PROMIS Pain Intensity Research Articles

Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma.

Study Design:Retrospective cohort study.Objectives:(1) To assess patient-reported outcomes—physical function, pain, and quality of life—in patients who underwent resection of a mobile spine chondrosarcoma. (2) To assess complications (90 days), readmissions, reoperations, oncological outcomes, and neurologic status.Methods:Thirty-three patients with spinal conventional chondrosarcoma resection between 1984 and 2014 at one hospital were included. The primary outcome measures were—minimally 6 months after surgery—the EuroQol 5 Dimensions (EQ5D), PROMIS–Physical Function, PROMIS–Pain Intensity, and Oswestry (ODI) Disability Index, or Neck (NDI) Disability established in 14 out of 20 alive (70.0%) patients. Complications, readmission, reoperations, oncological outcomes, and neurological status were reported for the complete cohort of 33 patients.Results:After spine chondrosarcoma resection, patients (n = 14) reported worse physical function (median 43, range 22-61, P = .026), worse quality of life (median EQ5D 0.70, range 0.04-1, P = .022), and comparable pain intensity (median 47, range 31-56, P = .362) when compared with US general population values. The median NDI/ODI was 25 (range 0-72) indicating mild to moderate disability. Patients undergoing reoperation had worse patient-reported outcomes than those who did not. Eighteen (55.5%) out of 33 patients suffered complications (90 days), 14 (42.4%) had unplanned readmission, and 13 (39.4%) underwent reoperation. Intralesional resection was associated with increased readmission, reoperation, and recurrence rate.Conclusions:Chondrosarcoma affects quality of life and physical function and its treatment frequently results in complications and reoperations. Our findings can be used to inform future patients about expected outcomes.

Pain is Independent of Stone Burden and Predicts Surgical Intervention in Patients with Ureteral Stones

Patients with obstructing ureteral stones typically experience sudden onset, severe pain. We examined the use of the NIH (National Institutes of Health) PROMIS® (Patient-Reported Outcome Measurement Information System) pain instruments in patients with acute ureteral stones. PROMIS pain measures were obtained from a complete cohort of patients who presented to a subspecialty kidney stone clinic after emergency department discharge. Patients were followed longitudinally through the course of care. Raw scores were translated into population normed T-scores with a T-score of 50 indicating the mean pain population in the United States. Objective and patient centered factors were evaluated with reference to T-score thresholds for pain intensity with 60 equal to 1 SD above the mean and pain interference with 70 equal to 2 SD. Multivariable logistic regression in 650 patients demonstrated an absent association between pain scores and stone size or location. Pain scores were associated with patient age, gender and emergency department pain scores (p<0.05). Initial stone surgery was predicted by a stone size less than 4 mm (OR 0.14, 95% CI 0.07-0.3), greater than 6 mm (OR 19.1, 95% CI 0.22-39.58), proximal location (OR 1.75, 95% CI 1.34-2.3) and pain intensity greater than 60 (OR 7.03, 95% CI 3.63-13.6) but not pain interference (p <0.001). Failed attempted stone passage was less likely for stones less than 4 mm (OR 0.26, 95% CI 0.14-0.48, p <0.001) and more likely for proximal stones (OR 1.61, 95% CI 1.21-2.14, p <0.01) and pain intensity greater than 60 (OR 2.74, 95% CI 1.23-6.07, p <0.05). PROMIS pain scores are independent of stone size and location. Attention to emergency department discharge symptom control offers the potential to improve patient care. PROMIS pain intensity is an independent predictor of surgical intervention in patients with ureteral stones 1 cm or less.

Does perceived injustice correlate with pain intensity and disability in orthopaedic trauma patients?

IntroductionIndividuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct comprised by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of this study is to explore the association of perceived injustice to pain intensity and physical function in patients with orthopaedic trauma. MethodsA total of 124 orthopaedic trauma patients completed the Injustice Experience Questionnaire (IEQ), the PROMIS Physical Function Computer Adaptive Testing (CAT), the PROMIS Pain Intensity instruments, the short form Patient Health Questionnaire for depression (PHQ-2), the short form Pain Self-Efficacy Questionnaire (PSEQ-2), and the short form Pain Catastrophizing Scale (PCS-4) on a tablet computer. A stepwise linear regression model was used to identify the best combination of predictors explaining variance in PROMIS Physical Function and PROMIS Pain Intensity. ResultsThe IEQ was associated with PROMIS Physical Function (r=−0.36; P<0.001) and PROMIS Pain Intensity (r=0.43; P<0.001). In multivariable analysis, however, Caucasian race (β=5.1, SE: 2.0, P=0.013, 95% CI: 1.1–9.2), employed work status (β=5.1, SE: 1.5, P=0.001, 95% CI: 2.1–8.2), any cause of injury other than sports, mvc, or fall (β=7.7, SE: 2.1, P<0.001, 95% CI: 3.5–12), and higher self-efficacy (PSEQ-2; β=0.93, SE: 0.23, P<0.001, 95% CI: 0.48–1.4) were selected as part of the best model predicting variance in PROMIS Physical Function. Only a higher degree of catastrophic thinking (PCS-4; β=1.2, SE: 0.12, P<0.001, 95% CI: 0.99 to 1.5) was selected as important in predicting higher PROMIS Pain Intensity. ConclusionPerceived injustice was associated with both physical function and pain intensity in bivariate correlations, but was not deemed as an important predictor when assessed along with other demographic and psychosocial variables in multivariable analysis. This study confirms prior research on the pivotal role of catastrophic thinking and self-efficacy in reports of pain intensity and physical function in patients with acute traumatic musculoskeletal pain.