical criteria for facet joint disease were evaluated by SPECT. Twenty-two had facetal uptake of isotope. These and the tender facet joints of 36 scan-negative patients were injected with 40 mg methylprednisolone and 1 ml 1% lignocaine under X-ray control. Pain was assessed by a blind observer using the McGill questionnaire (MGQ), Present Pain Intensity score (PPI) and a Visual Analogue Scale (VAS). VAS, PPI and MGQ were reduced in the scan-positive patients at 1 month (P = 0.05, P = 0.0005, P = 0.005) and MGQ at 3 months (P = 0.01), whilst scan-negative patients were unchanged. The percentage of scan-positive patients who reported improvement was 95% at 1 month and 79% at 3 months, significantly greater than the control group (P = 0.0005, P = 0.01). Within 6 months, pain improvement in the SPECT-positive group was no longer statistically significant. Tenderness did not correlate with increased uptake on SPECT scan. Osteoarthritis of the facets was more common in the SPECT-positive patients (P < 0.001), but did not correspond with sites of increased uptake on SPECT scan. These results suggest that SPECT can enhance the identification of back pain sufferers likely to obtain short-term benefit from facet joint injection.

Operative laparoscopy and postoperative pain relief

To evaluate the immediate postoperative pain and discomfort in patients who underwent operative laparoscopy under general anesthesia with or without peritoneal lidocaine and incisional bupivacaine instillations.Fifty-four participants were prospectively randomized to three groups: group I, intraperitoneal (IP) lidocaine + intraincisional bupivacaine; group II, intraincisional bupivacaine; and group III, no additional drugs after general anesthesia (controls).University Hospital, Reproductive Endocrinology and Infertility Clinics.Private patients needing operative laparoscopy.One hundred milligrams of lidocaine were instilled with the irrigation device into the peritoneal cavity at the completion of surgery. Twenty-five milligrams of bupivacaine were injected into infraumbilical and suprapubic incisions.The analgesic use and modified McGill Present Pain Intensity scores were used for pain evaluation.McGill Present Pain Intensity scores for pain, and narcotic use in the recovery room were less in IP lidocaine-instilled group of patients (P less than 0.05). The mean maximum plasma lidocaine level achieved was 1.01 +/- 0.25 micrograms/mL.Peritoneal lidocaine and incisional bupivacaine use in operative laparoscopy as described after general anesthesia is safe and effective in reducing postoperative pain in the recovery room.

Operative laparoscopy and postoperative pain relief

To evaluate the immediate postoperative pain and discomfort in patients who underwent operative laparoscopy under general anesthesia with or without peritoneal lidocaine and incisional bupivacaine instillations. Fifty-four participants were prospectively randomized to three groups: group I, intraperitoneal (IP) lidocaine + intraincisional bupivacaine; group II, intraincisional bupivacaine; and group III, no additional drugs after general anesthesia (controls). University Hospital, Reproductive Endocrinology and Infertility Clinics. Private patients needing operative laparoscopy. One hundred milligrams of lidocaine were instilled with the irrigation device into the peritoneal cavity at the completion of surgery. Twenty-five milligrams of bupivacaine were injected into infraumbilical and suprapubic incisions. The analgesic use and modified McGill Present Pain Intensity scores were used for pain evaluation. McGill Present Pain Intensity scores for pain, and narcotic use in the recovery room were less in IP lidocaine-instilled group of patients ( P < 0.05). The mean maximum plasma lidocaine level achieved was 1.01 ± 0.25 μ g/mL. Peritoneal lidocaine and incisional bupivacaine use in operative laparoscopy as described after general anesthesia is safe and effective in reducing postoperative pain in the recovery room.

Psychological factors that influence self-reported pain.

Explored the relationship among the MMPI, the Beck Depression Inventory, and the pain dimensions from the McGill Pain Questionnaire. The instruments were administered to 30 male VA patients with histories of pain for longer than 3 months. Multiple regression analyses that investigated the relationship between depression and the pain measures found no statistically significant correlations. Additionally, the MMPI subscales were not related significantly to the sensory-discriminative pain scores, the cognitive-evaluative pain scores, the present pain intensity scores, the percent of body area in pain, or the total number of pain words endorsed. In contrast, the MMPI subscales were related significantly to the motivational-affective pain dimension and the miscellaneous pain dimension. In the motivational-affective analysis, a significant positive correlation was found for the PT subscale, but a significant negative correlation was found for the Sc subscale. In the miscellaneous pain analysis, a significant positive correlation was found for the Hs subscale. The results are interpreted in the context of cognitive-behavioral conceptualizations of chronic pain.